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Comparative Study
. 2017 Nov 1;2(11):1256-1260.
doi: 10.1001/jamacardio.2017.3574.

Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non-African American Women

Olga Corazón Irizarry  1 , Lisa D Levine  1 , Jennifer Lewey  2 , Theresa Boyer  3 , Valerie Riis  1 , Michal A Elovitz  1 , Zolt Arany  2
Affiliations
Comparative Study

Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non-African American Women

Olga Corazón Irizarry et al. JAMA Cardiol. .

Abstract

Importance: Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry, but well-powered studies to explore differences in severity of disease and clinical outcomes are lacking.

Objective: To compare the clinical characteristics, presentation, and outcomes of PPCM between African American and non-African American women.

Design, setting, and participants: This retrospective cohort study using data from January 1, 1986, through December 31, 2016, performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of African American individuals, included 220 women with PPCM.

Main outcomes and measures: Demographic and clinical characteristics and echocardiographic findings at presentation, as well as clinical outcomes including cardiac recovery, time to recovery, cardiac transplant, persistent dysfunction, and death, were compared between African American and non-African American women with PPCM.

Results: A total of 220 women were studied (mean [SD] age at diagnosis, 29.5 [6.6] years). African American women were diagnosed with PPCM at a younger age (27.6 vs 31.7 years, P < .001), were diagnosed with PPCM later in the postpartum period, and were more likely to present with a left ventricular ejection fraction less than 30% compared with non-African American women (48 [56.5%] vs 30 [39.5%], P = .03). African American women were also more likely to worsen after initial diagnosis (30 [35.3%] vs 14 [18.4%], P = .02), were twice as likely to fail to recover (52 [43.0%] vs 24 [24.2%], P = .004), and, when they did recover, recovery took at least twice as long (median, 265 vs 125.5 days; P = .02) despite apparent adequate treatment.

Conclusions and relevance: In a large cohort of women with well-phenotyped PPCM, this study demonstrates a different profile of disease in African American vs non-African American women. Further work is needed to understand to what extent these differences stem from genetic or socioeconomic differences and how treatment of African American patients might be tailored to improve health outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Irizarry reported receiving grants unrelated to the present work from FOCUS Medical Student Fellowship in Women’s Health supported by the Edna G. Kynett Memorial Foundation. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Time of Peripartum Cardiomyopathy Diagnosis Stratified by Time of Delivery and Race
Time of diagnosis of PPCM in relation to time of delivery is indicated for 190 women (88 non–African American and 102 African American).
Figure 2.
Figure 2.. Time to Recovery Stratified by Race
Kaplan-Meier estimates of median time to recovery for 80 women (50 non–African American and 30 African American).
See this image and copyright information in PMC

Comment in

References

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