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Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy : an ESC EORP registry

Sliwa, Karen
; 
Petrie, Mark C.
; 
van der Meer, Peter
; 
Mebazaa, Alexandre
; 
Hilfiker-Kleiner, Denise
; 
Jackson, Alice M.
; 
Maggioni, Aldo P.
; 
Laroche, Cecile
; 
Regitz-Zagrosek, Vera
; 
Schaufelberger, Maria
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Author
Sliwa, Karen
Petrie, Mark C.
van der Meer, Peter
Mebazaa, Alexandre
Hilfiker-Kleiner, Denise
Jackson, Alice M.
Maggioni, Aldo P.
Laroche, Cecile
Regitz-Zagrosek, Vera
Schaufelberger, Maria
Tavazzi, Luigi
Roos-Hesselink, Jolien W.
Seferovic, Petar
van Spaendonck-Zwarts, Karin
Mbakwem, Amam
Böhm, Michael
Mouquet, Frederic
Pieske, Burkert
Johnson, Mark R.
Hamdan, Righab
Ponikowski, Piotr
Van Veldhuisen, Dirk J.
McMurray, John J. V.
Bauersachs, Johann
EurObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum, Cardiomyopathy
Abstract
Aims  We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. Methods and results  In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). Conclusion  Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.
Keywords
peripartum cardiomyopathy, registry, outcome
Date
2020
Type
Journal article
Journal
European Heart Journal
Book
Volume
41
Issue
39
Page Range
3787-3797
Article Number
ACU Department
Collections
Non-faculty - General
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URI
https://hdl.handle.net/20.500.14802/4306
Relation URI
DOI
10.1093/eurheartj/ehaa455
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Event URL
Open Access Status
License
All rights reserved
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Controlled
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