Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

Abstract

Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and after 1 year of follow-up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.

Peripartum cardiomyopathy in Iraq: initial registry‐based data and 6 month outcomes

“… 8 Baseline mean LVEF was comparable with that in the Middle East (35 ± 9%) but significantly higher than the findings in the EORP‐PPCM registry (31 ± 10%) ( P ‐value 0.011). 3 , 9 Mean left ventricular end‐diastolic and systolic diameters in our cohort approximate those in patients from the Middle East 62 ± 8 and 51 ± 9 mm, respectively, although they were higher than those in other regions, such as Asia‐Pacific 55 ± 6 and 46 ± 7 mm, respectively, as shown in the EORP‐PPCM registry. 3 Low mean GLS was found among the patients.…”

“… 10 , 11 , 12 Regarding the treatment strategy for PPCM, the most commonly prescribed anti‐failure agent in Iraq was beta‐blocker, higher than that reported in the global (81%) and Middle East (75%) registries, P ‐value 0.059 and 0.02, respectively. 3 , 9 This might be explained by the significantly lower mean of the heart rate among PPCM patients in the Middle East registry group (79.7 ± 10.8), compared with that recorded in Iraq ( P ‐value <0.001). 9 However, in the global registry, the heart rate was 100 ± 22, comparable with that in Iraq ( P ‐value <0.997).…”

“… 3 , 9 This might be explained by the significantly lower mean of the heart rate among PPCM patients in the Middle East registry group (79.7 ± 10.8), compared with that recorded in Iraq ( P ‐value <0.001). 9 However, in the global registry, the heart rate was 100 ± 22, comparable with that in Iraq ( P ‐value <0.997). 3 In both global and Middle East patients, the most commonly prescribed drug group was ACEI/ARB in 85% and 86% of cases, respectively, while ACEI/ARB/ARNI was the second most commonly group prescribed in Iraq, an issue that may be related to the lower mean systolic and diastolic blood pressure readings among PPCM patients in Iraq compared with that in the Middle East, 125.5 ± 28.8 and 83.4 ± 21 mmHg, respectively.…”

“… 3 In both global and Middle East patients, the most commonly prescribed drug group was ACEI/ARB in 85% and 86% of cases, respectively, while ACEI/ARB/ARNI was the second most commonly group prescribed in Iraq, an issue that may be related to the lower mean systolic and diastolic blood pressure readings among PPCM patients in Iraq compared with that in the Middle East, 125.5 ± 28.8 and 83.4 ± 21 mmHg, respectively. 3 , 9 Anticoagulant use was significantly higher in Iraq compared with its use in the global registry (16%) ( P ‐value <0.024). Notably, the use of anticoagulant in our study was not used for PPCM severity per se but was rather prescribed in a prophylactic dose concomitantly with bromocriptine or in a therapeutic dose for atrial fibrillation or thrombo‐embolic event.…”

“… 3 Data about using bromocriptine in the Middle East were available from the EORP‐PPCM registry, whereas such data were lacking from the Middle East cohort study. 3 , 9 Thus, the Middle East was the region least using bromocriptine for the management of PPCM patients despite the recommendation of the Heart Failure Association of the ESC Study Group on PPCM, as well as the new recommendation in the 2018 ESC guidelines, which emphasized the use of bromocriptine post‐delivery in PPCM patients with different severity of LVEF, due to its beneficial effect on the cessation of lactation, enhancement of LVEF recovery, and reduction in mortality. 3 , 13 , 14 The reason for the limited use of bromocriptine in the Middle East registry was not clear.…”