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.
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。