Lori A Blauwet1, Antonia Delgado-Montero2, Keiko Ryo2, Josef J Marek2, Rami Alharethi2, Paul J Mather2, Kalgi Modi2, Richard Sheppard2, Vinay Thohan2, Jessica Pisarcik2, Dennis M McNamara2, John Gorcsan2. 1. From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.). blauwet.lori@mayo.edu. 2. From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
Abstract
BACKGROUND: Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome. METHODS AND RESULTS: Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathy women with LV ejection fraction (LVEF) <45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was <35% in 38% of patients. Of 84 patients with 1-year follow-up data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional area change by multivariable analysis was independently associated with subsequent LV recovery and clinical outcome. CONCLUSIONS: Peripartum cardiomyopathy patients had a high incidence of LV recovery, but a significant minority had persistent LV dysfunction or a major clinical event by 1 year. RV function per echocardiographic fractional area change at presentation was associated with subsequent LV recovery and clinical outcomes and thus is prognostically important.
BACKGROUND: Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome. METHODS AND RESULTS: Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathywomen with LV ejection fraction (LVEF) <45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was <35% in 38% of patients. Of 84 patients with 1-year follow-up data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional area change by multivariable analysis was independently associated with subsequent LV recovery and clinical outcome. CONCLUSIONS: Peripartum cardiomyopathypatients had a high incidence of LV recovery, but a significant minority had persistent LV dysfunction or a major clinical event by 1 year. RV function per echocardiographic fractional area change at presentation was associated with subsequent LV recovery and clinical outcomes and thus is prognostically important.
Authors: Masataka Sugahara; Nobuyuki Kagiyama; Nina E Hasselberg; Lori A Blauwet; Joan Briller; Leslie Cooper; James D Fett; Eileen Hsich; Gretchen Wells; Dennis McNamara; John Gorcsan Journal: J Am Soc Echocardiogr Date: 2019-09-25 Impact factor: 5.251
Authors: Andrew Peters; Mara Caroline; Huaqing Zhao; Matthew R Baldwin; Paul R Forfia; Emily J Tsai Journal: J Am Heart Assoc Date: 2018-04-23 Impact factor: 5.501