Abstract：
Peripartum cardiomyopathy (PPCM) remains a major contributor to maternal morbidity and mortality worldwide. The disease is associated with various complications occurring mainly early during its course. Reported adverse outcomes include decompensated heart failure, thromboembolic complications, arrhythmias and death. We sought to systematically and comprehensively review published literature on the management and outcome of women with PPCM across different geographical regions and to identify possible predictors of adverse outcomes.
We performed a comprehensive search of relevant literature (2000 to June 2021) across a number of electronic databases. Cohort, case-control and cross-sectional studies, as well as control arms of randomized controlled trials reporting on 6- and/or 12-month outcomes of PPCM were considered eligible (PROSPERO registration: CRD42021255654). Forty-seven studies (4875 patients across 60 countries) met the inclusion criteria. Haemodynamic and echocardiographic parameters were similar across all continents. All-cause mortality was 8.0% (95% confidence interval [CI] 5.5-10.8, I2 = 79.1%) at 6 months and 9.8% (95% CI 6.2-14.0, I2 = 80.5%) at 12 months. All-cause mortality was highest in Africa and Asia/Pacific. Overall, 44.1% (95% CI 36.1-52.2, I2 = 91.7%) of patients recovered their left ventricular (LV) function within 6 months and 58.7% (95% CI 48.1-68.9, I2 = 75.8%) within 12 months. Europe and North America reported the highest prevalence of LV recovery. Frequent prescription of beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and bromocriptine/cabergoline were associated with significantly lower all-cause mortality and better LV recovery.
We identified significant global differences in 6- and 12-month outcomes in women with PPCM. Frequent prescription of guideline-directed heart failure therapy was associated with better LV recovery and lower all-cause mortality. Timely initiation and up-titration of heart failure therapy should therefore be strongly encouraged to improve outcome in PPCM.
We performed a comprehensive search of relevant literature (2000 to June 2021) across a number of electronic databases. Cohort, case-control and cross-sectional studies, as well as control arms of randomized controlled trials reporting on 6- and/or 12-month outcomes of PPCM were considered eligible (PROSPERO registration: CRD42021255654). Forty-seven studies (4875 patients across 60 countries) met the inclusion criteria. Haemodynamic and echocardiographic parameters were similar across all continents. All-cause mortality was 8.0% (95% confidence interval [CI] 5.5-10.8, I2 = 79.1%) at 6 months and 9.8% (95% CI 6.2-14.0, I2 = 80.5%) at 12 months. All-cause mortality was highest in Africa and Asia/Pacific. Overall, 44.1% (95% CI 36.1-52.2, I2 = 91.7%) of patients recovered their left ventricular (LV) function within 6 months and 58.7% (95% CI 48.1-68.9, I2 = 75.8%) within 12 months. Europe and North America reported the highest prevalence of LV recovery. Frequent prescription of beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and bromocriptine/cabergoline were associated with significantly lower all-cause mortality and better LV recovery.
We identified significant global differences in 6- and 12-month outcomes in women with PPCM. Frequent prescription of guideline-directed heart failure therapy was associated with better LV recovery and lower all-cause mortality. Timely initiation and up-titration of heart failure therapy should therefore be strongly encouraged to improve outcome in PPCM.
摘要：
围产期心肌病（PPCM）仍然是全球孕产妇发病率和死亡率的主要原因。该疾病与主要在其病程早期发生的各种并发症有关。报告的不良结果包括失代偿性心力衰竭，血栓栓塞并发症,心律失常和死亡。我们试图系统地和全面地回顾已发表的关于不同地理区域PPCM女性治疗和结局的文献，并确定可能的不良结局预测因素。
我们在多个电子数据库中对相关文献（2000年至2021年6月）进行了全面搜索。队列,病例对照和横断面研究，报告PPCM6个月和/或12个月结局的随机对照试验的对照组也被认为是合格的(PROSPERO注册:CRD42021255654).47项研究（来自60个国家的4875名患者）符合纳入标准。所有大陆的血流动力学和超声心动图参数相似。6个月时的全因死亡率为8.0%（95%置信区间[CI]5.5-10.8，I2=79.1%），12个月时为9.8%（95%CI6.2-14.0，I2=80.5%）。全因死亡率在非洲和亚太地区最高。总的来说,44.1%（95%CI36.1-52.2，I2=91.7%）的患者在6个月内恢复左心室（LV）功能，58.7%（95%CI48.1-68.9，I2=75.8%）在12个月内恢复。欧洲和北美报告了LV恢复的最高患病率。经常开β受体阻滞剂,血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂和溴隐亭/卡麦角林与全因死亡率显著降低和LV恢复改善相关.
我们发现PPCM女性在6个月和12个月结局方面存在显著的全球差异。经常处方指导的心力衰竭治疗与更好的LV恢复和更低的全因死亡率相关。因此，应大力鼓励及时开始和增加心力衰竭治疗，以改善PPCM的预后。
我们在多个电子数据库中对相关文献（2000年至2021年6月）进行了全面搜索。队列,病例对照和横断面研究，报告PPCM6个月和/或12个月结局的随机对照试验的对照组也被认为是合格的(PROSPERO注册:CRD42021255654).47项研究（来自60个国家的4875名患者）符合纳入标准。所有大陆的血流动力学和超声心动图参数相似。6个月时的全因死亡率为8.0%（95%置信区间[CI]5.5-10.8，I2=79.1%），12个月时为9.8%（95%CI6.2-14.0，I2=80.5%）。全因死亡率在非洲和亚太地区最高。总的来说,44.1%（95%CI36.1-52.2，I2=91.7%）的患者在6个月内恢复左心室（LV）功能，58.7%（95%CI48.1-68.9，I2=75.8%）在12个月内恢复。欧洲和北美报告了LV恢复的最高患病率。经常开β受体阻滞剂,血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂和溴隐亭/卡麦角林与全因死亡率显著降低和LV恢复改善相关.
我们发现PPCM女性在6个月和12个月结局方面存在显著的全球差异。经常处方指导的心力衰竭治疗与更好的LV恢复和更低的全因死亡率相关。因此，应大力鼓励及时开始和增加心力衰竭治疗，以改善PPCM的预后。
