Global longitudinal strain and myocardial work in women with peripartum cardiomyopathy and recovered left ventricular function: insights from the Italian multicentre registry

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% 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, p