In a healthy woman of child‑bearing age presenting in the late pregnancy or early postpartum period, is right‑ventricular dysfunction common in peripartum cardiomyopathy?

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Right Ventricular Dysfunction in Peripartum Cardiomyopathy

Yes, right ventricular dysfunction (RVD) is common in peripartum cardiomyopathy, occurring in approximately 27-48% of patients, and it carries significant prognostic implications for both recovery and adverse outcomes.

Prevalence of RVD in PPCM

The most recent and comprehensive evidence demonstrates that RVD is present in a substantial proportion of PPCM patients:

  • A 2025 systematic review and meta-analysis found a pooled prevalence of RVD in 48% of PPCM patients (95% CI: 0.36 to 0.59) across 14 studies involving 1,385 patients 1.

  • The 2016 prospective multicenter Investigations of Pregnancy-Associated Cardiomyopathy study found that 38% of PPCM patients had RV fractional area change <35%, indicating RV systolic dysfunction 2.

  • A 2022 Canadian cohort study reported RV systolic dysfunction in 27% of women with PPCM at diagnosis 3.

  • Nigerian data from 2017 showed even higher rates, with RV systolic dysfunction present in 88.4% and combined RV systolic and diastolic dysfunction in 58.1% of PPCM patients 4.

The meta-analysis revealed a decreasing trend in RVD prevalence in more recent publications (p=0.03), suggesting either improved early detection and treatment or evolving diagnostic criteria 1.

Prognostic Significance of RVD

RVD is not merely a marker of disease severity—it independently predicts worse outcomes and lower likelihood of left ventricular recovery:

Impact on Mortality and Major Events

  • Patients with RVD have a 2.71-fold higher risk of composite adverse outcomes (including death, LV assist device implantation, heart transplantation, or ECMO use; HR 2.71; 95% CI 1.08-6.84; p=0.04) 1.

  • RVD increases the risk of heart transplantation by 4.71-fold (RR 4.71; 95% CI 1.82-12.20; p<0.01) 1.

  • RVD is associated with a 10.10-fold increased need for mechanical circulatory support (OR 10.10; 95% CI: 1.86-54.81; p=0.007) 3.

Impact on Left Ventricular Recovery

  • RVD is associated with a 62% increased risk of unrecovered LV function (RR 1.62; 95% CI 1.25-2.11; p<0.01) 1.

  • Patients with RVD at presentation had significantly lower baseline LVEF (mean difference -10.94%; 95% CI -14.80 to -7.08; p<0.01) 1.

  • Full cardiac recovery at 6 months occurred in only 58% of patients with RV dysfunction versus 81% of those with normal RV function (p=0.027) 5.

  • RV fractional area change at baseline was independently associated with subsequent LV recovery and clinical outcomes in multivariable analysis 2.

Clinical Assessment of RV Function

Echocardiographic assessment of RV function should be performed routinely in all PPCM patients at presentation:

  • RV fractional area change <35% is the most prognostically important measure and was feasible in 94% of patients 2.

  • Tricuspid annular plane excursion (TAPSE) and RV longitudinal strain did not independently predict outcomes in the prospective study 2.

  • RV end-diastolic and end-systolic area measurements provide additional prognostic information 2.

  • Cardiac MRI allows more accurate assessment of RV volumes and function than echocardiography and should be considered when available 6.

Common Pitfalls and Clinical Implications

The presence of RVD should trigger more aggressive monitoring and earlier consideration of advanced therapies:

  • Do not assume RVD is simply a reflection of LV dysfunction severity—it provides independent prognostic information beyond LVEF alone 2, 1.

  • Patients with RVD require closer follow-up and lower threshold for referral to advanced heart failure centers with mechanical support capabilities 3.

  • The European guidelines emphasize that 50% of PPCM patients experience spontaneous LV recovery, but this rate is significantly lower in those with RVD 6.

  • RV diastolic dysfunction is also common (69.8% in one cohort) and may be associated with selenium deficiency and pulmonary hypertension 4.

Treatment Considerations

While the European guidelines do not specifically address RV-targeted therapy 6, emerging research suggests:

  • Bromocriptine treatment may benefit PPCM patients with biventricular involvement, with RV recovery rates of 40% with short-term (1 week) and 79% with long-term (8 weeks) treatment 5.

  • Standard heart failure therapy should be optimized, as RV function improved substantially in both treatment groups (ΔRVEF +15% to +23%) 5.

References

5
Research

Bromocriptine treatment in patients with peripartum cardiomyopathy and right ventricular dysfunction.

Clinical research in cardiology : official journal of the German Cardiac Society, 2019

6
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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