Hemodynamic Patterns and Left Ventricular Function Recovery in Peripartum Cardiomyopathy: A Comprehensive Echocardiographic Analysis.

BACKGROUND

The influence of hemodynamic changes at presentation on the recovery of left ventricular (LV) function in peripartum cardiomyopathy (PPCM) patients remains uncertain.

OBJECTIVES

This study aims to identify hemodynamic patterns in individuals with PPCM.

METHODS

This study included women with PPCM from 2 databases in Israel and Indonesia. Conventional echocardiography, 2-dimensional strain, myocardial work, and noninvasive pressure-volume loop analysis were performed with subsequent data clustering.

RESULTS

Among 89 women (median age 32 years, IQR: 8.7 years; LV ejection fraction [EF] 36.0%, IQR: 11.5%), 63 (70.8%) experienced LV function recovery (LVEF ≥50%) during 6 months of follow-up. Gestation hypertension/pre-eclampsia and LVEF >35% and LVDD ≤55 mm at presentation were associated with LV recovery. Significant hemodynamic variability was observed, indicating a nonuniform PPCM pattern. Cluster analysis of 43 patients identified 3 hemodynamic subtypes. In cluster 1, patients exhibited the lowest rate of LV recovery (12.5%), profound contractility impairment, severe LV remodeling, and reduced cardiac output (CO). Cluster 2 showed a high LV recovery rate of 78.6%, prevalent in Southeast Asian patients with gestational hypertension. These patients displayed decreased CO and extremely elevated afterload. Load-dependent contractility indexes, like LVEF and global longitudinal strain, were markedly reduced, while load-independent end-systolic elastance remained unaffected, indicating afterload-dependent contractility impairment. All patients in cluster 3 recovered LVEF, presenting mildly reduced contractility indexes, mild ventricular dilatation, slightly increased afterload, and preserved CO.

CONCLUSIONS

PPCM exhibits heterogeneous hemodynamic patterns, with 3 distinct phenotypes displaying varying rates of LV recovery. Understanding the heterogeneity in PPCM hemodynamic phenotypes can guide optimal treatment.