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

Abstract

AimsThis study aimed to evaluate the clinical characteristics, echocardiographic measurements, medical treatment, pregnancy outcomes, and the 6 month follow-up outcomes among patients with peripartum cardiomyopathy (PPCM) in Iraq. Methods and results Data were collected prospectively at cardio-maternal clinic in Baghdad Heart Center, using case report form for the EORP-PPCM registry from January 2015 to November 2020. Six month follow-up was performed either by attendance of patients or by phone contact. A total of 64 PPCM patients were enrolled with a mean age of 32.1 ± 6.8 years. Diagnosis in 35 (54.7%) women was made in the post-partum period. There was a history of previous PPCM in 9 (14%), coexisting hypertension with the current pregnancy in 30 (51.7%), cholelithiasis in 5 (7.8%), and cancer in 3 (4.7%). Baseline mean left ventricular ejection fraction (LVEF) was 34.7 ± 8.1%, significantly higher than that reported globally (31 ± 10%) (P-value 0.011), and 26 (40.6%) of our patients had LVEF of ≤34%. Baseline mean global longitudinal strain (GLS) for 26 (40.6%) patients was À9.4 ± 4.1%. Baseline mean left ventricular end-diastolic and end-systolic dimensions were 61.2 ± 8.5 and 50.6 ± 10.2 mm, respectively. At 6 month follow-up, 11 (36.7%) women recovered their LVEF, lower than global data (46%) but higher than that in the Middle East (25%) with P-value 0.241 and 0.919, respectively. The mean LVEF was 44.5 ± 11.9%, and the mean GLS for 15 (23.4%) of patients was À13.4 ± 5.3%, including 5 (33.3%) with the range of À18.6% to À17%. Bromocriptine was the least used drug in 4 (8.2%) vs. globally reported (15%) (P-value 0.188). Thrombo-embolic events and maternal death were reported in 2 (4.1%) and 3 (4.7%) cases, respectively, within 6 months. Conclusions Around half of our PPCM patients were diagnosed at post-partum period with impaired initial LVEF and GLS, and one-third had early LVEF recovery at 6 month follow-up, higher than that in the Middle East but lower than the globally reported figure in the EORP-PPCM registry. Limited use of bromocriptine might explain the later finding. The co-morbid diseases in our setting were hypertension and cholelithiasis. Interestingly, the comparable ratios of neonatal and maternal mortalities in our study to that of the EORP-PPCM registry were found less than the Middle East figures. Bromocriptine needs to be considered in Middle East countries, including Iraq, which may be the key to improving LVEF recovery and perhaps reducing maternal mortality.

Thromboembolism in peripartum cardiomyopathy: a systematic review

“…Using the EORP-PPCM registry approach, in 64 PPCM patients from Iraq, 4.1% presented with thromboembolism within 6 months. Interestingly, among participants from Pakistan, 16% of patients were administered anticoagulation prophylactically, significantly greater than that of the global registry, and may also explain Pakistan’s comparatively lower thromboembolic rate ( 29 ). In a retrospective cohort study conducted in India, among 36 patients with PPCM, 14% presented with thromboembolic events (three central and two peripheral) within 4–6 months of PPCM diagnosis.…”

The year in cardiovascular medicine 2021: heart failure and cardiomyopathies

“…Patients with peripartum cardiomyopathy are at risk for detrimental outcomes 36 , 37 but often do recover from HFrEF. Recent publications investigated the value of ECG abnormalities for predicting echocardiographic results and the role of hypertensive disorders during pregnancy.…”