Clinical Profile, Risk Factors, Echocardiographic Findings, and Six-Month Outcomes of Peripartum Cardiomyopathy: A Prospective Observational Study

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of systolic heart failure that occurs in the last month of pregnancy or within five months of delivery in women with no pre-existing structural heart disease. Despite advances in cardiovascular and obstetric care, PPCM remains a significant cause of maternal morbidity and mortality, especially in developing countries where delayed diagnosis and limited access to specialized healthcare facilities may negatively impact outcomes. The clinical presentation is often similar to physiological symptoms of pregnancy, resulting in difficulties in diagnosis and delay in intervention. The objective is to assess the clinical profile, associated risk factors, echocardiographic features, complications and six-month outcomes of patients diagnosed with peripartum cardiomyopathy in a tertiary care centre. Material and Methods: A prospective observational study was conducted in 40 consecutive patients diagnosed with PPCM and admitted to the Departments of Obstetrics and Gynecology, General Medicine and Cardiology at Mc Gann Teaching Hospital, Shivamogga from May 2023 to December 2024. We included patients with PPCM who fulfilled the diagnostic criteria and had a left ventricular ejection fraction (LVEF) <45%. Detailed demographic data, clinical presentation, obstetric characteristics, risk factors, electrocardiographic findings and echocardiographic parameters were recorded. Patients were treated with the standard guideline directed heart failure therapy, and followed up for 6 months serial clinical and echocardiography assessment. The primary end-points were recovery of left ventricular function, persistence of symptoms, complications and mortality. Results: The mean age of the participants was 28.8 ± 7.13 years. Thirty percent of the participants were in the 24–29-year age group. 65% of the study population were primigravidae. Most patients presented in the postpartum period (57.5%), especially within the first ten days after delivery. The most common presenting symptoms were dyspnea (32.5%) and orthopnea (22.5%). Raised jugular venous pressure (95%) and peripheral edema (80%) were the commonest clinical findings. Seventy-five percent of patients were in NYHA functional class III or IV at presentation. The most common associated risk factors were preeclampsia (45%) and anemia (37.5%). The most common electrocardiographic abnormality was sinus tachycardia (52.5%). The most frequent complication was acute pulmonary edema (27.5%), and thromboembolic events and cardiogenic shock were important contributors to adverse outcomes. Echocardiographic follow-up showed progressive improvement in ventricular function, with 65.7% of patients having LVEF >45% at six months. Complete recovery was observed in 62.5% of patients, partial recovery in 32.5% and mortality was 5%. Conclusion: Peripartum cardiomyopathy is common in young women in the peripartum period especially in primigravidae with associated pre-eclampsia and anaemia. Early diagnosis and timely initiation of evidence-based heart failure therapy along with close echocardiographic monitoring lead to significant recovery of ventricular function and improved maternal outcomes. Identification of high risk patients and multidisciplinary management are still essential to reduce the complications and mortality.

Keywords: Peripartum cardiomyopathy, pregnancy-associated heart failure, left ventricular ejection fraction, preeclampsia, echocardiography, maternal outcome.