Race, Hypertensive Disorders of Pregnancy and Outcomes in Peripartum Cardiomyopathy

Introduction Black women with peripartum cardiomyopathy (PPCM) have a high prevalence of hypertensive disorders of pregnancy (HDP) and worse clinical outcomes compared with other races. We examined the role of HDP and race on myocardial recovery in women with PPCM. Methods A total of 100 women were enrolled into the Investigation in Pregnancy Associated Cardiomyopathy (IPAC) study. A hypertensive disorder of pregnancy (HDP) was defined as a gestational hypertension and preeclampsia, chronic hypertension was not included in the HDP subgroup. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6, and 12-months post-partum (PP). Clinical outcomes including persistent cardiomyopathy (LVEF≤35%), left ventricular assist device, (LVAD), transplantation, or death at 12-months were examined with and without HDP and between Black and non-Black subsets of women. Results Mean age in IPAC was 30±6 years, with a baseline LVEF of 35±10%. In Black women, those with HDP were more likely to present earlier (days PP HDP: 35±20 vs 54±27 days, P=0.03) compared to women without HDP. There was no difference in LVEF at study entry, but better recovery with HDP at 6 (HDP:0.52±0.11 vs no HDP:0.40±0.14, P=0.03) and 12-months (HDP:0.53±0.10 vs no HDP:0.40±0.16, P=0.02). At 12-months, Black women had a lower LVEF than non-Black women (P=0.007), driven by worse recovery in Black women without HDP (P=0.002). Black women with HDP had a similar LVEF to non-Black women (P=0.31). Conclusions In women with PPCM, HDP among Black women was associated with earlier presentation and better recovery compared to Black women without HDP. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the National Heart, Lung, and Blood Institute through contract HL102429. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB of University of Pittsburgh gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * (PPCM) : Peripartum cardiomyopathy (HDP) : Hypertensive disorders of pregnancy (LVEF) : Left ventricular ejection fraction (PP) : Post-partum (LVEDD) : Left Ventricular End-Diastolic Diameter (LAP) : Left Atrial Pressure (IPAC) : Investigation in pregnancy associated cardiomyopathy.