Peripartum Cardiomyopathy: From Pathopysiology to Management: Chapter 3: Risk Stratification in Patients newly diagnosed with peripartum cardiomyopathy

Elsevier, Peripartum Cardiomyopathy, 2021, Pages 21-31
Sorel Goland and Frederic Mouquet

Peripartum cardiomyopathy (PPCM) is a significant cause of pregnancy-associated morbidity and mortality. Therefore, risk stratification, which should be performed at different disease stages, is a critical step when managing patients with PPCM. At the time of diagnosis, risk stratification can assist in deciding on appropriate management of acute heart failure and interventions. After initial stabilization, risk stratification should be repeated, since most life-threatening complications such as severe decompensated heart failure, fatal arrhythmias, or systemic thromboembolism can be prevented with timely proper treatment. Finally, risk stratification is necessary to fully inform the patient about the risks of potential subsequent pregnancies. Left ventricular (LV) enlargement, the degree of LV systolic dysfunction at the time of diagnosis, and ethnicity have been reported to be the strongest outcome predictors, including cardiac function recovery and mortality. Moreover, persistent LV dysfunction can affect the long-term prognosis in young women with PPCM. Other parameters such as medical history, patient characteristics, clinical presentation, delay of diagnosis, the electrocardiogram (ECG), and cardiac biomarkers are also useful for refining risk stratification. Novel biomarkers and genetics are promising, but are still under investigation.