Role of Echocardiography in the Assessment of Right Ventricular Dysfunction in Peripartum Cardiomyopathy Globally: Current Knowledge and Clinical Implications.

Emmy O and Karen S

Published on: 2022-12-29

Abstract

Aims Peripartum cardiomyopathy is a syndrome that occurs globally in all ethnic groups. PPCM remains a major contributor to maternal morbidity and mortality worldwide with variable disease progression and left ventricular (LV) recovery whose predictors for recovery are not well defined globally. The literature on right ventricular systolic dysfunction (RVSD) in Peripartum Cardiomyopathy patients is scanty as a focal parameter for predicting LV recovery worldwide. We sought to systemically and comprehensively review published literature on the role of Right Ventricular systolic function assessment as a predictor of outcome amongst women with PPCM across different geographical regions.

Methods

Search strategy, selection criteria and data extraction for results: This systematic review was performed as a comprehensive search of relevant literature (2000 to June 2022) across a number of electronic databases for potentially relevant articles using the following search terms: (peripartum cardiomyopathy OR pregnancy) AND (right ventricular systolic dysfunction).

Women with a confirmed diagnosis of PPCM according to the latest European Society of Cardiology (ESC) position statement were considered eligible. References of selected papers were screened, searching for other potentially relevant publications. This yielded results inclusive of cohort, case-control and cross- sectional studies with a focus on the role of RV systolic dysfunction in PPCM globally. A selection of the most relevant studies comprised of fifteen papers (1600 patients across 10 countries) that met the inclusion criteria and were finally included in the review Right Ventricular echocardiographic assessment parameter tools for systolic function were majorly Tricuspid Annular Plane Systolic Excursion (TAPSE), Fractional Area Change (FAC) and Sa? Tricuspid wave which were similar across all continents. All patients had LV dysfunction with an average of 23.01% +/- 9.73% at Simpson biplane. 52.6% had a Sa? tricuspid wave (speed of the systolic wave to the tricuspid ring in tissue Doppler) below the standard. The average RV area shortening was 23.73% +/- 14.16%, as the major study parameters for RV

Conclusion: RV dysfunction is common in PPCM. In view of the prognostic interest of the right ventricle; comprehensive evaluation taking into account all of the measurable parameters in order to have an accurate mode of early detection and prognostication of LV outcome in PPCM