Cardiovascular Magnetic Resonance in Peripartum Cardiomyopathy: Comparison with Idiopathic Dilated Cardiomyopathy

Abstract

Background: Peripartum (PPCM) and dilated (DCM) cardiomyopathies are distinct forms of cardiac disease that share certain aspects in clinical presentation. Aim: We hypothesized that different cardiac structural changes underlie PPCM and DCM, and we aimed to investigate them with cardiovascular magnetic resonance (CMR). Methods: We included 21 PPCM patients (30.5 ± 5.9 years) and 30 female DCM patients (41.5 ± 16.8 years) matched for left ventricular ejection fraction. Biventricular and biatrial volumetric and functional parameters were assessed along with ventricular and atrial strain indices based on feature-tracking techniques. The presence of late gadolinium enhancement (LGE) was also assessed. Results: In PPCM, the left ventricular (LV) stroke volume index was lower (p = 0.04), right atrial (RA) minimal and pre-systolic volumes were higher (p < 0.01 and p = 0.02, respectively), and the total RA ejection fraction was lower (p = 0.02) in comparison to DCM. Moreover, in PPCM, the LV global longitudinal strain (p = 0.03), global circumferential strain rate (p = 0.04), and global longitudinal strain rate (p < 0.01) were less impaired than in DCM. Both PPCM and DCM patients with LGE had more dilated ventricles and more impaired LV and left atrial function than in PPCM and DCM patients without LGE. Conclusions: Subtle differences appear on CMR between PPCM and DCM. Most importantly, the RA is larger and more impaired, and LV global longitudinal strain is less reduced in PPCM than in DCM. Furthermore, similarly to DCM, PPCM patients with LGE have more dilated and impaired ventricles than patients without LGE.

Biomarkers in Peripartum Cardiomyopathy—What We Know and What Is Still to Be Found

“…PPCM's initial presentation is often acute. Therefore, there are frequently no or limited areas of fibrosis detected in CMRI [28]. This partially elucidates the ability of the heart muscle to recover.…”

Peripartum cardiomyopathy: risk factors and predictors of outcome

“…Prior CMR studies have shown that there is a high prevalence of myocardial oedema, fibrosis [as shown with late gadolinium enhancement (LGE)], regional wall motion abnormalities and pericardial effusion at the time of diagnosis [67]. Prevalence of LGE in previous studies on PPCM ranged between 13 and 71% [67,68 ▪▪ ,69 ▪▪ ,70]. LGE distribution typically has a nonischemic pattern.…”