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Eur J Heart Fail. 2019 Dec;21(12):1534-1542. doi: 10.1002/ejhf.1624. Epub 2019 Nov 13.

Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co-morbidities.

Author information

1
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
2
Department of Cardiology, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany.
3
Department of Cardiology, Pulmonology, and Vascular Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
4
Department of Cardiology, Charité Universitätsmedizin, Campus Benjamin Franklin, Berlin, Germany.
5
Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany.

Abstract

AIMS:

Peripartum cardiomyopathy (PPCM) establishes late in pregnancy or in the first postpartum months. Many patients recover well within the first year, but long-term outcome studies on morbidity and mortality are rare. Here, we present 5-year follow-up data of a German PPCM cohort.

METHODS AND RESULTS:

Five-year follow-up data were available for 66 PPCM patients (mean age 34 ± 5 years) with a mean left ventricular ejection fraction (LVEF) of 26 ± 9% at diagnosis. Ninety-eight percent initially received standard heart failure therapy (beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and/or mineralocorticoid receptor antagonists), and 86% were additionally treated with dopamine D2 receptor agonists (mainly bromocriptine) and anticoagulation. After 1 year, mean LVEF had improved to 50 ± 11% (n = 48) and further increased to 54 ± 7% at 5-year follow-up with 72% of patients having achieved full cardiac recovery (LVEF >50%). At 5-year follow-up, only three patients (5%) displayed no recovery, of whom one had died. However, 20% had arterial hypertension and 17% arrhythmias, including paroxysmal supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation. Moreover, 70% were still on at least one heart failure drug. Subsequent pregnancy occurred in 16 patients with two abortions and 14 uneventful pregnancies. Mean LVEF was 55 ± 7% at 5-year follow-up in these patients.

CONCLUSION:

Our PPCM collective treated with standard therapy for heart failure, dopamine D2 receptor agonists, and anticoagulation displays a high and stable long-term recovery rate with low mortality at 5-year follow-up. However, long-term use of cardiovascular medication, persisting or de novo hypertension and arrhythmias were frequent.

KEYWORDS:

Co-morbidities; Heart failure; Medication; Peripartum cardiomyopathy; Subsequent pregnancy

PMID:
31724271
DOI:
10.1002/ejhf.1624

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