Novel adaptation of the KCC-questionnaire for cardiomyopathy screening in a racially diverse obstetric population

Abstract

AbstractCardiomyopathy occurring during pregnancy or postpartum represents a leading cause of maternal mortality. An overlap between pregnancy-associated symptoms and symptoms of cardiomyopathy contributes to delays in diagnosis. To address the need for screening and improve the diagnosis of pregnancy-related cardiomyopathy, we sought to evaluate the association between cardiovascular symptoms, an adapted version of the 12-item Kansas City Cardiomyopathy Questionnaire for pregnancy (KCCQ-P) and left ventricular systolic dysfunction (LVSD). We conducted a single-arm prospective observational study of pregnant and postpartum participants enrolled between October 2021 and October 2022. A symptom questionnaire, KCCQ-P, and a resting echocardiogram were performed. The primary study outcome was LVSD, defined as left ventricular ejection fraction (LVEF) < 50%. We sub-divided those with LVEF (≥50%) into subclinical LVSD (left ventricular global longitudinal strain (GLS) > –18), and no LVSD (GLS ≤ −18). Ninety women were included in the final analysis. The median age was 31 years (Q1: 28, Q3: 35), 37% identified as Non-Hispanic White, 30% as Non-Hispanic Black, and 23% as Hispanic or Latino. KCCQ-P total scores were markedly lower with LVSD (median: 30.2; Q1: 22.9, Q3: 61.5) vs. subclinical LVSD (median: 60.7; Q1: 47.0, Q3: 76.2) vs. no LVSD (median: 86.5; Q1: 62.5, Q3: 95.8) p < 0.001. KCCQ-P score was able to detect LVSD with an AUC of 0.848. While individual cardiovascular symptoms were not associated with LVSD, KCCQ-P scores were significantly lower in those with apparent and subclinical LVSD and may be useful as a screening tool pending additional evaluation in larger cohorts.