The use of speckle tracking echocardiography and cardiac biomarkers for diagnosis of patients with peripartum cardiomyopathy

Fouad, Doaa A.; Salman, Safwat A.; Abdel-Azeem, Hanan G.; Helmy, Hatem A. R.; Moheb El-Din, Ahmed M.

doi:10.4103/JCMRP.JCMRP_2_19

The use of speckle tracking echocardiography and cardiac biomarkers for diagnosis of patients with peripartum cardiomyopathy

Authors

Abstract

Context
Peripartum cardiomyopathy (PPCM) is a well-known though poorly understood disease.
Aim
We aimed to provide new diagnostic tools for patients with PPCM using speckle tracking echocardiography (STE) and cardiac biomarkers.
Patients and methods
This is a case–control study. We recruited 20 patients with newly discovered PPCM and 20 control women. They were subjected to 2D traditional echocardiography, STE, and serum analysis for N-terminal probrain natriuretic peptide (NT-proBNP) and cardiac troponin I (cTn-I).
Results
The mean age of the patients was 29.7 ± 7.63 years. Overall, 75% of them presented in the postpartum period. Patient's left ventricular ejection fraction (LVEF) was impaired compared with controls at presentation (34.2 ± 8.84 vs. 62.65 ± 5.61%, < 0.001). Their serum level of NT-proBNP was 1416.55 ± 590.23 versus 60.55 ± 26.398 pg/ml ( < 0.001) and for cTn-I, it was 0.1 ± 0.16 versus 0 ± 0 ng/ml ( = 0.014). The STE showed reduction of global longitudinal strain (GLS) (−10.02 ± 6.76 vs. −19.49 ± 2.82%, < 0.001) and global circumferential strain (GCS) (−11.84 ± 3.34 vs. −23.63 ± 2.93%, < 0.001). The GLS of apical four chamber view had 100% sensitivity and 40% specificity, GLS of apical two chamber view had 100% sensitivity and 60% specificity, GLS of apical three chamber view had sensitivity and specificity of 80%, and GCS of left ventricle had 100% sensitivity and 80% specificity for prediction of LVEF.
Conclusion
Global longitudinal and circumferential strains are depressed in patients with PPCM. GLS apical four chamber view, GLS apical two chamber view, and GCS had high sensitivity and 40–80% specificity for LVEF changes, so strain can be used as an objective marker of left ventricular dysfunction in patients with PPCM. NT-proBNP and cTn-I can help in the diagnosis of peripartum patients presented to emergency room with symptoms and signs of heart failure.

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