Peripartum Cardiomyopathy Associated With Left Ventricular Noncompaction Phenotype and Reversible Rigid Body Rotation

Abstract

A 30-year-old woman presented 1-month postpartum with new-onset biventricular heart failure for which no other contributing cause could be found clinically or on laboratory investigations. Her 2 previous pregnancies were uncomplicated. She was HIV-positive for the preceding 3 years, but had never been on antiretroviral therapy. Initial echocardiography revealed a left ventricular (LV) end-diastolic diameter of 59 mm and LV ejection fraction of 32% (online-only Data Supplement Movies 1 and 2). There was evidence of LV noncompaction involving the apex and midinferior and midlateral walls of the LV that satisfied the Jenni criteria (Figure 1). There was no echocardiographic evidence of other congenital or organic valvular disease. Speckle tracking revealed rigid body rotation (ie, rotation at both the basal and apical levels of the LV occurred in a counterclockwise direction during systole; Figure 2). The patient was treated with furosemide, carvedilol, an angiotensin-converting enzyme inhibitor, and spironolactone. On reevaluation 6 months later, her functional status was New York Heart Association Class 1. Echocardiography revealed that LV ejection fraction was now 48% …