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J Am Coll Cardiol. 2015 Aug 25;66(8):905-14. doi: 10.1016/j.jacc.2015.06.1309.

Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy).

Author information

1
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: mcnamaradm@upmc.edu.
2
University of Southern California, Los Angeles, California.
3
Intermountain Medical Center, Salt Lake City, Utah.
4
Vanderbilt University, Nashville, Tennessee.
5
Cleveland Clinic, Cleveland, Ohio.
6
Washington University, St. Louis, Missouri.
7
Louisiana State University Health Sciences Center, Shreveport, Louisiana.
8
University of Rochester School of Medicine and Dentistry, Rochester, New York.
9
University of Maryland, Baltimore, Maryland.
10
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
11
Columbia University, New York, New York.
12
Emory University, Atlanta, Georgia.
13
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
14
University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
15
Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
16
Mayo Clinic, Rochester, Minnesota.

Abstract

BACKGROUND:

Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality.

OBJECTIVES:

This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study.

METHODS:

We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses.

RESULTS:

The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001).

CONCLUSIONS:

In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).

KEYWORDS:

heart failure; myocardial recovery; race; remodeling

PMID:
26293760
PMCID:
PMC5645077
DOI:
10.1016/j.jacc.2015.06.1309
[Indexed for MEDLINE]
Free PMC Article

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