In women with recovered peripartum cardiomyopathy, global longitudinal strain remained significantly impaired compared to controls (19.9% vs 21.7%, p=0.007).
Observational (n=17)
Yes
Does speckle tracking-derived global longitudinal strain and myocardial work identify continued LV dysfunction in women with peripartum cardiomyopathy and recovered LVEF?
Global longitudinal strain remains impaired in women with peripartum cardiomyopathy even after LVEF normalization, suggesting it is a sensitive marker of subclinical LV dysfunction.
Absolute Event Rate: 19.9% vs 21.7%
p-value: p=0.007
Abstract Background Peripartum cardiomyopathy (PPCM) is a rare complication occurring in the last weeks of pregnancy and in the peripartum period characterized by sign and symptoms of heart failure and left ventricular (LV) systolic dysfunction. While recovery is observed in about 50% of women, this condition is still associated with high morbidity and mortality. To date, little is known about clinical and echocardiographic factors related to LV function recovery, and no data are available on myocardial mechanics and performance. Methods We retrospectively selected 17 consecutive women (mean age 39.2 ±9.0 years) with confirmed diagnosis of PPCM enrolled in the Italian multicenter, observational registry of PPCM coordinated by our hospital. Demographics were collected and myocardial mechanics were assessed using speckle tracking-derived global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Patients were categorized according to the subsequent LV ejection fraction (LVEF): group A, LVEF≤35%; group B, 35%LVEF50%; Results LV recovery was observed in 8 women (47%, group C), with a mean LVEF of 55±2%. In 6 patients (35%) mild dysfunction was still observed (mean LVEF 44±3%, group B), while 3 patients had persistent severe LV dysfunction (mean LVEF 26±7%), requiring ICD implantation (group A). The three groups significantly differed for LV end-diastolic diameter (62.7 ± 9.5 vs 54.7 ± 5.0 vs 48.5 ±2.6 mm respectively in group A vs group B vs group C, p=0.002), LV volume (209.7 ± 110.6 vs 147.3 ±37.1 vs 101.1 ± 19.8 ml respectively, p=0.017), TAPSE (15.3 ± 5.8 vs 23.3 ± 1.9 vs 22.9 ± 2.3 mm respectively, p=). Speckle tracking analysis revealed a significant improvement in myocardial performance from group A to C: GLS (9.7 ±5.4 vs 14.6 ±3.2% vs 19.9 ±0.9% respectively, p0.001), GWI (854±674 vs 1231±476 vs 1914±511mmHg%, p=0.021), GCW(1123±699 vs 1695±536 vs 2239 ± 540 mmHg%, p=0.032), GWW (166±81 vs 261±78 vs 104±34 mmHg%, p=0.002), GWE (84±10 vs 86±4 vs 95±2%, p=0.005). Also atrial strain improved across the different groups (17±11 vs 29±9 vs 42±4%, p=0.001), with no significant difference in left atrial volume. Also in patients with recovered LV systolic function, GLS was significantly reduced compared to controls (19.9 ±9 vs 21.7±1.3% respectively, p=0.007). Conclusion in patients with history of PPCM, GLS and myocardial work provide a better definition of myocardial performance in those with partially o complete systolic recovery. GLS remains impaired also in women with normalized LVEF suggesting that GLS is a more sensitive marker of continued LV dysfunction in recovered PPCM.LVEF50%;
Ilardi et al. (Thu,) conducted a observational in Peripartum cardiomyopathy (n=17). Recovered left ventricular systolic function vs. Healthy controls was evaluated on Global longitudinal strain (GLS) (p=0.007). In women with recovered peripartum cardiomyopathy, global longitudinal strain remained significantly impaired compared to controls (19.9% vs 21.7%, p=0.007).