A 20-year population study of peripartum cardiomyopathy

Alice M Jackson; Mark Macartney; Katriona Brooksbank; Carolyn Brown; Dana Dawson; Mark Francis; Alan Japp; Vera Lennie; Stephen J Leslie; Thomas Martin; Paul Neary; Sowmya Venkatasubramanian; Debra Vickers; Robin A Weir; John J V McMurray; Pardeep S Jhund; Mark C Petrie

doi:10.1093/eurheartj/ehad626

A 20-year population study of peripartum cardiomyopathy

Alice M Jackson, Mark Macartney, Katriona Brooksbank, Carolyn Brown, Dana Dawson, Mark Francis, Alan Japp, Vera Lennie, Stephen J Leslie, Thomas Martin, Paul Neary, Sowmya Venkatasubramanian, Debra Vickers, Robin A Weir, John J V McMurray, Pardeep S Jhund, Mark C Petrie

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted.

METHODS: Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children.

RESULTS: The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years.

CONCLUSIONS: PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.

Original language	English
Article number	ehad626
Pages (from-to)	5128-5141
Number of pages	14
Journal	European Heart Journal
Volume	44
Issue number	48
Early online date	7 Oct 2023
DOIs	https://doi.org/10.1093/eurheartj/ehad626
Publication status	E-pub ahead of print - 7 Oct 2023

Bibliographical note

Funding
The study was funded by the British Heart Foundation (BHF) through a BHF Clinical Research Training Fellowship (FS/18/14/33330) awarded to A.M.J. J.J.V., P.S.J., and M.C.P. are funded by the BHF Centre of Research Excellence Grant RE/18/6/34217 and the Vera Melrose Heart Failure Research Fund.

Data Availability Statement

Data are not routinely available in line with the NHS National Services Scotland confidentiality policy.

Keywords

Peripartum cardiomyopathy
Incidence
Outcomes
Recovery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1093/eurheartj/ehad626

Jackson_etal_ESC_A_20-Year_Population_VOR
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
Final published version, 1.53 MBLicence: CC BY-NC

Cite this

Jackson, A. M., Macartney, M., Brooksbank, K., Brown, C., Dawson, D., Francis, M., Japp, A., Lennie, V., Leslie, S. J., Martin, T., Neary, P., Venkatasubramanian, S., Vickers, D., Weir, R. A., McMurray, J. J. V., Jhund, P. S., & Petrie, M. C. (2023). A 20-year population study of peripartum cardiomyopathy. European Heart Journal, 44(48), 5128-5141. Article ehad626. Advance online publication. https://doi.org/10.1093/eurheartj/ehad626

Jackson, AM, Macartney, M, Brooksbank, K, Brown, C, Dawson, D, Francis, M, Japp, A, Lennie, V, Leslie, SJ, Martin, T, Neary, P, Venkatasubramanian, S, Vickers, D, Weir, RA, McMurray, JJV, Jhund, PS & Petrie, MC 2023, 'A 20-year population study of peripartum cardiomyopathy', European Heart Journal, vol. 44, no. 48, ehad626, pp. 5128-5141. https://doi.org/10.1093/eurheartj/ehad626

@article{e718f97090094450bbe9bc9cb660cae9,

title = "A 20-year population study of peripartum cardiomyopathy",

abstract = "BACKGROUND AND AIMS: The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted.METHODS: Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children.RESULTS: The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years.CONCLUSIONS: PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.",

keywords = "Peripartum cardiomyopathy, Incidence, Outcomes, Recovery",

author = "Jackson, {Alice M} and Mark Macartney and Katriona Brooksbank and Carolyn Brown and Dana Dawson and Mark Francis and Alan Japp and Vera Lennie and Leslie, {Stephen J} and Thomas Martin and Paul Neary and Sowmya Venkatasubramanian and Debra Vickers and Weir, {Robin A} and McMurray, {John J V} and Jhund, {Pardeep S} and Petrie, {Mark C}",

note = "Funding The study was funded by the British Heart Foundation (BHF) through a BHF Clinical Research Training Fellowship (FS/18/14/33330) awarded to A.M.J. J.J.V., P.S.J., and M.C.P. are funded by the BHF Centre of Research Excellence Grant RE/18/6/34217 and the Vera Melrose Heart Failure Research Fund.",

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doi = "10.1093/eurheartj/ehad626",

language = "English",

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journal = "European Heart Journal",

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TY - JOUR

T1 - A 20-year population study of peripartum cardiomyopathy

AU - Jackson, Alice M

AU - Macartney, Mark

AU - Brooksbank, Katriona

AU - Brown, Carolyn

AU - Dawson, Dana

AU - Francis, Mark

AU - Japp, Alan

AU - Lennie, Vera

AU - Leslie, Stephen J

AU - Martin, Thomas

AU - Neary, Paul

AU - Venkatasubramanian, Sowmya

AU - Vickers, Debra

AU - Weir, Robin A

AU - McMurray, John J V

AU - Jhund, Pardeep S

AU - Petrie, Mark C

N1 - Funding The study was funded by the British Heart Foundation (BHF) through a BHF Clinical Research Training Fellowship (FS/18/14/33330) awarded to A.M.J. J.J.V., P.S.J., and M.C.P. are funded by the BHF Centre of Research Excellence Grant RE/18/6/34217 and the Vera Melrose Heart Failure Research Fund.

PY - 2023/10/7

Y1 - 2023/10/7

N2 - BACKGROUND AND AIMS: The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted.METHODS: Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children.RESULTS: The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years.CONCLUSIONS: PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.

AB - BACKGROUND AND AIMS: The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted.METHODS: Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children.RESULTS: The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years.CONCLUSIONS: PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.

KW - Peripartum cardiomyopathy

KW - Incidence

KW - Outcomes

KW - Recovery

U2 - 10.1093/eurheartj/ehad626

DO - 10.1093/eurheartj/ehad626

M3 - Article

C2 - 37804234

SN - 0195-668X

VL - 44

SP - 5128

EP - 5141

JO - European Heart Journal

JF - European Heart Journal

IS - 48

M1 - ehad626

ER -

A 20-year population study of peripartum cardiomyopathy

Abstract

Bibliographical note

Data Availability Statement

Keywords

UN SDGs

Access to Document

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Cite this