Long-Term Outcomes in Women with a History of Peripartum Cardiomyopathy: A Prospective Study Based on Data from Israel - The 72nd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Ortal Tuvali ¹ Raphael Kuperstein ³ Donna Zefat ⁴ Igor Volodarsky ¹ Edi Vaisbuch ² Sara Shimoni ¹ Jacob George ¹ Sorel Goland ¹

¹The Heart Institute, Kaplan Medical Center, Hadassah Medical School, Hebrew University, Jerusalem, Israel, Israel
²Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot Hadassah Medical School, Hebrew University, Israel
³Leviev Heart Center Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
⁴The Heart Center, Hadassah Medical Center, The Hebrew University, Israel

Background: Data on the long-term outcome of peripartum cardiomyopathy (PPCM) are sparse.
Objectives: To evaluate the long-term outcomes of patients with PPCM in Israel.

Methods: We prospectively followed 147 women in the cardio-obstetric clinic at three medical centers in Israel. Ninety-six women with complete clinical and echocardiographic data and at least three years of follow-up were included.

Results: The mean age at diagnosis was 31.6 ± 6.4 years; 18% had twin pregnancies, and 35% had pregnancy-associated hypertension. The median left ventricular ejection fraction (LVEF) at presentation was 38% (30% to 43%). At 1 year, 76% achieved LV recovery (LVEF ≥ 50%). The median follow-up duration was 9.0 years (6.1 to 13.8), with 83% of participants having 5-year follow-up and 40% for more than 10 years. During the follow-up period, no cardiovascular mortality (CV) was observed; 3 patients died from non-cardiac causes, and one patient underwent heart transplantation. The overall median LVEF for the entire cohort was 56% (50% to 60%). In women with LV recovery, the median LVEF remained stable at 60% (55% to 60%). Of the 23 patients with persistent LV dysfunction at 1 year, 5 achieved LV recovery (38% to 55%). Throughout the study, 21% of participants developed hypertension, 11% diabetes, and 22% dyslipidemia; 53% of women received CV medications, and 12% underwent CV interventions. Among 56 women who had subsequent pregnancies (SSPs), no significant decline in LVEF or increase in CV comorbidities in the long term was reported.

Conclusions: Our prospective study is the first to demonstrate favorable long-term outcomes, with low mortality, cardiac function stability in the vast majority, and no impact of SSP on the clinical course in women with PPCM. However, cardiovascular comorbidities and medication use were observed during the long-term follow-up in these young women, suggesting the importance of lifelong surveillance.