Abstract 14760: Elevated Heart Rate at Diagnosis is Associated With Adverse Outcomes in Peripartum Cardiomyopathy

Introduction: Understanding predictors of adverse outcomes in patients with peripartum cardiomyopathy (PPCM) is essential to inform clinical practice and improve outcomes.

Aim: The aim of this study is to examine the relationship between heart rate (HR) at diagnosis and adverse outcomes in PPCM.

Methods: We conducted a multi-center cohort study to identify patients with PPCM (1993-2017) who met the inclusion criteria: left ventricular ejection fraction (LVEF) <40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. The primary composite outcome of major adverse events included heart failure hospitalization, need for extra-corporeal membrane oxygenation, left ventricular assist device, orthotopic heart transplant, or all-cause death. Using Cox proportional hazards models, we examined the relationship between categories of HR at diagnosis and adverse outcomes.

Results: A total of 177 women met criteria (81 with HR <100bpm, 54 with HR 100-119bpm, 42 with HR ≥120bpm) with a mean age of 33 ± 7 years and median follow up 3.4 years (IQR 1.0-8.8); 48 (27%) experienced the composite outcome. In a multivariable model adjusting for age, race, preeclampsia or hypertension, women with HR ≥ 120 bpm were four times more likely to experience major adverse events compared to women with HR < 100 bpm (HR 4.1, 95% CI 1.6- 10.4). HR was significantly associated with LVEF in age adjusted linear regression (F= 39.1, p <0.001). Patients with HR <100 bpm were significantly more likely to have survival free from adverse events in survival analysis (logrank p= 0.03, Fig 1).

Conclusions: Tachycardia may be an early prognostic indicator of adverse outcomes in PPCM and could identify high risk patients who may benefit from close follow-up and early intervention.