Incidence, risk factors, and clinical outcomes of peripartum cardiomyopathy in Hong Kong.

INTRODUCTION

Peripartum cardiomyopathy (PPCM) is an uncommon but serious form of heart failure affecting women during late pregnancy or early postpartum. This territory-wide multicentre retrospective study aimed to evaluate the local incidence, risk factors, and clinical outcomes, including subsequent pregnancies, in Hong Kong.

METHODS

Medical records were retrospectively reviewed for women who delivered at all public hospitals between 1 January 2013 and 31 December 2022 and met the 2010 European Society of Cardiology Working Group criteria for PPCM. Regression analysis was performed to investigate maternal risk factors.

RESULTS

Thirty Asian women were diagnosed with PPCM, corresponding to an incidence of 1 in 11 179 live births. Eleven (36.7%) had antepartum onset of symptoms, and 25 (83.3%) were diagnosed after childbirth, most presenting with severe symptoms (90%). The median left ventricular ejection fraction was 30% (range, 10%-44%). Notable complications included cardiogenic shock (10%), respiratory failure (23.3%), acute renal failure (23.3%), and thromboembolism (23.3%). Most women received guideline-directed heart failure therapy. At 12 months, all-cause mortality was 6.7%, and cardiac recovery occurred in 60%. Eleven women had 13 subsequent pregnancies (three miscarriages, five terminations, and five live births). There were no maternal deaths or cases of recurrent PPCM. Genetic testing identified potentially pathogenic variants in at least 10% of women. Antenatal anaemia (adjusted odds ratio [OR]=13.04; 95% confidence interval [95% CI]=3.72-45.70) and hypertensive disorders of pregnancy (adjusted OR=38.00; 95% CI=9.66-149.52) were associated with higher odds of PPCM.

CONCLUSION

This study highlights the substantial morbidity and mortality associated with PPCM. Genetic testing may aid in risk stratification and prognostication.