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

Abstract

AimsThe aetiology of peripartum cardiomyopathy (PPCM) is still not clear, and it is unknown who would recover from PPCM. In this meta-analysis, for the first time, we aimed to explore the prognostic value of potential baseline factors that may help predict recovery in patients with PPCM. Methods A systematic approach following the Meta-analysis of Observational Studies in Epidemiology guideline was taken by using appropriate keywords in PubMed, Scopus, and Embase databases. Studies that had compared different clinical and paraclinical markers at the time of diagnosis related to cardiovascular function between recovered and non-recovered patients with PPCM were included. To find potential predictors of recovery, the odds ratio (OR) was calculated for different parameters using the random-effects model. Results Eighteen cohort studies including 1047 patients with PPCM were enrolled. Six markers out of the 11 potentially eligible markers were associated with PPCM recovery. Baseline echocardiographic parameters [left ventricular ejection fraction (LVEF) (OR = 4.84 [2.53; 9.26]), left ventricular end-diastolic diameter (OR = 3.67 [2.58; 5.23]), left ventricular end-systolic diameter (OR = 3.99 [2.27; 7.02]), and fractional shortening (OR = 6.14 [1.81; 20.85])] were strong predictors of PPCM recovery. Systolic blood pressure (OR = 2.16 [1.38; 3.38]) and diastolic blood pressure (OR = 2.06 [1.07; 3.96]) at diagnosis were also associated with recovery. Conclusions Patients with PPCM who have a higher baseline LVEF, lower left ventricular diameters, and higher blood pressure levels have a greater chance to recover from PPCM.

Peripartum Cardiomyopathy: Current Understanding of Pathophysiology, Diagnosis, Treatment, and Maternal-Fetal Outcomes

“…Patients with a higher baseline LVEF, higher blood pressure levels and a smaller enddiastolic diameter (54.19-58.37 mm) would have a higher recovery rate, while an increased end-systolic diameter would be deleterious for the patient and associated with mortality rates. (HOSSEINPOUR, A. et al, 2022). In addition to these values, the impact of NT pro-BNP on the prognosis and recovery of these patients was evaluated; values of this marker equal to or greater than 900 pg/ml indicated a lower probability of recovery of LVEF, normal levels of LV end-diastolic diameter (less than 55 mm) and, consequently, a lower chance of recovery of left ventricular function (HOEVELMANN, J. et al, 2021).…”

Transient Left Ventricular Dysfunction from Cardiomyopathies to Myocardial Viability: When and Why Cardiac Function Recovers

“…Several factors influence recovery likelihood and outcomes [12], including initial LVEF [109], African American ethnicity [109,110], CRP levels, hypertensive disorders, and presence of a LV thrombus [109,111]. A meta-analysis by Hosseinpour indicated that patients with higher baseline LVEF, smaller left ventricular diameters, and elevated blood pressure are more likely to recover from PPCM [112].…”

“…LV enlargement, presence of LV thrombus, RV dysfunction, obesity, African American ethnicity, higher Tn and NT-proBNP values, the presence of LGE, and higher ECV values predict lower LV recovery rates and extended LV recovery [109][110][111][112][113][114][115][116][117][118][119].…”

Common Cardiovascular Diseases in Women

“…However, no correlation was found between diabetes and New York Heart Association functional class and recovery. Breastfeeding prolongs the elevated prolactin levels, so it may also play a role in helping with recovery 57–60,62…”

“…Breastfeeding prolongs the elevated prolactin levels, so it may also play a role in helping with recovery. [57][58][59][60]62…”