Long-Term Cardiac Function After Peripartum Cardiomyopathy and Preeclampsia: A Danish Nationwide, Clinical Follow-Up Study Using Maximal Exercise Testing and Cardiac Magnetic Resonance Imaging.

Ersboll AS; Bojer AS; Hauge MG; Johansen M; Damm P; Gustafsson F;
Vejlstrup NG.

Journal of the American Heart Association. 7(20):e008991, 2018 10 16.
VI 1

Background Long-term clinical studies of peripartum cardiomyopathy ( PPCM)
are few. We aimed to measure the long-term effect of PPCM on cardiac
function in comparison with the long-term effects of severe preeclampsia
and uncomplicated pregnancy.
Methods and Results A nationwide Danish
cohort of women diagnosed with PPCM from 2005 to 2014 ( PPCM group) were
invited to participate in a clinical follow-up study including maximal
cardiopulmonary exercise testing and cardiac magnetic resonance imaging.
Matched women with previous severe preeclampsia (preeclampsia group) and
previous uncomplicated pregnancies (uncomplicated pregnancies group)
served as comparison groups. A total of 84 women with 28 in each group
participated. Median time to follow-up after PPCM was 91 months. Most
women (85%) in the PPCM group reported no symptoms of heart failure. Mean
left ventricular ejection fraction in the PPCM group was normal at 62%,
but significantly lower than in the preeclampsia group and the
uncomplicated pregnancies group where mean left ventricular ejection
fraction was 69% and 67%, respectively ( P<0.0001). Women in the PPCM
group also had impaired diastolic function with reduced left ventricular
peak filling rate, left atrial passive emptying volume, and left atrial
passive emptying fraction. Maximal exercise capacity (peak VO2) was also
reduced in the PPCM group compared with the preeclampsia group and the
uncomplicated pregnancies group, and PPCM , high body mass index, and low
left ventricular ejection fraction independently predicted reduced peak VO2.
Only 1 woman with PPCM had late gadolinium enhancement.
Conclusions Women generally recovered left ventricular ejection fraction and were
asymptomatic 7 years after PPCM , but had subtle diastolic dysfunction on
cardiac magnetic resonance imaging and reduced peak VO2. Focal myocardial
fibrosis assessed with late gadolinium enhancement was, however, uncommon.