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Black race, LV dysfunction linked to poorer outcomes of peripartum cardiomyopathy
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In the IPAC study, most women with peripartum cardiomyopathy experienced significant recovery. However, black race, left ventricular dysfunction and greater remodeling were associated with lower rates of recovery.
The study included 100 women with peripartum cardiomyopathy, enrolled within 13 weeks postpartum at 30 centers. All patients had LV ejection fraction measurement via echocardiogram at enrollment and at 6 and 12 months postpartum (mean age, 30 years; 65% white, 30% black). A repeat measurement was conducted at 2 months among 66 women enrolled within 6 weeks postpartum.
The outcome of interest was survival from major CV events, including death, transplantation or LV assist device implantation. Outcomes data were available for 97 women at 6 months and 91 women at 12 months.
Mean LVEF was 0.35 ± 0.1 at baseline, 0.51 ± at 6 months and 0.53 ± 0.1 at 12 months. During follow-up, six patients experienced nine major CV events, including four deaths, one transplantation and four LVAD implantations.
At 1 year, the event-free survival rate was 93%. The survival rate was lower among women with baseline LVEF less than 0.3 compared with 0.3 or higher (82% vs. 99%; P = .004). Major events or persistent severe cardiomyopathy at 12 months were observed in 13% of evaluable patients. Seventy-two percent of women experienced complete recovery and 15% experienced partial recovery.
Factors associated with lower LVEF at 12 months on univariate analysis included black race (P = .001), presentation after 6 postpartum weeks (P = .02), baseline LVEF below 0.3 (P = .001) and LV end-diastolic diameter (LVEDD) of 6 cm or greater (P < .001). On multivariate analysis, only black race (P = .002) and LVEDD at baseline (P < .0001) maintained significant risk factors.
The researchers noted that 91% of patients with a baseline LVEF of 0.3 or higher and LVEDD less than 6 cm experienced recovery by 1-year postpartum, whereas no patients with a baseline LV less than 0.3 and LVEDD of 6 cm or greater recovered.
“The results … demonstrated significant recovery in the majority of women with [peripartum cardiomyopathy] and should be very encouraging to women presenting with this disorder and to their physicians,” the researchers concluded. “Unfortunately, adverse outcomes remain unacceptably high. … There remains a great need for more targeted therapies to improve outcomes in those women whose probability of recovery on conventional therapy is diminished.”
In a related editorial, Gregg M. Lanier, MD, of the cardiology division at New York Medical College/Westchester Medical Center in Valhalla, New York, noted that the study is a “landmark trial” for this patient population and will hopefully be followed by several more analyses.
“Many questions still need to be addressed, such as the risk of recurrent HF after additional pregnancies in patients with [peripartum cardiomyopathy],” Lanier wrote. “The multicenter framework of this large cohort will likely continue to add new insights into this rare and potentially devastating cardiomyopathy.” – by Adam Taliercio
Disclosure: The researchers and Lanier report no relevant financial disclosures.
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