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

• Type of Material: Article
• Authors: Dennis M. McNamara, University of Pittsburgh; Uri Elkayam, University of Southern California; Rami Alharethi, Intermountain Medical Center; Julie Damp, Vanderbilt University; Eileen Hsich, Cleveland Clinic; Gregory Ewald, Washington University; Kalgi Modi, Louisiana State University; Jeffrey D. Alexis, University of Rochester; Gautam V. Ramani, University of Maryland; Marc J. Semigran, Harvard University; Jennifer Haythe, Columbia University; David Markham, Emory University; Josef Marek, University of Pittsburgh; John Gorcsan, University of Pittsburgh; Wen-Chi Wu, University of Pittsburgh; Yan Lin, University of Pittsburgh; Indrani Halder, University of Pittsburgh; Jessica Pisarcik, University of Pittsburgh; Leslie T. Cooper, Mayo Clinic; James D. Fett, University of Pittsburgh
• Language: English
• Date: 2015-08-25
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American College of Cardiology Foundation.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2015.06.1309
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 66
• Issue: 8
• Start Page: 905
• End Page: 914
• Grant/Funding Information: This investigation was supported by the National Heart, Lung, and Blood Institute through contract HL102429.
• Keywords: RECOVERY; HEART-FAILURE; myocardial recovery; PREDICTORS; TASK-FORCE; Life Sciences & Biomedicine; remodeling; MANAGEMENT; heart failure; GUIDELINES; MYOCARDITIS; Cardiovascular System & Cardiology; Cardiac & Cardiovascular Systems; MORTALITY; Science & Technology; MUTATIONS; DILATED CARDIOMYOPATHY; race
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

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).