Peripartum cardiomyopathy (PPCM) contributes to maternal death during or after pregnancy. Previously healthy women present with often severe heart failure during the last month of pregnancy or the first months postdelivery. 1 Peripartum cardiomyopathy is a global disease that occurs in about 1 in 1000 pregnancies, with a mortality rate ranging from 5% to 30%. Previous analyses have pointed to a worse outcome of patients with PPCM of African ancestry. In this issue of JAMA Cardiology, using a retrospective analysis of the University of Pennsylvania Health System, Irizarry et al 2 present the largest cohort of patients with PPCM to date, including 121 African American women. 2 The investigators used stringent definitions for PPCM and excluded all patients with a potential other explanation for heart failure, such as a history of congenital heart disease, valvular heart disease, or receiving radiation treatment or chemotherapy.African American patients with PPCM were younger, received their diagnoses later during the postpartum period, and presented with significantly lower left ventricular ejection fraction. These results are not completely matched by the baseline characteristics of the recently published first 400 patients in the worldwide PPCM registry of the EURObservational Research Programme. 3 Among these patients, despite the huge differences in sociodemographic factors among regions of the world, the baseline characteristics of patients with PPCM, such as an obstetric history and clinical presentation, were remarkably similar. The mode of presentation and mean age were also independent of ethnic and socioeconomic backgrounds. 3 However, a detailed analysis regarding racial/ethnic groups has yet to be performed in this registry.Even more troublesome in comparison with non-African American patients in the Pennsylvanian cohort with PPCM, African American patients also had a markedly delayed recovery and a much higher proportion did not recover to an ejection fraction of more than 50%, despite receiving similar treatment with drugs often prescribed for heart failure such as angiotensin-converting enzyme inhibitors and β-blockers (although it is unclear whether drug prescription resulted in similar drug intake among African American and non-African American patients, and there are no data reported on drug dosage). However, compared with the Sliwa cohort of African American patients from South Africa 4 that reported a 12% mortality rate, and a recovery of ejection fraction in only 21%, outcomes regarding mortality rates and recovery were clearly better in the current US cohort. In fact, mortality rates and cardiac transplantats, as well as arrhythmia, were not different between African American and non-African American patients.