Abstract 18725: Predictors of Adverse Outcomes in Peripartum Cardiomyopathy

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a devastating condition leading to heart failure (HF) in the final trimester of pregnancy or within five months postpartum. Nearly half of women with PPCM suffer chronic HF, and some progress towards advanced HF requiring cardiac transplantation. While risk factors for developing PPCM have been identified, predictors of poor long-term outcome are not well defined. Hypothesis: We believe that right heart failure may predict adverse outcomes in PPCM. Methods: We performed a single-center retrospective cohort study of patients with at least one pregnancy and live birth and diagnosis of PPCM between 1994 and 2014. The primary outcome was a lack of improvement in LVEF and NYHA, and the secondary outcome was cardiac transplantation within 5 years. We used univariate logistic regression to assess associations between these outcomes and various clinical and echocardiographic characteristics at the time of PPCM diagnosis. Results: Of the 57 subjects who met inclusion criteria, 19 (33%) showed no improvement in NYHA class and LVEF and 10 (18%) underwent cardiac transplantation. Median (IQR) follow-up period was 4.9 (2.9-5.8) years; 2-year mortality was 4%. Diabetes was associated with no improvement in LVEF and NYHA (OR 5.0 [95% CI 1.3 to 19.7]). LVEF <30% at diagnosis was associated with no improvement in LVEF and NYHA class (OR 22.5 [95% CI 2.6 to 194]). LV internal diameter at end-diastole (LVIDd) ≥56mm was associated with no improvement in LVEF and NYHA class (OR 11.1 [95% CI 1.2 to 99]). Every 1 mm increase in LVIDd above 50 mm was associated with 22% greater odds of no improvement in LVEF and NYHA class (OR 1.22 [95% CI 1.07 to 1.38]). RV dysfunction was associated with lack of improvement in LVEF and NYHA class (OR 10.5 [95% CI 2.0 to 54]). Moderate to severe RV dysfunction was associated with cardiac transplantation (OR 4.38 [95% CI 1.0 to 19.3]). Conclusions: Diabetes is associated with chronic heart failure in PPCM. PPCM patients at risk for adverse long-term outcomes, including cardiac transplantation, may be identified by LVEF <30%, LVIDd≥56mm, and RV dysfunction at time of diagnosis. Such high-risk PPCM patients could benefit from early referral to advanced heart failure specialty programs.