Prevalence and associated outcomes of right ventricular dysfunction in peripartum cardiomyopathy: a systematic review, meta-analysis and meta-regression.

INTRODUCTION

Recent studies have highlighted the presence of right ventricular dysfunction (RVD) in a substantial proportion of peripartum cardiomyopathy (PPCM), with evidence suggesting that RVD is associated with worse outcomes and a lower likelihood of left ventricular (LV) recovery. This study aims to comprehensively assess the pooled prevalence, associated outcomes and LV recovery of RVD in PPCM.

METHODS

PubMed, Scopus and ScienceDirect were used to identify relevant literature prior to 19 January 2025. Statistical analysis was conducted using RStudio. All meta-analyses were performed using random effects, with subsequent subgroup analysis and univariate meta-regression conducted for prevalence meta-analysis.

RESULTS

The pooled prevalence of RVD in PPCM was 0.48 (95% CI: 0.36 to 0.59; I² 95.3%) across 14 studies (1385 patients). RVD was diagnosed using multimodality imaging (e.g., echocardiography and cardiac magnetic resonance imaging), with diagnostic criteria defined in the original studies. Meta-regression showed a decreasing trend in RVD prevalence in more recent publications (p=0.03), with variability based on study design, location and diagnostic modality on subgroup analysis. Patients with RVD had a significantly higher risk of composite adverse outcomes (including death, LV assist device implantation, heart transplantation or the use of extracorporeal membrane oxygenation; hazard ratio 2.71; 95% CI 1.08 to 6.84; p=0.04; three studies) and heart transplantation (risk ratio (RR) 4.71; 95% CI 1.82 to 12.20; p<0.01; two studies). Additionally, RVD was associated with a lower baseline LV ejection fraction (mean difference -10.94; 95% CI -14.80 to -7.08; p<0.01; six studies) and an increased risk of unrecovered LV function (RR 1.62; 95% CI 1.25 to 2.11; p<0.01; four studies).

CONCLUSION

RVD occurs in nearly half of patients with PPCM and is associated with a poor prognosis. It may represent a crucial marker for prognostic stratification, particularly for the risk of unrecovered LV function.

PROSPERO REGISTRATION NUMBER: CRD42025626739.