Prevalence and associated outcomes of right ventricular dysfunction in peripartum cardiomyopathy: a systematic review, meta-analysis and meta-regression.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-08-17 DOI:10.1136/openhrt-2025-003253

Matthew Aldo Wijayanto, Christopher Daniel Tristan, Graciella Angelica Lukas, Annisa Aghnia Rahma, Muhana Fawwazy Ilyas, Risalina Myrtha, Hary Sakti Muliawan, Bambang Budi Siswanto

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Abstract

Introduction: Recent studies have highlighted the presence of right ventricular dysfunction (RVD) in a substantial proportion of peripartum cardiomyopathy (PPCM), with evidence suggesting that RVD is associated with worse outcomes and a lower likelihood of left ventricular (LV) recovery. This study aims to comprehensively assess the pooled prevalence, associated outcomes and LV recovery of RVD in PPCM.

Methods: PubMed, Scopus and ScienceDirect were used to identify relevant literature prior to 19 January 2025. Statistical analysis was conducted using RStudio. All meta-analyses were performed using random effects, with subsequent subgroup analysis and univariate meta-regression conducted for prevalence meta-analysis.

Results: The pooled prevalence of RVD in PPCM was 0.48 (95% CI: 0.36 to 0.59; I² 95.3%) across 14 studies (1385 patients). RVD was diagnosed using multimodality imaging (e.g., echocardiography and cardiac magnetic resonance imaging), with diagnostic criteria defined in the original studies. Meta-regression showed a decreasing trend in RVD prevalence in more recent publications (p=0.03), with variability based on study design, location and diagnostic modality on subgroup analysis. Patients with RVD had a significantly higher risk of composite adverse outcomes (including death, LV assist device implantation, heart transplantation or the use of extracorporeal membrane oxygenation; hazard ratio 2.71; 95% CI 1.08 to 6.84; p=0.04; three studies) and heart transplantation (risk ratio (RR) 4.71; 95% CI 1.82 to 12.20; p<0.01; two studies). Additionally, RVD was associated with a lower baseline LV ejection fraction (mean difference -10.94; 95% CI -14.80 to -7.08; p<0.01; six studies) and an increased risk of unrecovered LV function (RR 1.62; 95% CI 1.25 to 2.11; p<0.01; four studies).

Conclusion: RVD occurs in nearly half of patients with PPCM and is associated with a poor prognosis. It may represent a crucial marker for prognostic stratification, particularly for the risk of unrecovered LV function.

Prospero registration number: CRD42025626739.

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查看原文本刊更多论文

围产期心肌病患者右室功能障碍的患病率和相关结果：系统回顾、荟萃分析和荟萃回归。

最近的研究强调了围产期心肌病（PPCM）中相当大比例的右心室功能障碍（RVD）的存在，有证据表明RVD与较差的结果和较低的左心室（LV）恢复的可能性相关。本研究旨在全面评估PPCM中RVD的总患病率、相关结局和左室恢复情况。方法：使用PubMed、Scopus和ScienceDirect检索2025年1月19日前的相关文献。使用RStudio进行统计分析。所有荟萃分析均采用随机效应，随后进行亚组分析和单变量荟萃回归进行患病率荟萃分析。结果：在14项研究（1385例患者）中，PPCM中RVD的总患病率为0.48 （95% CI: 0.36至0.59;I²95.3%）。RVD的诊断采用多模态成像（如超声心动图和心脏磁共振成像），诊断标准在原始研究中定义。meta回归显示，在最近的出版物中，RVD患病率呈下降趋势（p=0.03），在亚组分析中，存在基于研究设计、地点和诊断方式的变异性。RVD患者复合不良结局（包括死亡、左室辅助装置植入、心脏移植或使用体外膜氧合）和心脏移植的风险显著较高（风险比2.71;95% CI 1.08 ~ 6.84; p=0.04； 3项研究）(风险比（RR） 4.71；95% CI 1.82 ~ 12.20；结论：近一半的PPCM患者发生RVD，并伴有不良预后。它可能是预后分层的关键标志，特别是对于左室功能未恢复的风险。普洛斯彼罗注册号：CRD42025626739。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.