Myocardial function recovery in peripartum cardiomyopathy: the role of global longitudinal strain and myocardial work

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Introduction Peripartum cardiomyopathy (PPCM) occurs during the peripartum period or shortly thereafter and is characterised by left ventricular (LV) systolic dysfunction. Although some women achieve recovery of LV ejection fraction (LVEF), others develop persistent systolic impairment. Data on myocardial mechanics and contractile performance after the acute phase are limited. Aim We aimed to evaluate whether global longitudinal strain (GLS) and myocardial work (MW) indices could provide a more comprehensive assessment of myocardial performance and identify subtle abnormalities associated with incomplete myocardial recovery in PPCM. Methods We retrospectively analysed 22 women (mean age 42.1 ± 8.9 years) with PPCM, evaluated ≥6 months after the acute phase, enrolled in the Italian Multicentre Observational PPCM Registry (NCT05878041). Myocardial mechanics were assessed using GLS, global work index, global constructive work, global wasted work, and global work efficiency (GWE). Patients were stratified by LVEF into Group A (<50%) and Group B (≥50%) and compared with 21 age-matched healthy women (Group C). Results LV recovery was observed in 16 women (72.7%). Compared with controls, Groups A and B displayed larger LV diameters and volumes ( p < 0.001), impaired tricuspid annular plane systolic excursion ( p = 0.007), and left atrial strain ( p < 0.001). Group A exhibited significantly worse GLS and MW parameters ( p < 0.001 for all), consistent with the impairment of LVEF. Despite LVEF recovery, Group B still showed reduced GLS (18.0 ± 3.1% vs. 21.8 ± 1.7%, p < 0.001) and GWE (92.6 ± 6.0 vs. 95.9 ± 2.0%, p = 0.023) compared with controls. Conclusions GLS and MW indices enable a refined assessment of myocardial performance in PPCM. Persistent abnormalities despite normalised LVEF suggest residual subclinical dysfunction and support their potential role as sensitive markers of myocardial impairment beyond conventional measures of systolic function.