Prevalence and characteristics of dysfunction of right ventricle in peripartum cardiomyopathy

Background: The study of the right ventricle (RV) is of particular interest as it is believed to be involved in several heart diseases. Peripartum cardiomyopathy (PPCM) is characterized by left ventricular systolic dysfunction occurring between the last month of pregnancy and the fifth month postpartum. It is often combined with RV dysfunction, but this has rarely been described in the literature. The main aim of this study was to assess the prevalence of RV dysfunction in a PPCM population. Methods: We conducted a prospective and investigative study at the Cardiac Clinic of the Aristide Le Dantec Teaching Hospital in Dakar, Senegal, between March and June 2013. All patients hospitalized during the study period and meeting the diagnostic criteria for PPCM were included. Results: During the study period, 326 patients were hospitalized in the cardiology department; 19 were diagnosed with PPCM corresponding to a hospital prevalence of 5.8%. All patients had left ventricular dysfunction, with an average ejection fraction of 23.01% ± 9.73% at the Simpson biplane. Based on the tricuspid annular plane systolic excursion (TAPSE), 11 out of the 19 patients (57.9%) had RV systolic dysfunction. Ten patients (52.6%) had an Sa tricuspid wave (speed of the systolic wave to the tricuspid ring in tissue Doppler) below the standard. The average RV area shortening was 23.73% ± 14.16%, with extremes of 7.8% and 53.7%. Fifteen patients (78.9%) had a rate of shortening fraction of the surface area of RV below the standard. When the other parameters were taken into account, 15 patients (78.9%) had at least 3 of the following indexes altered: fractional area change (FAC), Sa tricuspid, TAPSE, and the ratio between the sum of both isovolumic times and the ejection time (TEI index). Conclusion: RV dysfunction is common in PPCM. In view of the prognostic interest on the right ventricle; its evaluation must take into account all of the measurement parameters in order to allow for better detection.