Hemodynamic Patterns and Left Ventricular Function Recovery in Peripartum Cardiomyopathy

JACC. Asia Pub Date : 2025-04-01 DOI:10.1016/j.jacasi.2024.11.019

Valery Meledin MD, PhD , Hawani Sasmaya Prameswari MD , Sara Shimoni MD , Roni Ramon-Gonen PhD , Melawati Hasan MD , Jacob George MD , Sorel Goland MD

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Abstract

Background

The influence of hemodynamic changes at presentation on the recovery of left ventricular (LV) function in peripartum cardiomyopathy (PPCM) patients remains uncertain.

Objectives

This study aims to identify hemodynamic patterns in individuals with PPCM.

Methods

This study included women with PPCM from 2 databases in Israel and Indonesia. Conventional echocardiography, 2-dimensional strain, myocardial work, and noninvasive pressure-volume loop analysis were performed with subsequent data clustering.

Results

Among 89 women (median age 32 years, IQR: 8.7 years; LV ejection fraction [EF] 36.0%, IQR: 11.5%), 63 (70.8%) experienced LV function recovery (LVEF ≥50%) during 6 months of follow-up. Gestation hypertension/pre-eclampsia and LVEF >35% and LVDD ≤55 mm at presentation were associated with LV recovery. Significant hemodynamic variability was observed, indicating a nonuniform PPCM pattern. Cluster analysis of 43 patients identified 3 hemodynamic subtypes. In cluster 1, patients exhibited the lowest rate of LV recovery (12.5%), profound contractility impairment, severe LV remodeling, and reduced cardiac output (CO). Cluster 2 showed a high LV recovery rate of 78.6%, prevalent in Southeast Asian patients with gestational hypertension. These patients displayed decreased CO and extremely elevated afterload. Load-dependent contractility indexes, like LVEF and global longitudinal strain, were markedly reduced, while load-independent end-systolic elastance remained unaffected, indicating afterload-dependent contractility impairment. All patients in cluster 3 recovered LVEF, presenting mildly reduced contractility indexes, mild ventricular dilatation, slightly increased afterload, and preserved CO.

Conclusions

PPCM exhibits heterogeneous hemodynamic patterns, with 3 distinct phenotypes displaying varying rates of LV recovery. Understanding the heterogeneity in PPCM hemodynamic phenotypes can guide optimal treatment.

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围产期心肌病的血流动力学模式和左心室功能恢复

背景：围生期心肌病（PPCM）患者入院时血流动力学变化对左室功能恢复的影响尚不清楚。目的本研究旨在确定PPCM患者的血流动力学模式。方法本研究包括来自以色列和印度尼西亚2个数据库的PPCM妇女。常规超声心动图、二维应变、心肌功和无创压力-容量环路分析，随后进行数据聚类。结果89例女性中位年龄32岁，IQR: 8.7岁；随访6个月，左室射血分数[EF] 36.0%, IQR: 11.5%)， 63例（70.8%）左室功能恢复（LVEF≥50%）。妊娠期高血压/先兆子痫、LVEF 35%和LVDD≤55 mm与左室恢复相关。观察到明显的血流动力学变异性，表明PPCM模式不均匀。对43例患者进行聚类分析，发现3种血流动力学亚型。在第1组中，患者表现出最低的左室恢复率（12.5%）、严重的左室重塑、严重的左室重塑和心输出量（CO）降低。聚类2显示高左室恢复率78.6%，普遍存在于东南亚的妊娠高血压患者中。这些患者表现为CO降低和后负荷极度升高。载荷相关的收缩性指标，如LVEF和整体纵向应变显著降低，而载荷无关的收缩末期弹性未受影响，表明后载荷相关的收缩性受损。聚类3患者均恢复LVEF，表现为收缩性指数轻度降低，心室轻度扩张，后负荷略有增加，co值保持不变。结论sppcm具有异质性血流动力学模式，具有3种不同的表型，显示不同的左室恢复率。了解PPCM血流动力学表型的异质性可以指导最佳治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Asia Cardiology and Cardiovascular Medicine

CiteScore

4.00

自引率

0.00%

发文量