Clinical characteristics, predictors and pregnancy outcomes in Indian women with peripartum cardiomyopathy

Abstract

Background Predictors, pregnancy and subsequent pregnancy outcomes in women with peripartum cardiomyopathy (PPCM) are poorly understood in our geographical region. Methods We retrospectively analysed 58 women with PPCM diagnosed using criteria by the European Society of Cardiology during 2015 to 2019. The main outcome measures were predictors of left ventricular (LV) recovery. LV recovery was defined as return of LV ejection fraction to over 50%. Results Nearly 80% of women had LV recovery during 6 months follow up. Univariate logistic regression revealed LV end diastolic diameter (adjusted odds ratio (OR); 0.87; 95% CI, 0.78–0.98; p = 0.02), LV end systolic diameter (OR; 0.89; 95% CI, 0.8–0.98; p = 0.02) and inotrope use (OR; 0.2, 95% CI, 0.05–0.7; p = 0.01) as predictors of LV recovery. Relapse was not seen in any of the nine women who had a subsequent pregnancy. Conclusion LV recovery was higher than those reported in contemporary PPCM cohorts from other parts of the world.

Prognostic value of various markers in recovery from peripartum cardiomyopathy: a systematic review and meta‐analysis

“…A total of 1047 patients with PPCM, comprising 520 (50%) in the recovery group and 526 (50%) in the non‐recovery group, from 18 studies were included. 6 , 7 , 8 , 10 , 13 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Majority of the studies were from the USA, China, South Africa, and Turkey. All eligible studies were published between 2005 and 2021.…”

“…There was a race diversity across studies: some studies recruited from the African race only, 17 some had patients from different ethnicities (Caucasian and non‐Caucasian), 7 , 13 , 19 , 26 , 27 and one study had patients from rural Haiti, 18 whereas others did not mention the proportion of different races. 6 , 8 , 10 , 20 , 21 , 22 , 23 , 24 , 25 , 28 , 29 Table 1 summarizes the characteristics of the eligible studies.…”

“…Predictors of the LV function recovery differed among the included studies. Among the baseline echocardiographic parameters, initial LVEF was reported in 18 studies, 6 , 7 , 8 , 10 , 13 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 and the values differed significantly between the recovery and non‐recovery groups in 12 studies. 6 , 7 , 8 , 10 , 18 , 19 , 20 , 22 , 23 , 24 , 25 , 27 [One study 28 measured EF values using cardiac magnetic resonance (CMR) and was not included for analysis of echocardiographic parameters.]…”

“…The recovery group had significantly lower values of LVEDD compared to the non‐recovery group (MD = −4.74 mm, 95% CI = [−5.48, −4.00], P < 0.001), and higher levels of LVEDD at baseline were associated with non‐recovery of LV function (OR = 3.67, 95% CI = [2.58, 5.23], P < 0.001) ( I 2 = 31.9%, P = 0.12) ( Figure 2 B ). There were six studies 6 , 10 , 17 , 20 , 24 , 29 including 346 participants for measuring the initial LVESD between the two groups, and there was a statistical difference between the recovery and non‐recovery groups in five out of the six included studies. 6 , 10 , 17 , 20 , 29 The pooled mean of LVESD of the recovery and non‐recovery groups was 45.84 mm (40.75–50.92) and 50.93 mm (44.22–57.64), respectively, and the recovery group had lower values of LVESD (MD = −5.30 mm, 95% CI = [−7.53, −3.08], P = 0.001).…”

“…There were six studies 6 , 10 , 17 , 20 , 24 , 29 including 346 participants for measuring the initial LVESD between the two groups, and there was a statistical difference between the recovery and non‐recovery groups in five out of the six included studies. 6 , 10 , 17 , 20 , 29 The pooled mean of LVESD of the recovery and non‐recovery groups was 45.84 mm (40.75–50.92) and 50.93 mm (44.22–57.64), respectively, and the recovery group had lower values of LVESD (MD = −5.30 mm, 95% CI = [−7.53, −3.08], P = 0.001). Pooled analysis of the six studies showed that higher levels of LVESD at diagnosis were associated with non‐recovery from PPCM (OR = 3.99, 95% CI = [2.27, 7.02], P < 0.001) ( I 2 = 37.9%, P = 0.15) ( Figure 2 C ).…”