Du Plessis Jacques, Gujrathi Rahul, Hassanin Magdi, McKee Hayley, Hanneman Kate, Karur Gauri Rani, Chan Victor, Warnica Will, Wald Rachel M, Nguyen Elsie T
Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
University Medical Imaging Toronto, Joint Department of Medical Imaging, University Health Network (UHN), Toronto, ON, Canada.
Can Assoc Radiol J. 2025 Feb;76(1):153-160. doi: 10.1177/08465371241268426. Epub 2024 Sep 6.
Peripartum cardiomyopathy (PPCM) affects women in late pregnancy and postpartum. Cardiovascular magnetic resonance (CMR) can contribute to PPCM diagnosis and management. We explored CMR findings in PPCM, including myocardial strain and late gadolinium enhancement (LGE) patterns. This retrospective single-centre study included patients with PPCM who underwent CMR from 2010 to 2018. Exclusions were other cardiomyopathy causes. CMR parameters, including ventricular function, LGE, and myocardial strain, were compared between the PPCM group and healthy controls. Transthoracic echocardiographic data were reviewed to assess functional improvement in PPCM patients. Thirty-two women with PPCM (mean age 42 ± 6 years) and 26 controls (mean age 43 ± 14 years) were included. PPCM patients had significantly lower left ventricular (LV) ejection fractions (median 37.5% vs 60.5%, < .001), higher LV end-diastolic volumes (median 108 ml/m² vs 76 ml/m², < .001), and reduced global LV strain compared to controls. Eighteen PPCM patients (58%) had non-ischaemic pattern LGE, with no LGE in controls besides hingepoint LGE (23%). LGE was most prevalent in the basal and mid anteroseptum. LGE patterns included linear mid-wall, subepicardial, and right ventricular side of the septum. Twenty-four patients (92%) showed improvement in LVEF at follow-up echocardiogram (mean LVEF 28% ± 1.9% at diagnosis and 45% ± 3% at follow-up, < .001). We identified a non-ischaemic pattern LGE that is nonspecific in isolation but could suggest PPCM in the correct clinical context along with abnormal CMR strain values. Future studies should evaluate the clinical application of these findings to facilitate earlier diagnosis and enhance management.
围产期心肌病（PPCM）影响妊娠晚期和产后的女性。心血管磁共振成像（CMR）有助于PPCM的诊断和管理。我们探讨了PPCM的CMR表现，包括心肌应变和钆增强延迟（LGE）模式。这项回顾性单中心研究纳入了2010年至2018年接受CMR检查的PPCM患者。排除其他心肌病病因。比较了PPCM组和健康对照组之间的CMR参数，包括心室功能、LGE和心肌应变。回顾经胸超声心动图数据以评估PPCM患者的功能改善情况。纳入了32例PPCM女性患者（平均年龄42±6岁）和26例对照组（平均年龄43±14岁）。与对照组相比，PPCM患者的左心室（LV）射血分数显著降低（中位数37.5%对60.5%，P<0.001），左心室舒张末期容积更高（中位数108 ml/m²对76 ml/m²，P<0.001），整体左心室应变降低。18例PPCM患者（58%）有非缺血性LGE模式，对照组除了铰链点LGE（23%）外无LGE。LGE最常见于基底和前间隔中部。LGE模式包括中壁线性、心外膜下和室间隔右心室侧。24例患者（92%）在随访超声心动图时左心室射血分数有所改善（诊断时平均左心室射血分数28%±1.9%，随访时为45%±3%，P<0.001）。我们发现一种非缺血性LGE模式，单独存在时不具有特异性，但在正确的临床背景下，结合异常的CMR应变值，可能提示PPCM。未来的研究应评估这些发现的临床应用，以促进早期诊断并加强管理。
