Peripartum Cardiomyopathy: Diagnostic and Prognostic Value of Cardiac Magnetic Resonance in the Acute Stage.

Alexander Isaak,Claus C Pieper,Ulrich M Becher,Daniel Kuetting,Alois M Sprinkart,Darius Dabir,Sebastian Zimmer,Tiyasha H Ayub,Julian A Luetkens,Anton Faron,Christoph Endler,Waltraut M Merz,Ulrike Attenberger

doi:10.3390/diagnostics12020378

Abstract

This study aimed to evaluate the diagnostic and prognostic value of cardiac magnetic resonance in acute peripartum cardiomyopathy (PPCM). A total of 17 patients with PPCM in the acute stage and 15 healthy controls were retrospectively analyzed regarding myocardial function, edema, late gadolinium enhancement (LGE), and T1 and T2 mappings (T1, T2). Echocardiographic follow-ups were performed. Functional recovery was defined as a left ventricular ejection fraction (LVEF) of ≥50%. Patients with PPCM displayed biventricular dysfunction with reduced myocardial strain parameters and left ventricular and atrial dilatation, as well as diffuse myocardial edema (T2 signal intensity ratio: 2.10 ± 0.34 vs. 1.58 ± 0.21, p < 0.001; T1: 1070 ± 51 ms vs. 980 ± 28 ms, p = 0.001; T2: 63 ± 5 ms vs. 53 ± 2 ms, p < 0.001). Visual myocardial edema was present in 10 patients (59%). LGE was positive in 2 patients (12%). A total of 13 patients (76%) showed full LVEF recovery. The absence of visual myocardial edema and impairment of strain parameters were associated with delayed LVEF recovery. Multivariable Cox regression analysis revealed global longitudinal strain as an independent prognostic factor for LVEF recovery. In conclusion, biventricular systolic dysfunction with diffuse myocardial edema seems to be present in acute PPCM. Myocardial edema and strain may have prognostic value for LVEF recovery.

Highlights

Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening condition. It is defined as development of new-onset cardiomyopathy during the peripartum episode with an initial left ventricular (LV) ejection fraction (EF) of
The majority of patients show left ventricular ejection fraction (LVEF) recovery within 6 months after diagnosis, but full LVEF recovery can be delayed, and there might even be a need for an implantable cardioverter defibrillator [1,6,7]
Acute peripartum cardiomyopathy (PPCM) was diagnosed based on recent diagnostic criteria [1]

Summary

Introduction

Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening condition. It is defined as development of new-onset cardiomyopathy during the peripartum episode (the majority of patients present postpartum, mostly during the week after delivery) with an initial left ventricular (LV) ejection fraction (EF) of

Objectives

Methods

Results

Conclusion