Patients with severe peripartum cardiomyopathy (PPCM) often receive mechanical circulatory support with good outcomes. However, the mechanisms underlying the functional improvements are poorly understood. This study investigated the effects of partial, continuous-flow left ventricular assist device (LVAD) support on cardiac function and mechanics in patients with PPCM of different severity. Patient-specific biventricular finite element models of six PPCM patients (four recovered, two non-recovered) were developed from magnetic resonance images and combined with a circulatory system model, including variable LVAD support. Ventricular function and myocardial mechanics were predicted, and changes due to LVAD support were quantified. The LVAD support decreased myofiber stress and increased ejection fraction (EF) of the LV. EF increased steadily (two patients), fluctuated (two patients), or peaked before a steady decrease (two patients) with increasing LVAD speed. Improvement due to LVAD support was greater for PPCM patients with higher disease severity than those with lower disease severity. The LVAD and native LV jointly generated stroke volume (SV) in four patients, and the LV contribution diminished with increasing LVAD speed. In the two patients with the lowest EF, the LVAD was the sole source of SV. The improvement of cardiac function and mechanics due to LVAD support in PPCM exceeds that reported for chronic heart failure due to ischemia. However, the predicted variability of the LVAD benefits with PPCM severity and mechanical support level suggests the need and potential for further studies to guide clinicians in selecting personalised treatment parameters required for optimised LVAD therapy for each PPCM patient.

The authors have declared no competing interest.

This work was financially supported by DAAD-AIMS In-Region PhD scholarship South Africa, the National Research Foundation of South Africa (IFR14011761118 to TF), the CSIR Centre for High Performance Computing (CHPC Flagship Project Grant IRMA9543 to TF), and the Dr. Leopold und Carmen Ellinger Stiftung (UCT Three-Way PhD Global Partnership Programme Grant DAD937134 to TF). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Any opinion, findings, conclusions, and recommendations expressed in this publication are those of the authors, and therefore, the funders do not accept any liability.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Faculty of Health Sciences Human Research Ethics Committee of the University of Cape Town gave ethical approval for this work under the approval number HREC REF: 752/2018.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Computational models and data supporting this study are available on the University of Cape Town's institutional data repository ZivaHub under the DOI https://doi.org/10.25375/uct.26047783 as Nagawa J, Sack KL, Nchejane NJ, Motchon YD, Sirry MS, Kraus S, Davies NH, Ntusi NAB, Franz T. Software and data for Patient-specific in silico prediction of outcomes of partial continuous-flow LVAD treatment in peripartum cardiomyopathy. ZivaHub, 2024, DOI: 10.25375/uct.26047783.

https://doi.org/10.25375/uct.26047783