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. 2022 Dec;9(6):4262-4270.
doi: 10.1002/ehf2.14141. Epub 2022 Sep 20.

Contemporary outcome of subsequent pregnancies in patients with previous peripartum cardiomyopathy

Sorel Goland  1   2 , Jacob George  1   2 , Uri Elkayam  3 , Sara Shimoni  1   2 , Irena Fugenfirov  1   2 , Edi Vaisbuch  2   4 , Michael Arad  5   6 , Dov Freimark  5   6 , Michal Simchen  6   7 , Rafael Kuperstein  5   6
Affiliations

Contemporary outcome of subsequent pregnancies in patients with previous peripartum cardiomyopathy

Sorel Goland et al. ESC Heart Fail. 2022 Dec.

Abstract

Aims: To describe the effect of subsequent pregnancies (SSP) on left ventricular (LV) function and outcomes in patients with peripartum cardiomyopathy (PPCM).

Methods: Among146 women with PPCM who were prospectively followed at two medical centres in Israel (2007-2019), 75 SSPs (in 50 women) were identified: 8 miscarriages, 8 terminations, and 59 life birth.

Results: Forty-five patients with 59 full-term SSPs [mean age was 32.9 ± 4.1 years, LV ejection fraction (LVEF) 57.7 ± 5.1%] were analysed. Data on LVEF at 1-month post-delivery were available in 46 and at 6 months in 36 SSPs. There was a small decrease in the mean LVEF, mostly at third trimester (57.2 ± 5.6 vs. 54.4. ± 7.3, P < 0.001); and at 1-mont (57.9 ± 5.7% vs. 55.4 ± 6.1%, P = 0.001) and at 6-month post-delivery (57.4 ± 6.1 vs. 55.3 ± 7.9%, P = 0.03). In patients with pre-SSP LV LVEF ≥55%, a mild reduction in the mean group LVEF was seen at 1-month post-delivery (P = 0.009). One patient with pre-SSP LVEF ≥55% developed severe relapse. In patients with pre-SSP LVEF <55%, a mild reduction in LVEF was obtained mostly at third trimester (51.1 ± 5.6 vs 47.0 ± 7.4%, P < 0.001), which persisted at 6 months (P = 0.03). A relapse was observed in three (25%) women with LVEF <55%. There was no maternal mortality, 32 patients delivered by caesarean section, and there were no foetal complications.

Conclusions: Our study indicates a favourable outcome and low likelihood of maternal mortality associated with SSP in women with a history of PPCM and recovered LV systolic function. SSP was associated with a slight reduction in LVEF mostly during the third trimester, which persisted up to 6 months after delivery.

Keywords: Cardiomyopathy; Outcome; Peripartum; Pregnancies; Subsequent.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Derivation of the patient population of women with subsequent pregnancies and available echocardiographic follow‐up at different time points.
Figure 2
Figure 2
Changes in LVEF during each trimester and after (1 week to 1 month). SSP, subsequent pregnancy; TR, trimester.
Figure 3
Figure 3
Changes in LVEF during each trimester and after (1 week to 1 month) delivery in patients with LVEF ≥55% and LVEF<55%. The black line represents changes in LVEF during pregnancies in patients with ≥55% (n = 23), and the grey line in patients LVEF <55% (n = 11). SSP, subsequent pregnancy; TR, trimester.
Figure 4
Figure 4
Individual changes in LVEF and 2D global longitudinal strain during each trimester and after (1 week to 1 month) delivery. (A) Individual changes in LVEF during each trimester and after (1 week to 1 month) delivery. The black line represents changes in the mean LVEF. P < 0.001 between all time points. LVEF, left ventricular ejection fraction. (B) Changes in global longitudinal strain in LVEF during each trimester and after (1 week to 1 month) delivery. The black line represents changes in the mean global longitudinal strain. P < 0.001 between all time points. 2DS, two‐dimensional strain; LVEF, left ventricular ejection fraction; SSP, subsequent pregnancy; TR, trimester.
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