Loving Mothers’ Hearts: Screening for Undiagnosed Cardiomyopathy in Peripartum Women [A229

Abstract

INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a leading cause of pregnancy-related maternal mortality, but it is easily treated if diagnosed early. Better screening allows earlier treatment, which can decrease maternal mortality. Prognosis is closely linked to left ventricular ejection fraction (LVEF) at time of diagnosis and treatment. There are no consensus screening guidelines for PPCM. METHODS: To address this need, we have created a PPCM screening questionnaire (PSQ), which is used to calculate a PPCM Severity Index (PSI). The PSQ was distributed on social media to women with PPCM (N ∼4,900), preeclampsia (N ∼3,000), uncomplicated pregnancies, and participants enrolled from a cross-sectional sample of peripartum patients presenting to a single maternity center. Peripartum participants in this ongoing, Institutional review board‒approved study (n=1,500) are screened for PPCM using bedside echocardiography. The LVEF measurements are paired with PSI scores and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels for analysis. Study participants are offered free serial echocardiographic assessments at 0–2 weeks, 4–6 weeks and 5–12 months postpartum. RESULTS: Preliminary data show that PSI scores are correlated with degree of LV dysfunction and can differentiate between women with PPCM (n=178), healthy pregnant controls (n=32), and women with preeclampsia (n=43). Postpartum PSI scores were more specific for PPCM than pregnant PSI scores. The most frequent symptoms reported by PPCM patients are dyspnea (94%), orthopnea (84%), and fatigue (79%). CONCLUSION: The PSQ is an effective screening tool for PPCM and, if used in conjunction with BNP testing and echocardiography, may significantly reduce pregnancy-related maternal mortality.