Clinical Presentation and Outcomes of Peri-Partum Cardiomyopathy in the Middle-East: A Report from Seven Arab Countries

Background: Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle-East. Methods: From February to November, 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital and 12 months outcomes were examined. Findings: During the study period 64 patients with PPCM were enrolled with a mean age of 32.5 ±5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnea with NYHA class VI in 51.6%, class III in 31.3% and class II in 17.2%. Basal lung crepitations and peripheral edema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and over one-year of follow-up 9 patients were re-hospitalized with HF (15%) and one patient died (1.6%). Interpretation: A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM. Trial Registration: The study was registered at clinicaltrials.gov with the number NCT01467973. Funding Statement: Gulf CARE was an investigator-initiated study conducted under the auspices of the Gulf Heart Association and funded by Servier, Paris, France; and (for centres in Saudi Arabia) by the Saudi Heart Association [The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG -1436-013)]. The publication of this article was funded by the Qatar National Library. Declaration of Interests: The authors report no relationships that could be construed as a conflict of interest. Ethics Approval Statement: Study ethical approval was obtained from all concerned authorities in the recruiting centers. Informed consent was obtained from all patients.