ASEAN Heart Journal

Intended for healthcare professional


ASEAN Heart Journal

October 2016, 24:9

First online: 25 November 2016

Original Paper

Clinical Profile and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience

Lucky R. Cuenza MD,1, 2 Normita Manapat MD, FPCP FPCC,3 Jundelle Romulo K. Jalique RN, MSPH4
Open Access
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  • Summary
  • Supplementary Material
  • References
  • About this Article


Peripartum cardiomyopathy is a rare form of dilated cardiomyopathy characterized by heart failure and left ventricular dysfunction associated with pregnancy. While clinical characteristics of these patients have been previously described in literature, there is limited data regarding the natural history and predictors of outcomes of these patients in Asia, most specifically in Filipino patients.

Clinical and echocardiographic data of 39 patients diagnosed with peripartum cardiomyopathy were analyzed. Patients were followed up for the occurrence of death and major adverse events (MAE) and outcomes were correlated with patient variables.

The mean age of the patients was 28.4 ¬Ī 6.9 and the mean ejection fraction (EF) was 27.8 ¬Ī 8.4%. Heart failure was the most common symptom (98%) while arrhythmia was the initial presentation in 5 patients (12.8%). 14 patients had recovery of ejection fraction in 6 months (39%) with a mean EF of 55.5 ¬Ī 6.3. 16 patients had an initial EF of <25% (41%) and only 2 patients in this subgroup experienced improvement in EF. 29 patients experienced death and/or MAEs (74.4%). Multivariate analysis showed that an EF of <25% (HR 12.0,p=0.019), recovery of LV function (HR 0.23,p=0.05) and improvement of EF in 6 months (HR 0.32,p=0.024) were signifi cant predictors of MAEs. Kaplan Meier curves showed that patients whose ejection fraction was <25% had a 50% incidence of MAEs in 1 year with an increasing trend. Patients whose EF recovered in 6 months experienced a 60% freedom from MAE for almost 6 years. Patients with an EF of <25% had a mortality rate of 50% in two years. Patients with an EF of >25% had a 90% likelihood of survival for 8 years with a higher trend of mortality for patients whose EF did not recover in 6 months.


Peripartum cardiomyopathy is associated with signifi cant morbidity and mortality. The degree of left ventricular dysfunction on presentation as well as improvement of EF within 6 months were predictive for the occurrence of death and major adverse events. This study emphasizes the need for aggressive treatment as well as clinical and echocardiographic follow up early in the course of disease in order to improve outcomes.

‚Äč Keywords:

dextrocardia - situs inversus - STEMI - acute myocardial infarction - percutaneous coronary intervention

‚Äč ‚Äč‚Äč

1 Clinical Fellow in Cardiology, Philippine Heart Center and National Heart Centre Singapore ‚Äč
2 Consultant Cardiologist, Head, Department of Emergency and Ambulatory Services, Philippine Heart Center ‚Äč
3 Biostatistician, Department of Education Training and Research, Philippine Heart Center

‚Äč ¬© The Author(s) 2016. This article is published with open access by ASEAN Federation of Cardiology.

‚ÄčCorrespondence to: Lucky R. Cuenza MD, FPCP FPCC, Clinical Fellow in Cardiology, Philippine Heart Center, East Avenue, Quezon City, Philippines 1100 Email:

‚Äč Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.


Supplementary Material




1. Sliwa K., Hilfi ker-Kleiner D., Petrie M.C.; Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the heart failure association of European Society of Cardiology Working Group on Peripartum Cardiomypathy. Eur J Heart Fail. 12 2010:767-778. CrossRef  PubMed

2. Ntusi, B.M. Mayosi, Aetiology and risk factors of peripartum cardiomyopathy a systematic review Int J Cardiol, 131 (2009), pp. 168-179. CrossRef    PubMed

3. Samonte V. et al, Clinical and echocardiographic profile and outcomes of peripartum cardiomyopathy: the Philippine General Hospital experience, Heart Asia 2013;5:245-249. CrossRef  PubMed PubMedCentral

4. Lim CP, Sim DK, Peripartum Cardiomyopathy: experience in an Asian tertiary centre, Singapore Med J. 2013 Jan;54(1):24-7. CrossRef  PubMed

5. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006;368:687e93. CrossRef

6. M. Habli, T. O’Brien, E. Nowack, S. Khoury, J.R. Barton, B. Sibai, Peripartum cardiomyopathy: prognostic factors for long-term maternal outcome, Am J Obstet Gynecol, 199 (415.) (2008), pp. e1-5e.

7. Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, Shotan A: Pregnancy associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005, 111:2050-2055. CrossRef   PubMed

8. Gentry MB, Dias JK, Luis A, Patel R, Thornton J, Reed GL. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol. 2010;55(7):654-659. CrossRef  PubMed

9. Amos A., Jaber W.A., Russell S.D.; Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J. 152 2006:509-513. CrossRef  PubMed

10. Hellgren M. Hemostasis during normal pregnancy and puerperium. Semin Thromb Hemost 2003;29:125-30. CrossRef   PubMed

11. Safirstein JG, Ro AS, Grandhi S, Wang L, Fett JD, Staniloae C. Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet. Int J Cardiol 2010 Sep 20.

12 .Goland S,¬†et al, Evaluation of the Clinical Relevance of Baseline Left Ventricular Ejection Fraction as a Predictor of Recovery or Persistence of Severe Dysfunction in Women in the United States With Peripartum Cardiomyopathy,¬†Journal of Cardiac Failure Volume¬†17, Issue 5, Pages 426‚Äď430,May 2011.CrossRef ¬†PubMed

13. Pearson GD, Veille JC, Rahimtoola S, et al. Peripartum cardiomyopathy: National Heart, Lung and Blood Institute and Offi ce of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000;283:1183-8. CrossRef  PubMed

14. McNamara D, Damp J, Elkayam U, et al. Myocardial recovery at six months in peripartum cardiomyopathy: results of the NHLBI Multicenter IPAC study. Circulation 2013;128:A12898.

15. Whitehead S.J.,¬†Berg C.J., Chang J.; Pregnancy-related mortality due to cardiomyopathy: United States, 1991‚Äď1997.¬†Obstet Gynecol.¬†1022003:1326-1331. PubMed

16. Goland S., Modi K., Bitar F.; Clinical profi le and predictors of complications in peripartum cardiomyopathy. J Card Fail. 15 2009:645-650. CrossRef  PubMed

17. Barbosa et al, Rest left ventricular function and contractile reserve by dobutamine stress echocardiography in peripartum cardiomyopathy, Rev Port Cardiol. 2012 Apr;31(4):287-93.

18. Pillarisetti J1,¬†Kondur A2, Alani A2, Reddy M1, Reddy M3, Vacek J1 et al, Peripartum cardiomyopathy: predictors of recovery and current state of implantable cardioverterdefi brillator use.¬†J Am Coll Cardiol.¬†2014 Jul 1;63 (25 Pt A):2831-9. doi:10.‚Äč1016/‚Äčj.‚Äčjacc.‚Äč2014.‚Äč04.‚Äč014.¬†Epub¬†2014 May 7.

19. Fett JD, Sannon H, Thelisma E, Sprunger T, Suresh V. Recovery from severe heart failure following peripartum cardiomyopathy. Int J Gynaecol Obstet 2009;104(2):125-7. CrossRef  PubMed

20. Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail 2012;14:895-901. CrossRef  PubMed

21. Elkayam U,¬†Clinical Characteristics of Peripartum Cardiomyopathy in the United State Diagnosis, Prognosis, and Management,¬†J Am Coll Cardiol.¬†2011;58(7):659-670. doi:10.‚Äč1016/‚Äčj.‚Äčjacc.‚Äč2011.‚Äč03.‚Äč047‚Äč CrossRef¬†¬†¬†PubMed

About this Article


Clinical Profile and Predictors of Outcomes of Patients with Peripartum Cardiomyopathy: The Philippine Heart Center Experience

Open Access

Available under Open Access


>> ASEAN Heart Journal 
>> 24:1

Online Date

21 November 2019



Online ISSN



ASEAN Federation of Cardiology

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peripartum cardiomyopathy outcomes

Author Affiliations

1. Clinical Fellow in Cardiology, Philippine Heart Center and National Heart Centre, East Avenue, Quezon City, Philippines, 1100
2. National Heart Centre, Singapore, Singapore
3. Department of Emergency and Ambulatory Services, Philippine Heart Center, Quezon City, Philippines
4. Department of Education Training and Research, Philippine Heart Center, Quezon City, Philippines

Correspondence to

Lucky R. Cuenza,