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. 2018 Aug 2;20(1):52.
doi: 10.1186/s12968-018-0476-5.

Myocardial tissue characterization and strain analysis in healthy pregnant women using cardiovascular magnetic resonance native T1 mapping and feature tracking technique

Masafumi Nii  1 , Masaki Ishida  2 , Kaoru Dohi  3 , Hiroaki Tanaka  4 , Eiji Kondo  4 , Masaaki Ito  3 , Hajime Sakuma  2 , Tomoaki Ikeda  4
Affiliations

Myocardial tissue characterization and strain analysis in healthy pregnant women using cardiovascular magnetic resonance native T1 mapping and feature tracking technique

Masafumi Nii et al. J Cardiovasc Magn Reson. .

Abstract

Background: Peripartum cardiomyopathy is a life-threatening condition that occurs during the peripartum period in previously healthy women. Cardiovascular magnetic resonance (CMR) T1 mapping permits sensitive detection of tissue edema and fibrosis, and it may be useful in identifying altered myocardial tissue characteristics in peripartum cardiomyopathy. However, left ventricular (LV) volumes and mass increase considerably even in normal pregnancy, and it is not known whether altered tissue characteristics can be found in normal pregnancy. The aim of this study was to investigate whether the LV remodeling observed in normal pregnancy is associated with altered tissue characteristics determined by CMR.

Methods: Twelve normal pregnant women and 15 non pregnant women underwent cine CMR and myocardial T1 measurement at 1.5 T. Pregnant women were scanned three times, in the 2nd and 3rd trimesters of pregnancy and at 1 month postpartum. LV volumes, LV mass (LVM), and global longitudinal strain (GLS) were analyzed by cine CMR. Native myocardial T1 was determined using modified Look-Locker inversion recovery (MOLLI) images.

Results: LV end-diastolic volume (EDV) was significantly greater in the 3rd trimester (126 ± 22 mL) than in non-pregnant women (108 ± 14 mL, p < 0.05). LVM was significantly greater in the 3rd trimester (88.7 ± 11.8 g) than at 1 month postpartum (70.0 ± 9.8 g, p < 0.05) and in non-pregnant women (66.3 ± 13.9 g, p < 0.05). Myocardial native T1 among the 2nd and 3rd trimesters, 1 month postpartum, and non-pregnant women were similar (1133 ± 55 ms, 1138 ± 86 ms, 1105 ± 45 ms, and 1129 ± 52 ms, respectively, p = 0.59) as were GLS (- 19.5 ± 1.8, - 19.7% ± 2.2, - 19.0% ± 2.0%, and - 19.3% ± 1.9%, respectively, p = 0.66).

Conclusions: LV remodeling during normal pregnancy is associated with myocardial hypertrophy, but not with edema or diffuse fibrosis of the myocardium or LV contractile dysfunction. These results observed in normal pregnancy will serve as an important basis for identifying myocardial abnormalities in patients with peripartum cardiomyopathy and other pregnancy-related myocardial diseases.

Keywords: Cardiac function; Cardiovascular magnetic resonance; Myocyte mass; Native myocardial T1 mapping; Peripartum cardiomyopathy; Pregnancy.

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Conflict of interest statement

This prospective study was conducted in accordance with the principles of the Declaration of Helsinki and with the approval of the Mie University Institutional Review Board at Mie University Hospital (2858, February 5, 2014). All women gave their written, informed consent prior to participation in this study. No studies involving animals were performed.

Written, informed consent was obtained from the patients for publication of their individual details and accompanying images in this manuscript. The consent form is held by the authors/the author’s institution and is available for review by the Editor-in-Chief.

Dr. Sakuma and Dr. Ishida received a departmental research grant from Fuji Pharma Co., Ltd., Daiichi Sankyo Co., Ltd., and FUJIFILM RI Pharma Co., Ltd.. Dr. Ito and Dr. Dohi received a departmental research grant from MSD K.K., Daiichi Sankyo Co, Ltd., Astellas Pharma Inc., Otsuka Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co, Ltd.. Dr. Sakuma received lecture fees from Bayer Yakuhin, Ltd. Dr. Ito received lecture fees from Daiichi Sankyo Co, Ltd., Mitsubishi Tanabe Pharma Corporation, and Bayer Yakuhin, Ltd. Dr. Dohi received lecture fees from Otsuka Pharmaceutical Co.. All other authors have no conflicts of interest to declare. No relevant conflicts of interest related to the article were disclosed by the authors.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Cine CMR in a representative pregnant woman with end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF) and left ventricular mass (LVM) of 132 mL, 69 mL, 48.0% and 106 g, respectively in the 2nd trimester, 136 mL, 60 mL, 55.8% and 95 g, respectively in the 3rd trimester, and 112 mL, 57 mL, 53.6% and 76 g, respectively at 1 month postpartum
Fig. 2
Fig. 2
Native T1 mapping using MOLLI in a representative pregnant woman, with a native T1 of 1206 ms in the 2nd trimester, 1025 ms in the 3rd trimester, and 1128 ms at 1 month postpartum
Fig. 3
Fig. 3
LVM by the stages of pregnancy in healthy pregnant women and in non-pregnant women. Mean LVM is 82.6 ± 18.2 g in the 2nd trimester, 88.7 ± 11.8 g in the 3rd trimester, 72.0 ± 9.8 g at 1 month postpartum, and 66.3 ± 13.9 g in non-pregnant women. *, P < 0.05
Fig. 4
Fig. 4
Peak global longitudinal strain (GLS) (%) in the LV and right ventricle (RV) in pregnant women and non-pregnant women. Neither the LV nor the RV GLS shows significant differences among the 2nd and 3rd trimesters, 1 month postpartum, and non-pregnant women
Fig. 5
Fig. 5
Native T1 determined using MOLLI. Change in the native T1 using MOLLI by the stage of pregnancy and in non-pregnant women. Native T1 shows no significant differences among the 2nd and 3rd trimesters, 1 month postpartum, and non-pregnant women
Fig. 6
Fig. 6
Association between LVM and native T1 during pregnancy and in non-pregnant women. N = number of samples, R = correlation efficient, P=P value
See this image and copyright information in PMC

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References

    1. Ersbøll AS, Damm P, Gustafsson F, Vejlstrup NG, Johansen M. Peripartum cardiomyopathy: a systematic literature review. Acta Obstet Gynecol Scand. 2016;95:1205–1219. doi: 10.1111/aogs.13005. - DOI - PubMed
    1. Kamiya CA, Yoshimatsu J, Ikeda T. Peripartum cardiomyopathy from a genetic perspective. Circ J. 2016;80:1684–1688. doi: 10.1253/circj.CJ-16-0342. - DOI - PubMed
    1. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Heart failure Association of the European Society of cardiology working group on Peripartum cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the heart failure Association of the European Society of cardiology working group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12:767–778. doi: 10.1093/eurjhf/hfq120. - DOI - PubMed
    1. Ducas RA, Elliott JE, Melnyk SF, Premecz S, daSilva M, Cleverley K, et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson. 2014;16:1. doi: 10.1186/1532-429X-16-1. - DOI - PMC - PubMed
    1. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG, Jr, Froelich JW, et al. ACR blue ribbon panel on MR safety. ACR guidance document for safe MR practices: 2007. ARJ Am J Roentgenol. 2007;188:1447–1474. doi: 10.2214/AJR.06.1616. - DOI - PubMed

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