title: New insights into peripartum cardiomyopathy using cardiac magnetic resonance imaging.
abstract: OBJECTIVE
  The aim of this study was to evaluate a comprehensive cardiac magnetic resonance (MR) imaging approach in patients with peripartum cardiomyopathy (PPCM). The focus was on inflammatory myocardial changes.
  
  
  METHODS
  Retrospective analysis of 12 cardiac MR examinations was performed in 6 patients with PPCM. The protocol comprised cine sequences for the determination of chamber sizes and function. T 2-weighted sequences for determination of edema (T 2 ratio), T 1-weighted images for measurement of early gadolinium enhancement ratio (EGER), and late gadolinium enhancement (LGE) sequences were used for tissue characterization. 5 examinations were performed during the acute stage, and 7 examinations were performed during the course of the disease.
  
  
  RESULTS
  Initially, 3 of 5 patients presented with an elevated left ventricular end-diastolic volume (LVEDV); in one patient, the LVEDV was in the upper range. In 4 of 5 subjects, the left ventricular ejection fraction (LVEF) was decreased. The T 2 ratio and EGER values were initially elevated in all women. No LGE was detected in initial scans. In follow-up examinations, the LVEDV decreased and the LVEF increased in all patients. Tissue-characterizing parameters decreased to normal in all but 1 patient. 2 patients showing LGE did not present a favorable clinical course.
  
  
  CONCLUSIONS
  Myocardial inflammation was detected in the acute stage of PPCM, which was mostly transient. In our small group, patients showing LGE had a non-favorable clinical course. Future studies should include tissue-characterizing parameters, such as T 2 ratio and EGER. Thus, further insights into pathophysiology can be gained and therapeutic effects can be measured in a more extensive manner.
authors.affiliation: Institut für Radiologie, Charité Universitätsmedizin Berlin, Germany.
authors.forename: D M
authors.initials: DM
authors.lastname: Renz
authors.forename: R
authors.initials: R
authors.lastname: Röttgen
authors.forename: D
authors.initials: D
authors.lastname: Habedank
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.forename: J
authors.initials: J
authors.lastname: Böttcher
authors.forename: A
authors.initials: A
authors.lastname: Pfeil
authors.forename: R
authors.initials: R
authors.lastname: Dietz
authors.forename: D
authors.initials: D
authors.lastname: Kivelitz
authors.forename: T
authors.initials: T
authors.lastname: Elgeti
mesh_terms: D000208:Acute Disease; D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006325:Heart Atria / Q000473:pathology; D006333:Heart Failure / Q000175:diagnosis; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis*; D011644:Puerperal Disorders / Q000175:diagnosis*; D012016:Reference Values; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA