“Fifty two cases of Peripartum Cardiomyopathy among 136,149 consecutive deliveries”
Abstract Number: T-21
Abstract Type: Original Research
Peripartum cardiomyopathy (PPCM) is a rare and potentially fatal pregnancy complication. There is an approximately 4-fold higher incidence of PPCM among African-American women . However, little is known about whether the clinical course and outcomes of PPCM are different between African-American (AA) women and their non-African (non-AA) counterparts.
We performed a retrospective chart review of all pregnant women diagnosed with PPCM who received care or delivered at the Massachusetts General Hospital and Brigham and Women’s Hospital from 1999 to 2011. Potential cases were identified with the Partners Healthcare System Research Patient Data Registry (RPDR), using appropriate ICD9-CM codes (674.5, 674.53, and 674.54). Charts were then reviewed to determine if the patient met criteria for PPCM based on NHLBI guidelines  including: 1) new heart failure (HF) in the last month of pregnancy or within 5 months of delivery, 2) HF without identifiable cause, 3) absence of heart disease prior to the last month of pregnancy, and 4) left ventricular (LV)systolic dysfunction by echocardiography.
LV ejection fraction (EF) was recorded at the time of diagnosis, hospital discharge following delivery, and approximately 1 year following delivery. The composite outcome measure was maternal death, or severe morbidity defined as heart transplantation, stroke, pulmonary embolus, left ventricular assist device implantation, left ventricular thrombus, and severe end organ failure. The effect of race on ejection fraction was examined using 2-way repeated measures of analysis and on the frequency of occurrence and severe morbidity using chi-square analysis.
Between 1999 and 2011 there were 52 cases of PPCM from 136,149 deliveries; 33% (n=17) were AA and 67% were non-AA (Whites 89%, Hispanics 9%, and other 2%). The frequency of PPCM was 11 per 10,000 deliveries in AAs and 3 per 10,000 deliveries for non-AAs(p = 0.0001).
Amongst patients with PPCM, AA patients had non-significantly lower mean EFs at presentation (28.2 ± 11.6 vs. 30.1 ± 11.3; p = 0.59), at hospital discharge (33.3 ± 10.5 vs. 38.1 ± 12.4; p = 0.16), and at 1 yr follow up (46.1 ± 15.6 vs. 51.7 ± 11.4; p = 0.22). They had a non-significantly higher rate of the composite outcome measure (30% vs. 14%; p = 0.25). One AA patient died from complications of decompensated heart failure within one year of follow up; no non-AA patients died.
Our observed frequency of PPCM was 2.8 fold higher in AA than in non-AA. EF was lower for AA at all measured time points and the rate of the composite outcome measure higher, although these differences did not reach statistical significance likely owing to our modest sample size.
1.Mielniczuk LM, Williams K, Davis DR, et al. Frequency of PPCM. Am J Cardiol 2006; 97:1765– 8.
2.Pearson GD, Veille JC, Rahimtoola S, et al. PPCM: NHLB Institute and ORD Workshop Recommendations (NIH). JAMA 2000; 283:1183– 8.