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Review
. 2023 Aug 15;12(16):5303.
doi: 10.3390/jcm12165303.

Analysis of Clinical Profiles and Echocardiographic Cardiac Outcomes in Peripartum Cardiomyopathy (PPCM) vs. PPCM with Co-Existing Hypertensive Pregnancy Disorder (HPD-PPCM) Patients: A Systematic Review and Meta-Analysis

Annisa Dewi Nugrahani  1   2 , Sidik Maulana  3 , Kevin Dominique Tjandraprawira  2 , Dhanny Primantara Johari Santoso  1   2 , Dani Setiawan  2 , Adhi Pribadi  2 , Amillia Siddiq  2 , Akhmad Yogi Pramatirta  2 , Muhammad Alamsyah Aziz  2 , Setyorini Irianti  2
Affiliations
Review

Analysis of Clinical Profiles and Echocardiographic Cardiac Outcomes in Peripartum Cardiomyopathy (PPCM) vs. PPCM with Co-Existing Hypertensive Pregnancy Disorder (HPD-PPCM) Patients: A Systematic Review and Meta-Analysis

Annisa Dewi Nugrahani et al. J Clin Med. .

Abstract

Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian-Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = -1.63) (95% CI; -4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = -1.55, [CI: -2.89, -0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07-3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (-1.08--0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease's response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.

Keywords: PPCM; echocardiography; hypertensive pregnancy disorder; peripartum cardiomyopathy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Risk of bias assessment with ROBINS-I [14,15,21,22].
Figure 3
Figure 3
Forest plot of the impact of chronic hypertension on PPCM vs. HPD-PPCM [15,21,22].
Figure 4
Figure 4
Forest plot thehe impact of systolic blood pressure on PPCM vs. HPD-PPCM [15,22].
Figure 5
Figure 5
Forest plot of the impact of diastolic blood pressure on PPCM vs. HPD-PPCM [15,22].
Figure 6
Figure 6
Forest plot of the impact of furosemide on PPCM vs. HPD-PPCM initiated after diagnosis [15,22].
Figure 7
Figure 7
Forest plot of the impact of beta blocker on PPCM vs. HPD-PPCM Initiated after Diagnosis [15,22].
Figure 8
Figure 8
Forest plot of the impact of PPCM vs. HPD-PPCM on LVEF reduction [14,15,22].
Figure 9
Figure 9
Forest plot of the impact of PPCM vs. HPD-PPCM on LV dilation [15,22].
Figure 10
Figure 10
Forest plot of the impact of PPCM vs. HPD-PPCM on relative wall thickness reduction [15,22].
See this image and copyright information in PMC

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