Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and nonperipartum women

Abstract

Background: Whether myocardial recovery occurs more frequently in peripartum cardiomyopathy (PPCM) than in recent onset cardiomyopathies in men and nonperipartum women has not been prospectively evaluated. This was examined through an analysis of outcomes in the Intervention in Myocarditis and Acute Cardiomyopathy 2 (IMAC2) registry.

Methods and results: IMAC2 enrolled 373 subjects with recent onset nonischemic dilated cardiomyopathy. Left ventricular ejection fraction (LVEF) was assessed at entry and 6 months, and subjects followed for up to 4 years. Myocardial recovery was compared between men (group 1), nonperipartum women (group 2) and subjects with PPCM (group 3). The cohort included 230 subjects in group 1, 104 in group 2, and 39 in group 3. The mean LVEF at baseline in groups 1, 2, and 3 was 0.23 ± 0.08, 0.24 ± 0.08, and 0.27 ± 0.07 (P = .04), and at 6 months was 0.39 ± 0.12, 0.42 ± 0.11, and 0.45 ± 0.14 (P = .007). Subjects in group 3 had a much greater likelihood of achieving an LVEF >0.50 at 6 months than groups 1 or 2 (19 %, 34%, and 48% respectively, P = .002).

Conclusions: Prospective evaluation confirms myocardial recovery is greatest in women with PPCM, poorest in men, and intermediate in nonperipartum women. On contemporary therapy, nearly half of women with PPCM normalize cardiac function by 6 months.

Figure 1. LVEF at baseline 6 months and change in LVEF by Group: Men, non-PPCM Women, and PPCM

Label on each bar represents mean LVEF for the subset. Error bar represents standard deviation. LVEF significantly greater in PPCM at baseline (p=0.04) and 6 month (p=0.007) with a trend toward greater ΔLVEF, with men at all point having the lowest mean LVEF and non–PPCM women being intermediate.

Figure 2. Distribution of values for LVEF and 6 months by Group: Men, non-PPCM Women, and PPCM

Percent of subjects with LVEF≥0.50 greatest in PPCM (p=0.002), However similar percentage in all groups with LVEF less than 0.30 at 6 months.

Figure 3. Time post partum

Timing of enrollment (months post partum) for women with PPCM. Majority enrolled within 2 months post partum.

Figure 4. Myocardial Recovery in PPCM women

A. Comparison by time to enrollment: Subjects enrolled late (>120 days post partum, n=8) compared with those enrolled less than 120 days (n=31). LVEF at 6 months significantly lower in those enrolled late (p=0.01). B. Comparison by race: black subjects (n=14) versus white (n=25). Mean values for LVEF at baseline, LVEF at 6 months and change in LVEF all tend to be lower in black subset however no significant differences. Note: Label on each bar represents mean LVEF for the subset. Error bar represents standard deviation.

Figure 4. Myocardial Recovery in PPCM women

A. Comparison by time to enrollment: Subjects enrolled late (>120 days post partum, n=8) compared with those enrolled less than 120 days (n=31). LVEF at 6 months significantly lower in those enrolled late (p=0.01). B. Comparison by race: black subjects (n=14) versus white (n=25). Mean values for LVEF at baseline, LVEF at 6 months and change in LVEF all tend to be lower in black subset however no significant differences. Note: Label on each bar represents mean LVEF for the subset. Error bar represents standard deviation.