BACKGROUND Peripartum 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. METHODS Data 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. RESULTS CMR 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. CONCLUSIONS Compared 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.

中文翻译：

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围产期心肌病的左心室功能恢复：通过心肌T1和T2定位进行的心血管磁共振研究。

背景技术围产期心肌病（PPCM）罕见，可能危及生命。其病因尚不清楚。很少研究心血管磁共振（CMR）的影像学特征及其预后意义。我们试图通过使用T1和T2映射技术来确定CMR在PPCM中的预后价值。方法分析了来自我们CMR注册数据库的21名PPCM患者的数据。对照组包括20名年龄匹配的健康女性。所有受试者均接受全面的对比增强CMR。T1和T2映射分别使用修改的Look-Locker反演恢复和T2准备平衡稳态自由进动序列。分析心室大小和功能，晚期g增强（LGE），心肌T1值，细胞外体积（ECV）和T2值。在基线和随访期间进行经胸超声心动图检查。诊断至少6个月后，在超声心动图随访中将恢复的左心室射血分数（LVEF）定义为LVEF≥50％。结果CMR影像显示，PPCM患者的LVEF和右心室射血分数严重受损（LVEF：26.8±10.6％； RVEF：33.9±14.6％）。在八例（38.1％）病例中发现了LGE。PPCM患者的天然T1和ECV明显更高（分别为1345±79 vs.1212±32 ms，P <0.001; 33.9±5.2％vs. 27.1±3.1％，P <0.001;）和较高的心肌T2值（42.3±3.7）与36.8±2.3毫秒相比，P <0.001）。在进行2.5年中位随访（范围：8个月至5年）后，有6名患者因心力衰竭而再次入院，其中2例死亡，10例显示左心室功能恢复。LVEF恢复组显示ECV（30.7±2.1％vs. 36.8±5.6％，P = 0.005）和T2（40.6±3.0 vs. 43.9±3.7 ms，P = 0.040）显着低于未恢复组。多变量logistic回归分析显示ECV（每增加1％，OR = 0.58，P = 0.032）与PPCM中的左心室恢复独立相关。结论与正常对照组相比，PPCM患者表现出明显更高的天然T1，ECV和T2。本地T1，ECV和T2与PPCM中的LVEF恢复相关。此外，ECV可以独立预测PPCM中左心室功能的恢复。多变量logistic回归分析显示ECV（每增加1％，OR = 0.58，P = 0.032）与PPCM中的左心室恢复独立相关。结论与正常对照组相比，PPCM患者表现出明显更高的天然T1，ECV和T2。本地T1，ECV和T2与PPCM中的LVEF恢复相关。此外，ECV可以独立预测PPCM中左心室功能的恢复。多变量logistic回归分析显示ECV（每增加1％，OR = 0.58，P = 0.032）与PPCM中的左心室恢复独立相关。结论与正常对照组相比，PPCM患者表现出明显更高的天然T1，ECV和T2。本地T1，ECV和T2与PPCM中的LVEF恢复相关。此外，ECV可以独立预测PPCM中左心室功能的恢复。