Abstract 13532: Diastolic Function at Presentation Has Independent Prognostic Value in Patients With Peripartum Cardiomyopathy

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare disease with variable but potentially devastating consequences. The prognostic importance of alterations in LV diastolic function is unclear. Methods: Pregnancy Associated Cardiomyopathy cohort was a prospective study of 100 PPCM women from 30 centers presenting with LV ejection fraction (EF) < 45% within 2 months of delivery. Baseline data were mitral inflow E-wave, A-wave, E/A ratio, E deceleration time (DT), tissue Doppler septal and lateral annular velocities and biplane LA volume index. There were 90 PPCM patients and 21 female controls (8 healthy postpartum and 13 non-pregnant) with diastolic data. LV recovery was defined as LVEF ≥ 50% at 1 year. Outcome events were predefined as death, heart transplant or LV assist device (LVAD). Results: PPCM patients were aged 30±6 years with EF 35±9% at presentation. At 1 year, 84 patients had follow-up data: 63 patients (75%) had LV recovery (EF ≥50%) and 11 patients (13%) had either LVEF ≤35% or a major event (4 LVADs and 2 deaths). Elevated filling pressures (E/A≥2 and DT<150ms) were present in 57% at baseline and persisted in 11% at last echo, p<0.0001. Abnormalities in baseline diastolic function were associated with clinical outcomes and lack of LV recovery: area under the ROC curve (AUC) for E/A 0.78, p=0.0002, AUC for DT 0.82, p<0.0001, AUC for LA volume index 0.79, p<0.0001. Diastolic measures were also predictive of persistent severe LV dysfunction (EF ≤35%) or unfavorable events: E/A, p<0.0001; DT, p<0.0001, and LA volume index, p=0.0001. By multivariate analysis, baseline diastolic function was independently associated with subsequent lack of LV recovery or unfavorable events (Table). Conclusions: In PPCM patients, echo-Doppler measures of diastolic function at presentation provide important prognostic information regarding LV recovery and clinical outcomes.