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. 2020 Oct 14;41(39):3787-3797.
doi: 10.1093/eurheartj/ehaa455.

Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry

Karen Sliwa  1 , Mark C Petrie  2 , Peter van der Meer  3 , Alexandre Mebazaa  4 , Denise Hilfiker-Kleiner  5 , Alice M Jackson  2 , Aldo P Maggioni  6   7 , Cecile Laroche  6 , Vera Regitz-Zagrosek  8 , Maria Schaufelberger  9 , Luigi Tavazzi  10 , Jolien W Roos-Hesselink  11 , Petar Seferovic  12 , Karin van Spaendonck-Zwarts  13 , Amam Mbakwem  14 , Michael Böhm  15 , Frederic Mouquet  16 , Burkert Pieske  17 , Mark R Johnson  18 , Righab Hamdan  19 , Piotr Ponikowski  20 , Dirk J Van Veldhuisen  3 , John J V McMurray  2 , Johann Bauersachs  5
Affiliations

Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry

Karen Sliwa et al. Eur Heart J. .

Erratum in

Abstract

Aims: We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally.

Methods and results: In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%).

Conclusion: Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

Keywords: Outcome; Peripartum cardiomyopathy; Registry.

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Figures

Figure 1
Figure 1
Recruitment and global enrolment by country.
Figure 2
Figure 2
Kaplan-Meier survival curves for 6-month outcomes: (A) Death from any cause and (B) Re-hospitalization for any cause.
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