Abstract 15147: Echocardiographic Predictors of Persistent Left Ventricular Systolic Dysfunction in Peripartum Cardiomyopathy
Background: Peripartum cardiomyopathy (PPCM) is often associated with persistent left ventricular systolic dysfunction. We sought to determine the echocardiographic predictors of lack of left ventricular ejection fraction (LVEF) recovery in this high-risk group.
Methods: Forty-three cases of PPCM with serial echocardiography between 2003 and 2015 were identified from our echocardiography database. LVEF recovery was defined as LVEF ≥ 50% at follow-up. Univariate analyses and receiver operating characteristic were used to determine echocardiographic predictors and diagnostic models of persistent LVEF reduction.
Results: The mean age, gravida, and parity were 32 ± 7 years, 2.3 ± 1.6, and 1.8 ± 1.1. During a mean echocardiographic follow-up of 27 months (range = 1-267), 26 (58%) patients had LVEF recovery, of which 18 (70%) recovered within 12 months of diagnosis. At baseline, compared with LVEF recovery, patients with persistent LVEF reduction (N=17) were more likely of Black race (41% vs. 8%; p=0.008) and diagnosed later after delivery (47 vs. 10 days; p=0.004), had a lower mean LVEF (29% vs. 37%; p<0.001) and larger LV end-systolic volume index (81 vs. 45 cc/m2; p<0.001), and had a greater prevalence of right ventricular (RV) systolic dysfunction (59% vs. 19%; p=0.008) and mean mitral regurgitation grade (1.6 vs. 1.0; p=0.04). Similarly, lack of LVEF recovery was associated with larger LV end-systolic volume index (74 vs. 29 cc/m2), and greater RV systolic dysfunction (47% vs. 0%) at follow-up (p<0.001 for both). Univariate predictors of LVEF recovery were baseline LVEF (r2=0.47; p=0.001), LV end-systolic volume index (r2=0.58; p=0.001), and RV systolic dysfunction (r2=0.21; p=0.01). Baseline LVEF ≤ 20% plus RV systolic dysfunction predicted a lack of LVEF recovery with a sensitivity and specificity of 53% and 100% (area under the curve = 0.765; p=0.004), while LV end-systolic volume index ≥ 44cc/m2 plus RV systolic dysfunction had a sensitivity and specificity of 59% and 96% (area under the curve = 0.774; p=0.003).
Conclusion: LVEF and degree of LV remodeling, combined with RV systolic dysfunction, are important baseline echocardiographic predictors for lack of LVEF recovery in patients with PPCM, and may provide additional patient risk stratification.
Author Disclosures: E. Yucel: None. C.G. Mihos: None. N.S. Scott: None. J. Mangion: None. D. DeFaria Yeh: None.
- © 2016 by American Heart Association, Inc.