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Comparative Study
. 2015 Aug 7;10(8):e0133466.
doi: 10.1371/journal.pone.0133466. eCollection 2015.

Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy

Ntobeko B A Ntusi  1 , Motasim Badri  1 , Freedom Gumedze  2 , Karen Sliwa  3 , Bongani M Mayosi  4
Affiliations
Comparative Study

Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy

Ntobeko B A Ntusi et al. PLoS One. .

Abstract

Aims: There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM), as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP) (i.e., peripartum cardiac failure associated with any form of hypertension) and PPCM have similar or different clinical features and outcome.

Methods and results: We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features) and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years) and PPCM (n = 30; age 31.5 ± 7.5 years). The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001). PPCM was more significantly associated with the following features than HHFP (p<0.05): twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05) to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05). There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005) during follow-up.

Conclusion: There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Onset of heart failure symptoms in hypertensive heart failure of pregnancy and peripartum cardiomyopathy.
Fig 2
Fig 2. Use of medication at follow-up.
Fig 3
Fig 3. Kaplan-Meier survival plot for hypertensive heart failure of pregnancy and peripartum cardiomyopathy patients over 14 years.
See this image and copyright information in PMC

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Grants and funding

The authors of this article are funded in part by research grants from the Discovery Foundation(NBAN), Medical Research Council of South Africa(www.mrc.ac.za) (BMM), the National Research Foundation (www.nrf.ac.za)(BMM, KS), and the Lily & Ernst Hausmann Research Trust (BMM). The funders played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.