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Eur J Heart Fail. 2017 Dec;19(12):1723-1728. doi: 10.1002/ejhf.808. Epub 2017 Mar 27.

Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy.

Author information

1
Department of Cardiology and Angiology, Medical School Hannover, Germany.
2
Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
3
School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
4
University of Glasgow and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland.

Abstract

AIMS:

Subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have a high risk of heart failure relapse. We report on outcome of SSPs in PPCM patients in Germany, Scotland, and South Africa.

METHODS AND RESULTS:

Among 34 PPCM patients with a SSP, pregnancy ended prematurely in four patients while it was full-term in 30. Overall relapse rate [left ventricular ejection fraction, (LVEF) <50% or death after at least 6-month follow-up] was 56% with 12% (4/34) mortality. Relapse of PPCM after SSP was not associated with differences in parity, twin pregnancy, gestational hypertension, or smoking. Persistently reduced LVEF (<50%) before entering SSP was present in 47% of patients while full recovery (LVEF ≥50%) was present in 53%. The majority of patients entering SSP with persistently reduced LVEF were of African ethnicity (75%). Persistently reduced LVEF before SSP was associated with higher mortality (25% vs. 0%) and lower rate of full recovery at follow-up. Patients obtaining standard therapy for heart failure and bromocriptine immediately after delivery displayed significantly better LVEF at follow-up and a higher rate of full recovery with no patient dying compared with patients obtaining standard therapy for heart failure alone. This was independent of African or Caucasian race.

CONCLUSION:

Full recovery of LVEF before SSP was associated with lower mortality and better cardiac function at follow-up. Addition of bromocriptine to standard therapy for heart failure immediately after delivery was safe and seemed to be associated with a better outcome of SSP in African and Caucasian patients.

KEYWORDS:

Biomarker; Peripartum cardiomyopathy; Subsequent pregnancy; Therapy

Comment in

PMID:
28345302
DOI:
10.1002/ejhf.808
[Indexed for MEDLINE]
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