Abstract 4366557: Assessment of Myocardial Function Recovery in Peripartum Cardiomyopathy: Role of Global Longitudinal Strain and Myocardial Work

Abstract

Background: Peripartum cardiomyopathy (PPCM) occurs in late pregnancy or early postpartum and is characterized by left ventricular (LV) systolic dysfunction. Although approximately 50% of patients recover LV function, current knowledge on myocardial mechanics and contractile performance after the acute phase is lack. Hypothesis: Global longitudinal strain (GLS) and myocardial work indices may provide a more accurate assessment of myocardial performance in women affected by PPCM. 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 (NCT05878041) coordinated by Federico II University Hospital (Naples, Italy). Myocardial mechanics were assessed using speckle tracking-derived 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%<LVEF<50%; group C, LVEF≥50%. The study population was compared with 12 healthy women matched for age (group D). Results: LV recovery was observed in 8 women (47%, group C), with a mean LVEF of 55±2%. In 6 patients (35%) mild dysfunction still was observed (group B), while 3 patients had persistent severe LV dysfunction, requiring cardioverter-defibrillator implantation (group A). The four groups significantly differed for LV end-diastolic diameter and LV volumes (p<0.0001 for all, Table 1). A significant improvement in myocardial performance from group A to C was observed: GLS (9.7 ±5.4 vs 14.6 ±3.2% vs 19.9 ±0.9% respectively in group A vs group B vs group C, p<0.001), 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). Peak longitudinal atrial strain also improved across the different groups (p<0.001). In group C, GLS was still significantly reduced compared to controls (19.9 ±9 vs 21.7±1.3% respectively, p=0.007). Conclusions: GLS and myocardial work provide a better definition of myocardial performance in patients with PPCM and partially or complete systolic recovery. Since GLS remains impaired in women with normalized LVEF, we suggest it might represent a sensitive marker of persistent LV abnormal function despite recovery in LVEF.