Natural history, management, and outcomes of peripartum cardiomyopathy: an Irish single-center cohort study

Abstract

Aim: To describe the natural history, management and outcomes of peripartum cardiomyopathy (PPCM) in an unselected Northern European population. Methods: A retrospective single-center observational study was performed at a tertiary referral heart failure and transplantation unit. Outcomes measured were baseline demographics, clinical presentation, course, and treatment. Echocardiographic findings were compared at baseline, 2 months, and 6 months. Results: Twelve cases of PPCM were identified between 2002 and 2008. Mean age was 34.7 years. Nine patients were multiparous and nine had preeclampsia. Ten patients presented in the first week postpartum. Two patients required inotropic support. Mean ejection fraction (EF) at presentation was 27% (SD = 8%) which improved to 47% (SD = 13%) at 6 months. At this time, 10 patients were asymptomatic and 6 had recovered normal cardiac function. Left ventricular (LV) function improved but did not reach normal limits in five cases. One case with persistent severe LV dysfunction required cardiac transplantation. One patient suffered an arrhythmic death several years after the 6 months follow-up period. Conclusions: PPCM is a rare condition. With appropriate therapy, a good clinical outcome is common but not universal. Continued deterioration requiring ventricular support and cardiac transplantation can occur. In our cohort, older maternal age, multiparity, and preeclampsia appeared to be risk factors.

Keywords::

• Cardiac transplantation
• ejection fraction
• left ventricular failure
• maternal mortality
• puerperium

Acknowledgments

We would like to acknowledge Cecilia Tracey and Edel Kavanagh, heart failure nurse specialists, for their assistance in identifying the 12 cases and managing the heart failure database at the Mater Hospital. Details of ethics approval: Ethical approval was granted by the Mater Misericordiae University Hospital and Mater Private Hospital Research Ethics Committee on the 14 November 2011. (Reference: 1/378/1440 TMR). Funding: none received.

Declaration of Interest: The authors report no conflicts of interest.

Notice of Correction

The version of this article published online ahead of print on 25 Sep 2012 contained an error on page 1. The sentence “*Drs Horgan and Mahon contributed equally to this manuscript.” should have read “*Drs Horgan and Margey contributed equally to this manuscript.”.The error has been corrected for this version.