Peripartum cardiomyopathy requiring tertiary care admission: Clinical course and one -year outcomes from a prospective observational cohort.

Abstract

Background: Peripartum cardiomyopathy(PPCM) is an uncommon but potentially life-threatening cause of heart failure occurring during late pregnancy or the early postpartum period. Data describing the clinical profile and long-term outcomes of hospitalized PPCM patients remain limited.

Objectives: To describe the clinical presentation, disease severity, one-year clinical and echocardiographic outcomes of women with PPCM requiring hospitalisation, and to explore factors associated with left ventricular (LV) functional recovery.

Methods: A prospective observational study enrolled 47 consecutive women diagnosed with PPCM between June 2021 to June 2023 at a tertiary cardiac care hospital. The study assessed clinical characteristics, echocardiographic, electrocardiographic parameters, with the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and maternal outcomes at presentation, 6 months and 1 year follow up, with LV recovery defined as LVEF ≥45%.

Results: The mean age was 29.3 ± 5.5 years. Most patients presented postpartum (83%) and with advanced heart failure; over 98% were in NYHA class III-IV, and 83% had severe LV systolic dysfunction at admission.Mean LVEF improved from 25.7 ± 6.3% at baseline to 31.8 ± 9.4% at 6 months and 38.8 ± 13.1% at 1 year (p=<0.0001).LV recovery (LVEF ≥45%) occurred in 13.3% of patients at 6 months and 42.2% at 1 year. TAPSE, NYHA class and KCCQ score were also improved significantly at 1 year (p=<0.0001). Exploratory analysis showed baseline TAPSE(OR 1.29,95% CI 1.03-1.61,p = 0.03)was independent predictor of LV recovery.Rehospitalisation occurred in 29.8% and overall, one-year mortality rate was 6.4%.

Conclusions: Despite severe initial presentation, substantial improvement in ventricular function and clinical status occurs in many high risk PPCM patients with guideline-directed therapy and structured follow-up.