RESULTS:
Thirty-seven patients that met the ESC PPCM criteria were included in the study. The mean age was 30.5±5.6 years. All patients first presented with HF symptoms; six patients also had left ventricular thrombus, and two had a concomitant acute pulmonary embolism.
Six patients (16.2%) had a diagnosis of hypertension, four patients had preeclampsia before the diagnosis of HF, seven (18.9%) patients had diabetes mellitus, and three (8.1%) patients had a smoking history before pregnancy. Four (10.8%) patients reported a family history of HF related to non-ischemic CM. Two (8.3%) patients’ rhythm was atrial fibrillation, two patients had left bundle branch block (LBBB), one patient presented with right bundle branch block (RBBB) at baseline, and eight (21.6%) patients had implanted ICD.
Of the PPCM patients, 28 (80%) were treated with ACE-i or ARB, 33 (94.2%) patients with beta-blocker, and 25 (75.3%) patients were on mineralocorticoid receptor antagonists during the follow-up period. Three patients who presented acute HF were treated with bromocriptine (Table 1).
The mean baseline LVEF was 28.2±6.7%, the mean left ventricular end-diastolic diameter (LVEDd) was 59.6±7.4 mm, and the left ventricular end-systolic diameter (LVESd) was 50.1±8.5 mm. Twenty-two (62.9%) patients had moderate or severe functional mitral regurgitation, and 15 (42.9%) patients had moderate or severe functional tricuspid regurgitation. On the last follow-up, 24 patients’ echocardiography was re-assessed, and the mean LVEF was 39.9±13.5%. During the follow-up period, the mean LVEF change was 11.7±15.7% (p=0.001) (Table 2).
In thirteen (35.7%) patients, left ventricular systolic function recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days.
Cox regression analysis did not demonstrate a significant predictor for recovery.