Hemodynamic Patterns and Left Ventricular Function Recovery in Peripartum Cardiomyopathy: A Comprehensive Echocardiographic Analysis

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.