Echocardiography Features of Peripartum Cardiomyopathy
The hallmark echocardiographic finding in peripartum cardiomyopathy is reduced left ventricular ejection fraction (LVEF) below 45%, though the left ventricle may not always be dilated. 1
Core Echocardiographic Diagnostic Criteria
Left Ventricular Systolic Dysfunction:
- LVEF <45% is the primary diagnostic criterion 1, 2
- Fractional shortening <30% is an alternative measure of systolic dysfunction 1
- The ejection fraction is "nearly always" reduced below 45%, making this the most consistent finding 1, 2
Left Ventricular Dimensions:
- LV end-diastolic dimension >2.7 cm/m² body surface area is part of formal diagnostic criteria 1
- Not all patients present with LV dilatation - this is a critical distinction from other dilated cardiomyopathies 1, 2
- LV end-diastolic diameter >60 mm predicts poor recovery of LV function and carries prognostic significance 1
Prognostic Echocardiographic Features
Poor Recovery Indicators:
- LVEF <30% at presentation predicts poor recovery of ventricular function 1
- LV end-diastolic diameter >60 mm is associated with worse outcomes 1
Structural Findings:
- Mitral regurgitation is present in 43% of patients on physical examination, which correlates with echocardiographic findings 1
- Relative wall thickness may be reduced, indicating eccentric remodeling 3
Critical Complications to Assess
Left Ventricular Thrombus:
- LV thrombus is not uncommon in patients with LVEF <35% 1
- Echocardiography is essential for ruling out LV thrombus, particularly when LVEF is severely depressed 1
- Cardiac MRI has higher sensitivity than echocardiography for detecting LV thrombus 1
Timing of Echocardiographic Assessment
Serial Imaging Protocol:
- Initial echocardiography should be performed as quickly as possible when PPCM is suspected 1
- Repeat before patient discharge 1
- Follow-up at 6 weeks, 6 months, and annually to evaluate treatment efficacy and recovery 1
- Cardiac MRI can be repeated at 6 months and 1 year for more accurate assessment if available 1
Distinguishing Features from Other Cardiomyopathies
Key Differentiating Points:
- Pre-existing idiopathic or familial dilated cardiomyopathy typically presents with larger cardiac dimensions than PPCM and usually manifests by the 2nd trimester rather than postpartum 1
- HIV cardiomyopathy often presents with non-dilated ventricles 1
- Hypertensive heart disease and pre-eclampsia can confuse the diagnosis; HPD-PPCM patients show less eccentric remodeling and less LV dilation compared to PPCM-only patients 3
Common Pitfalls
Avoid These Diagnostic Errors:
- Do not exclude PPCM based solely on absence of LV dilatation - the ventricle may not be dilated 1, 2
- Do not rely on clinical criteria alone without strict echocardiographic confirmation 4
- Do not miss LV thrombus screening in patients with LVEF <35%, as this carries significant embolic risk 1, 2
- Remember that normal pregnancy can cause physiological changes; compare findings against established PPCM criteria rather than normal non-pregnant values 1