Peripartum cardiomyopathy: A systematic review of the literature

Abstract

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. It is defined as cardiomyopathy that develops in the last month of pregnancy or within 5 months of the postpartum period without an identifiable cause. We conducted a systematic review of literature of prospective studies with a focus on echocardiographic and long-term clinical outcomes in PPCM. We searched MEDLINE and Embase up to October 1, 2017. Prospective studies (sample size ≥20) reporting all-cause mortality and follow-up duration of ≥1 year were included. Of the 956 studies identified, 7 met the inclusion criteria. A total of 445 patients with a mean age of 30 years (range, 27-32 years) were included. The mean follow-up duration was 41 months (range, 12-61 months). The majority of patients had New York Heart Association class III or IV symptoms at the time of diagnosis. Only 3 studies reported data on ethnicity where the majority of patients were non-Caucasian. Most of the patients (81%-93%) were on guideline-directed medical therapy, except 1 study (41%). Left ventricular ejection fraction at baseline ranged from 24% to 35% (mean, 28%) and at follow-up from 31% to 53% (mean, 44%). Recovery in systolic function was noted in 20% to 82% (mean, 50%) of patients. All-cause mortality ranged from 0% to 28% (mean, 16%). This systematic review summarizes the evidence to date on the clinical characteristics and outcomes of patients with PPCM. Multicenter registries with long-term follow-up will help shed further light on characteristics and outcomes of patients with this rare disease.

Peripartum women with dyspnea in the emergency department

“…However, timely and accurate diagnosis is not without a clue to follow; as previously reported, the mean hs-CRP in control patients of the same postpartum period with diagnosed patients with PPCM varied somewhat from patients with PPCM. [ 26 ] Similarly, in our study, an elevated plasma concentration of hs-CRP was observed in patients with PPCM, and these results possibly reflected the existence of a mild chronic inflammatory process because of the emission of endotoxin or endotoxin-like materials and the following pro-inflammatory cytokines discharge, which might matter in PPCM development [ 12 , 27 ] (Table 3 ).…”

Electrocardiographic findings in peripartum cardiomyopathy

“…Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy marked by systolic dysfunction occurring at the end of pregnancy or, more commonly, in the early postpartum period . Globally, incidence appears to be highest in Nigeria (up to 1 in 100 live births) and Haiti (1 in 300 live births) .…”

Acute kidney injury predicts poor left ventricular function for patients with peripartum cardiomyopathy

“…To the best of our knowledge, there is currently a lack of large cohort studies of PPCM in China. A study involving pregnant women treated at Peking Union Medical College Hospital between January 1995 and December 2014 showed that only one maternal morbidity event was noted per 1067 deliveries [ 11 ]. Although PPCM is a rare disease, it poses a serious threat to the health of pregnant women and their newborns.…”