Author + information
- Amy Marino,
- Agnes Koczo,
- Arun Jeyabalan,
- Uri Elkayam,
- Leslie Cooper,
- James Fett and
- Dennis McNamara
Background: Multi-fetal gestations are a reported risk factor for peripartum cardiomyopathy (PPCM), but the impact on myocardial recovery in PPCM has not been studied. In addition, the effect of breastfeeding on maternal outcomes remains controversial. We investigated the effect of multi-fetal births, breastfeeding, and method of delivery on myocardial recovery through analysis of the IPAC (Investigations of Pregnancy-Associated Cardiomyopathy) study.
Methods: 100 women with PPCM were enrolled at 30 centers within three months postpartum. Information regarding multiple versus singleton births, method of delivery, and breastfeeding was collected at time of entry. Women were followed for up to 12 months postpartum, and left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6 months, and 12 months postpartum.
Results: Nineteen women (19%) of the IPAC cohort presented after giving birth to either twins (16%) or triplets (3%). When compared to IPAC women presenting after single pregnancies, women presenting after multi-fetal births had a better LVEF at entry (0.39 +0.07 vs 0.33+0.10, p=0.03), which persisted at 12 months postpartum (12 month LVEF 0.60+0.04 vs 0.51+0.11, p=0.004). For method of delivery, 50% of women in IPAC underwent C-section, and there was no significant difference in LVEF for women undergoing vaginal delivery versus C-section at entry (0.34±0.10, 0.35+0.10, p=0.50), 6 months (0.51±0.12, 0.52±0.09, p=0.83), or 12 months postpartum (0.52+0.11, 0.55±0.09, p=0.22). For women who breastfed (15%), there was a trend for a higher LVEF at entry (0.39±0.06, 0.34+0.10, p=0.06), which persisted at 6 months (0.56 ±0.05, 0.50+0.11, p=0.048) and 12 months postpartum (0.57±0.04, 0.52+0.11, p=0.10). There was no evidence that breastfeeding limited recovery.
Conclusions: Nearly 20% of women in IPAC presented after a multi-fetal gestation. While this remains a risk factor for the development of PPCM, it did not impact myocardial recovery. Similarly, method of delivery and breastfeeding did not appear to impact outcomes, and these decisions should focus on the immediate needs of the mother and child, as there is no clear impact on maternal myocardial recovery.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in HCM, PPCM and Other Cardiomyopathies
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1201-283
- 2017 American College of Cardiology Foundation