Major Adverse Events Hit 25% In Peripartum Cardiomyopathy


SEATTLE — One-fourth of 182 women with peripartum cardiomyopathy developed major adverse events, half of which were death or heart transplantation, Dr. Sorel Goland reported in a poster presentation at the annual meeting of the Heart Failure Society of America.

Women with peripartum cardiomyopathy who had very low ejection fractions of 25% or who were not white were most likely to develop major adverse events, 50% of which occurred before the diagnosis of peripartum cardiomyopathy was made, said Dr. Goland of the department of cardiology at Cedars-Sinai Medical Center, Los Angeles, and associates. A diagnostic delay of a week or more raised the risk for death or heart transplant fivefold.

“Early diagnosis and aggressive therapy, including treatment of heart failure, anticoagulation, and sudden death prevention, should improve the outcome of patients,” the investigators stated.

The clinical profile of peripartum cardiomyopathy and risk factors for complications have not been well characterized due to its low incidence. Peripartum cardiomyopathy occurs during pregnancy or the postpartum period for unknown reasons and can cause severe complications.

The retrospective review of 182 patients found that 25% died, had a heart transplantation, developed cardiopulmonary arrest, required temporary circulatory support by an intra-aortic balloon pump or a left ventricular assist device, developed pulmonary edema or thromboembolic complications, or received a pacemaker or implantable cardioverter defibrillator. Of the 46 major adverse events, 36 (78%) occurred within 6 months of the diagnosis of peripartum cardiomyopathy.

Of the 182 patients, 24 (13%) died or underwent heart transplantation; 16 of the 24 deaths or transplants happened within 6 months of diagnosis.

Patients with ejection fractions of 25% or less had quadruple the risk for major adverse events in general and for death or heart transplant, compared with patients with higher ejection fractions. Nonwhites were three times as likely to develop major complications and four times likely to die or need a heart transplant, compared with whites.


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