Changes in LV function and outcomes of subsequent pregnancies in patients with a history of PPCM

Background: Women with subsequent pregnancies (SSPs) in patients and history of peripartum cardiomyopathy (PPCM) are at risk of HF relapse.

Purpose: To describe outcomes of SSP in post-PPCM women and evaluate changes in LV function during pregnancy

Methods: Sixty-four women with PPCM are prospectively followed in our pregnancy clinic. We identified 28 women SSP and analyzed their clinical, obstetrical and echocardiographic data.

Results: Twenty women with full-term SSP were included in this analysis. The mean age was 33±7 years, the mean LV ejection fraction (LVEF) was 53.4±7.4%. Most of the women (80%) with SSP had recovered LV function (LVEF ≥55%) prior to SSP. Four patients had reduced LVEF at the time of SSP (ranged 38-43%). All 20 women delivered healthy babies. Overall a decrease in LVEF was obtained at 3^rd trimester (p<0.01) and at 1^st month post-delivery (p=0.03) with uneventful clinical course. Longitudinal strain (LGS) was assessed in 10 patients. Impaired LGS was obtained at 3^rd trimester, even in those with unchanged LVEF (p<0.001). In women with LVEF<55% before SSP transient reduction in LVEF was obtained at 3^rd trimester (p<0.001) (an absolute reduction of 5 to 8% of LVEF) with a return to the initial LVEF. No major complications were observed during pregnancy and post-partum in all but 1 patient. The one woman with normal LVEF prior to SSP dropped her LVEF to 20% and presented with symptoms of severe heart failure at 2 weeks after delivery with gradual improvement on maximal therapy.

Conclusions: In our cohort, most of the women with a history of PPCM had recovered LV function prior to their SSP and all but one had an uncomplicated clinical course. In one woman severe LV dysfunction and heart failure occurred, emphasizing that uncomplicated SSP can be not guaranteed even in a patient with post-PPCM LV function recovery.