Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy: A Meta-Analysis

The prognostic significance of right ventricular (RV) dysfunction in peripartum cardiomyopathy (PPCM) remains inconsistent across studies.

This study aimed to evaluate the association between RV dysfunction at diagnosis and likelihood of left ventricular (LV) systolic function recovery and major adverse outcomes in PPCM.

We conducted a meta-analysis to identify studies with assessment of RV function, major adverse outcomes, and LV systolic function recovery. RV dysfunction was defined using echocardiographic parameters such as tricuspid annular plane systolic excursion <16 mm, fractional area change <35%, S' <10 cm/s, or RV ejection fraction <45% on cardiac magnetic resonance imaging. The primary outcomes were LV systolic function recovery (LV ejection fraction ≥50%) and major adverse clinical outcomes (LV assist device, recurrent heart failure hospitalization, orthotopic heart transplantation, or death). Pooled ORs and 95% CIs were calculated using random-effect models.

Five studies (N = 472, n = 117 with RV dysfunction; 1,212 person-years of follow-up) met criteria. Participants had a mean age of 32 ± 7 years. After a median follow-up of 25 months (Q1-Q3: 6.8-36.9), RV dysfunction in PPCM was significantly associated with a decreased likelihood of LV systolic function recovery (OR: 0.39; 95% CI: 0.21-0.71; P < 0.001) compared to those without RV dysfunction. With a median follow-up of 32.9 months (Q1-Q3: 15.3-42.6), those with RV dysfunction were 4 times more likely to experience adverse clinical outcomes (OR: 4.19; 95% CI: 2.23-7.85; P < 0.001).

Our findings suggest that RV dysfunction at diagnosis is associated with a higher risk of major adverse outcomes and a lower likelihood of LV function recovery in PPCM.