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Clinical outcomes of peripartum cardiomyopathy: a 15-year nationwide population-based study in Asia.

ABSTRACT: Peripartum cardiomyopathy (PPCM) is the development of heart failure during late pregnancy to months postpartum with potential fatal outcome. However, the disease is not well-studied in Asia.We aimed to investigate the epidemiology and clinical outcomes of PPCM in Taiwan.Electronic medical records were retrieved from Taiwan National Health Insurance Research Database from 1997 to 2011. Patients with PPCM were separated into 3 groups based on the timing of diagnosis. Early: PPCM diagnosed first to ninth month of pregnancy. Traditional: PPCM diagnosed last month of pregnancy till fifth month post-delivery. Late: PPCM diagnosed sixth to twelfth month post-delivery. Primary outcomes defined as cardiac death, all-cause mortality, and major adverse cardiovascular events (MACE) within 1 year.A total of 3,506,081 deliveries during 1997 to 2011 were retrieved and 925 patients with PPCM were identified. Overall incidence of PPCM was 1:3,790 during the 15 years. Early, Traditional, and Late group each had 88, 742, and 95 patients. Cardiac death occurred in 31 patients, all-cause mortality in 72 patients, and MACE in 65 patients. Late group had 2- to 3-fold event rates in cardiac death, all-cause mortality, and MACE compared with Early and Traditional groups. Cumulative incidence showed significant differences for cardiac death (P?=?.0011), all-cause mortality (P?=?.0031), and MACE (P?=?.0014) among 3 groups. Multivariate Cox model showed Late group had significantly worse outcomes after adjusted for clinical variables compared with 2 other groups.Our study is the largest national cohort among Asian countries that showed timing of diagnosis of PPCM had different outcomes. Late diagnosis portended significantly increased morbidity and mortality, even after adjusted for clinical variables.

SUBMITTER: Wu VC

PROVIDER: S-EPMC5671863 | biostudies-other | 2017 Oct

REPOSITORIES: biostudies-other

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Clinical outcomes of peripartum cardiomyopathy: a 15-year nationwide population-based study in Asia.

Wu Victor Chien-Chia VC Chen Tien-Hsing TH Yeh Jih-Kai JK Wu Michael M Lu Cheng-Hui CH Chen Shao-Wei SW Wu Katie Pei-Hsuan KP Cheng Chun-Wen CW Chang Chih-Hsiang CH Hung Kuo-Chun KC Chern Ming-Shyan MS Lin Fen-Chiung FC Wen Ming-Shien MS

Medicine 20171001 43

Peripartum cardiomyopathy (PPCM) is the development of heart failure during late pregnancy to months postpartum with potential fatal outcome. However, the disease is not well-studied in Asia.We aimed to investigate the epidemiology and clinical outcomes of PPCM in Taiwan.Electronic medical records were retrieved from Taiwan National Health Insurance Research Database from 1997 to 2011. Patients with PPCM were separated into 3 groups based on the timing of diagnosis. Early: PPCM diagnosed first t ...[more]

PMID: 29069030

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Project description:OBJECTIVES:Hypertrophic cardiomyopathy (HCM) entails thickening of the myocardium and an increased risk of ischaemia. However, the prognosis of patients with HCM with acute myocardial infarction (AMI) is incompletely understood. METHODS:Medical information was retrieved from the Taiwan National Health Insurance Research Database in 1997-2011. The exclusion criteria were patients <18 years old, and history of AMI, coronary intervention, aortic valve disease, disease of the pericardium, heart surgery, device implantation, venous thromboembolism, cardiac transplant, congenital heart disease and end-stage renal disease on dialysis. Patients with HCM with AMI were compared with propensity score (PS)-matched patients with AMI without HCM. The primary endpoints were in-hospital and 1-year cardiovascular events. RESULTS:In total, 201?166 patients were admitted for AMI. There were 177?058 patients with new-onset AMI, 257 with HCM and 176?801 without HCM after exclusion criteria. Using 1:4 PS matching, the study population consisted of patients with AMI, 257 with HCM and 1028 without HCM. Patients with AMI with HCM received significantly less coronary intervention (OR=0.46; 95% CI 0.32 to 0.65; p<0.001), coronary intervention with stenting (OR=0.33; 95% CI 0.20 to 0.57; p<0.001) and coronary artery bypass graft surgery (OR=0.22; 95% CI 0.05 to 0.90; p=0.036), and fewer episodes of shock (OR=0.64; 95% CI 0.48 to 0.86; p=0.003) and in-hospital death (OR=0.46; 95% CI 0.30 to 0.70; p<0.001), compared with patients with AMI without HCM. Specifically, for patients with HCM with AMI, AMI occurred predominantly (82.5%) in the form of ischaemia without requiring coronary stenting. Patients with AMI with HCM had significantly better survival than patients without HCM (HR=0.66; 95% CI 0.51 to 0.85; p=0.001) during the 1-year follow-up. CONCLUSIONS:This is the first PS-matched study to compare the prognosis of patients with AMI with and without HCM. Compared with patients with AMI without HCM, patients with HCM had significantly better in-hospital and within 1-year outcomes.

Project description:BackgroundPeripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality.ObjectivesThis study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study.MethodsWe enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses.ResultsThe cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001).ConclusionsIn a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).

Project description:AimsWe sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally.Methods and resultsIn 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%).ConclusionPeripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

Project description:ImportancePeripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry, but well-powered studies to explore differences in severity of disease and clinical outcomes are lacking.ObjectiveTo compare the clinical characteristics, presentation, and outcomes of PPCM between African American and non-African American women.Design, setting, and participantsThis retrospective cohort study using data from January 1, 1986, through December 31, 2016, performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of African American individuals, included 220 women with PPCM.Main outcomes and measuresDemographic and clinical characteristics and echocardiographic findings at presentation, as well as clinical outcomes including cardiac recovery, time to recovery, cardiac transplant, persistent dysfunction, and death, were compared between African American and non-African American women with PPCM.ResultsA total of 220 women were studied (mean [SD] age at diagnosis, 29.5 [6.6] years). African American women were diagnosed with PPCM at a younger age (27.6 vs 31.7 years, P < .001), were diagnosed with PPCM later in the postpartum period, and were more likely to present with a left ventricular ejection fraction less than 30% compared with non-African American women (48 [56.5%] vs 30 [39.5%], P = .03). African American women were also more likely to worsen after initial diagnosis (30 [35.3%] vs 14 [18.4%], P = .02), were twice as likely to fail to recover (52 [43.0%] vs 24 [24.2%], P = .004), and, when they did recover, recovery took at least twice as long (median, 265 vs 125.5 days; P = .02) despite apparent adequate treatment.Conclusions and relevanceIn a large cohort of women with well-phenotyped PPCM, this study demonstrates a different profile of disease in African American vs non-African American women. Further work is needed to understand to what extent these differences stem from genetic or socioeconomic differences and how treatment of African American patients might be tailored to improve health outcomes.

Dataset Information

Clinical outcomes of peripartum cardiomyopathy: a 15-year nationwide population-based study in Asia.

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Clinical outcomes of peripartum cardiomyopathy: a 15-year nationwide population-based study in Asia.

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