Abstract 4366881: Clinical and Echocardiographic Correlates of Persistent Left Ventricle Dysfunction in Peripartum Cardiomyopathy: Insights from the Italian Multicentre Registry

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure (HF) occurring toward the end of pregnancy or early after delivery with variable clinical presentations which differs across different regions. Research Questions: We report the clinical and echocardiographic data of an Italian multicenter, observational registry of PPCM patients (NCT05878041). Methods: Women with history or recent diagnosis of PPCM were considered eligible. Inclusion criteria were (i) age ≥18 years; (ii) onset of HF signs or symptoms in the last month of pregnancy or within 5 months of delivery, (iii) no identifiable cause of heart failure; (iv) left ventricle ejection fraction (LVEF) ≤45 % (v) no known structural heart disease before pregnancy. Data included clinical, echocardiographic parameters, and blood samples for multi-omic analysis. Results: Twenty-eight women with confirmed PPCM diagnosis were enrolled. The mean age at clinical onset was 33.9 ± 5.1 years. Hypertensive disorders of pregnancy occurred in 21.4% of cases, and 14.3% developed pre-eclampsia. Overweight was reported in 25% of patients, and 11% were severely obese. Two thirds of women presented with severe symptoms (NYHA class III/IV) within the first month after delivery, and 67% had an initial LVEF ≤35%. In 25% of cases, the clinical presentation included an arrhythmic phenotype. A persistent severe LV dysfunction (LVEF<35%) was reported in 14% of patients, requiring cardioverter-defibrillator implantation. However, 50% of patients showed complete recovery of systolic function over an average follow-up of 11 ± 19 months, with no reported deaths. On transthoracic echocardiography, compared to women with recovered LV function, those with persisting LV dysfunction had more dilated LV (end-diastolic diameter 61.2±8.1 mm in LVEF<35% group vs 51.8±6.9 mm in 35%<EF< 50% group vs 44.7±11.7 mm in EF≥50% group, p=0.017), left atrium (47.0±24.7 vs 30.0±7.1 vs 27.4±7.0 ml/mq, respectively, p=0.013), impaired LV global longitudinal strain (10.0±1.2 vs 15.2±3.1 vs 19.1±1.9% respectively, p=0.009) and Tricuspid Annular Plane Systolic Excursion (17.5±4.2 vs 22.4±2.0 vs 21.5±2.9 mm, respectively, p=0.024). Conclusions: Despite frequent severe onset, many PPCM patients experience favorable outcomes. Factors predicting LVEF recovery remain unclear, hence the need for further research, particularly into underlying mechanisms and long-term outcomes using integrated multi-omics approaches.