From the Guidelines
A 10 percent left ventricular ejection fraction (LVEF) in a 37-year-old female with peripartum cardiomyopathy signifies severe heart dysfunction and a high risk of mortality, necessitating immediate medical attention and aggressive treatment. This condition is defined as systolic dysfunction, typically LVEF <45%, often with LV dilation, occurring in late pregnancy or early postpartum with no other identifiable cardiomyopathy cause 1. The patient's LVEF of 10% is significantly lower than the normal range of 55-70%, indicating a life-threatening condition that requires prompt intervention.
Key Considerations
- The prognosis is related to initial LVEF, LV thrombosis, RV involvement, preeclampsia, geographic region, and race 1
- Treatment includes guideline-directed medical therapy (GDMT) adjusted for pregnancy or breastfeeding status and anticoagulation consideration 1
- Advanced therapies, such as mechanical circulatory support devices or evaluation for heart transplantation, may be necessary in severe cases like this
- Close monitoring in a hospital setting, with regular echocardiograms to track heart function, is essential
Treatment Options
- Medications: beta-blockers, ACE inhibitors, diuretics, and possibly aldosterone antagonists
- Advanced therapies: mechanical circulatory support devices or evaluation for heart transplantation
- Patient-centered multidisciplinary planning is essential, including early institution of mechanical support for shock 1
Prognosis
- LV recovery and survival is generally favorable in developed countries, but a low LVEF like 10% indicates a poor prognosis without aggressive intervention 1
- A 100-patient U.S. registry showed 93% transplant/LVAD-free 1-year survival, but this patient's low LVEF puts her at higher risk 1
From the Research
Left Ventricular Ejection Fraction (LVEF) Significance
A 10 percent left ventricular ejection fraction (LVEF) in a 37-year-old female with peripartum cardiomyopathy (PPCM) signifies a severely reduced systolic function of the left ventricle. This is below the normal range and indicates heart failure with reduced ejection fraction (HFrEF) 2, 3.
Diagnostic Criteria
According to diagnostic echocardiographic criteria, a left ventricular ejection fraction <0.45 is one of the indicators of peripartum cardiomyopathy 2. A 10 percent LVEF falls within this category, suggesting a severe form of the disease.
Prognosis and Management
Patients with PPCM and severely reduced LVEF, such as 10 percent, are at high risk of morbidity and mortality 3, 4. However, with contemporary treatment, including standard heart failure therapy and mechanical support, some patients may experience improvement in LVEF and overall outcomes 4, 5. Factors associated with lack of recovery include a left ventricular end-diastolic dimension >5.6 cm, the presence of LV thrombus, and African-American race 4.
Treatment Options
Treatment for PPCM includes conventional pharmacologic heart-failure therapies, such as diuretics, angiotensin-converting enzyme inhibitors, vasodilators, digoxin, β-blockers, anticoagulants, and peripartum cardiomyopathy-targeted therapies 2, 3. Mechanical support, such as peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO), and transplantation may be necessary in severe cases 5.
Key Points
- A 10 percent LVEF in PPCM indicates severe systolic dysfunction and heart failure with reduced ejection fraction.
- Diagnostic criteria for PPCM include LVEF <0.45, among other factors.
- Prognosis and management depend on various factors, including LVEF, left ventricular end-diastolic dimension, and presence of LV thrombus.
- Treatment options include standard heart failure therapy, mechanical support, and transplantation.