Prognostic value of various markers in recovery from peripartum cardiomyopathy: a systematic review and meta-analysis

Abstract

Aims: The aetiology of peripartum cardiomyopathy (PPCM) is still not clear, and it is unknown who would recover from PPCM. In this meta-analysis, for the first time, we aimed to explore the prognostic value of potential baseline factors that may help predict recovery in patients with PPCM.

Methods: A systematic approach following the Meta-analysis of Observational Studies in Epidemiology guideline was taken by using appropriate keywords in PubMed, Scopus, and Embase databases. Studies that had compared different clinical and paraclinical markers at the time of diagnosis related to cardiovascular function between recovered and non-recovered patients with PPCM were included. To find potential predictors of recovery, the odds ratio (OR) was calculated for different parameters using the random-effects model.

Results: Eighteen cohort studies including 1047 patients with PPCM were enrolled. Six markers out of the 11 potentially eligible markers were associated with PPCM recovery. Baseline echocardiographic parameters [left ventricular ejection fraction (LVEF) (OR = 4.84 [2.53; 9.26]), left ventricular end-diastolic diameter (OR = 3.67 [2.58; 5.23]), left ventricular end-systolic diameter (OR = 3.99 [2.27; 7.02]), and fractional shortening (OR = 6.14 [1.81; 20.85])] were strong predictors of PPCM recovery. Systolic blood pressure (OR = 2.16 [1.38; 3.38]) and diastolic blood pressure (OR = 2.06 [1.07; 3.96]) at diagnosis were also associated with recovery.

Conclusions: Patients with PPCM who have a higher baseline LVEF, lower left ventricular diameters, and higher blood pressure levels have a greater chance to recover from PPCM.

Keywords: Heart failure; Left ventricular recovery; Peripartum cardiomyopathy; Predictors of recovery.

Figure 1

PRISMA flow diagram of the search strategy.

Figure 2

Forest plots of the correlation between echocardiographic parameters [(A) LVEF, (B) LVEDD^a, (C) LVESD^a, and (D) FS] and peripartum cardiomyopathy recovery (LVEF, left ventricular ejection fraction; LVEDD, left ventricular end‐diastolic diameter; LVESD, left ventricular end‐systolic diameter; FS, fractional shortening). ^aThe mentioned forest plots were reversed to the odds ratio of the non‐recovery group for easier interpretation.

Figure 3

Forest plots of the correlation between baseline blood pressure and heart rates [(A) SBP, (B) DBP, and (C) heart rate^a) and peripartum cardiomyopathy recovery (SBP, systolic blood pressure; and DBP, diastolic blood pressure). ^aThe mentioned forest plots were reversed to the odds ratio of the non‐recovery group for easier interpretation.

Figure 4

Forest plots of the correlation between (A) hypertensive disorders, (B) diabetes mellitus,^a (C) LV thrombus,^a and (D) NYHA FC^a and peripartum cardiomyopathy recovery (LV thrombus, left ventricular thrombus; and NYHA FC, New York Heart Association functional class). ^aThe mentioned forest plots were reversed to the odds ratio of the non‐recovery group for easier interpretation.