Predictors factor of left ventricular (LV) remission peripartum cardiomyopathy

Abstract

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening disease. The purpose was to identify the predictors of left ventricular (LV) recovery. We retrospectively reviewed 40 patients hospitalized between 2013–2022. We included women with signs of heart failure in the last month of pregnancy and up to 5 months postpartum, with absence of identifiable causes of heart failure, with LV systolic dysfunction by TEE such as depressed shortening fraction (> 30%), EF (> 45%) and LV end-diastolic dimension > 2.7 cm/m2. All patients were followed clinically and echocardiography at 6 months and over 1 year. Thirty-two patients were multiparous, 28 had multifetal pregnancies, caesarean section was performed in 20 patients, 15 patients had severe preeclampsia PPCM was discovered in antepartum in one case 5, postpartum in 35 cases with a mean time: 15 weeks after delivery. The symptomatology was dyspnea in 40 women, orthopnea in 15 cases, signs of pulmonary oedema in 20 cases and right heart failure in 9 cases. TEE at admission revealed dilatation of the LV with a mean EF 26%. A RV dysfunction in 16 cases, a functional MR in 15 cases; PH in 10 cases all patients received iv diuretics in case of AHF, CEI were prescribed in 35 cases, beta blockers and MRA in 22 cases. The duration of treatment was 6 months for 9 patients and over a year for others. Inotropic drug and circulatory support were necessary in 2 cases hospital mortality rate was of 1% because of cardiogenic shock. Twenty-five patients (45%) had “any improvement” in LVEF within 6 months and 3 patients during a mean follow-up of 26 months. Of these patients, 3 had complete improvement, 5 had partial recovery of LVEF. The factors associated with a higher likelihood of recovery were: postpartum diagnosis of PCCM, LVEF > 30%, LVEDD < 6 cm. PCCM is a complication of pregnancy with unknown causes. Preeclampsia and multiparity appears to be strong associations.