title: Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy.
abstract: Subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have a high risk of heart failure relapse. We report on outcome of SSPs in PPCM patients in Germany, Scotland, and South Africa.
  
  
  
  Among 34 PPCM patients with a SSP, pregnancy ended prematurely in four patients while it was full-term in 30. Overall relapse rate [left ventricular ejection fraction, (LVEF) <50% or death after at least 6-month follow-up] was 56% with 12% (4/34) mortality. Relapse of PPCM after SSP was not associated with differences in parity, twin pregnancy, gestational hypertension, or smoking. Persistently reduced LVEF (<50%) before entering SSP was present in 47% of patients while full recovery (LVEF ≥50%) was present in 53%. The majority of patients entering SSP with persistently reduced LVEF were of African ethnicity (75%). Persistently reduced LVEF before SSP was associated with higher mortality (25% vs. 0%) and lower rate of full recovery at follow-up. Patients obtaining standard therapy for heart failure and bromocriptine immediately after delivery displayed significantly better LVEF at follow-up and a higher rate of full recovery with no patient dying compared with patients obtaining standard therapy for heart failure alone. This was independent of African or Caucasian race.
  
  
  
  Full recovery of LVEF before SSP was associated with lower mortality and better cardiac function at follow-up. Addition of bromocriptine to standard therapy for heart failure immediately after delivery was safe and seemed to be associated with a better outcome of SSP in African and Caucasian patients.
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Denise
authors.initials: D
authors.lastname: Hilfiker-Kleiner
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Haghikia
authors.affiliation: Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: David
authors.initials: D
authors.lastname: Masuko
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Justus
authors.initials: J
authors.lastname: Nonhoff
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Held
authors.affiliation: School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Elena
authors.initials: E
authors.lastname: Libhaber
authors.affiliation: University of Glasgow and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Petrie
authors.affiliation: University of Glasgow and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland.
authors.forename: Niki L
authors.initials: NL
authors.lastname: Walker
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Edith
authors.initials: E
authors.lastname: Podewski
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Berliner
authors.affiliation: Department of Cardiology and Angiology, Medical School Hannover, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Bauersachs
authors.affiliation: Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.|School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D011256:Pregnancy Outcome; D012606:Scotland / Q000453:epidemiology; D013019:South Africa / Q000453:epidemiology; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Biomarker; Peripartum cardiomyopathy; Subsequent pregnancy; Therapy