Anna E Bortnick1,2,3, Claudia Lama von Buchwald4, Aliaskar Hasani5, Christina Liu6, Julia L Berkowitz7, Shayna Vega8, Mohammad Hashim Mustehsan1, Diana S Wolfe3,9, Cynthia Taub10. 1. Division of Cardiology, At Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. 2. Division of Geriatrics, At Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. 3. Maternal Fetal Medicine-Cardiology Joint Program, At Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. 4. Department of Medicine, Division of Cardiology, Rush University Medical Center, Chicago, IL, USA. 5. Department of Medicine, At Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. 6. Department of Emergency Medicine, Mount Sinai/Morningside West, New York, NY, USA. 7. Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA. 8. Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA. 9. Department of Obstetrics and Gynecology, At Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA. 10. Department of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA.
Abstract
OBJECTIVES: Data regarding the longitudinal relationship of global longitudinal strain (GLS) and echocardiographic parameters are lacking in peripartum cardiomyopathy (PPCM). We evaluated GLS and its correlation with change (∆) in left ventricular ejection fraction (LVEF). METHODS: We retrospectively identified women age ≥16 years hospitalized at Montefiore Medical Center in Bronx, NY from 1999-2015 with International Statistical Classification of Diseases and Related Health Problems, 9th revision codes for PPCM or an occurrence of unexplained heart failure during or up to 5 months postpartum. N = 195 charts were reviewed for inclusion/exclusion criteria, n = 53 patients met criteria for PPCM, and of those, n = 13 had a baseline and follow-up echocardiogram suitable for GLS analysis. RESULTS: Of those eligible for strain analysis, the mean age was 30 ± 6 years, 46.2% identified as Black and 38.5% as Hispanic/Latina. Baseline LVEF was 30 (25, 35)%, GLS was -13.2 (-14, -7.6)%. At a mean follow-up time of 1.2 ± 0.7 years, 11/13 had persistently mild -15.6 (-16.3, -12.7)%, and 2/13 severely abnormal GLS -7.05 (-7.1, -7.0)%. There was no correlation between baseline GLS and ∆LVEF (r = .014, P = .965). CONCLUSIONS: Global longitudinal strain is a sensitive method to identify subclinical myocardial dysfunction. In this series of women with PPCM, GLS remained persistently abnormal over time, even if LVEF improved. Future studies should examine the implication of persistently abnormal GLS in PPCM.
OBJECTIVES: Data regarding the longitudinal relationship of global longitudinal strain (GLS) and echocardiographic parameters are lacking in peripartum cardiomyopathy (PPCM). We evaluated GLS and its correlation with change (∆) in left ventricular ejection fraction (LVEF). METHODS: We retrospectively identified women age ≥16 years hospitalized at Montefiore Medical Center in Bronx, NY from 1999-2015 with International Statistical Classification of Diseases and Related Health Problems, 9th revision codes for PPCM or an occurrence of unexplained heart failure during or up to 5 months postpartum. N = 195 charts were reviewed for inclusion/exclusion criteria, n = 53 patients met criteria for PPCM, and of those, n = 13 had a baseline and follow-up echocardiogram suitable for GLS analysis. RESULTS: Of those eligible for strain analysis, the mean age was 30 ± 6 years, 46.2% identified as Black and 38.5% as Hispanic/Latina. Baseline LVEF was 30 (25, 35)%, GLS was -13.2 (-14, -7.6)%. At a mean follow-up time of 1.2 ± 0.7 years, 11/13 had persistently mild -15.6 (-16.3, -12.7)%, and 2/13 severely abnormal GLS -7.05 (-7.1, -7.0)%. There was no correlation between baseline GLS and ∆LVEF (r = .014, P = .965). CONCLUSIONS: Global longitudinal strain is a sensitive method to identify subclinical myocardial dysfunction. In this series of women with PPCM, GLS remained persistently abnormal over time, even if LVEF improved. Future studies should examine the implication of persistently abnormal GLS in PPCM.
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