title: Physiological Reduction in Left Ventricular Contractile Function in Healthy Postpartum Women: Potential Overlap with Peripartum Cardiomyopathy.
abstract: OBJECTIVE
  Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure, commoner in Afro-Caribbean than Caucasian women. Its diagnosis can be challenging due to physiological changes in cardiac function that also occur in healthy women during the early postpartum period. This study aimed to (i) establish the overlap between normal cardiac physiology in the immediate postpartum period and pathological changes in peripartum cardiomyopathy ii) identify any ethnicity-specific changes in cardiac function and cardiac biomarkers in healthy postpartum women.
  
  
  RESULTS
  We conducted a cross-sectional study of 58 healthy postpartum women within 48 hours of delivery and 18 matched non-pregnant controls. Participants underwent cardiac assessment by echocardiography and strain analysis, including 3D echocardiography in 40 postpartum women. Results were compared with 12 retrospectively studied peripartum cardiomyopathy patients. Healthy postpartum women had significantly higher left ventricular volumes and mass, and lower ejection fraction and global longitudinal strain than non-pregnant controls. These parameters were significantly more impaired in peripartum cardiomyopathy patients but with overlapping ranges of values. Healthy postpartum women had higher levels of adrenomedullin, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt1) compared to controls. The postpartum state, adrenomedullin, sFlt1 and the sFlt1:PlGF ratio were independent predictors of LV remodelling and function in healthy postpartum women.
  
  
  CONCLUSIONS
  Healthy postpartum women demonstrate several echocardiographic indicators of left ventricular remodelling and reduced function, which are associated with altered levels of angiogenic and cardiac biomarkers.
authors: Department of Cardiology, King's College London British Heart Foundation Centre, London, United Kingdom.|Department of Cardiology, King's College Hospital, London, United Kingdom.
authors: Sitara G
authors: SG
authors: Khan
authors: Department of Cardiology, King's College London British Heart Foundation Centre, London, United Kingdom.|Department of Cardiology, King's College Hospital, London, United Kingdom.
authors: Narbeh
authors: N
authors: Melikian
authors: Department of Cardiology, King's College London British Heart Foundation Centre, London, United Kingdom.|Department of Cardiology, King's College Hospital, London, United Kingdom.
authors: Sitali
authors: S
authors: Mushemi-Blake
authors: Department of Obstetrics and Gynaecology, King's College Hospital, London, United Kingdom.
authors: William
authors: W
authors: Dennes
authors: Department of Cardiology, King's College Hospital, London, United Kingdom.
authors: Fadi
authors: F
authors: Jouhra
authors: Department of Cardiology, King's College London British Heart Foundation Centre, London, United Kingdom.|Department of Cardiology, King's College Hospital, London, United Kingdom.
authors: Mark
authors: M
authors: Monaghan
authors: Department of Cardiology, King's College London British Heart Foundation Centre, London, United Kingdom.|Department of Cardiology, King's College Hospital, London, United Kingdom.
authors: Ajay M
authors: AM
authors: Shah
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D009200:Myocardial Contraction; D058725:Peripartum Period / Q000378:metabolism / Q000502:physiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers