Recovery of Myocardial Function in Peripartum Cardiomyopathy: Insights from Global Longitudinal Strain and Myocardial Work Analysis

By
Federica Ilardi
Federica Carusone
Dario D’Alconzo
Rachele Manzo
Alessia Palmentieri
Ciro Battaglia
Dalila Nappa
Giuseppe Giugliano
Raffaella Lombardi
Santo Dellegrottaglie
Viviana Narciso
Roberta Paolillo
Luca Bardi
Francesco S. Loffredo
Daniele Masarone
Enrica Pezzullo
Francesca Lanni
Donato Gerardi
Eugenio Stabile
Angelicarosa Cascone
Nouha Azaza
Giovanni Peretto
Giuseppe Bifulco
Attilio Di Spiezio Sardo
Gabriele Saccone
Alaide Chieffo
Cinzia Perrino
Giovanni Esposito
August 26, 2026

Frontiers In Cardiovascular Medicine

Objective:

To investigate whether incomplete myocardial recovery in peripartum cardiomyopathy (PPCM) is associated with subtle abnormalities in myocardial performance using global longitudinal strain (GLS) and myocardial work (MW) indices.

Approach:

Study Design: Retrospective analysis of 22 women with PPCM, assessed at least 6 months post-acute phase, registered in the Italian Multicentre Observational PPCM Registry.
Echocardiographic Assessment: Evaluation of myocardial mechanics included GLS, global work index, global constructive work, global wasted work, and GWE.
Group Classification: Participants were categorized based on LVEF into Group A (<50%) and Group B (≥50%), with a control group of 21 age-matched healthy women.

Key Findings:

LV recovery occurred in 16 women (72.7%).
Groups A and B had greater LV diameters and volumes compared to controls (p < 0.001).
Group A exhibited significantly poorer GLS and MW parameters (p < 0.001 for all).
Group B had lower 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) than controls.

Interpretation:

GLS and MW indices may detect myocardial impairment not captured by conventional systolic-function measures, indicating residual subclinical dysfunction in PPCM patients.

Limitations:

Small sample size of 22 women.
Retrospective nature may introduce bias.

Conclusion:

GLS and MW indices provide a more sensitive assessment of myocardial performance in PPCM, highlighting persistent abnormalities even after LVEF normalization.