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Am J Perinatol 2022; 39(03): 225-231
DOI: 10.1055/s-0041-1740016
SMFM Fellowship Series Article

Imaging-Based Risk Stratification for Recurrence Risk in Women with a History of Peripartum Cardiomyopathy

Marwan Ma'ayeh
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Jeremy A. Slivnick
2   Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
,
Monique E. McKiever
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Zachary D. Garrett
2   Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
,
Woobeen Lim 
3   Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
,
Michael Cackovic
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Kara M. Rood
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Elisa A. Bradley
3   Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
› Author Affiliations Funding This work was supported by National Institute of Health, identifier no.: K08HL148701 (EAB).
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Abstract

Objective Peripartum cardiomyopathy (PPCM) affects 1:1,000 U.S. pregnancies, and while many recover from the disease, the risk of recurrence in subsequent pregnancy (SSP) is high. This study aims to evaluate the utility of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) to predict the risk of recurrence of PPCM in SSP.

Study Design We retrospectively evaluated outcomes in women with a history of PPCM and SSP at a large-volume cardioobstetrics program (2008–2019).

Results There were 18 women who had incident PPCM and pursued SSP. Of 24 pregnancies in these women, 8 (33%) were complicated by the development of recurrent PPCM. LVEF ≥ 52% or GLS ≤ −16 was associated with a low risk of recurrent PPCM.

Conclusion Approximately one-third of women with PPCM developed recurrent PPCM in SSP. LVEF and GLS on prepregnancy echocardiography may predict the risk of recurrence. Additional studies evaluating risk for recurrence are required to better understand which women are the safest to consider SSP.

Key Points

  1. Peripartum cardiomyopathy affects 1:1000 US pregnancies.

  2. Approximately one third of women with a history of peripartum cardiomyopathy developed recurrent disease in a subsequent pregnancy.

  3. A left ventricular ejection fraction ≥52% or global longitudinal strain ≤−16 on echocardiogram is associated with a low risk of recurrence.

Keywords

peripartum - cardiomyopathy - strain - ejection fraction

Supplementary Material



Publication History

Received: 11 November 2020

Accepted: 04 October 2021

Article published online:
02 December 2021

© 2021. Thieme. All rights reserved.

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