Abstract 17365: Patients with Peripartum Cardiomyopathy Have Reduced Left Ventricular Reserve Capacity by Ergometric Stress Echocardiography 10 Months Postpartum

Abstract

Background Peripartum cardiomyopathy (PPCM) is associated with high maternal mortality. Risk of recurrence of PPCM in a subsequent pregnancy is significant although risk prediction of recurrence is challenging. The aim of this study was to evaluate the left ventricular (LV) functional reserve capacity post partum by use of ergometric stress echocardiography (ESE) in patients PPCM.

Methods Patients with PPCM were investigated at delivery with echocardiography, including LV ejection fraction and strain analyses. Pro-BNP was collected. After 10±3 months, tests were repeated and an additional ESE was performed. All patients received optimal medical treatment. Genetic testing was performed, including 7 genes involved in dilated cardiomyopathy (MYH7, MYBPC3, TNNT2, MYL2, MYL3, LMNA, ACTC).

Results In all, 8 women (age 33±7 years) with PPCM were included. At follow up, all patients were asymptomatic. Pro-BNP almost normalized (541±628 to 18±13 pmol/l, p<0.05). LVEF and global strain at rest were improved (34±8% vs. 55 ±8%, p<0.05 and -10.6±3.2% vs. -16.7±2.3%, p<0.05). LV end-diastolic diameter was reduced (5.7±0.3 cm to 5.1±0.3 cm, p<0.01). During ESE, heart rate increased from 77±11 to 138±13 bpm (p<0.01) and blood pressure from 108±20/68±11 to 141±18/84±13 mmHg (p<0.01). Mean duration of ESE was 8±2 min and maximum work load was 78±20 Watt. ESE showed a slight improvement in global means of LV function (LVEF: 57±9% vs 55 ±8%, p<0.05 and global strain: -17.1±4.2% vs -16.7±2.3 %, p<0.05). No mutations were found in the 7 DCM related genes.

Conclusion All patients had improved LV function at rest 10 months post partum. However, improvement of LV function during exercise testing was small. These findings may suggest that patients with PPCM have a reduced LV reserve capacity despite normalization of ventricular function at rest. This might be a potential reason for the high risk of recurrence of PPCM in a subsequent pregnancy.