Background
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure that can occur within the last month of pregnancy up to five months postpartum. It is diagnosed after the exclusion of other causes of heart failure when symptoms of heart failure (dyspnoea, especially orthopnoea, oedema etc.), LVEF <45% and elevated NT-proBNP levels are documented. Given the rarity of the disease in Germany and the overlap between pregnancy-related complaints and heart failure symptoms, there is a risk that the condition may be overlooked and left untreated.
Methods
We conducted a retrospective, monocentric analysis of all patients coded with a diagnosis of postpartum cardiomyopathy (ICD code O90.3). In a first step, we characterized the cohort and verified the accuracy of the coded diagnosis by comparing the diagnostic results with the current diagnostic criteria according to the most recently updated European guideline on the treatment of cardiovascular diseases in pregnancy.
Results
We included 117 women (mean age 30.37 ± 11.09 years) in the analysis who were coded with PPCM between 1st, October 2015 and 21st march, 2025 in our centre. On average, the patients suffered from heart failure in their second pregnancy, with a mean NT-proBNP of 4,318.15 mg/dl (± 8,416 mg/dl). 23 patients (27%) had previously given birth vaginally, while 63 (73%) had had a caesarean section. The majority of the patients was European/Caucasian (62, 70%), 7 (8%) were of Africain origin, 8 patients (9%) of South Asian and Middle Eastern origin respectively. 41 patients (47.1%) received bromocriptine.
With regard to the diagnosis, 109 (93%) patients underwent TTE during their hospital stay, with a mean EF of 41%±13.46. 63 (53.8%) of all patients underwent either cardiac MRI or coronary angiography to rule out other differential diagnoses (MRI 48 (41%); coronary angiography 34 (35%)). In the further course, 4 (3.4%) patients underwent a cardiogenetic testing, and all 4 patients were newly diagnosed with a mutation. Recent cases have shown an increasing use of genetic testing and MR imaging. Regarding the accuracy of the diagnosis for coding PPCM, we found 29 patients (24.8%) who met the required criteria for PPCM, namely elevated elevated NT-proBNP, along with LVEF <45% and a supplementary examination to rule out a differential diagnosis.
Conclusion
Knowledge about PPCM has increased significantly over the last 10 years. Nevertheless, the diagnostic process at the end of pregnancy can be challenging, which is highlighted in this cohort. Only 24.8% of the 117 patients who were formally categorized as PPCM patients in the last 10 years met all the diagnostic criteria required by the current guideline. Nevertheless, there was a recent increase in the use of genetic and MRI diagnostics which could facilitate a reliable and precise medical diagnosis and furthermore enable a more individualized course of treatment.
