Background: During pregnancy the differential diagnosis of acute heart failure (AHF) due to a precipitating factor(PF) and peripartum cardiomyopathy (PPCM) is quite difficult and such patients are often discharged with a diagnosis of PPCM, an ominous prognostic factor regarding future pregnancies.
Methods: We studied women diagnosed with AHF during pregnancy according to Leviev Heart Center registry between 1998-2012 in order to differentiate between patients with and without PF. Mean follow up time was 54±21 months (30-169). After a full and detailed revision of each case, patients with AHF+PF who desired a new pregnancy were evaluated by exercise stress echocardiography (ESE) and or cardiac MRI(c-MRI). Patients with a normal ESE and or c-MRI were allowed for a new pregnancy.
Results: 44 women diagnosed with AHF and discharged with a diagnosis of AHF during pregnancy were evaluated in our clinic. Seventeen had identifiable PF for AHF(5 hypertensive crisis or eclampsia, 6 acute blood dyscrasia with massive fluid reposition, 2 sepsis, 4 other causes). During follow up period 14 patients (83%) with AHF+ PF improved their LVEF to ≥50%. Ten patients (59%) had a new pregnancy (4 after normal ESE and c-MRI, 1 normal C-MRI, 4 normal ESE and 1 after rest echo). Apart from 1 spontaneous abortion all patients completed their pregnancies with no cardiac complications.
Conclusions: Most of the patients with AHF+PF recover LV function. Future pregnancies can be allowed in this population
