Prognostic value of late gadolinium enhancement in peripartum cardiomyopathy: a systematic review and meta-analysis.

BACKGROUND

Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition occurring during late pregnancy or the postpartum period. Although late gadolinium enhancement (LGE) has prognostic value in other cardiomyopathies, its role in PPCM remains unclear. This study aimed to evaluate the prognostic significance of LGE in PPCM.

METHODS

Three electronic databases were systematically searched to identify studies assessing the association between LGE and clinical outcomes in PPCM. Outcomes included reduced left ventricular ejection fraction (LVEF), arrhythmia, heart failure decompensation, device implantation, transplantation, and mortality. Pooled hazard ratios were calculated using the generic inverse variance method.

RESULTS

Eight cohort studies involving 227 patients were included. The mean age was 32.2 ± 6.6 years and mean LVEF was 30.5%. The pooled hazard ratio analysis revealed that LGE was significantly associated with poor outcomes (HR 1.34, CI 1.04-1.73 I2 = 52%, p = 0.02). Further analysis demonstrated that LGE was strongly linked to adverse clinical outcomes (HR 2.95, CI 1.62-5.37, I2 = 0%, p = 0.004), whereas no significant association was observed with persistently reduced LVEF (HR 1.11, CI 0.85-1.45, I2 = 14%, p = 0.45).

CONCLUSION

LGE is associated with poor outcomes in PPCM and may provide complementary prognostic value for risk stratification.

PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD42024568502.