Karen Sliwa1, Mark C Petrie2, Peter van der Meer3, Alexandre Mebazaa4, Denise Hilfiker-Kleiner5, Alice M Jackson2, Aldo P Maggioni6,7, Cecile Laroche6, Vera Regitz-Zagrosek8, Maria Schaufelberger9, Luigi Tavazzi10, Jolien W Roos-Hesselink11, Petar Seferovic12, Karin van Spaendonck-Zwarts13, Amam Mbakwem14, Michael Böhm15, Frederic Mouquet16, Burkert Pieske17, Mark R Johnson18, Righab Hamdan19, Piotr Ponikowski20, Dirk J Van Veldhuisen3, John J V McMurray2, Johann Bauersachs5. 1. Department of Medicine and Cardiology, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa. 2. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 3. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 4. UMRS 942 Inserm-MASCOT Unit, Université de Paris, Hôpitaux Universitaires Saint-Louis-Lariboisière, Paris, France. 5. Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany. 6. EurObservational Research Programme, European Society of Cardiology, Sophie Antipolis, France. 7. ANMCO Research Centre, Firenze, Italy. 8. Berlin Institute of Gender in Medicine (GiM), Charité-Universitätsmedizin, Berlin, Germany. 9. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 10. Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy. 11. Department Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. 12. University of Belgrade Faculty of Medicine, Belgrade, Serbia. 13. Department of Genetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 14. Department of Medicine, College of Medicine and Lagos University Teaching Hospital, Lagos, Nigeria. 15. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany. 16. Hôpital privé le Bois, LilleService de Cardiologie, France. 17. Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany. 18. Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK. 19. Department of Cardiology, Beirut Cardiac Institute, Beirut, Lebanon. 20. Warsaw Medical University, Warsaw, Poland.
Abstract
AIMS: We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. METHODS AND RESULTS: In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). CONCLUSION: Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. METHODS AND RESULTS: In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P < 0.001). Follow-up was available for 598 (81%) women. Six-month mortality was 6% overall, lowest in Europe (4%), and highest in the Middle East (10%). Most deaths were due to heart failure (42%) or sudden (30%). Re-admission for any reason occurred in 10% (with just over half of these for heart failure) and thromboembolic events in 7%. Myocardial recovery (LVEF > 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). CONCLUSION:Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
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