In the JournalsPerspective

Peripartum cardiomyopathy more common in black women

Black women appear to have a higher risk for peripartum cardiomyopathy compared with women of other races and ethnicities, according to a study published in JAMA Cardiology.

“While we know that African-American women are at greater risk for [peripartum cardiomyopathy], the disparity in disease diversity at presentation and the subsequent progression of the condition in this patient population was staggering,” Olga Corazón Irizarry, MD, a first-year obstetrics and gynecology resident at University of Pennsylvania Perelman School of Medicine, said in a press release.

Researchers analyzed 1986-2016 data from 220 women (mean age at diagnosis, 30 years; 121 black) who were diagnosed with peripartum cardiomyopathy or HF either toward the end of their pregnancy or several months after delivery. All patients had no other explanation for their HF such as valvular disease before being diagnosed with peripartum cardiomyopathy and congenital heart disease.

Black women were more likely to receive a diagnosis of peripartum cardiomyopathy at a younger age compared with women of other ethnic backgrounds (27.6 years vs. 31.7 years; P < .001). Peripartum cardiomyopathy diagnosis was also diagnosed later in the postpartum period in black women. Left ventricular ejection fraction less than 30% was seen in 56.5% of black women vs. 39.5% of other women (P = .03).

After initial diagnosis, the condition of 35.3% of black women worsened vs. 18.4% of other women (P = .02). Black women were twice as likely to fail to recover (43% vs. 24.2%; P = .004) and recovered more than twice as slowly (median, 265 days vs. 125.5 days; P = .02) compared with other women even with appropriate treatment.

“African-American patients with [peripartum cardiomyopathy], at the very least, need to be counseled differently than non-African-American patients,” Irizarry and colleagues wrote. “Future studies will be needed to determine whether these differences are primarily genetic or socioeconomic in origin and whether personalized therapeutic approaches could benefit these patients.”

Johann Bauersachs, MD, FAHA, FESC, professor and director of the department of cardiology and angiology at Medical School Hannover in Germany, discussed the need for further research in a related editorial.

“The current study adds to our understanding of [peripartum cardiomyopathy] as a clinical syndrome, not a distinct entity: It is likely that several peripartal heart failure entities are summarized under this diagnosis of exclusion with different pathophysiologies and potentially different treatment approaches (eg, a shared genetic predisposition has been described in peripartum and dilated cardiomyopathy, and 10% of patients with [peripartum cardiomyopathy] have truncating genetic variants in the gene that encodes the sarcomeric protein titin that were found both in African-American and non-African-American patients).

“Clearly, more research is needed to discern the genetic basis and the pathophysiological mechanisms that explain different disease entities that are summarized currently under the [peripartum cardiomyopathy] syndrome. Larger patient cohorts need to be investigated in detail and followed up long term,” Bauersachs wrote. – by Darlene Dobkowski

Disclosures: Irizarry and Bauersachs report no relevant financial disclosures.

Black women appear to have a higher risk for peripartum cardiomyopathy compared with women of other races and ethnicities, according to a study published in JAMA Cardiology.

“While we know that African-American women are at greater risk for [peripartum cardiomyopathy], the disparity in disease diversity at presentation and the subsequent progression of the condition in this patient population was staggering,” Olga Corazón Irizarry, MD, a first-year obstetrics and gynecology resident at University of Pennsylvania Perelman School of Medicine, said in a press release.

Researchers analyzed 1986-2016 data from 220 women (mean age at diagnosis, 30 years; 121 black) who were diagnosed with peripartum cardiomyopathy or HF either toward the end of their pregnancy or several months after delivery. All patients had no other explanation for their HF such as valvular disease before being diagnosed with peripartum cardiomyopathy and congenital heart disease.

Black women were more likely to receive a diagnosis of peripartum cardiomyopathy at a younger age compared with women of other ethnic backgrounds (27.6 years vs. 31.7 years; P < .001). Peripartum cardiomyopathy diagnosis was also diagnosed later in the postpartum period in black women. Left ventricular ejection fraction less than 30% was seen in 56.5% of black women vs. 39.5% of other women (P = .03).

After initial diagnosis, the condition of 35.3% of black women worsened vs. 18.4% of other women (P = .02). Black women were twice as likely to fail to recover (43% vs. 24.2%; P = .004) and recovered more than twice as slowly (median, 265 days vs. 125.5 days; P = .02) compared with other women even with appropriate treatment.

“African-American patients with [peripartum cardiomyopathy], at the very least, need to be counseled differently than non-African-American patients,” Irizarry and colleagues wrote. “Future studies will be needed to determine whether these differences are primarily genetic or socioeconomic in origin and whether personalized therapeutic approaches could benefit these patients.”

Johann Bauersachs, MD, FAHA, FESC, professor and director of the department of cardiology and angiology at Medical School Hannover in Germany, discussed the need for further research in a related editorial.

“The current study adds to our understanding of [peripartum cardiomyopathy] as a clinical syndrome, not a distinct entity: It is likely that several peripartal heart failure entities are summarized under this diagnosis of exclusion with different pathophysiologies and potentially different treatment approaches (eg, a shared genetic predisposition has been described in peripartum and dilated cardiomyopathy, and 10% of patients with [peripartum cardiomyopathy] have truncating genetic variants in the gene that encodes the sarcomeric protein titin that were found both in African-American and non-African-American patients).

“Clearly, more research is needed to discern the genetic basis and the pathophysiological mechanisms that explain different disease entities that are summarized currently under the [peripartum cardiomyopathy] syndrome. Larger patient cohorts need to be investigated in detail and followed up long term,” Bauersachs wrote. – by Darlene Dobkowski

Disclosures: Irizarry and Bauersachs report no relevant financial disclosures.

    Perspective
    Margo B. Minissian

    Margo B. Minissian

    African-American women with peripartum cardiomyopathy have much higher rates of chronic hypertension, and their presentation may occur later after the delivery, so following up with these women regularly after delivery and altering them to signs and symptoms of HF.
    There are higher rates in women who have chronic hypertension who are not accurately diagnosed or have poorly managed hypertension. These women, in particular African-American women, should be monitored carefully during and immediately after pregnancy.
    This is an important research field. Little is known why African-American women present with peripartum cardiomyopathy later after delivery compared to Caucasian and other minority women. Identifying key mechanistic pathways will improve treatment and recovery. Further research in vascular, inflammation, immunology and genetics in this field will likely help lead to mechanistic pathway discovery.

    • Margo B. Minissian, PhD, ACNP, CLS, AACC, FAHA
    • Nurse Scientist Cardiology Nurse Practitioner Clinical Lipid Specialist Cedars-Sinai Heart Institute Women's Heart Center

    Disclosures: Minissian reports no relevant financial disclosures.