title: Myocardial Damage Detected by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Uncommon in Peripartum Cardiomyopathy.
abstract: 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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01085955.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA schelberteb@upmc.edu.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Schelbert
authors.affiliation: University of Southern California, Los Angeles, CA.
authors.forename: Uri
authors.initials: U
authors.lastname: Elkayam
authors.affiliation: Mayo Clinic, Jacksonville, FL.
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Cooper
authors.affiliation: Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Givertz
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Alexis
authors.affiliation: University of Illinois, Chicago, IL.
authors.forename: Joan
authors.initials: J
authors.lastname: Briller
authors.affiliation: Duke University, Durham, NC.
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.affiliation: University of Miami, FL.
authors.forename: Sandra
authors.initials: S
authors.lastname: Chaparro
authors.affiliation: University of Calgary, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Kealey
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Pisarcik
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: James D
authors.initials: JD
authors.lastname: Fett
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: McNamara
mesh_terms: D002170:Canada; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D005355:Fibrosis; D005682:Gadolinium / Q000008:administration & dosage; D016027:Heart Transplantation; D006571:Heterocyclic Compounds / Q000008:administration & dosage*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D009206:Myocardium / Q000473:pathology*; D009942:Organometallic Compounds / Q000008:administration & dosage*; D058725:Peripartum Period; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium
keywords: cardiovascular magnetic resonance; heart failure; myocardial fibrosis; peripartum cardiomyopathy; pregnancy and postpartum