Clinical Profi le and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience

BACKGROUND: Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifi cally in Filipino patients. METHODS: Clinical and echocardiographic data of 39 patients diagnosed with peripartum cardiomyopathy were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables. RESULTS: The mean age of the patients was 28.4 ± 6.9 and the mean ejection fraction (EF) was 27.8 ± 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ± 6.3. 16 patients had an initial EF of <25% (41%) and only 2 patients in this subgroup experienced improvement in EF. 29 patients experienced death and/or MAEs (74.4%). Multivariate analysis showed that an EF of <25% (HR 12.0,p=0.019), recovery of LV function (HR 0.23,p=0.05) and improvement of EF in 6 months (HR 0.32,p=0.024) were signifi cant predictors of MAEs. Kaplan Meier curves showed that patients whose ejection fraction was <25% had a 50% incidence of MAEs in 1 year with an increasing trend. Patients whose EF recovered in 6 months experienced a 60% freedom from MAE for almost 6 years. Patients with an EF of <25% had a mortality rate of 50% in two years. Patients with an EF of >25% had a 90% likelihood of survival for 8 years with a higher trend of mortality for patients whose EF did not recover in 6 months. CONCLUSION: Peripartum cardiomyopathy is associated with signifi cant morbidity and mortality. The degree of left ventricular dysfunction on presentation as well as improvement of EF within 6 months were predictive for the occurrence of death and major adverse events. This study emphasizes the need for aggressive treatment as well as clinical and echocardiographic follow up early in the course of disease in order to improve outcomes.