Abstract 5916: Delayed Mortality in Peripartum Cardiomyopathy Indicates Need for Long-Term Follow-Up

Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy occurring in women between one month antepartum and five months postpartum. It has been shown to carry a substantial risk of mortality within the first six months after diagnosis but few studies have outlined prospective long-term morbidity and mortality. The aim of this study is to assess long-term clinical outcome and mortality over a two-year period. Methods: Eighty consecutive women with PPCM were enrolled at diagnosis at a single center in a prospective study over a period of two years. Patients were started on standard heart failure therapy and detailed assessments, including echocardiography, were made at six-month intervals for twenty four months in surviving cases. Results: At baseline, the mean age of this cohort was 29.7 ± 6.4 years and 30 of 80 (38%) were in their first pregnancy. Overall, 71 (89%) patients presented in NYHA functional class III–IV at baseline and mean left ventricular ejection fraction (LVEF) was 29.7% ± 8.7%. During the two-year study period, 4 patients were lost to follow-up, 9 moved to remote areas, and 8 had a subsequent pregnancy, predisposing them to additional myocardial risk. In the remaining cases, mean LVEF was 45.1 ± 11.3, 46.3 ± 13.0 and 50.4 ± 13.5 at six, twelve, and twenty four months, respectively. Within two years, 22 women had died (28%), confirming the poor prognostic implications of PPCM. However, the majority of fatal events occurred between six and twenty four months (15 of 22; 68%). At six months, 7 of 80 (9%) patients had died. During extended follow-up, a further 15 of 69 (22%) died despite apparent recovery of left ventricular function. Conclusion: First, our findings emphasize the poor prognosis of PPCM. Furthermore, the fatality rate was higher than expected over a two-year period. The delayed mortality beyond six months observed in our study suggests the need for long-term clinical follow-up in women with PPCM.