Background: Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifically in Filipino patients.
Methods: A retrospective review of 39 patients diagnosed with peripartum cardiomyopathy was done at the Philippine Heart Center. Clinical and echocardiographic data were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables.
Results: The mean age of the patients was 28.4 ± 6.9 and the mean ejection fraction (EF) was 27.8 ± 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). There were 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ± 6.3 while 16 patients had an initial EF of <25% (41%) and only 2 patients in this subgroup experienced improvement in EF. Twenty nine patients experienced death and/or MAE. (74.4%) Kaplan Meier survival curve showed that patients whose ejection fraction recovered in 6 months experienced a 75% freedom from MAE at almost two years. The occurrence of death is highest in the first two years before reaching an almost 60% free incidence from mortality. Patients with an ejection fraction of less than 25% had a mortality rate of 50% in two years. Patients with ejection fraction of >25% had a 90% likelihood of survival for 8 years. Patients whose EF recovered in 6 months were alive for almost 7 years. Significant variables associated with the occurrence of MAEs were arrhythmia on initial presentation (OR 3.38,p=0.026) and no improvement of EF in 6 months(OR 0.319,p=0.024) Variables associated with mortality were initial EF (OR 0.92,p=0.033), EF <25%(OR 12.0,p=0.019), Fractional shortening (OR 0.88,p=0.024) and recovery of LV function (OR 0.232,p=0.05).
Conclusion: Peripartum cardiomyopathy is associated with significant morbidity and mortality. The degree of left ventricular dysfunction on presentation, the absence of recovery of EF as well as improvement of EF within 6 months were predictive for the occurrence of major adverse events. This study emphasizes the need for aggressive treatment and monitoring early in the course of disease in order to improve outcomes