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The role of multimodality cardiovascular imaging in peripartum cardiomyopathy

Ricci, Fabrizio LU ; De Innocentiis, Carlo ; Verrengia, Elvira ; Ceriello, Laura ; Mantini, Cesare ; Pietrangelo, Carla ; Irsuti, Flaviano ; Gabriele, Stefano ; D'Alleva, Alberto and Khanji, Mohammed Y. , et al. (2020) In Frontiers in Cardiovascular Medicine 7.
Abstract

The burden of pregnancy-related heart disease has dramatically increased over the last decades due to the increasing age at first pregnancy and higher prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. Pregnancy is associated with physiological changes in the cardiovascular system, including hemodynamic, metabolic, and hormonal adaptations to meet the increased metabolic demands of the mother and fetus. It has been postulated that pregnancy may act as a cardiovascular stress test to identify women at high risk for heart disease, where the inability to adequately adapt to the physiologic stress of pregnancy may reveal the presence of genetic susceptibility to cardiovascular disease or accelerate the... (More)

The burden of pregnancy-related heart disease has dramatically increased over the last decades due to the increasing age at first pregnancy and higher prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. Pregnancy is associated with physiological changes in the cardiovascular system, including hemodynamic, metabolic, and hormonal adaptations to meet the increased metabolic demands of the mother and fetus. It has been postulated that pregnancy may act as a cardiovascular stress test to identify women at high risk for heart disease, where the inability to adequately adapt to the physiologic stress of pregnancy may reveal the presence of genetic susceptibility to cardiovascular disease or accelerate the phenotypic expression of both inherited and acquired heart diseases, such as peripartum cardiomyopathy (PPCM). PPCM is arare and incompletely understood clinical condition. Despite recent advances in the understanding of its pathogenesis, PPCM is not attributable to a well-defined pathological mechanism, and therefore, its diagnosis still relies on the exclusion of overlapping dilated phenotypes. Cardiac imaging plays a key role in any peripartum woman with signs and symptoms of heart failure in establishing the diagnosis, ruling out life-threatening complications, guiding therapy and conveying prognostic information. Echocardiography represents the first-line imaging technique, given its robust diagnostic yield and its favorable cost-effectiveness. Cardiovascular magnetic resonance is a biologically safe high-throughput modality that allows accurate morpho-functional assessment of the cardiovascular system in addition to the unique asset of myocardial tissue characterization as a pivotal piece of information in the pathophysiological puzzle of PPCM. In this review, we will highlight current evidence on the role of multimodality imaging in the differential diagnosis, prognostic assessment, and understanding of the pathophysiological basis of PPCM.

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type
Contribution to journal
publication status
published
subject
keywords
Cardiac magnetic resonance, Echocardiography, Heart failure, Peripartum cardiomyopathy, Pregnancy, Tissue characterization
in
Frontiers in Cardiovascular Medicine
volume
7
article number
4
publisher
Frontiers Media S. A.
external identifiers
  • scopus:85084592233
  • pmid:32133371
ISSN
2297-055X
DOI
10.3389/fcvm.2020.00004
language
English
LU publication?
yes
id
e3f15c72-a86e-4595-93c3-29375df77578
date added to LUP
2020-06-15 14:03:49
date last changed
2024-05-01 11:49:05
@article{e3f15c72-a86e-4595-93c3-29375df77578,
  abstract     = {{<p>The burden of pregnancy-related heart disease has dramatically increased over the last decades due to the increasing age at first pregnancy and higher prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. Pregnancy is associated with physiological changes in the cardiovascular system, including hemodynamic, metabolic, and hormonal adaptations to meet the increased metabolic demands of the mother and fetus. It has been postulated that pregnancy may act as a cardiovascular stress test to identify women at high risk for heart disease, where the inability to adequately adapt to the physiologic stress of pregnancy may reveal the presence of genetic susceptibility to cardiovascular disease or accelerate the phenotypic expression of both inherited and acquired heart diseases, such as peripartum cardiomyopathy (PPCM). PPCM is arare and incompletely understood clinical condition. Despite recent advances in the understanding of its pathogenesis, PPCM is not attributable to a well-defined pathological mechanism, and therefore, its diagnosis still relies on the exclusion of overlapping dilated phenotypes. Cardiac imaging plays a key role in any peripartum woman with signs and symptoms of heart failure in establishing the diagnosis, ruling out life-threatening complications, guiding therapy and conveying prognostic information. Echocardiography represents the first-line imaging technique, given its robust diagnostic yield and its favorable cost-effectiveness. Cardiovascular magnetic resonance is a biologically safe high-throughput modality that allows accurate morpho-functional assessment of the cardiovascular system in addition to the unique asset of myocardial tissue characterization as a pivotal piece of information in the pathophysiological puzzle of PPCM. In this review, we will highlight current evidence on the role of multimodality imaging in the differential diagnosis, prognostic assessment, and understanding of the pathophysiological basis of PPCM.</p>}},
  author       = {{Ricci, Fabrizio and De Innocentiis, Carlo and Verrengia, Elvira and Ceriello, Laura and Mantini, Cesare and Pietrangelo, Carla and Irsuti, Flaviano and Gabriele, Stefano and D'Alleva, Alberto and Khanji, Mohammed Y. and Aung, Nay and Renda, Giulia and Cameli, Matteo and Petersen, Steffen E. and Di Cesare, Ernesto and Gallina, Sabina}},
  issn         = {{2297-055X}},
  keywords     = {{Cardiac magnetic resonance; Echocardiography; Heart failure; Peripartum cardiomyopathy; Pregnancy; Tissue characterization}},
  language     = {{eng}},
  month        = {{02}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Cardiovascular Medicine}},
  title        = {{The role of multimodality cardiovascular imaging in peripartum cardiomyopathy}},
  url          = {{http://dx.doi.org/10.3389/fcvm.2020.00004}},
  doi          = {{10.3389/fcvm.2020.00004}},
  volume       = {{7}},
  year         = {{2020}},
}