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Five-year follow-up in patients with peripartum cardiomyopathy (PPCM) shows high and stable recovery rate and longterm use of cardiovascular medication

Session Acute heart failure: how to improve survival

Speaker Valeska Abou Moulig

Event : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Rapid Fire Abstracts

Authors : V Abou Moulig (Hannover,DE), T Pfeffer (Hannover,DE), M Ricke-Hoch (Hannover,DE), S Schlothauer (Hannover,DE), M Kasten (Hannover,DE), D Berliner (Hannover,DE), T Koenig (Hannover,DE), J Schwab (Nuremberg,DE), J Bauersachs (Hannover,DE), D Hilfiker-Kleiner (Hannover,DE)

Authors:
V Abou Moulig1 , T Pfeffer1 , M Ricke-Hoch1 , S Schlothauer1 , M Kasten1 , D Berliner1 , T Koenig1 , J Schwab2 , J Bauersachs1 , D Hilfiker-Kleiner1 , 1Hannover Medical School, Klinik für Kardiologie und Angiologie - Hannover - Germany , 2Nuremberg Hospital South - Nuremberg - Germany ,

Topic(s):
Acute Heart Failure – Epidemiology, Prognosis, Outcome

Background: Peripartum cardiomyopathy (PPCM) is a rare type of heart failure, defined by reduced left ventricular ejection fraction (LVEF) occurring in previously healthy women during late pregnancy or in the months following delivery. Although many patients recover, PPCM is lethal for some women despite optimal treatment. Longterm studies are rare. Here, we present five-year follow-up data in PPCM patients.

Methods: All patients who were diagnosed with PPCM between February 2006 and May 2013 were included (n=70). LVEF, medical treatment, adverse events and subsequent pregnancies were recorded. Follow-up data were obtained one and five years after the first diagnosis either by a subsequent visit in our clinic or by requesting the medical report from the treating cardiologist. For 14 patients who did not attend to any cardiologic follow-up, a telephone interview was performed.

Results: Of the 70 patients six were lost to follow-up. Of the remaining 64 patients (mean age 34±5 y) follow-up data after one year (13±2 months) were available for 42 patients and after five years (63 ± 9 months) for 50 patients. At diagnosis LVEF was reduced (26±10%). 70% of the patients received combination therapy of beta-blocker, angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor-blockers (ARB) and mineralocorticoid receptor antagonists (MRA), 28% received two of these drugs and 2% did not get any heart failure medication. In addition 90% were treated with the dopamine agonist bromocriptine.
After one year mean LVEF had improved to 51±11%. 60% of the patients had achieved full cardiac recovery with LVEF =50%, 31% had recovered partially (LVEF 35-49%), 9% showed no recovery (LVEF<35% or left ventricular assist device, LVAD) and no patient had died.
After five years mean LVEF had increased to 54±6%. 70% of the patients showed full and 26% partial recovery. No recovery was seen in 4% (two patients needed LVAD of whom one had died). 76% of the patients still took heart failure medication (29% had three drugs, 27% had two drugs and 20% one drug). 20% needed these medications for arterial hypertension or ventricular extrasystoles. Ten patients had a subsequent pregnancy, the mean LVEF after delivery was normal.

Conclusion: Our prospective five-year follow-up study shows a high and stable longterm recovery rate of PPCM with low mortality with standard heart failure treatment combined with prolactin blockers in the acute phase, and longterm cardiovascular drug therapy during the years following the diagnosis. Our results emphasize that the recovery process continues even beyond the first year after diagnosis. Selected patients achieving good LVEF recovery when managed according to this concept seem to have a good chance for successful subsequent pregnancies without relapse. However, a high percentage of patients had developed hypertension and arrhythmias, suggesting that PPCM is associated with cardiovascular disease even in patients with recovery in LVEF.

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