Key result
CMR LGE predicts ~8-fold greater odds of poor clinical outcomes in peripartum cardiomyopathy.
Why the study?
Persistent heart failure and death affect a significant proportion of PPCM patients, potentially attributable to myocardial tissue damage.
Does the presence of cardiac MRI late gadolinium enhancement predict poor outcomes in women with peripartum cardiomyopathy?
Cohort (n=84)
Does the presence of cardiac MRI late gadolinium enhancement predict poor outcomes in women with peripartum cardiomyopathy?
Effect estimate: OR 8.2 (95% CI 1.1-59.2)
p-value: p=0.003
Cardiac MRI LGE presence and extent are significant predictors of poor clinical outcomes and can aid in risk stratification for women with peripartum cardiomyopathy.
A significant proportion of peripartum cardiomyopathy (PPCM) patients experience persistent heart failure even death, the underneath reason of non-recovery may attribute to the myocardial tissue damage. This study aims to explore the prognostic value of cardiac MRI late gadolinium enhancement (LGE) in women with PPCM, and further establish a predictive model for poor outcomes. Eighty-four consecutively diagnosed women with PPCM underwent cardiac MRI between January 2010 to December 2019. A combined endpoint of poor outcomes (death, New York Heart Association functional class III/IV, heart transplantation or a persistently reduced left ventricular ejection fraction [LVEF)] and complete recovery [an LVEF ≥50%]) were defined. Least absolute shrinkage and selection operator regression and nomogram model were performed to demonstrate prognostic value of cardiac MRI. Higher occurrence of LGE was detected in PPCM women with reached poor outcomes than those who completely recovered (odds ratio: 4.4, 95% CI: 2.6 to 7.5, P<0.001) . PPCM women with LGE+ were more likely to reach combined endpoint of poor outcomes than those with LGE– (odds ratio: 8.2, 95% CI: 1.1 to 59.2, P=0.003). The poor outcome-free rates PPCM women in the group with LGE were lower than those without LGE (log-rank χ2=13.5, P<0.001). LGE presence (hazard ratio [HR]=10.7, 95% CI: 1.38-83.5, P<0.05) and LGE extent (HR=1.2, 95% CI: 1.0-1.3, P<0.05) were prognostic factors for poor outcomes. The predictive nomogram model on LGE showed good discrimination (C index=0.8, 95% CI: 0.6-0.9).Cardiac MRI LGE was an incremental predictive modality for poor outcomes and risk stratification in women with PPCM.
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Xu et al. (2023) conducted a cohort in Peripartum cardiomyopathy (n=84). Cardiac MRI late gadolinium enhancement (LGE) vs. Absence of LGE was evaluated on Combined endpoint of poor outcomes (death, NYHA class III/IV, heart transplantation, or persistently reduced LVEF) (OR 8.2, 95% CI 1.1-59.2, p=0.003). Cardiac MRI late gadolinium enhancement in women with peripartum cardiomyopathy strongly predicted a combined endpoint of poor clinical outcomes (OR 8.2; 95% CI 1.1-59.2; P=0.003).
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