Pregnancy outcomes in women with dilated cardiomyopathy: Peripartum cardiovascular events predict post delivery prognosis

• Published in: Journal of cardiology 2021-03, Vol.77 (3), p.217-223
• Main Authors: Yokouchi-Konishi, Tae, Kamiya, Chizuko A., Shionoiri, Tadasu, Nakanishi, Atsushi, Iwanaga, Naoko, Izumi, Chisato, Yasuda, Satoshi, Yoshimatsu, Jun
• Format: Article
• Language: English
• Subjects: Dilated cardiomyopathy; Heart failure; Pregnancy; Prognosis
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2020.07.007

•Women with dilated cardiomyopathy (DCM) with left ventricular ejection fraction (LVEF) ≥30–35% mostly tolerated pregnancy.•New York Heart Association class and advanced diastolic dysfunction were risk factors of cardiac events.•Pre-pregnancy brain natriuretic peptide levels were significantly high in women with cardiac events.•Beta-blockers allowed similar pregnancy outcomes for DCM patients with lower LVEFs.•The event-free survival was worse among women with peripartum cardiac events. The number of pregnant women with dilated cardiomyopathy (DCM) is relatively small, and therefore their prognosis after pregnancy is unknown. This study aims to elucidate pregnancy outcomes among women with DCM, as well as the long-term prognosis after pregnancy. Thirty-five pregnancies and deliveries in 30 women, diagnosed with DCM before pregnancy, were retrospectively analyzed. All women had a left ventricular ejection fraction (LVEF) over 30% and belonged to the New York Heart Association (NYHA) class I or II before pregnancy. The mean gestational age at delivery was 36 weeks with 15 (43%) preterm deliveries. Eight pregnancies (23%) were complicated by peripartum cardiac events including 1 ventricular arrhythmia, 6 heart failures, and 1 significant deterioration in LVEF requiring termination of pregnancy. NYHA class II, pre-pregnancy use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/diuretics, elevated brain natriuretic peptide (BNP), and advanced diastolic dysfunction assessed by Doppler echocardiography were defined as risk factors for cardiac events. Although the more severe cases took beta-blockers during pregnancy, the rates of cardiac events and decreasing LVEF did not differ significantly between those taking beta-blockers and those who were not. Values of LVEF decreased by almost 10% after the average 4-year post-delivery follow-up period. The long-term event-free survival was considerably worse among women with peripartum cardiac events than in those without (p