Statement of the problem: Although peripartum cardiomyopathy (PPCM) is a rare disease, its frequency is higher in some regions including Egypt. It can result in morbidity and mortality of 5- 32%. Identifying prognostic indicators of women with PPCM is of paramount importance. Speckle tracking echocardiography (STE) was found helpful to assess early changes of left ventricular function and mechanics; however its prognostic value is still under investigation.
Methodology & Theoretical Orientation: This is a case-control prospective study that included 25 PPCM patients admitted to the cardiology and woman health hospitals of Assiut University, Egypt from September 2016 – December 2018 and 20 control pregnant women. Clinical assessment, 2-D echocardiography & STE were done to study population upon inclusion, and at scheduled quarterly visits.
Findings: Patients age was 29.9±7.68 years, 75% presented in the postpartum period. At presentation, LVEF was impaired in patients vs. controls (33.2±8.84 % vs. 62.65±5.61 %, P <0.001), STE showed reduction of GLS (-10.08±6.76 vs.-19.49±2.82) , GCS (-11.65±3.34 % vs.-23.63±2.93%) (P<0.001). Patients were followed-up for a median of 13.5 months where 9 improved (LVEF ≥ 50%), 7 partially improved (LVEF =40-49%), 4 had persistent LV dysfunction (LVEF<40%), 4 died. Along the study; GLS & GCS increased significantly (-13.03±4.53% to -20.18±1.75), (-13.28±3.37% to -22.53±4.82%) in improved patients. Patients who died had significantly impaired GLS and GCS vs. those improved (-9.07±0.65 vs.-16.09±2.57%, -8.17±3.1 vs. -14.02±2.62 %, P<0.01)). More reduction was noted in apical GCS (-6.97±4.67 vs. -17.43±6.75%). Patients with persistent LV dysfunction and those who died were presented later than improved (18±11.79 vs.7.5±4.93 days postpartum)
Conclusion & Significance: Longitudinal and circumferential strains are depressed in PPCM patients. 2D-STE can be used as an objective marker of LV dysfunction in PPCM patients at long term.
Recommendation: A larger multicenter study is recommended. Meanwhile, STE is advised whenever PPCM is suspected.
