Comparison of Patients With Peripartum Heart Failure and Normal (≥55%) Versus Low (<45%) Left Ventricular Ejection Fractions

The current definition of peripartum cardiomyopathy (PC) is restricted to patients with left ventricular systolic dysfunction (ejection fraction [EF] <45%). Data on peripartum heart failure (HF) with normal EF are sparse. We describe clinical characteristics of patients with normal (≥55%) and patients with low (<45%) left ventricular ejection fractions (LVEFs). Electronic medical records (2006 to 2013) of our tertiary care center were retrospectively screened to identify peripartum HF with normal EF, defined as an entity meeting Framingham criteria for HF with symptom onset during the last month of pregnancy or up to 5 months after delivery and with an EF of ≥55%. Clinical characteristics, echocardiographic parameters, and outcomes of these patients were compared with age-matched control patients with traditionally defined PC (EF <45%). A total of 25 patients with PC and EF ≥55% were identified. Exclusion of hypertension (n = 9), preeclampsia (n = 1), and diabetes mellitus (n = 2) yielded 13 patients with PC and EF ≥55%. Age-matched patients with traditional PC (EF <45%) constituted controls (n = 16). Compared with patients with PC and low LVEF, patients with PC and normal LVEF had lower B-type natriuretic peptide levels, systolic and diastolic left ventricular dimensions, left atrial size, and incidence of decompensated HF during delivery (p <0.05). Compared with historical age-matched controls, patients with normal LVEF exhibited attenuated E′ mitral annular velocities. On follow-up, these patients were associated with a lower New York Heart Association functional class. In conclusion, peripartum HF with normal LVEF appears to be a distinct entity.