Nine in ten women with pregnancy related cardiomyopathy make full recovery

3rd September 2015

Although the majority of women with pregnancy related cardiomyopathy make a full recovery within a year of birth, those with severe heart pumping problems are at risk of future heart problems, new research from America suggests.

A study of 100 women with peripartum cardiomyopathy (PPCM) showed that 91% of women who had an ejection fraction of 30% or more (a measure of how well the heart is pumping blood out of the heart) and only a mild or moderately dilated left ventricle had made a full recovery a year after giving birth.

The women had received conventional heart failure treatments.

cardiomyopathy and pregnancy

Thirteen per cent of women experiences a major event or had persistent severe cardiomyopathy at one year follow up. Black women were especially at risk.

The results came from the country's Investigations of Pregnancy Associated Cardiomyopathy (IPAC) study.

Lead author Dr Dennis McNamara from the University of Pittsburgh Medical Centre in America said: "I was encouraged and pleasantly surprised by the degree of overall recovery we saw. However, the mortality rate at one year was too high at roughly 6%, and a number of women were left with severe cardiomyopathy. So we still have work to do."

He added that severity of left ventricular dysfunction, as measured by echocardiogram, when the women were first seen by doctors was probably the best clinical predictor how they would do in future.

The researchers said that PPCM affects roughly one in 2,000 pregnant women in America. Although it was an uncommon complication of pregnancy, it could become very serious.

Dr McNamara said "It is poorly understood, and because of its rarity we felt we needed to get a large group together to be able to investigate what was causing this disease and see how we could better predict who would and would not recover."

In the IPAC study, 100 women (65% white, 30% black; mean age 30 years) with newly diagnosed PPCM, but no history of heart problems, were enrolled at 30 US centres between December 2009 and September 2012. The mean ejection fraction of women in the study was 35%.

Conventional heart failure treatments of beta-blockers were used by 88% of participants, and ACE inhibitors or angiotensin-receptor blockers were used by 81%.

At one year, there had been four left heart pumps fitted, one heart transplant and four deaths among six women in the study, and various other hospital admissions experienced by three others.

Overall, there was a 93% event-free survival rate (without a transplant or heart pump) and 95% transplantation-free survival rate at one year.

Researchers said that although the overwhelming majority of women in the study recovered, the poor outcomes remained unacceptably high.

They said: "There remains a great need for more targeted therapies to improve outcomes in those women whose probability of recovery on conventional therapy is diminished," adding that future studies that target those with poor ejection fraction and greater left ventricle dilation "may permit a better assessment of novel therapeutic interventions."

Dr McNamara reiterated that the simple clinical tool of a cardiac was extremely valuable.

He said: "If a woman, at birth or in the immediate postpartum period, complains of shortness of breath, clinicians should have a low threshold for at least doing a transaortic echo—a simple, noninvasive test that will pick up any cases of cardiomyopathy."

The findings were published in the August 25, 2015 issue of the Journal of the American College of Cardiology.