Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy

Persistence of left ventricular (LV) systolic dysfunction after 6 months of diagnosis is believed to be a marker of an irreversible cardiomyopathy in peripartum cardiomyopathy (PPCM). We sought to determine the length of time required for recovery of LV systolic function (LVSF) in patients with PPCM. Forty-two consecutive women with PPCM were enrolled in this prospective study. The minimum required time of follow-up for inclusion was 30 months. Each patient underwent transthoracic echocardiography, and plasma brain natriuretic peptide (BNP) and C-reactive protein measurement at admission, and every 3 months. Early recovery was defined as normalization of LVSF at 6 months post-diagnosis. Delayed recovery was defined if the length of time required for recovery of LVSF was longer than 6 months. Persistent left ventricular dysfunction (PLVD) was defined as an ejection fraction of 50 at the end of follow-up. Twenty patients (47.6) recovered completely, 10 died (23.8), and 12 (28.6) had PLVD. Average time to complete recovery was 19.3 months after initial diagnosis (342 months). Early recovery was observed only in six patients (30), whereas delayed recovery was observed in 14 out of 20 patients (70). Patients with complete recovery were more likely to have a higher LV ejection fraction and smaller LV end-systolic dimensions at baseline. Full recovery of LVSF in PPCM patients often requires longer than 6 months.