Abstract 12898: Myocardial Recovery at Six Months in Peripartum Cardiomyopathy: Results of the NHLBI Multicenter IPAC study
Introduction: Peripartum cardiomyopathy (PPCM) is a rare complication of pregnancy which remains a major cause of maternal morbidity and mortality. We sought to prospectively define contemporary outcomes and predictors of recovery at 6 months post-partum in the multicenter IPAC investigation.
Method: IPAC (Investigation of Pregnancy Associated Cardiomyopathy) is an NHLBI sponsored multicenter investigation of myocardial recovery in PPCM. Women presenting with an LVEF≤0.45 within two months of delivery were enrolled at 30 centers. LVEF was assessed by transthoracic echocardiography at entry and at 6 months postpartum. Status at 6 months (alive, dead, on LVAD or transplanted) as well as the degree of recovery was compared by race and presenting LVEF.
Results: For the cohort of 100 women the mean age=30 ± 6, Gravida= 2.8 ± 1.9, Para=2.2 ± 1.3, % NYHA class 1-4=12/46/24/17, and % race= 66 white, 30 black, 4 other. Medical therapy at entry included beta blockers in 89% and ACE inhibitors in 80%. Bromocriptine was utilized in only one subject. Mean LVEF was 0.34 ± 0.11 at entry and 0.51 ± 0.11 at 6 months. Only 9% of subjects had an LVEF≤0.35 at 6 months, while 65% had an LVEF> 0.50. Major events by six months included 3 LVADs, 3 deaths, and one transplant in 5 total patients (5%). LVEF was lower at entry and 6 month in blacks compared to whites (LVEF at entry B/W=0.28±0.12/0.36±0.10, p=0.002; 6 month 0.47±0.14/ 0.53±0.08, p=0.02). Outcomes were poorer in subjects with an LVEF≤0.30 at entry (n=30) as 4 of 5 subjects with events were in this subset and the LVEF at 6 months was significantly lower (mean EF at 6 months 0.42±0.13 versus 0.54±0.08, p=0.001).
Conclusions: The majority of women with PPCM treated with standard therapy recover, however the rate of death, transplant or LVAD remains unacceptably high. Outcomes differ by race and initial LVEF. Women with severe dysfunction at presentation have the poorest outcomes and may represent a target for future interventional trials
- © 2013 by American Heart Association, Inc.