Electrocardiographic findings in peripartum cardiomyopathy

Abstract

Background There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods Standard 12‐lead ECGs were obtained at enrollment in the Investigations of Pregnancy‐Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST‐segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event‐free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T‐wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event‐free survival at 1 year (100% vs 85%, P = 0.01). Conclusions ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event‐free survival, and a normal ECG predicted favorable event‐free survival.

Cardiomyopathies: An Overview

“…The most typically observed symptoms are dyspnea, cough, orthopnea, nocturnal dyspnea, peripheral edema, fatigue; these latter symptoms are not very specific during pregnancy. Possible complications can be arrhythmias and the development of thromboembolism [ 139 , 140 ].…”

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

“…Along with patients' medical history, physical examination, electrocardiogram (ECG), and B-type natriuretic peptide assessment (18), cardiac imaging plays a key role for the clinical evaluation of peripartum women with symptoms and signs of HF (Figure 1, Table 1). Echocardiography is the first-line diagnostic imaging modality given its wide availability, biological safety, and robust diagnostic yield in HF patients (6,19).…”

Detection and management of arrhythmias in peripartum cardiomyopathy

“…Despite the QRS complex of patients with PPCM being marginally wider than that of a healthy population (21), it is typically narrow (i.e., QRS <110 ms) (20,22,29). As opposed to other forms of dilated cardiomyopathy where bundle branch blocks are encountered in 25-30% of patients (34,35), bundle branch blocks are seldom found in PPCM (20,22).…”

“…Although there is no specific electrocardiographic abnormality that is pathognomonic of PPCM, women with PPCM rarely have a normal ECG (19,20). The most common waveform abnormalities seen on the 12-lead ECG include non-specific T wave changes (i.e., T wave inversion) and prolongation of the QTc interval (Table 2) (19)(20)(21)29,33). T wave inversion at the time of diagnosis is associated with poor systolic function (LVEF <35%) (20).…”