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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 delay in diagnosing peripartum cardiomyopathy of a week or longer increased the risk for death or heart transplant fivefold.

“Diagnosis of peripartum cardiomyopathy is often delayed and preceded by major adverse events. 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 the risk factors for complications have not been well characterized previously because of the low incidence of this disorder. Peripartum cardiomyopathy occurs during pregnancy or the postpartum period because of unknown causes and can be associated with severe complications.

The retrospective review of data on 182 patients found that 25% died, underwent 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 had a pacemaker or implantable cardioverter defibrillator implanted. 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 who had higher ejection fractions. Nonwhite patients were three times more likely to develop major complications and four times more likely to die or need a heart transplant, compared with white patients.

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