title: Prognostic implication of right ventricular involvement in peripartum cardiomyopathy: a cardiovascular magnetic resonance study.
abstract: OBJECTIVE
  Peripartum cardiomyopathy (PPCM) is a major cause of acute heart failure in the peripartum period and considered potentially life threatening. While many aspects of its clinical profiles have been frequently reported, functional analysis, in particular of the right ventricle, and tissue characterization by cardiovascular magnetic resonance (CMR) imaging have been only sporadically described. The aim of the present study was to analyse pathological alterations and their prognostic relevance found in CMR imaging of patients newly diagnosed with PPCM.
  
  
  RESULTS
  In this multicenter study 34 patients with confirmed PPCM underwent CMR imaging at the time of diagnosis and at 5 ± 1 months follow-up. Cine imaging of PPCM patients showed moderate to severe reduction of systolic left ventricular (LV) function (mean LVEF: 29.7 ± 12.8%). In 35% of the patients right ventricular (RV) systolic function was also reduced with a mean RVEF of 42.9 ± 13.9%. Dilatation of the LV was observed in 91% (mean LV-EDV/BSA 128.5 ± 32.1 mL/m2), and dilatation of the RV was present in 24% (mean RV-EDV/BSA 87.4 ± 18.5 mL/m2) of the patients. Focal non-ischemic late gadolinium enhancement (LGE) was visible in 71%, and regional wall motion abnormalities were evident in 88% of the patients. LGE and wall motion abnormalities were predominantly located in the anteroseptal and basal to midventricular segments. RV dysfunction at baseline was associated with reduced probability of full cardiac recovery at 5 ± 1 months follow-up.
  
  
  CONCLUSIONS
  Besides LV systolic dysfunction, RV dysfunction and dilatation are observed in about one third of PPCM patients at the time of diagnosis. RV dysfunction is associated with unfavourable outcome. A distinct pattern of LV wall motion abnormalities and myocardial scar is evident in most PPCM patients. The present study may help to establish a set of CMR criteria suitable for diagnosis in patients with suspected PPCM and may add further knowledge to the pathology of the disease.
authors: Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
authors: Arash
authors: A
authors: Haghikia
authors: Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
authors: Philipp
authors: P
authors: Röntgen
authors: Institute of Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.
authors: Jens
authors: J
authors: Vogel-Claussen
authors: Department of Cardiology Paracelsus Medical University, General Hospital Nuernberg Nuernberg Germany.
authors: Johannes
authors: J
authors: Schwab
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Duesseldorf Germany.
authors: Ralf
authors: R
authors: Westenfeld
authors: Department of Cardiology, Pulmonology, and Vascular Medicine University of Heidelberg Heidelberg Germany.
authors: Philipp
authors: P
authors: Ehlermann
authors: Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
authors: Dominik
authors: D
authors: Berliner
authors: Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
authors: Edith
authors: E
authors: Podewski
authors: Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
authors: Denise
authors: D
authors: Hilfiker-Kleiner
authors: Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
authors: Johann
authors: J
authors: Bauersachs
keywords: Multiparametric cardiovascular magnetic resonance imaging; Peripartum cardiomyopathy; Right ventricular involvement