Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy
Background: The prognostic significance of right ventricular (RV) dysfunction in peripartum cardiomyopathy (PPCM) remains inconsistent across studies. Objectives: This study aimed to evaluate the association between RV dysfunction at diagnosis and likelihood of left ventricular (LV) systolic functio...
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Elsevier
2025-09-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25004727 |
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| author | Ali A. Khan, BSPH Fayez H. Fayad, BA Chan W. Kim, MD Feven Ataklte, MD Phinnara Has, MS Ali Nebipasagil, PhD Zolt Arany, MD, PhD Athena Poppas, MD Wen-Chih Wu, MD, MPH Gaurav Choudhary, MD Tasnim F. Imran, MD, MPH |
| author_facet | Ali A. Khan, BSPH Fayez H. Fayad, BA Chan W. Kim, MD Feven Ataklte, MD Phinnara Has, MS Ali Nebipasagil, PhD Zolt Arany, MD, PhD Athena Poppas, MD Wen-Chih Wu, MD, MPH Gaurav Choudhary, MD Tasnim F. Imran, MD, MPH |
| author_sort | Ali A. Khan, BSPH |
| collection | DOAJ |
| description | Background: The prognostic significance of right ventricular (RV) dysfunction in peripartum cardiomyopathy (PPCM) remains inconsistent across studies. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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. |
| format | Article |
| id | doaj-art-d506ae41f93949d896d4ebd93124d25b |
| institution | DOAJ |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-d506ae41f93949d896d4ebd93124d25b2025-08-20T02:56:24ZengElsevierJACC: Advances2772-963X2025-09-014910204710.1016/j.jacadv.2025.102047Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum CardiomyopathyAli A. Khan, BSPH0Fayez H. Fayad, BA1Chan W. Kim, MD2Feven Ataklte, MD3Phinnara Has, MS4Ali Nebipasagil, PhD5Zolt Arany, MD, PhD6Athena Poppas, MD7Wen-Chih Wu, MD, MPH8Gaurav Choudhary, MD9Tasnim F. Imran, MD, MPH10Warren Alpert Medical School of Brown University, Providence, Rhode Island, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Cardiovascular Institute, Brown University Health, Providence, Rhode Island, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Cardiovascular Institute, Brown University Health, Providence, Rhode Island, USA; Division of Cardiology, Providence VA Medical Center, Providence, Rhode Island, USACardiovascular Institute, Brown University Health, Providence, Rhode Island, USAUniversity of North Carolina, Durham, North Carolina, USADivision of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Cardiovascular Institute, Brown University Health, Providence, Rhode Island, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Cardiovascular Institute, Brown University Health, Providence, Rhode Island, USA; Division of Cardiology, Providence VA Medical Center, Providence, Rhode Island, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Cardiovascular Institute, Brown University Health, Providence, Rhode Island, USA; Division of Cardiology, Providence VA Medical Center, Providence, Rhode Island, USAWarren Alpert Medical School of Brown University, Providence, Rhode Island, USA; Cardiovascular Institute, Brown University Health, Providence, Rhode Island, USA; Division of Cardiology, Providence VA Medical Center, Providence, Rhode Island, USA; Address for correspondence: Dr Tasnim F. Imran, Warren Alpert Medical School of Brown University, 830 Chalkstone Ave, Providence, Rhode Island 02908, USA.Background: The prognostic significance of right ventricular (RV) dysfunction in peripartum cardiomyopathy (PPCM) remains inconsistent across studies. Objectives: 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. Methods: 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. Results: 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). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2772963X25004727adverse clinical outcomesleft ventricular recoverymeta-analysisperipartum cardiomyopathyprognostic factorsright ventricular dysfunction |
| spellingShingle | Ali A. Khan, BSPH Fayez H. Fayad, BA Chan W. Kim, MD Feven Ataklte, MD Phinnara Has, MS Ali Nebipasagil, PhD Zolt Arany, MD, PhD Athena Poppas, MD Wen-Chih Wu, MD, MPH Gaurav Choudhary, MD Tasnim F. Imran, MD, MPH Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy JACC: Advances adverse clinical outcomes left ventricular recovery meta-analysis peripartum cardiomyopathy prognostic factors right ventricular dysfunction |
| title | Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy |
| title_full | Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy |
| title_fullStr | Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy |
| title_full_unstemmed | Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy |
| title_short | Right Ventricular Dysfunction and Adverse Clinical Outcomes in Peripartum Cardiomyopathy |
| title_sort | right ventricular dysfunction and adverse clinical outcomes in peripartum cardiomyopathy |
| topic | adverse clinical outcomes left ventricular recovery meta-analysis peripartum cardiomyopathy prognostic factors right ventricular dysfunction |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25004727 |
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