title: Right Ventricular Function in Peripartum Cardiomyopathy at Presentation Is Associated With Subsequent Left Ventricular Recovery and Clinical Outcomes.
abstract: Peripartum cardiomyopathy has variable disease progression and left ventricular (LV) recovery. We hypothesized that baseline right ventricular (RV) size and function are associated with LV recovery and outcome.
  
  
  
  Investigations of Pregnancy-Associated Cardiomyopathy was a prospective 30-center study of 100 peripartum cardiomyopathy women with LV ejection fraction (LVEF) <45% within 13 weeks after delivery. Baseline RV function was assessed by echocardiographic end-diastolic area, end-systolic area, fractional area change, tricuspid annular plane excursion, and RV speckle-tracking longitudinal strain. LV recovery was defined as LVEF of ≥50% at 1 year, persistent severe LV dysfunction as LVEF of ≤35%, and major events as death, transplant, or LV assist device implantation. RV measurements were feasible for 90 of the 96 patients (94%) with echocardiograms available. Mean baseline LVEF was 36±9%. RV fractional area change was <35% in 38% of patients. Of 84 patients with 1-year follow-up data, 63 (75%) had LV recovery and 11 (13%) had LVEF of ≤35% or a major event (4 LV assist devices and 2 deaths). Tricuspid annular plane excursion and RV strain did not predict outcome. Baseline RV fractional area change by multivariable analysis was independently associated with subsequent LV recovery and clinical outcome.
  
  
  
  Peripartum cardiomyopathy patients had a high incidence of LV recovery, but a significant minority had persistent LV dysfunction or a major clinical event by 1 year. RV function per echocardiographic fractional area change at presentation was associated with subsequent LV recovery and clinical outcomes and thus is prognostically important.
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.). blauwet.lori@mayo.edu.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Blauwet
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Antonia
authors.initials: A
authors.lastname: Delgado-Montero
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Keiko
authors.initials: K
authors.lastname: Ryo
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Josef J
authors.initials: JJ
authors.lastname: Marek
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mather
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Kalgi
authors.initials: K
authors.lastname: Modi
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Richard
authors.initials: R
authors.lastname: Sheppard
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Vinay
authors.initials: V
authors.lastname: Thohan
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Jessica
authors.initials: J
authors.lastname: Pisarcik
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
authors.affiliation: From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (L.A.B.); University of Pittsburgh, PA (A.D.-M., K.R., J.J.M., J.P., D.M.M., J.G.); Intermountain Medical Center, Murray, UT (R.A.); Thomas Jefferson University, Philadelphia, PA (P.J.M.); Louisiana State University Health Science Center, Shreveport, LA (K.M.); McGill University, Montreal, Canada (R.S.); and Aurora Healthcare, Milwaukee, Wisconsin (V.T.).
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
mesh_terms: D019540:Area Under Curve; D002170:Canada; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D058725:Peripartum Period; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020127:Recovery of Function; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: cardiomyopathies; echocardiography; heart failure; heart ventricles; pregnancy