Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy from a Tertiary Care Centre in India

Abstract

Background: Peripartum cardiomyopathy (PPCM) is an uncommon form of heart failure (HF) that occurs towards the end of pregnancy or in the months following childbirth, in the absence of any other identifiable cause of HF and cries significant maternal morbidity and mortality. We present the clinical characteristics, management strategies, and one-year outcomes of patients with PPCM treated at a tertiary care centre in India.

Methods: We performed a retrospective review of consecutive patients diagnosed with PPCM at our centre between 2016 and 2024. Data on demographics, timing of presentation, clinical features, echocardiographic severity, treatments, and 1-year outcomes were extracted from the records. The primary outcome was survival and improvement in left ventricular ejection fraction at one year. 

Results: The study included eighteen patients, with mean age of 30.5 ± 5.39 years. Six women presented antenatally in the third trimester, five of whom required emergency LSCS, while twelve presented postpartum. Five patients were diagnosed with gestational hypertension, and the majority (83.3%) exhibited NYHA class III/IV dyspnoea. The mean left ventricular ejection fraction (LVEF) was 32.94 ± 11.84%. All patients received guideline-directed medical therapy (GDMT) for HF. Bromocriptine was administered to five patients. Five patients required intubation, six received inotropic support, two necessitated mechanical circulatory support (ECMO), and one underwent heart transplantation at another centre. The recovery rate among the patients was 81.8%. At the one-year follow-up, LVEF improved to a mean of 55.08 ± 15.20%, with nine patients demonstrating normalization of LVEF.

Conclusion: In this cohort, PPCM frequently manifested during the postpartum period and was predominantly associated with severe LV dysfunction. The majority of patients exhibited recovery of LV function at the one-year follow-up. The integration of GDMT, selective bromocriptine administration, and advanced supportive measures was correlated with high recovery rates. One patient progressed to end-stage HF, necessitating heart transplantation.