Long-Term Outcomes in Women With a History of Peripartum Cardiomyopathy

Background Data on the long-term clinical course of peripartum cardiomyopathy (PPCM) are limited. Objectives This study aims to evaluate the long-term outcomes of patients with PPCM. Methods The authors prospectively followed 119 women at 3 medical centers in Israel, of whom 96 had complete clinical and echocardiographic data and at least 3 years of follow-up observation and were included in the analysis. Results The mean age at diagnosis was 31.6 ± 6.4 years, and the median left ventricular ejection fraction (LVEF) at presentation was 38% (Q1-Q3: 30%-43%). Of these patients, 76% achieved left ventricular recovery (defined as LVEF ≥50%), with a median LVEF of 55% (Q1-Q3: 49%-60%) at 1 year. The median follow-up period was 9.0 years (Q1-Q3: 6.1-13.8 years), 83% of women were followed for at least 5 years, and 40% for more than 10 years. During follow-up, 2 patients died of noncardiac causes, and the cause of death was unknown in 1. At long-term follow-up, LVEF was 56% (Q1-Q3: 50%-60%). Among the patients with LV recovery, 5 patients showed a decline in LVEF, and 5 of 23 patients with persistent LV dysfunction achieved LV recovery during long-term follow-up. Forty-six percent of patients received ≥1 cardiovascular medications during 10 years of follow-up evaluation. Of the 56 patients with a median LVEF of 58% (Q1-Q3: 55%-60%) who had subsequent pregnancies, 51 patients had full-term deliveries. No significant reduction in LVEF or increased cardiovascular comorbidities was observed at long-term follow-up. Conclusions This study demonstrates favorable long-term outcomes in women with PPCM, low mortality, and stability of cardiac function. Subsequent pregnancies had no significant impact on their clinical course. During follow-up, cardiovascular comorbidities and medication use were documented for a substantial proportion of patients.