Clinical presentation and echocardiographic characteristics of women with peripartum cardiomyopathy: Insights from the Italian Multicentre Registry

Background: Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart failure occurring in late pregnancy or postpartum, with variable clinical course and outcomes. We report preliminary clinical and echocardiographic findings from a national Italian registry of PPCM patients Methods: The study was approved by the institutional Ethics Committee and registered at ClinicalTrials.gov (NCT05878041). Twenty-eight patients aged ≥18 years with confirmed PPCM diagnosis were included. At enrollment, all patients underwent clinical assessment, echocardiography, and peripheral blood sampling for multi-omics profiling. Results: Participants had a mean age of 33.9 ± 5.1 years and a median body mass index of 28 kg/m2 (25.5–32.9). Key characteristics of enrolled patients included African ethnicity (10.7 %), assisted reproduction (14.3 %), pre-eclampsia (14.3 %), autoimmune disease (10.7 %), hypertension (21.4 %), diabetes mellitus (3.5 %), and smoking (32.1 %). Most patients were diagnosed PPCM with NYHA class III/IV symptoms within one month postpartum; mean Left Ventricular Ejection Fraction (LVEF) at admission was 33.2 ± 9.3 %. Arrhythmic presentation occurred in 25 % of patients. Despite initial severity, 50 % of patients recovered LVEF over 11 ± 19 months, while persistent severe dysfunction (LVEF<35 %) requiring defibrillator implantation was observed in 14 % of patients. Several echocardiographic markers differed significantly in enrolled patients according to recovery status, and those with persistent dysfunction had larger LV end-diastolic diameters (61.2 ± 8.1 mm) and left atrial volumes (47.0 ± 24.7 ml/m2), lower LV strain (9.0 ± 1.4 %), and TAPSE (17.5 ± 4.2 mm, p < 0.005 for all). Conclusions: Clinical and echocardiographic predictors of LV recovery in PPCM need further investigation.