Department of Cardiology, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, MD, USA.
Division of Cardiology, Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, 2-East Pavilion, Philadelphia, PA, 19104, USA.
ESC Heart Fail. 2021 Aug;8(4):3382-3386. doi: 10.1002/ehf2.13323. Epub 2021 May 4.
We report a case series of six women with peripartum cardiomyopathy (PPCM) who incidentally underwent echocardiography prior to the clinical presentation of PPCM. For comparison, we identified controls, matched 2:1 on age, race, body mass index, gestational age, and hypertensive disorder. Among the six cases, all were diagnosed with PPCM during the post-partum period. Pre-PPCM echocardiograms were performed between 17.7 weeks of gestation and 13 days post-partum. Baseline left ventricular ejection fraction and size were normal and similar to the 12 matched controls (60% ± 6.6% vs. 61.4% ± 6.3%, P = 0.63) or left ventricular end-diastolic dimension (4.6 cm ± 0.2 cm vs. 4.5 cm ± 0.4 cm, P = 0.689). There was a trend towards a less negative (more abnormal) mean global longitudinal strain in cases compared with controls (-14% ± 4% vs. -18.3% ± 4.5%, P = 0.0658). Mean global circumferential strain was significantly less negative (more abnormal) in cases compared with controls (-21.5% ± 5% vs. -29.3% ± 7.6%, P = 0.0329). We conclude that women who develop PPCM have normal left ventricular ejection fraction during gestation preceding PPCM, indicating that the disease develops acutely in the peripartum period. Abnormal strain can be detected, however, suggesting that strain imaging could represent a screening method in populations at high risk for PPCM if confirmed in future studies.
我们报告了六例围产期心肌病（PPCM）患者的病例系列，这些患者在 PPCM 临床表现前偶然接受了超声心动图检查。为了进行比较，我们选择了年龄、种族、体重指数、孕龄和高血压疾病相匹配的 2:1 对照组。在这 6 例病例中，所有患者均在产后期间被诊断为 PPCM。在 PPCM 之前进行的超声心动图检查是在妊娠 17.7 周和产后 13 天之间进行的。基线左心室射血分数和左心室大小正常，与 12 名匹配的对照组相似（60%±6.6%比 61.4%±6.3%，P=0.63）或左心室舒张末期内径（4.6cm±0.2cm 比 4.5cm±0.4cm，P=0.689）。与对照组相比，病例组的平均整体纵向应变更接近负值（更异常），呈下降趋势（-14%±4%比-18.3%±4.5%，P=0.0658）。与对照组相比，病例组的平均整体圆周应变更接近负值（更异常）（-21.5%±5%比-29.3%±7.6%，P=0.0329）。我们的结论是，在 PPCM 之前的妊娠期间发生 PPCM 的女性左心室射血分数正常，这表明该疾病在围产期急性发作。然而，异常应变可以被检测到，这表明应变成像如果在未来的研究中得到证实，可能成为 PPCM 高危人群的筛查方法。
