1
|
Jimenez Y, Elzeneini M, Siddique NF, Vilaro J, Aranda J, Al-Ani M, Park K, Wen TS, Egerman RS, Jeng EI, Ahmed MM, Parker AM. Temporary mechanical support in the peripartum patient as a bridge to postpartum recovery: A report of three cases. Artif Organs 2024. [PMID: 39023289 DOI: 10.1111/aor.14832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 05/16/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024]
Abstract
Cardiogenic shock (CS) is a severe complication of peripartum cardiomyopathy (PPCM). Patients with deteriorating CS often require temporary mechanical circulatory support. In PPCM, this can be used as a bridge to postpartum recovery or bridge to decision. The outcomes are unclear, especially if prolonged utilization is required. We present a case series of three patients with PPCM in deteriorating CS who were successfully supported with a ventricular assist device or veno-arterial extracorporeal membrane oxygenation as a bridge to postpartum recovery.
Collapse
Affiliation(s)
- Yomary Jimenez
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Mohammed Elzeneini
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Nasir F Siddique
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Juan Vilaro
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Juan Aranda
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Mohammad Al-Ani
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Tony S Wen
- Division of Maternal-Fetal Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert S Egerman
- Division of Maternal-Fetal Medicine, University of Florida, Gainesville, Florida, USA
| | - Eric I Jeng
- Division of Cardiothoracic Surgery, University of Florida, Gainesville, Florida, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| | - Alex M Parker
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Rosano GMC, Stolfo D, Anderson L, Abdelhamid M, Adamo M, Bauersachs J, Bayes-Genis A, Böhm M, Chioncel O, Filippatos G, Hill L, Lainscak M, Lambrinou E, Maas AHEM, Massouh AR, Moura B, Petrie MC, Rakisheva A, Ray R, Savarese G, Skouri H, Van Linthout S, Vitale C, Volterrani M, Metra M, Coats AJS. Differences in presentation, diagnosis and management of heart failure in women. A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024. [PMID: 38783694 DOI: 10.1002/ejhf.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
Despite the progress in the care of individuals with heart failure (HF), important sex disparities in knowledge and management remain, covering all the aspects of the syndrome, from aetiology and pathophysiology to treatment. Important distinctions in phenotypic presentation are widely known, but the mechanisms behind these differences are only partially defined. The impact of sex-specific conditions in the predisposition to HF has gained progressive interest in the HF community. Under-recruitment of women in large randomized clinical trials has continued in the more recent studies despite epidemiological data no longer reporting any substantial difference in the lifetime risk and prognosis between sexes. Target dose of medications and criteria for device eligibility are derived from studies with a large predominance of men, whereas specific information in women is lacking. The present scientific statement encompasses the whole scenario of available evidence on sex-disparities in HF and aims to define the most challenging and urgent residual gaps in the evidence for the scientific and clinical HF communities.
Collapse
Affiliation(s)
- Giuseppe M C Rosano
- Chair of Pharmacology, Department of Human Sciences and Promotion of Quality of Life, San Raffaele University of Rome, Rome, Italy
- Cardiology, San Raffaele Cassino Hospital, Cassino, Italy
| | - Davide Stolfo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Anderson
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Magdy Abdelhamid
- Department of Cardiovascular Medicine, Faculty of Medicine, Kasr Al Ainy, Cairo University, Giza, Egypt
| | - Marianna Adamo
- ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Poujol, CIBERCV, Badalona, Spain
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany
| | - Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest, Romania
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Gerasimos Filippatos
- National & Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Chaidari, Greece
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Rakičan, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela R Massouh
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Amina Rakisheva
- City Cardiological Center, Almaty Kazakhstan Qonaev city hospital, Almaty Region, Kazakhstan
| | - Robin Ray
- Department of Cardiology, St George's Hospital, London, UK
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Hadi Skouri
- Division of Cardiology, Sheikh Shakhbout Medical city, Abu Dhabi, UAE
| | - Sophie Van Linthout
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | | | - Maurizio Volterrani
- Department of Human Science and Promotion of Quality of Life, San Raffaele Open University, Rome, Italy
- Cardio-Pulmonary Department, IRCCS San Raffaele, Rome, Italy
| | - Marco Metra
- ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | |
Collapse
|
3
|
Pillai AA, Badr M, Mai X, Dilip A, Bell J. One Pump for Two Hearts: Using an Impella 5.5 Micro-Axial Pump in Peripartum Cardiogenic Shock. ASAIO J 2024:00002480-990000000-00472. [PMID: 38635520 DOI: 10.1097/mat.0000000000002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Cardiogenic shock (CS) occurs infrequently in pregnancy and has a high mortality rate. Medical treatment options are few, with limited evidence of efficacy. Temporary mechanical circulatory supports (tMCS) may play a key role in addressing this therapeutic lacuna. We report successfully managing second-trimester CS using an Impella 5.5 micro-axial pump. Our patient presented in the second-trimester with CS. Hemodynamic parameters indicated biventricular dysfunction (low cardiac index, low pulmonary artery pulsatility index). She received diuresis and inotropic support to optimize her fluid status and cardiac function. However, failure to improve to the point where she would be able to tolerate the hemodynamic stresses of labor despite optimizing medical therapy prompted consideration of tMCS. The Impella 5.5 was chosen for its higher output (to maximize fetal perfusion), relative longevity, and lower hemolysis rates compared to other devices. It was used to support her from gestational weeks 28-30 and through the delivery. Support was continued for 4 weeks postpartum to allow for any potential cardiac recovery. Hope unrealized, a workup for destination therapy was initiated. Patient preference and high panel reactive antibodies informed the decision to pursue destination left ventricular assist device (LVAD) therapy. After a 3 month neonatal intensive care unit (NICU) stay, mother and baby were successfully discharged home.
Collapse
Affiliation(s)
- Ashwin A Pillai
- From the Department of Medicine, University of Connecticut, Farmington, Connecticut
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Mai Badr
- From the Department of Medicine, University of Connecticut, Farmington, Connecticut
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Xingchen Mai
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Anum Dilip
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Jennifer Bell
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| |
Collapse
|
4
|
Lau ES, Aggarwal NR, Briller JE, Crousillat DR, Economy KE, Harrington CM, Lindley KJ, Malhamé I, Mattina DJ, Meng ML, Mohammed SF, Quesada O, Scott NS. Recommendations for the Management of High-Risk Cardiac Delivery: ACC Cardiovascular Disease in Women Committee Panel. JACC. ADVANCES 2024; 3:100901. [PMID: 38939671 PMCID: PMC11198580 DOI: 10.1016/j.jacadv.2024.100901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/28/2023] [Accepted: 01/30/2024] [Indexed: 06/29/2024]
Abstract
Maternal mortality is a major public health crisis in the United States. Cardiovascular disease (CVD) is a leading cause of maternal mortality and morbidity. Labor and delivery is a vulnerable time for pregnant individuals with CVD but there is significant heterogeneity in the management of labor and delivery in high-risk patients due in part to paucity of high-quality randomized data. The authors have convened a multidisciplinary panel of cardio-obstetrics experts including cardiologists, obstetricians and maternal fetal medicine physicians, critical care physicians, and anesthesiologists to provide a practical approach to the management of labor and delivery in high-risk individuals with CVD. This expert panel will review key elements of management from mode, timing, and location of delivery to use of invasive monitoring, cardiac devices, and mechanical circulatory support.
Collapse
Affiliation(s)
- Emily S. Lau
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Niti R. Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Joan E. Briller
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniela R. Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Katherine E. Economy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Colleen M. Harrington
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn J. Lindley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Deirdre J. Mattina
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marie-Louise Meng
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Selma F. Mohammed
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Odayme Quesada
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
| | - Nandita S. Scott
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - ACC Cardiovascular Disease in Women Committee
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
- Division of Cardiology, Department of Medicine, Obstetrics, and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
- Division of Cardiovascular Sciences, Department of Medicine, Obstetrics, and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
- Women’s Heart Center, The Carl and Edyth Lindner Center for Research & Education, The Christ Hospital Network Heart & Vascular Institute, Cincinnati, Ohio, USA
| |
Collapse
|
5
|
Afari H, Sheehan M, Reza N. Contemporary Management of Cardiomyopathy and Heart Failure in Pregnancy. Cardiol Ther 2024; 13:17-37. [PMID: 38340291 PMCID: PMC10899150 DOI: 10.1007/s40119-024-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
Cardiovascular disease is the primary cause of pregnancy-related mortality and morbidity in the United States, and maternal mortality has increased over the last decade. Pregnancy and the postpartum period are associated with significant vascular, metabolic, and physiologic adaptations that can unmask new heart failure or exacerbate heart failure symptoms in women with known underlying cardiomyopathy. There are unique management considerations for heart failure in women throughout pregnancy, and it is imperative that clinicians caring for pregnant women understand these important principles. Early involvement of multidisciplinary cardio-obstetrics teams is key to optimizing maternal and fetal outcomes. In this review, we discuss the unique challenges and opportunities in the diagnosis of heart failure in pregnancy, management principles along the continuum of pregnancy, and the safety of heart failure therapies during and after pregnancy.
Collapse
Affiliation(s)
- Henrietta Afari
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11Th Floor South Pavilion, Philadelphia, PA, 19104, USA
| | - Megan Sheehan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 11Th Floor South Pavilion, Philadelphia, PA, 19104, USA.
| |
Collapse
|
6
|
O'Kelly AC, Sarma A, Naoum E, Easter SR, Economy K, Ludmir J. Cardiogenic Shock and Utilization of Mechanical Circulatory Support in Pregnancy. J Intensive Care Med 2024:8850666231225606. [PMID: 38204193 DOI: 10.1177/08850666231225606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Maternal mortality rates are rising in the United States, a trend which is in contrast to that seen in other high-income nations. Cardiovascular disease and hypertensive disorders of pregnancy are consistently the leading causes of maternal mortality both in the United States and globally, accounting for about one-quarter to one-third of maternal and peripartum deaths. A large proportion of cardiovascular morbidity and mortality stems from acquired disease in the context of cardiovascular risk factors, which include obesity, pre-existing diabetes and hypertension, and inequities in care from maternal care deserts and structural racism. Patients may also become pregnant with preexisting structural heart disease, or acquire disease throughout pregnancy (ex: spontaneous coronary artery dissection, peripartum cardiomyopathy), and be at higher risk of pregnancy-related cardiovascular complications. While risk-stratification tools including the modified World Health Organization (mWHO) classification, Cardiac Disease in Pregnancy (CARPREG II) and Zwangerschap bij Aangeboren HARtAfwijking/Pregnancy in Women with Congenital Heart Disease (ZAHARA) have been designed to help physicians identify patients at increased risk for adverse pregnancy outcomes and who may therefore benefit from referral to a tertiary care center, the limitation of these scores is their predominant focus on patients with known preexisting heart disease. As such, identifying patients at risk for pregnancy complications presents a significant challenge, and it is often patients with high-risk cardiovascular substrates prior to or during pregnancy who are at a highest risk for adverse pregnancy outcomes including cardiogenic shock.
Collapse
Affiliation(s)
- Anna C O'Kelly
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amy Sarma
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Naoum
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Katherine Economy
- Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Ludmir
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
7
|
Botti G, Thirunavukarasu S, Ziviello F, Chieffo A. Peripartum Cardiogenic Shock and Mechanical Circulatory Support. Interv Cardiol 2023; 18:e28. [PMID: 38213746 PMCID: PMC10782424 DOI: 10.15420/icr.2020.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 10/08/2023] [Indexed: 01/13/2024] Open
Abstract
Despite remarkable improvements in the past two decades, the annual cardiovascular mortality rate has remained higher for women than for men. Pregnant women represent an underinvestigated population in clinical research, and the mechanisms of long-term cardiovascular complications in women with obstetric complications remain to be elucidated. Regarding advanced heart failure during pregnancy, interventional approaches are effective but still underutilised. Percutaneous mechanical circulatory support is a valuable option for peripartum cardiogenic shock, although its use during pregnancy is still limited. Survival rates have improved in recent years, but further emphasis on the importance of early recognition and initiation of heart failure treatment in this patient group is warranted. The aims of this review are to summarise the current literature on the implementation of mechanical circulatory support in cardiogenic shock during pregnancy and delivery and to understand the role of percutaneous ventricular assist devices in the management of such conditions.
Collapse
Affiliation(s)
- Giulia Botti
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
- Vita Salute San Raffaele UniversityMilan, Italy
| | | | - Francesca Ziviello
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific InstituteMilan, Italy
- Vita Salute San Raffaele UniversityMilan, Italy
| |
Collapse
|
8
|
Oliveros E, Saldarriaga Giraldo CI, Hall J, Tinuoye E, Rodriguez MJ, Gallego C, Contreras JP. Addressing Barriers for Women with Advanced Heart Failure. Curr Cardiol Rep 2023; 25:1257-1267. [PMID: 37698818 DOI: 10.1007/s11886-023-01946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Describe disparities in diagnosis and management between men and women with advanced heart failure (HF). Our goal is to identify barriers and suggest solutions. RECENT FINDINGS Women with advanced HF are less likely to undergo diagnostic testing and procedures (i.e., revascularization, implantable cardioverter defibrillators, cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplantation). Disparities related to gender create less favorable outcomes for women with advanced HF. The issues arise from access to care, paucity of knowledge, enrollment in clinical trials, and eligibility for advanced therapies. In this review, we propose a call to action to level the playing field in order to improve survival in women with advanced HF.
Collapse
Affiliation(s)
- Estefania Oliveros
- Heart and Vascular Institute, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19444, USA.
| | | | - Jillian Hall
- Heart and Vascular Institute, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19444, USA
| | - Elizabeth Tinuoye
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | | | - Catalina Gallego
- Pontificia Bolivariana, University of Antioquia, Cardiovid Clinic, Medellin, Colombia
| | | |
Collapse
|
9
|
Vogel B, Tycinska A, Sambola A. Cardiogenic shock in women - A review and call to action. Int J Cardiol 2023; 386:98-103. [PMID: 37211458 DOI: 10.1016/j.ijcard.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Antonia Sambola
- Acute Cardiac Care Unit, Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
| |
Collapse
|
10
|
Zahid S, Agrawal A, Rai D, Khan MZ, Michos ED. Cardiovascular Complications Associated With COVID-19 During Delivery Hospitalizations in Pandemic Year 2020. JACC. ADVANCES 2023; 2:100386. [PMID: 38938230 PMCID: PMC11198635 DOI: 10.1016/j.jacadv.2023.100386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2024]
Abstract
Background Persons with COVID-19 infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular (CV) complications during delivery admissions remain limited. Objectives The purpose of this study was to determine whether pregnant individuals with COVID-19 have an increased risk of acute peripartum CV complications during their delivery admission. Methods This population-based retrospective cohort study used the 2020 National Inpatient Sample database. The International Classification of Diseases, 10th Revision codes were used to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was performed to determine the association between COVID-19 and acute peripartum CV complications at delivery. Results A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n = 46,375). Persons with COVID-19 were younger (median 28 vs 29 years, P < 0.01) and had a higher prevalence of gestational diabetes mellitus, preterm births, and Cesarean delivery (P < 0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, COVID-19 remained independently associated with peripartum CV complications including preeclampsia (adjusted odds ratio [aOR]: 1.33 [95% CI, 1.29-1.37]), peripartum cardiomyopathy (aOR: 2.09 [1.54-2.84]), acute coronary syndrome (aOR: 12.94 [8.85-18.90]), and arrhythmias (aOR: 1.55 [1.45-1.67]), compared with no COVID-19. Likewise, the risks of in-hospital mortality, acute kidney injury, stroke, pulmonary edema, and venous thromboembolism were higher with COVID-19. For resource utilization, the cost of hospitalization ($5,374 vs $4,837, P < 0.01) was higher for deliveries among persons with COVID-19. Conclusions In the year 2020, pregnant persons with COVID-19 had a higher risk of preeclampsia, in-hospital mortality, and other serious CV complication during delivery hospitalizations compared to pregnant individuals without COVID-19.
Collapse
Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Ankit Agrawal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Devesh Rai
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad Zia Khan
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
11
|
Tapaskar N, Tremblay-Gravel M, Khush KK. Contemporary Management of Cardiogenic Shock During Pregnancy. J Card Fail 2023; 29:193-209. [PMID: 36243342 DOI: 10.1016/j.cardfail.2022.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Cardiogenic shock is the most extreme cardiovascular disease state during pregnancy. Peripartum cardiomyopathy is the most common cause of cardiogenic shock toward the end of pregnancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity and ventricular predominance, which are critical in the appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pumps, percutaneous left ventricular assist devices and venoarterial extracorporeal circulatory devices have been successfully used in pregnancy and the postpartum period. The most commonly used mechanical therapy in the pregnant patient is extracorporeal membranous oxygenation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival rates in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peripartum period are needed.
Collapse
Affiliation(s)
- Natalie Tapaskar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | | | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
12
|
Pfeffer TJ, König T, Berliner D, Bauersachs J. [Peripartum Cardiomyopathy]. Dtsch Med Wochenschr 2022; 147:1537-1544. [PMID: 36384155 DOI: 10.1055/a-1810-9318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery in previously heart-healthy women. PPCM patients typically present with heart failure due to left ventricular (LV) dysfunction with an LV ejection fraction (EF) < 45 %. In the last years clinical and experimental studies contributed to a better understanding of the pathophysiology and the clinical course of PPCM. In the context of oxidative stress, the nursing hormone prolactin is cleaved into a smaller antiangiogenic and proapoptotic 16k Da form, leading to myocardial dysfunction. In an animal model this can be prevented by treatment with the dopamine agonist bromocriptine, which suppresses prolactin release. This therapeutic approach was confirmed in several clinical studies. Therefore, the current guidelines recommend a treatment consisting of a heart failure treatment according to current guidelines in combination with the dopamine agonist bromocriptine. If the diagnosis is made early and the treatment is started immediately, the prognosis is good compared to other forms of cardiomyopathies, as LV function recovers in most cases.In the acute phase the severity of heart failure differs among PPCM patients. Some patients present with mild forms, whereas some PPCM patients display severely reduced LV function and cardiogenic shock. Especially the latter cases are still challenging, as treatment with β1-adrenergic receptor agonists is associated with progression of heart failure and a worse cardiac outcome. Therefore, patients with cardiogenic shock complicating PPCM should be treated in centers experienced in mechanical circulatory support in combination with bromocriptine treatment.
Collapse
|
13
|
Briller JE, Aggarwal NR, Davis MB, Hameed AB, Malhamé I, Mahmoud Z, McDonald EG, Moraes de Oliveira G, Quesada O, Scott NS, Sharma J. Cardiovascular Complications of Pregnancy-Associated COVID-19 Infections. JACC: ADVANCES 2022; 1:100057. [PMID: 35967591 PMCID: PMC9364954 DOI: 10.1016/j.jacadv.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
|
14
|
Sex Differences in Cardiomyopathy. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
O’Kelly AC, Ludmir J, Wood MJ. Acute Coronary Syndrome in Pregnancy and the Post-Partum Period. J Cardiovasc Dev Dis 2022; 9:jcdd9070198. [PMID: 35877560 PMCID: PMC9319853 DOI: 10.3390/jcdd9070198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease is the leading cause of maternal mortality in the United States. Acute coronary syndrome (ACS) is more common in pregnant women than in non-pregnant controls and contributes to the burden of maternal mortality. This review highlights numerous etiologies of chest discomfort during pregnancy, as well as risk factors and causes of ACS during pregnancy. It focuses on the evaluation and management of ACS during pregnancy and the post-partum period, including considerations when deciding between invasive and non-invasive ischemic evaluations. It also focuses specifically on the management of post-myocardial infarction complications, including shock, and outlines the role of mechanical circulatory support, including veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Finally, it offers additional recommendations for navigating delivery in women who experienced pregnancy-associated myocardial infarction and considerations for the post-partum patient who develops ACS.
Collapse
|
16
|
DeFilippis EM, Beale A, Martin T, Agarwal A, Elkayam U, Lam CSP, Hsich E. Heart Failure Subtypes and Cardiomyopathies in Women. Circ Res 2022; 130:436-454. [PMID: 35175847 PMCID: PMC10361647 DOI: 10.1161/circresaha.121.319900] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure affects over 2.6 million women and 3.4 million men in the United States with known sex differences in epidemiology, management, response to treatment, and outcomes across a wide spectrum of cardiomyopathies that include peripartum cardiomyopathy, hypertrophic cardiomyopathy, stress cardiomyopathy, cardiac amyloidosis, and sarcoidosis. Some of these sex-specific considerations are driven by the cellular effects of sex hormones on the renin-angiotensin-aldosterone system, endothelial response to injury, vascular aging, and left ventricular remodeling. Other sex differences are perpetuated by implicit bias leading to undertreatment and underrepresentation in clinical trials. The goal of this narrative review is to comprehensively examine the existing literature over the last decade regarding sex differences in various heart failure syndromes from pathophysiological insights to clinical practice.
Collapse
Affiliation(s)
| | - Anna Beale
- Department of Cardiology, Alfred Hospital, Melbourne, Australia (A.B.)
| | - Trejeeve Martin
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
| | - Anubha Agarwal
- Northwestern University Feinberg School of Medicine (A.A.)
| | - Uri Elkayam
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California (U.E.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Eileen Hsich
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
| |
Collapse
|
17
|
Upadhyay R, Alrayes H, Arno S, Kaushik M, Basir MB. Current Landscape of Temporary Percutaneous Mechanical Circulatory Support Technology. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2021.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mechanical circulatory support devices provide hemodynamic support to patients who present with cardiogenic shock. These devices work using different mechanisms to provide univentricular or biventricular support. There is a growing body of evidence supporting use of these devices as a goal for cardiac recovery or as a bridge to definitive therapy, but definitive, well-powered studies are still needed. Mechanical circulatory support devices are increasingly used using shock team and protocols, which can help clinicians in decision making, balancing operator and institutional experience and expertise. The aim of this article is to review commercially available mechanical circulatory support devices, their profiles and mechanisms of action, and the evidence available regarding their use.
Collapse
Affiliation(s)
- Rani Upadhyay
- Section of Interventional Cardiology, Stanford Health Care, Oakland, CA
| | | | - Scott Arno
- Division of Cardiology, Henry Ford Hospital, Detroit, MI
| | | | - Mir B Basir
- Division of Cardiology, Henry Ford Hospital, Detroit, MI
| |
Collapse
|
18
|
Benson B, Theret P, Tonini F, Marang A, Sergent F, Gondry J, Foulon A. [Peripartum cardiomyopathy: A review of the literature]. ACTA ACUST UNITED AC 2021; 50:266-271. [PMID: 34481099 DOI: 10.1016/j.gofs.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.
Collapse
Affiliation(s)
- B Benson
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - P Theret
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Service de gynécologie-obstétrique, centre hospitalier de Saint-Quentin, 1, avenue Michel-de-l'Hospital, BP 608, 02321 Saint-Quentin, France
| | - F Tonini
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - A Marang
- Service de cardiologie, centre hospitalier régional universitaire Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - F Sergent
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France.
| |
Collapse
|
19
|
Abstract
Heart failure (HF) remains the most common major cardiovascular complication arising in pregnancy and the postpartum period. Mothers who develop HF have been shown to experience an increased risk of death as well as a variety of adverse cardiac and obstetric outcomes. Recent studies have demonstrated that the risk to neonates is significant, with increased risks in perinatal morbidity and mortality, low Apgar scores, and prolonged neonatal intensive care unit stays. Information on the causal factors of HF can be used to predict risk and understand timing of onset, mortality, and morbidity. A variety of modifiable, nonmodifiable, and obstetric risk factors as well as comorbidities are known to increase a patient's likelihood of developing HF, and there are additional elements that are known to portend a poorer prognosis beyond the HF diagnosis. Multidisciplinary cardio‐obstetric teams are becoming more prominent, and their existence will both benefit patients through direct care and increased awareness and educate clinicians and trainees on this patient population. Detection, access to care, insurance barriers to extended postpartum follow‐up, and timely patient counseling are all areas where care for these women can be improved. Further data on maternal and fetal outcomes are necessary, with the formation of State Maternal Perinatal Quality Collaboratives paving the way for such advances.
Collapse
Affiliation(s)
- Rachel A Bright
- Division of Cardiovascular Medicine Department of Medicine State University of New YorkStony Brook University Medical CenterRenaissance School of Medicine Stony Brook NY
| | - Fabio V Lima
- Division of Cardiology Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute Providence RI
| | - Cecilia Avila
- Department of Obstetrics, Gynecology and Reproductive Medicine Stony Brook University Medical Center Stony Brook NY
| | - Javed Butler
- Department of Medicine University of Mississippi Jackson MS
| | | |
Collapse
|
20
|
Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 497] [Impact Index Per Article: 165.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
Collapse
Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
21
|
Abstract
Peripartum cardiomyopathy is a form of idiopathic systolic heart failure which occurs during the end of pregnancy or the early post-partum in the absence of an identifiable etiology. The exact pathogenesis remains unknown, and the incidence is higher in African ancestry, multiparous and hypertensive women, or older maternal age. Delay in diagnosis is common, mainly because symptoms of heart failure mimic those of normal pregnancy. Echocardiography showing decreased myocardial function is at the center of the diagnosis. Management relies on the general guidelines of management of other forms of non-ischemic cardiomyopathy; however, special attention should be paid when choosing medications to ensure fetal safety. Outcomes can be variable and can range from complete recovery to persistent heart failure requiring transplant or even death. High rates of relapse with subsequent pregnancies can occur, especially with incomplete myocardial recovery. Additional research about the etiology, experimental drugs, prognosis, and duration of treatment after recovery are needed.
Collapse
|
22
|
|
23
|
Pfeffer TJ, List M, Müller JH, Scherr M, Bauersachs J, Hilfiker-Kleiner D, Ricke-Hoch M. Perhexiline treatment improves toxic effects of β-adrenergic receptor stimulation in experimental peripartum cardiomyopathy. ESC Heart Fail 2021; 8:3375-3381. [PMID: 34002539 PMCID: PMC8318439 DOI: 10.1002/ehf2.13412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 01/13/2023] Open
Abstract
Aims Peripartum cardiomyopathy (PPCM) is a pregnancy‐associated cardiomyopathy that occurs in previously heart‐healthy women towards the end of pregnancy or in the first months after delivery and is characterized by heart failure due to systolic dysfunction. The clinical course of PPCM differs between mild symptoms and severe forms with acute heart failure complicated by cardiogenic shock (CS). Treatment of CS complicating PPCM is challenging, as β‐adrenergic receptor (β‐AR) stimulation seems to be associated with progression of heart failure and adverse outcome. This experimental study aims to examine whether postpartum treatment with the glucose uptake‐promoting drug perhexiline alone or as co‐treatment with β‐AR stimulation prevents heart failure in the experimental PPCM mouse model. Methods and results Postpartum (PP) female PPCM‐prone mice with a cardiomyocyte‐restricted STAT3‐deficiency (αMHC‐Cretg/+;Stat3fl/fl; CKO) were treated with perhexiline over two to three pregnancies and nursing periods (2/3PP) or were co‐treated with perhexiline after one pregnancy (1PP) under chronic β‐AR stimulation using isoproterenol (Iso) infusion. Perhexiline was not able to prevent onset of PPCM in CKO mice (FS: CKO Pexsig‐2/3PP: 25 ± 12% vs. CKO Ctrl‐2/3PP: 24 ± 9%, n.s.) but attenuated worsening of left ventricular function in response to treatment with the β‐AR agonist Iso (FS: CKO Pexsig‐Iso‐1PP: 19 ± 4% vs. CKO Ctrl‐Iso‐1PP: 11 ± 5%, P < 0.05). Conclusions Treatment of PPCM patients with β‐AR agonists should be avoided whenever possible. In cases with CS complicating PPCM, when treatment with β‐AR agonists cannot be prevented, co‐medication with perhexiline might help to reduce the cardiotoxic side effects of β‐AR stimulation. Clinical data are necessary to further validate this therapeutic approach.
Collapse
Affiliation(s)
- Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Manuel List
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Julia H Müller
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Michaela Scherr
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiovascular Complications of Oncologic Therapies, Medical Faculty, Philipps University Marburg, Marburg, Germany
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
24
|
Djordjevic I, Merkle J, Eghbalzadeh K, Sabashnikov A, Ivanov B, Gummert J, Potapov E, Schoenrath F, Meyns B, Özbaran M, de By TMMH, Wahlers T, Zeriouh M, Rahmanian PB. The outcome of patients with peripartum cardiomyopathy and consecutive implantation of a left ventricular assist device. J Card Surg 2021; 36:2651-2657. [PMID: 33960521 DOI: 10.1111/jocs.15598] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/03/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure occurring toward the end of pregnancy or in the period after delivery. Lack of myocardial recovery or therapy-refractory cardiogenic shock are rare complications and left ventricular assist device (LVAD) systems might be used as a life-saving option. The aim of this study was to investigate outcomes of PPCM patients supported with LVAD, registered in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). METHODS All patients registered in EUROMACS with a primary diagnosis of PPCM were included in this study. Demographic, preoperative, intraoperative, postoperative, and follow-up data were collected and patients analysed concerning their outcome after initiation of LVAD therapy. RESULTS Between May 2011 and September 2018, 16 patients with PPCM and consecutive LVAD implantation were enrolled into EUROMACS. The median age of the patient population was 31 (26;41) years with a mean left ventricular ejection fraction (LV-EF) of 15% ± 6%. In-hospital mortality after LVAD implantation was 6% (n = 1). One-year mortality accounted for 13% (n = 2). Six patients (40%) were transplanted with a median support time of 769 (193;1529) days. Weaning of LVAD support due to ventricular recovery was feasible in 3 (20%) patients. CONCLUSION In patients with severe PPCM, LVAD therapy is associated with considerably low in-hospital mortality, potentially allowing bridging to heart transplantation, or left ventricular recovery. Therefore, durable mechanical support should be considered as a treatment option in this, by nature, young and often otherwise healthy patient population.
Collapse
Affiliation(s)
- Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Borko Ivanov
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre, Berlin, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - Mustafa Özbaran
- Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
| | - Theo M M H de By
- European Registry for Patients with Mechanical Circulatory Support (EUROMACS), European Association of Cardiothoracic Surgery (EACTS), Windsor, UK
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| | - Mohamed Zeriouh
- Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Heart Centre Cologne, University Hospital Cologne, Cologne, Germany
| |
Collapse
|
25
|
Abstract
Abstract
Left ventricular assist device (LVAD) has emerged as a safe, durable, and revolutionary therapy for end-stage heart failure patients. Despite the appearance of newer-generation devices that have improved patient outcomes, the burden of adverse events remains significant. Although the survival rate for patients with LVAD is appreciated to be 81% at 1 year and 70% at 2 years, the incidence of adverse events is also high. Over time, both early and late postimplant complications have diminished in terms of prevalence and impact; however, complications, such as infections, bleeding, right heart failure, pump thrombosis, aortic insufficiency, or stroke, continue to represent a challenge for the practitioner. Therefore, the aim of this review is to highlight the most recent data regarding the current use of LVAD in the treatment of end-stage heart failure, with a specific focus on LVAD-related complications, in order to improve device-related outcomes. It will also revise how to mitigate the risk and how to approach specific adverse events. Withal, understanding the predisposing risk factors associated with postimplant complications, early recognition and appropriate treatment help to significantly improve the prognosis for patients with end-stage heart failure.
Collapse
|
26
|
Abstract
The cardiomyopathies are a diverse group of disorders characterized by structural abnormalities of heart muscle, many of which have a genetic component. They are associated with substantial morbidity and mortality in pregnancy. We review the distinct forms of cardiomyopathy (dilated, hypertrophic, and functional) which can be seen during pregnancy, discuss complications associated with each distinct group such as heart failure, arrhythmias, and transmission to offspring, and address management strategies for stable and unstable patients.
Collapse
|
27
|
Abstract
Care of the critically ill pregnant patient is anxiety-provoking for those unprepared, as the emergency physician must consider not only the welfare of the immediate patient, but of the fetus as well. Familiarity with the physiologic changes of pregnancy and how they affect clinical presentation and management is key. Although some medications may be safer in pregnancy than others, stabilizing the pregnant patient is paramount. Emergency physicians should target pregnancy-specific oxygen and ventilation goals and hemodynamics and should be prepared to perform a perimortem cesarean section, should the mother lose pulses, to increase chances for maternal and fetal survival.
Collapse
Affiliation(s)
- Kami M Hu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA; Department of Internal Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Aleta S Hong
- Department of Internal Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/hong_aleta
| |
Collapse
|
28
|
Alasnag M, Truesdell AG, Williams H, Martinez SC, Qadri SK, Skendelas JP, Jakobleff WA, Alasnag M. Mechanical Circulatory Support: a Comprehensive Review With a Focus on Women. Curr Atheroscler Rep 2020; 22:11. [DOI: 10.1007/s11883-020-0828-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
29
|
Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 75:207-221. [DOI: 10.1016/j.jacc.2019.11.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 01/13/2023]
|
30
|
Elkayam U, Schäfer A, Chieffo A, Lansky A, Hall S, Arany Z, Grines C. Use of Impella heart pump for management of women with peripartum cardiogenic shock. Clin Cardiol 2019; 42:974-981. [PMID: 31436333 PMCID: PMC6788473 DOI: 10.1002/clc.23249] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 12/26/2022] Open
Abstract
Background Percutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited. Objective To assess outcomes in women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry. Methods and Results A total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ± 7.34 years, eight women were Caucasian, and seven were African‐American. The occurrence of PPCM was post‐delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ± 6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno‐arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD). Conclusion MCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.
Collapse
Affiliation(s)
- Uri Elkayam
- University of Southern California, Los Angeles, California
| | | | | | | | | | - Zoltan Arany
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|