Abstract
BackgroundPeripartum cardiomyopathy (PPCM) is rare and potentially life-threatening; its etiology remains unclear. Imaging characteristics on cardiovascular magnetic resonance (CMR) and their prognostic significance have rarely been studied. We sought to determine CMR’s prognostic value in PPCM by using T1 and T2 mapping techniques.MethodsData from 21 PPCM patients from our CMR registry database were analyzed. The control group comprised 20 healthy age-matched females. All subjects underwent comprehensive contrast-enhanced CMR. T1 and T2 mapping using modified Look-Locker inversion recovery and T2 prep balanced steady-state free precession sequences, respectively. Ventricular size and function, late gadolinium enhancement (LGE), myocardial T1 value, extracellular volume (ECV), and T2 value were analyzed. Transthoracic echocardiography was performed at baseline and during follow-up. The recovered left ventricular ejection fraction (LVEF) was defined as LVEF ≥50% on echocardiography follow-up after at least 6 months of the diagnosis.ResultsCMR imaging showed that the PPCM patients had severely impaired LVEF and right ventricular ejection fraction (LVEF: 26.8 ± 10.6%; RVEF: 33.9 ± 14.6%). LGE was seen in eight (38.1%) cases. PPCM patients had significantly higher native T1 and ECV (1345 ± 79 vs. 1212 ± 32 ms, P < 0.001; 33.9 ± 5.2% vs. 27.1 ± 3.1%, P < 0.001; respectively) and higher myocardial T2 value (42.3 ± 3.7 vs. 36.8 ± 2.3 ms, P < 0.001) than did the normal controls. After a median 2.5-year follow-up (range: 8 months-5 years), six patients required readmission for heart failure, two died, and 10 showed left ventricular function recovery. The LVEF-recovered group showed significantly lower ECV (30.7 ± 2.1% vs. 36.8 ± 5.6%, P = 0.005) and T2 (40.6 ± 3.0 vs. 43.9 ± 3.7 ms, P = 0.040) than the unrecovered group. Multivariable logistic regression analysis showed ECV (OR = 0.58 for per 1% increase, P = 0.032) was independently associated with left ventricular recovery in PPCM.ConclusionsCompared to normal controls, PPCM patients showed significantly higher native T1, ECV, and T2. Native T1, ECV, and T2 were associated with LVEF recovery in PPCM. Furthermore, ECV could independently predict left ventricular function recovery in PPCM.
Highlights
Peripartum cardiomyopathy (PPCM) is rare and potentially life-threatening; its etiology remains unclear
None had a history of hypertension, preeclampsia, or eclampsia before or during the pregnancy
We found that a higher extracellular volume (ECV) indicated a poor clinical outcome in patients with PPCM
Summary
Peripartum cardiomyopathy (PPCM) is rare and potentially life-threatening; its etiology remains unclear. Peripartum cardiomyopathy (PPCM) is a rare, lifethreatening pregnancy-associated disease that is typically marked by ventricular dysfunction. The incidence of PPCM is gradually increasing [1] and varies geographically, most likely due to socioeconomic and genetic factors [2]. Previous studies have reported the incidence rates of the disease in different geographical regions as follows: 1 per 300 live births in Haiti [3], 1 per 346 live births in China [4], 1 per 1000 live births in South Africa [5], and 1 per 900–4000 live births in the United States [6,7,8]. Abnormal immune responses to pregnancy, abnormal responses to hemodynamic stress during pregnancy, cytokine-induced inflammation, and genetic factors have been suggested to be involved in the pathogenesis of PPCM, the precise pathogenetic mechanism remains unclear [9]. The lack of prognostic indicators in PPCM patients is another important clinical challenge [13]
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