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Long‐term follow‐up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co‐morbidities
Author(s) -
Moulig Valeska,
Pfeffer Tobias Jonathan,
RickeHoch Melanie,
Schlothauer Stella,
Koenig Tobias,
Schwab Johannes,
Berliner Dominik,
Pfister Roman,
Michels Guido,
Haghikia Arash,
Falk Christine S.,
Duncker David,
Veltmann Christian,
HilfikerKleiner Denise,
Bauersachs Johann
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1624
Subject(s) - medicine , peripartum cardiomyopathy , ejection fraction , heart failure , cardiology , atrial fibrillation , cardiomyopathy , ventricular tachycardia
Aims Peripartum cardiomyopathy (PPCM) establishes late in pregnancy or in the first postpartum months. Many patients recover well within the first year, but long‐term outcome studies on morbidity and mortality are rare. Here, we present 5‐year follow‐up data of a German PPCM cohort. Methods and results Five‐year follow‐up data were available for 66 PPCM patients (mean age 34 ± 5 years) with a mean left ventricular ejection fraction (LVEF) of 26 ± 9% at diagnosis. Ninety‐eight percent initially received standard heart failure therapy (beta‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and/or mineralocorticoid receptor antagonists), and 86% were additionally treated with dopamine D2 receptor agonists (mainly bromocriptine) and anticoagulation. After 1 year, mean LVEF had improved to 50 ± 11% ( n = 48) and further increased to 54 ± 7% at 5‐year follow‐up with 72% of patients having achieved full cardiac recovery (LVEF >50%). At 5‐year follow‐up, only three patients (5%) displayed no recovery, of whom one had died. However, 20% had arterial hypertension and 17% arrhythmias, including paroxysmal supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation. Moreover, 70% were still on at least one heart failure drug. Subsequent pregnancy occurred in 16 patients with two abortions and 14 uneventful pregnancies. Mean LVEF was 55 ± 7% at 5‐year follow‐up in these patients. Conclusion Our PPCM collective treated with standard therapy for heart failure, dopamine D2 receptor agonists, and anticoagulation displays a high and stable long‐term recovery rate with low mortality at 5‐year follow‐up. However, long‐term use of cardiovascular medication, persisting or de novo hypertension and arrhythmias were frequent.