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Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy.

Publication ,  Journal Article
Schelbert, EB; Elkayam, U; Cooper, LT; Givertz, MM; Alexis, JD; Briller, J; Felker, GM; Chaparro, S; Kealey, A; Pisarcik, J; Fett, JD ...
Published in: J Am Heart Assoc
April 3, 2017

BACKGROUND: In peripartum cardiomyopathy, the prevalence of focal myocardial damage detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance is important to elucidate mechanisms of myocardial injury and cardiac dysfunction. LGE equates irreversible myocardial injury, but LGE prevalence in peripartum cardiomyopathy is uncertain. METHODS AND RESULTS: Among 100 women enrolled within the Investigations of Pregnancy Associated Cardiomyopathy cohort, we recruited 40 women at 13 centers to undergo LGE cardiovascular magnetic resonance, enrolled within the first 13 weeks postpartum. Follow-up scans occurred at 6 months postpartum, and death/transplant rates at 12 months. Baseline characteristics did not differ significantly in the parent cohort according to cardiovascular magnetic resonance enrollment except for mechanical circulatory support. LGE was noted only in 2 women (5%) at baseline. While left ventricular dysfunction with enlargement was prevalent at baseline cardiovascular magnetic resonance scans (eg, ejection fraction 38% [Q1-Q3 31-50%], end diastolic volume index=108 mL/m2 [Q1-Q3 83-134 mL/m2]), most women demonstrated significant improvements at 6 months, consistent with a low prevalence of LGE. LGE was not related to baseline clinical variables, ejection fraction, New York Heart Association heart failure class, or mortality. Neither of the 2 women who died exhibited LGE. LGE was inversely associated with persistent left ventricular ejection fraction at 6 months (P=0.006). CONCLUSIONS: Factors other than focal myocardial damage detectable by LGE explain the initial transient depressions in baseline left ventricular ejection fraction, yet focal myocardial damage may contribute to persistent myocardial dysfunction and hinder recovery in a small minority. Most women exhibit favorable changes in ventricular function over 6 months. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01085955.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

April 3, 2017

Volume

6

Issue

4

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Right
  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Recovery of Function
  • Prospective Studies
 

Citation

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Schelbert, E. B., Elkayam, U., Cooper, L. T., Givertz, M. M., Alexis, J. D., Briller, J., … Investigations of Pregnancy Associated Cardiomyopathy (IPAC) Investigators, . (2017). Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy. J Am Heart Assoc, 6(4). https://doi.org/10.1161/JAHA.117.005472
Schelbert, Erik B., Uri Elkayam, Leslie T. Cooper, Michael M. Givertz, Jeffrey D. Alexis, Joan Briller, G Michael Felker, et al. “Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy.J Am Heart Assoc 6, no. 4 (April 3, 2017). https://doi.org/10.1161/JAHA.117.005472.
Schelbert EB, Elkayam U, Cooper LT, Givertz MM, Alexis JD, Briller J, et al. Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy. J Am Heart Assoc. 2017 Apr 3;6(4).
Schelbert, Erik B., et al. “Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy.J Am Heart Assoc, vol. 6, no. 4, Apr. 2017. Pubmed, doi:10.1161/JAHA.117.005472.
Schelbert EB, Elkayam U, Cooper LT, Givertz MM, Alexis JD, Briller J, Felker GM, Chaparro S, Kealey A, Pisarcik J, Fett JD, McNamara DM, Investigations of Pregnancy Associated Cardiomyopathy (IPAC) Investigators. Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy. J Am Heart Assoc. 2017 Apr 3;6(4).
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

April 3, 2017

Volume

6

Issue

4

Location

England

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Function, Right
  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke Volume
  • Recovery of Function
  • Prospective Studies