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

Hilfiker-Kleiner, D. et al. (2017) Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy. European Journal of Heart Failure, 19(12), pp. 1723-1728. (doi: 10.1002/ejhf.808) (PMID:28345302)

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. Conclusions: 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.

• Item Type: Articles
• Keywords: Biomarker, peripartum cardiomyopathy, subsequent pregnancy, therapy
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Petrie, Professor Mark and Walker, Dr Niki
• Authors: Hilfiker-Kleiner, D., Haghikia, A., Masuko, D., Nonhoff, J., Held, D., Libhaber, E., Petrie, M. C., Walker, N. L., Podewski, E., Berliner, D., Bauersachs, J., and Sliwa, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 27 March 2017