Related Experiment Video
Updated: Jul 9, 2025
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum
Tasnim F Imran1,2, Feven Ataklte1,2, Mahnoor Khalid2
1Providence VA Medical Center, Warren Alpert Medical School of Brown University, 830 Chalkstone Ave, Providence, RI, 02809, USA.
Insights
Right ventricular dysfunction and elevated pulmonary artery systolic pressure are linked to adverse outcomes in peripartum cardiomyopathy. Identifying these factors aids in risk stratification and timely intervention for affected women.
Area of Science:
- Cardiology
- Obstetrics
- Genetics
Background:
- Peripartum cardiomyopathy (PPCM) is a rare form of heart failure affecting women during late pregnancy or early postpartum.
- Right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) are potential complications of PPCM.
- Predictors and outcomes associated with RV dysfunction and PASP in PPCM require further investigation.
Purpose of the Study:
- To identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) in peripartum cardiomyopathy (PPCM).
- To determine the association between RV dysfunction, elevated PASP, and adverse outcomes in PPCM patients.
Main Methods:
- A multi-center cohort study involving 229 women diagnosed with PPCM between 1993 and 2017.
- PPCM criteria included left ventricular ejection fraction (LVEF) < 40% and heart failure onset within the last month of pregnancy or 5 months postpartum.
- RV function and PASP were assessed via echocardiogram reports; outcomes included major adverse cardiac events or recurrent heart failure hospitalizations.
Main Results:
- Among 229 women with PPCM, 22% had RV dysfunction and 17% had PASP ≥ 30 mmHg.
- African descent and family history of cardiomyopathy were significant predictors of RV dysfunction.
- RV dysfunction was associated with a threefold increased risk of adverse composite outcomes (HR 3.21, P=0.03), and elevated PASP correlated with poorer survival free from adverse events (log-rank P=0.04).
Conclusions:
- African descent and family history are significant predictors of RV dysfunction in PPCM.
- RV dysfunction and elevated PASP are independently associated with major adverse cardiac events in PPCM.
- These findings highlight an at-risk group that may benefit from closer monitoring and early consideration for advanced therapies.
Aims:
We sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM).
Methods And Results:
We conducted a multi-centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993-2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow-up of 3.4 years (interquartile range 1.0-8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11-9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log-rank P = 0.04).
Conclusions:
African descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at-risk group may prompt closer monitoring or early referral for advanced therapies.
More Related Videos
06:04Author Spotlight: Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model
Published on: June 9, 2023
10:18Generation and Characterization of Right Ventricular Myocardial Infarction Induced by Permanent Ligation of the Right Coronary Artery in Mice
Published on: February 1, 2022
Related Concept Videos
01:17Pathophysiology of Heart Failure
01:21Cardiac Catheterization II: Right Heart Catheterization
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...