A look at peripartum cardiomyopathy over the last decade: a single centre study in a US minority population

Abstract

Abstract Background The incidence of Peripartum Cardiomyopathy (PPCM) has been increasing and is estimated at 1 in 2000 live births in the United States. We explored the PPCM population at our institution – a South Florida cohort comprised largely of Haitian and Hispanic patients making it a distinct population compared to previously published data. Purpose To better understand the demographics and determinants of recovery in this minority population. Methods We retrospectively identified PPCM patients from January 2009 to January 2019 using ICD 10 codes. Data on baseline characteristics was collected from the electronic medical record. Our primary endpoint was to evaluate myocardial recovery as characterised by an ejection fraction (LVEF) greater than 50%. Secondary outcomes included the incidence of cardiac devices implantation, transplantation, and recurrent pregnancies. Results 52 patients were identified in the study period. Sixty-seven percent of patients were African American, 15% Hispanic, 10% Haitian and 8% were Caucasian. At the time of diagnosis, mean age was 29 years (95% CI 27.0–30.4), mean BMI 33 (95% CI 29.9–35.9) and mean LVEF 19% (95% CI: 16.4–22.7). Amongst the co-morbidities reported, hypertension (33%), pre-eclampsia (13%) and diabetes (12%) were the most prevalent. The time to diagnosis differed significantly; 32% were diagnosed at the time of delivery and of the remaining diagnosed post-delivery, average time to diagnosis was 12 weeks (95% CI: 4.3–19.4). Only 13% had recovery of their LVEF, 56% did not recover and 16% had no follow-up LVEF documented. Amongst the patients who did not recover, 41% had right ventricular dysfunction and the commonest valvopathy seen was moderate to severe mitral regurgitation. Interestingly, 29% of the patients had documented recurrent pregnancies after their initial diagnosis. Conclusion Elevated BMI, hypertension and pre-eclampsia are commonly seen in this PPCM minority population suggesting that patients seen in antenatal clinic with these features should be closely followed for progression to PPCM. The lack of follow-up echocardiograms and high incidence of recurrent pregnancy supports the need for a dedicated registry for PPCM patients to improve follow-up surveillance which may result in improved long-term mortality and recovery in these patients. Funding Acknowledgement Type of funding source: None