PROGNOSTIC SIGNIFICANCE OF CLINICAL, LABORATORY, AND ECHOCARDIOGRAPHIC MARKERS OF ADVERSE OUTCOMES IN PERIPARTUM CARDIOMYOPATHY

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure characterized by left ventricular systolic dysfunction. Early prediction of disease course remains a major clinical challenge. Objective: To evaluate the prognostic significance of clinical, laboratory, and echocardiographic parameters and to develop an integrated risk model for adverse outcomes in PPCM. Methods: This comparative clinical observational study included 75 pregnant women, of whom 60 constituted the main group and 15 served as controls. The main group was stratified into three subgroups according to gestational age. All participants underwent clinical and instrumental assessment, including electrocardiography, echocardiography, and measurement of NT-proBNP, cathepsin D, prolactin, C-reactive protein, and interleukin-6. Receiver operating characteristic (ROC) analysis and logistic regression were used for statistical evaluation. Results: Progression of PPCM was associated with increasing levels of NT-proBNP, prolactin, cathepsin D, and inflammatory markers, together with a decline in left ventricular ejection fraction (LVEF). An adverse outcome at 6 months postpartum was observed in 45% of patients. The strongest predictors of adverse outcome were elevated NT-proBNP, prolactin, cathepsin D, C-reactive protein, interleukin-6, and reduced LVEF. The integrated PPCM-PRO model demonstrated high prognostic performance (AUC = 0.93). Conclusion: The PPCM-PRO model showed high prognostic value and may be useful for early risk stratification and optimization of clinical management in patients with PPCM. Keywords: peripartum cardiomyopathy; pregnancy; heart failure; NT-proBNP; prolactin; cathepsin D; echocardiography; prognosis; risk model