Global Left Ventricular Strain at Presentation Is Associated with Subsequent Recovery in Patients with Peripartum Cardiomyopathy

Sugahara, Masataka; Kagiyama, Nobuyuki; Hasselberg, Nina E.; Blauwet, Lori A.; Briller, Joan; Cooper, Leslie T.; Fett, James D.; Hsich, Eileen; Wells, Gretchen; McNamara, Dennis M.; Gorcsan, John; Investigators, Ipac

doi:10.1016/j.echo.2019.07.018

Cited by 34 publications

(34 citation statements)

References 36 publications

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“…Data about the role of GLS in PPCM are controversial, with recent evidence showing an association between baseline impaired GLS and poor subsequent clinical outcomes, including death and unrecovered LVEF, while impaired GLS is considered a more sensitive marker for persistent left ventricular dysfunction, even after normalization of LVEF values. 10 , 11 , 12 Regarding the treatment strategy for PPCM, the most commonly prescribed anti‐failure agent in Iraq was beta‐blocker, higher than that reported in the global (81%) and Middle East (75%) registries, P ‐value 0.059 and 0.02, respectively. 3 , 9 This might be explained by the significantly lower mean of the heart rate among PPCM patients in the Middle East registry group (79.7 ± 10.8), compared with that recorded in Iraq ( P ‐value <0.001).…”

Section: Discussionmentioning

confidence: 97%

Peripartum cardiomyopathy in Iraq: initial registry‐based data and 6 month outcomes

Farhan

Yaseen

2021

ESC Heart Failure

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AimsThis study aimed to evaluate the clinical characteristics, echocardiographic measurements, medical treatment, pregnancy outcomes, and the 6 month follow-up outcomes among patients with peripartum cardiomyopathy (PPCM) in Iraq. Methods and results Data were collected prospectively at cardio-maternal clinic in Baghdad Heart Center, using case report form for the EORP-PPCM registry from January 2015 to November 2020. Six month follow-up was performed either by attendance of patients or by phone contact. A total of 64 PPCM patients were enrolled with a mean age of 32.1 ± 6.8 years. Diagnosis in 35 (54.7%) women was made in the post-partum period. There was a history of previous PPCM in 9 (14%), coexisting hypertension with the current pregnancy in 30 (51.7%), cholelithiasis in 5 (7.8%), and cancer in 3 (4.7%). Baseline mean left ventricular ejection fraction (LVEF) was 34.7 ± 8.1%, significantly higher than that reported globally (31 ± 10%) (P-value 0.011), and 26 (40.6%) of our patients had LVEF of ≤34%. Baseline mean global longitudinal strain (GLS) for 26 (40.6%) patients was À9.4 ± 4.1%. Baseline mean left ventricular end-diastolic and end-systolic dimensions were 61.2 ± 8.5 and 50.6 ± 10.2 mm, respectively. At 6 month follow-up, 11 (36.7%) women recovered their LVEF, lower than global data (46%) but higher than that in the Middle East (25%) with P-value 0.241 and 0.919, respectively. The mean LVEF was 44.5 ± 11.9%, and the mean GLS for 15 (23.4%) of patients was À13.4 ± 5.3%, including 5 (33.3%) with the range of À18.6% to À17%. Bromocriptine was the least used drug in 4 (8.2%) vs. globally reported (15%) (P-value 0.188). Thrombo-embolic events and maternal death were reported in 2 (4.1%) and 3 (4.7%) cases, respectively, within 6 months. Conclusions Around half of our PPCM patients were diagnosed at post-partum period with impaired initial LVEF and GLS, and one-third had early LVEF recovery at 6 month follow-up, higher than that in the Middle East but lower than the globally reported figure in the EORP-PPCM registry. Limited use of bromocriptine might explain the later finding. The co-morbid diseases in our setting were hypertension and cholelithiasis. Interestingly, the comparable ratios of neonatal and maternal mortalities in our study to that of the EORP-PPCM registry were found less than the Middle East figures. Bromocriptine needs to be considered in Middle East countries, including Iraq, which may be the key to improving LVEF recovery and perhaps reducing maternal mortality.

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Section: Discussionmentioning

confidence: 97%

Peripartum cardiomyopathy in Iraq: initial registry‐based data and 6 month outcomes

Farhan

Yaseen

2021

ESC Heart Failure

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“…Many studies of heart failure showed that patients with reduced LVEF had a higher mortality than patients with preserved LVEF [22,23]. In our study, we used LVEF 50% as the cut-off value because current guidelines regarded LVEF 40-50% as the mid-range LVEF and several research examples also used LVEF 50% as the cut-off value [24,25]. In addition, high baPWV is considered as a good indicator of vascular dysfunction and is also an independent predictor of CV morbidity and mortality in the elderly and general population, patients with hypertension, and patients with end-stage renal disease [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Impact of Simultaneous Consideration of Cardiac and Vascular Function on Long-Term All-Cause and Cardiovascular Mortality

Hsu

Lee

Tsai

et al. 2019

JCM

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Background: Left ventricular ejection fraction (LVEF) is a good indicator of cardiac function, and brachial-ankle pulse wave velocity (baPWV) is a good indicator of vascular function. Both of them can predict cardiovascular (CV) outcomes. Objectives: There is scarce literature discussing the impact of simultaneous consideration of cardiac and vascular function on overall and CV mortality. Methods: We included 958 patients and classified them into four groups. Groups 1 to 4 were patients with LVEF ≥ 50% and baPWV below the median, LVEF < 50% but baPWV below the median, LVEF ≥ 50% but baPWV above the median, and LVEF < 50% and baPWV above the median, respectively. Results: The median follow-up to mortality was 93 (25th–75th percentile: 69–101) months. There were 91 cases of CV mortality and 238 cases of all-cause mortality. After multivariable analysis, age, gender, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of all-cause mortality (P ≤ 0.038) and age, diabetes, mean blood pressure, group 2 versus group 1, and group 4 versus group 1 were significant predictors of CV mortality (P ≤ 0.008). Conclusions: Patients with higher LVEF and lower baPWV had a similar overall and CV mortality as patients with higher LVEF and baPWV. Patients with lower LVEF and higher baPWV had the highest overall and CV mortality among the four study groups. In addition, patients with lower LVEF alone had a higher CV mortality than the patients with higher baPWV alone. Therefore, simultaneous consideration of cardiac and vascular function may be useful in predicting overall and CV mortality.

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“…Analysis of strain patterns also shows a decrease in GLS in PPCM patients [58,59], and the presence of these strain changes appear to be associated with worse cardiovascular outcomes, which include higher rates of LV assist device implantation, persistent LV dysfunction, and death. In analysis of patients within IPAC, GLS at presentation at a cutoff of 10.6% (absolute value) and global circumferential strain (GCS) at a cutoff of 10.1% were both associated with adverse clinical outcomes with a high sensitivity and specificity and were found to be additive to LVEF assessment alone [59]. At baseline, 6 months, and 12 months, global longitudinal strain values were significantly lower for Black women as compared with non-Black women.…”

Section: Peripartum Cardiomyopathymentioning

confidence: 94%

“…Right ventricular function at diagnosis has also been shown to be predictive of prognosis with impaired right ventricular function (RV fractional area change G36%) associating with higher rates of persistent LV dysfunction or adverse clinical events (7.2 (95% CI, 5.1-58.6; P G 0.001)) [57]. Analysis of strain patterns also shows a decrease in GLS in PPCM patients [58,59], and the presence of these strain changes appear to be associated with worse cardiovascular outcomes, which include higher rates of LV assist device implantation, persistent LV dysfunction, and death. In analysis of patients within IPAC, GLS at presentation at a cutoff of 10.6% (absolute value) and global circumferential strain (GCS) at a cutoff of 10.1% were both associated with adverse clinical outcomes with a high sensitivity and specificity and were found to be additive to LVEF assessment alone [59].…”

Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Echocardiography for the Pregnant Heart

Afari

Davis

Sarma

2021

Curr Treat Options Cardio Med

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Purpose of review Pregnancy is associated with significant hemodynamic changes, making it a potentially high-risk period for women with underlying cardiovascular disease. Echocardiography remains the preferred modality for diagnosis and monitoring of pregnant women with cardiovascular disease as it is widely available and does not require radiation. This paper reviews the role of echocardiography along the continuum of pregnancy in at-risk patients, with a focus on key cardiac disease states in pregnancy. Recent findings In the preconception stage, risk stratification scores such as CARPREG II, ZAHARA and the modified WHO remain central to counseling and planning. As such, echocardiography serves an important role in assessing the severity of pre-existing structural disease. Among women with pre-existing cardiovascular disease who become pregnant-as well as those who develop cardiovascular symptoms during pregnancy-echocardiography is a key imaging tool for assessment of hemodynamic and structural changes and is recommended as the first-line imaging modality when appropriate by both the American College of Obstetricians and Gynecologists (ACOG) and the Food and Drug Administration (FDA). However, routine screening intervals during pregnancy for various cardiac lesions are not well defined, resulting in clinical heterogeneity in care. Summary Echocardiography is the imaging modality of choice for defining, risk stratifying, and monitoring cardiovascular changes throughout pregnancy. Once identified, at-risk patients should receive careful individual counseling and follow-up with a multidisciplinary team. Echocardiography serves as a widely available tool for serial monitoring of pregnant women with cardiovascular disease throughout pregnancy and the postpartum period.

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Global Left Ventricular Strain at Presentation Is Associated with Subsequent Recovery in Patients with Peripartum Cardiomyopathy

Cited by 34 publications

References 36 publications

Peripartum cardiomyopathy in Iraq: initial registry‐based data and 6 month outcomes

Peripartum cardiomyopathy in Iraq: initial registry‐based data and 6 month outcomes

Impact of Simultaneous Consideration of Cardiac and Vascular Function on Long-Term All-Cause and Cardiovascular Mortality

Echocardiography for the Pregnant Heart

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