Mark C. Petrie
Niki L. Walker
Karen Sliwa-Hahnle, Australian Catholic University
Hilfiker-Kleiner, D., Haghikia, A., Masuko, D., Nonhoff, J., Held, D., Libhaber, E., Petrie, M. C, Walker, N. L, Podewski, E., Berliner, D., Bauersachs, J. & Sliwa-Hahnle, K. (2017). Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy. European Journal of Heart Failure,19(12), M. Metra. 1723-1728. United Kingdom: John Wiley & Sons Ltd.. Retrieved from https://doi.org/10.1002/ejhf.80
Aims: Subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have a high risk of heart failure relapse. We report on outcome of SSPs in PPCM patients inGermany, Scotland, and South Africa. Methods and results: Among 34 PPCM patients with a SSP, pregnancy ended prematurely in four patients while it was full-term in 30. Overall relapse rate [left ventricular ejection fraction, (LVEF) < 50% or death after at least 6-month follow-up] was 56% with 12% (4/34) mortality. Relapse of PPCM after SSP was not associated with differences in parity, twin pregnancy, gestational hypertension, or smoking. Persistently reduced LVEF ( < 50%) before entering SSP was present in 47% of patients while full recovery (LVEF ≥50%) was present in 53%. The majority of patients entering SSP with persistently reduced LVEF were of African ethnicity (75%). Persistently reduced LVEF before SSP was associated with higher mortality (25% vs. 0%) and lower rate of full recovery at follow-up. Patients obtaining standard therapy for heart failure and bromocriptine immediately after delivery displayed significantly better LVEF at follow-up and a higher rate of full recovery with no patient dying compared with patients obtaining standard therapy for heart failure alone. This was independent of African or Caucasian race. Conclusion: Full recovery of LVEF before SSP was associated with lower mortality and better cardiac function at follow-up. Addition of bromocriptine to standard therapy for heart failure immediately after delivery was safe and seemed to be associated with a better outcome of SSP in African and Caucasian patients.
Mary MacKillop Institute for Health Research