Reverse Remodeling in Late Presenter Peripartum Cardiomyopathy: Strain and Myocardial Work Analysis

Peripartum cardiomyopathy (PPCM) is a condition of myocardial systolic dysfunction with dilated cardiomyopathy phenotype which occurs in the last months of pregnancy to several months postpartum period. There are several predictors of poor recovery in PPCM, especially severe left ventricular (LV) systolic dysfunction at initial presentation. We reported a case of a 41-year-old woman with late presenter PPCM and the presence of poor predictors of recovery from echocardiographic parameters. Echocardiography showed severely reduced ventricular function and global hypokinetic LV with severe tricuspid regurgitation. After 6 months of guideline-directed medical treatment (GDMT) for heart failure (HF) with reduced ejection fraction, complete ventricular reverse remodeling which evaluated by conventional echocardiography parameters. In addition to that, global longitudinal strain and myocardial work index assessment by echocardiographic evaluation also showed progressive myocardial recovery. This case highlights the role and efficacy of HF GDMT in late presenter PPCM and emphasizes the importance of meticulous echocardiographic evaluation with the purpose to track the therapeutic response in the presence of poor prognostic factors in patients.