Ricci Fabrizio, De Innocentiis Carlo, Verrengia Elvira, Ceriello Laura, Mantini Cesare, Pietrangelo Carla, Irsuti Flaviano, Gabriele Stefano, D'Alleva Alberto, Khanji Mohammed Y, Aung Nay, Renda Giulia, Cameli Matteo, Petersen Steffen E, Cesare Ernesto Di, Gallina Sabina
Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy.
Department of Clinical Sciences, Lund University, Clinical Research Center, Malmö, Sweden.
Front Cardiovasc Med. 2020 Feb 18;7:4. doi: 10.3389/fcvm.2020.00004. eCollection 2020.
The burden of pregnancy-related heart disease has dramatically increased over the last decades due to the increasing age at first pregnancy and higher prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. Pregnancy is associated with physiological changes in the cardiovascular system, including hemodynamic, metabolic, and hormonal adaptations to meet the increased metabolic demands of the mother and fetus. It has been postulated that pregnancy may act as a cardiovascular stress test to identify women at high risk for heart disease, where the inability to adequately adapt to the physiologic stress of pregnancy may reveal the presence of genetic susceptibility to cardiovascular disease or accelerate the phenotypic expression of both inherited and acquired heart diseases, such as peripartum cardiomyopathy (PPCM). PPCM is a rare and incompletely understood clinical condition. Despite recent advances in the understanding of its pathogenesis, PPCM is not attributable to a well-defined pathological mechanism, and therefore, its diagnosis still relies on the exclusion of overlapping dilated phenotypes. Cardiac imaging plays a key role in any peripartum woman with signs and symptoms of heart failure in establishing the diagnosis, ruling out life-threatening complications, guiding therapy and conveying prognostic information. Echocardiography represents the first-line imaging technique, given its robust diagnostic yield and its favorable cost-effectiveness. Cardiovascular magnetic resonance is a biologically safe high-throughput modality that allows accurate morpho-functional assessment of the cardiovascular system in addition to the unique asset of myocardial tissue characterization as a pivotal piece of information in the pathophysiological puzzle of PPCM. In this review, we will highlight current evidence on the role of multimodality imaging in the differential diagnosis, prognostic assessment, and understanding of the pathophysiological basis of PPCM.
在过去几十年中，由于初孕年龄增加以及糖尿病、高血压和肥胖等心血管危险因素的患病率上升，妊娠相关心脏病的负担显著增加。妊娠与心血管系统的生理变化相关，包括血流动力学、代谢和激素方面的适应性变化，以满足母亲和胎儿增加的代谢需求。据推测，妊娠可能起到心血管压力测试的作用，以识别心脏病高危女性，无法充分适应妊娠生理压力可能揭示心血管疾病遗传易感性的存在，或加速遗传性和后天性心脏病（如围产期心肌病，PPCM）的表型表达。PPCM是一种罕见且尚未完全了解的临床病症。尽管最近在其发病机制的理解方面取得了进展，但PPCM并非归因于明确的病理机制，因此，其诊断仍依赖于排除重叠的扩张型表型。心脏成像在任何有心力衰竭体征和症状的围产期女性的诊断、排除危及生命的并发症、指导治疗和传达预后信息方面都起着关键作用。鉴于超声心动图强大的诊断率和良好的成本效益，它是一线成像技术。心血管磁共振是一种生物安全的高通量检查方式，除了作为PPCM病理生理难题中关键信息的心肌组织特征化这一独特优势外，还能对心血管系统进行准确的形态功能评估。在本综述中，我们将重点介绍多模态成像在PPCM鉴别诊断、预后评估和病理生理基础理解方面的当前证据。
