title: Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy).
abstract: BACKGROUND
  Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality.
  
  
  OBJECTIVE
  This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study.
  
  
  METHODS
  We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses.
  
  
  RESULTS
  The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001).
  
  
  CONCLUSIONS
  In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: mcnamaradm@upmc.edu.
authors: Dennis M
authors: DM
authors: McNamara
authors: University of Southern California, Los Angeles, California.
authors: Uri
authors: U
authors: Elkayam
authors: Intermountain Medical Center, Salt Lake City, Utah.
authors: Rami
authors: R
authors: Alharethi
authors: Vanderbilt University, Nashville, Tennessee.
authors: Julie
authors: J
authors: Damp
authors: Cleveland Clinic, Cleveland, Ohio.
authors: Eileen
authors: E
authors: Hsich
authors: Washington University, St. Louis, Missouri.
authors: Gregory
authors: G
authors: Ewald
authors: Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors: Kalgi
authors: K
authors: Modi
authors: University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors: Jeffrey D
authors: JD
authors: Alexis
authors: University of Maryland, Baltimore, Maryland.
authors: Gautam V
authors: GV
authors: Ramani
authors: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Marc J
authors: MJ
authors: Semigran
authors: Columbia University, New York, New York.
authors: Jennifer
authors: J
authors: Haythe
authors: Emory University, Atlanta, Georgia.
authors: David W
authors: DW
authors: Markham
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Josef
authors: J
authors: Marek
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: John
authors: J
authors: Gorcsan
authors: University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
authors: Wen-Chi
authors: WC
authors: Wu
authors: University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania.
authors: Yan
authors: Y
authors: Lin
authors: Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Indrani
authors: I
authors: Halder
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Jessica
authors: J
authors: Pisarcik
authors: Mayo Clinic, Rochester, Minnesota.
authors: Leslie T
authors: LT
authors: Cooper
authors: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: James D
authors: JD
authors: Fett
mesh_terms: D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D044469:Racial Groups; D013318:Stroke Volume; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: heart failure; myocardial recovery; race; remodeling