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Elkattawy O, Sabra A, Patel S, Elkattawy S, Delorenzo J, Kumar N, Abdeen M, Elsamna H, Shamoon F. Ventricular Tachycardia in Patients With Peripartum Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events. Cureus 2024; 16:e56386. [PMID: 38633921 PMCID: PMC11022975 DOI: 10.7759/cureus.56386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction The purpose of this study was to determine the prevalence of ventricular tachycardia (VT) among patients admitted with peripartum cardiomyopathy (PPCM) as well as to analyze the independent association of VT with in-hospital outcomes among PPCM patients. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We assessed predictors of VT in patients admitted with PPCM. We also assessed the independent association of VT with clinical outcomes among patients admitted with PPCM. Results From 2016 to 2019, 4730 patients with PPCM were reported to the national inpatient sample database, 309 of which developed VT (6.5%). Using multivariate analysis, we found predictors of VT to include patient characteristics and factors such as age (adjusted OR (aOR)=1.020, p=0.023), chronic kidney disease (aOR=1.440, p=0.048), coagulopathy (aOR=1.964, p=0.006), and atrial fibrillation (aOR=3.965, p<0.001). Conversely, pre-eclampsia was significantly associated with a decreased risk of VT in PPCM patients (aOR=0.218, p=0.001). Conclusion In a large cohort of patients admitted with peripartum cardiomyopathy, we found the prevalence of VT to be 6.5%. Risk factors for VT in this patient population included conditions such as coagulopathy and atrial fibrillation.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University, New Jersey Medical School, Newark, USA
| | - Ahmed Sabra
- Internal Medicine, Rutgers University, New Jersey Medical School, Newark, USA
| | - Sanjna Patel
- Internal Medicine, Rutgers University, New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Julia Delorenzo
- Internal Medicine, Rutgers University, New Jersey Medical School, Newark, USA
| | - Navina Kumar
- Internal Medicine, Rutgers University, New Jersey Medical School, Newark, USA
| | - Mariam Abdeen
- Internal Medicine, Rowan University School of Osteopathic Medicine, Stratford, USA
| | - Hassan Elsamna
- College of Medicine, Rutgers University, New Brunswick, USA
| | - Fayez Shamoon
- Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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Altaher AM, Eid M, Moslem H, H.Ali A, Mustafa S, Foad AM. FNDC5 genetic polymorphism in patients with peripartum cardiomyopathy. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:66-75. [PMID: 38463931 PMCID: PMC10921118 DOI: 10.22088/cjim.15.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 03/12/2024]
Abstract
Background Late in pregnancy or soon after delivery, peripartum cardiomyopathy (PPCM) which is an uncommon type of cardiomyopathy, can develop. To assess the association between the level of irisin expression and (FNDC5) (rs3480) gene polymorphism with peripartum cardiomyopathy. Methods This is a case control study included a thirty female patients with new-onset PPCM and sixty healthy females at the at the peripartum period in same time window for PPCM as a control. For each patient, comprehensive medical history was taken, full clinical assessment was done, ECHO., FNDC5 (rs3480) & Irisin assay. Results The left ventricle end diastolic dimensions &left atrium diameters were statistically significant higher in patients' group than controls' group (P=0.000 for all), Also left ventricular ejection fraction (%) was statistically significant lower in patients than controls and as regards irisin, its Mean ±SD was lower in patient group than control group (8.44±1.1 vs 10.65±2.31) with (p <0.001) which is considered a significant difference statistically. Conclusion Irisin level was lower in peripartum cardiomyopathic patients when compared with normal individuals and regarding its genotype, the homotype A/A was higher than homotype G/G.
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Affiliation(s)
- Ali Mohamad Altaher
- Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Eid
- Department of Internal Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hesham Moslem
- Department of Clinical Pathology Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Amal H.Ali
- Department of Medical microbiology & Immunology, Faculty of Medicine, Aswan University, Sohag, Egypt
| | - Samar Mustafa
- Department Medical Biochemistry Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Amera Morad Foad
- Department Medical Biochemistry Faculty of Medicine, Sohag University, Sohag, Egypt
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Kamdem F, Nganou-Gnindjio CN, Ymele HK, Eboutibe POM, Djomou A, Léle ECB, Hamadou B, Mouliom S, Viché L, Ngoté H, Kenmegne C, Ebongue MSN, Djibrilla S, Essome H. Epidemiological features and mortality risk factors of peripartum cardiomyopathy in a group of Sub-Saharan African population. Ann Cardiol Angeiol (Paris) 2023; 72:101615. [PMID: 37348442 DOI: 10.1016/j.ancard.2023.101615] [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: 03/12/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure occurring during pregnancy. Its prevalence seems more frequent in Africa but its epidemiological, clinical and evolutionary particularities remain unknown. This study aimed to evaluate the epidemiological features and mortality risk factors of PPCM. MATERIAL AND METHOD We conducted a retrospective cross-sectional study over 38 months (January 2018 to March 2021) in 3 hospitals in the city of Douala(Cameroon). We included all patients with heart failure between the last month of pregnancy and 5 months after delivery without an identified cause. Were excluded, files not containing data on echocardiography, patients with heart failure without dilation or with LVEF≥ 45% and patients with a history of heart disease of known aetiology. Chi² tests and binary logistic regression were used for data analysis; the survival curve according to Kaplan Meier was drawn for the evolution. The threshold of significance was set at 0.05. RESULTS A total of 2102 medical records of women with heart failure were searched. In these records, a total of 59 patients showed signs of peripartum heart failure and only 29 fulfilled the inclusion criteria. From a socio-demographic point of view, the average age was 29 ± 7 years and 51.7% of patients were over 30 years old. Among these patients, 79.3% of patients lived in urban areas and 10.3% of patients had a low socio-economic level. The hospital frequency of PPCM was 1.3%. Clinically, primiparous and pauciparous women were the most affected; the diagnosis was made after more than a month of progression in 65.5% of patients. Dyspnea was present in all patients. In addition, 89.7% of patients had a left ventricular end-diastolic diameter ≥ 62 m, 48.3 % had a left ventricular ejection fraction (LVEF) between 30% and 45%, and 51.7% had an LVEF < 30%. The associated mortality rate was 27.7%. The only prognostic factor independently associated with mortality was age < 30 years. CONCLUSION The frequency of PPCM is relatively low in Cameroonian urban settings. Moreover, its diagnosis is generally delayed and it induces high mortality. Its occurrence in a woman under the age of 30 is a factor of poor prognosis.
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Affiliation(s)
- Félicité Kamdem
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | | | | | | | - Armel Djomou
- Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
| | | | - Ba Hamadou
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Sidick Mouliom
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | - Lade Viché
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Garoua, Cameroon
| | - Henri Ngoté
- Department of Internal Medicine, Douala General Hospital, Cameroon
| | | | - Marie Solange Ndom Ebongue
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
| | - Siddikatou Djibrilla
- Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon; Faculty of Health Sciences, University of Buea, Cameroon
| | - Henri Essome
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
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Koziol KJ, Aronow WS. Peripartum Cardiomyopathy: Current Understanding of Pathophysiology, Diagnostic Workup, Management, and Outcomes. Curr Probl Cardiol 2023; 48:101716. [PMID: 36972860 DOI: 10.1016/j.cpcardiol.2023.101716] [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: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
Peripartum cardiomyopathy (PPCM) is a relatively rare, potentially life-threatening, idiopathic form of cardiomyopathy that affects previously healthy young women during late pregnancy or in the early postpartum period and is characterized by left ventricular (LV) systolic dysfunction in the absence of any other identifiable cardiac causes. Morbidity and mortality with PPCM are remarkably high and it continues to be one of the leading causes of maternal death. Although remarkable advances have been made in our understanding of PPCM in the last few decades, unanswered questions remain regarding its pathophysiology, diagnostic workup, and management options. In this article, we will complete an updated, comprehensive review of PPCM, including the epidemiology and risk factors, proposed etiology, presentation and complications, management, prognostic indicators and outcomes. In addition, we will identify current challenges and gaps in knowledge.
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Affiliation(s)
- Klaudia J Koziol
- New York Medical College, School of Medicine, Valhalla, New York.
| | - Wilbert S Aronow
- New York Medical College, School of Medicine, Valhalla, New York; Department of Cardiology, Westchester Medical Center, Valhalla, NY.
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Zhang Z, Zheng W, Chen M, Xie Q, Huang M, Li W, Huang Z. A new risk score for the assessment of outcomes for Chinese patients with peripartum cardiomyopathy. Heart Lung 2023; 60:81-86. [PMID: 36933287 DOI: 10.1016/j.hrtlng.2023.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a potentially life-threatening complication of pregnancy, but identifying patients at higher risk of this condition remains difficult. OBJECTIVES We conducted a study to identify new risk factors associated with PPCM and predictors of poor outcomes. METHODS This retrospective analysis included a total of 44 women with PPCM. As a control group, 79 women who gave birth around the same time as the PPCM patients and who did not have organic disease were included. A multivariate regression analysis was conducted to identify risk factors associated with PPCM and with delayed recovery. RESULTS All PPCM patients were discharged within 28 days. In comparison to the control group, PPCM patients had higher rates of preeclampsia (20.4% vs. 1.27%, P<0.001), autoimmune disease (27.3% vs. 11.4%, P = 0.018), and cesarean delivery with preterm labor (31.8% vs. 17.7%, P = 0.037). The neonates of PPCM patients had lower birth weight (2.70±0.66 kg vs. 3.21±0.57 kg, P<0.001). PPCM patients had higher levels of C-reactive protein, d-dimer, brain natriuretic peptide (BNP), and serum phosphorus, but lower levels of albumin and serum calcium (all P<0.001). In all patients with PPCM, the left ventricular ejection fraction (LVEF) returned to normal (≥50%) within 28 days after admission. Subjects with early recovery (n = 34) had lower BNP than those with delayed recovery (n = 10) (649.7 ± 526.0 pg/mL vs. 1444.1 ± 1040.8 pg/mL, P = 0.002). Multivariate regression led to a three-point score system to predict PPCM (1 point each for the presence of pericardial effusion, left ventricular dilatation, and d-dimer level ≥0.5 μg/mL). At a cutoff of ≥2, this scoring system predicted delayed recovery with 95.5% sensitivity and 96.1% specificity. The negative predictive value was 97.4% and the positive predictive value was 93.3%. Binary logistic regression indicated that PPCM patients with pulmonary hypertension, lower hemoglobin, or worse LVEF tended to require longer hospital stay (minimum 14 days). CONCLUSIONS A risk score that consists of pericardial effusion, left ventricular dilatation, and d-dimer level ≥ 0.5 μg/mL could help streamline the diagnosis of PPCM prior to confirmatory investigations. Moreover, a risk score that consists of pulmonary hypertension, lower hemoglobin and worse LVEF could help to predict poor outcomes in PPCM patients.
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Affiliation(s)
- Ziguan Zhang
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
| | - Wuyang Zheng
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
| | - Minwei Chen
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
| | - Qiang Xie
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China
| | - Meirong Huang
- Department of Echocardiography, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian 361003, China.
| | - Weihua Li
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China.
| | - Zhengrong Huang
- Department of Cardiology, Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen Institute of Cardiovascular Diseases, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian 361003, China.
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Hess RF, Donnenwirth JA. Peripartum Cardiomyopathy and Spouses' Experiences of Persistent Uncertainty. MCN Am J Matern Child Nurs 2022; 47:207-212. [PMID: 35749765 DOI: 10.1097/nmc.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to explore the experiences of spouses whose wives had peripartum cardiomyopathy (PPCM). DESIGN METHODS Participants were recruited for this phenomenological study through online sites Facebook and SavetheMommies. Fifteen men from four countries participated through semistructured phone interviews conducted between October 2019 and August 2020. Data were analyzed using a modified version of the constant comparison method. RESULTS The overarching theme of spouses' experiences was Living with the 'what ifs' of persistent uncertainty. Four main themes were: Feeling the shock, Facing the challenge, Figuring out a new normal, and Finding meaning. Spouses had to deal with the fear of their wives' heart failure relapse or death, changed marital and parental roles, and unclear expectations of the future. CLINICAL IMPLICATIONS PPCM is a rare complication of pregnancy with uncertain implications for the future that can have a profound impact on the woman's spouse and family. Our findings should alert nurses and other health care professionals to the need for emotional, spiritual, and informational support of spouses or partners of women who have PPCM. Nurses should include spouses and partners in care and communication to make sure they are as informed as possible, have their questions and concerns addressed as needed, and receive adequate follow-up support.
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Mueller-Leisse J, Brunn J, Zormpas C, Hohmann S, Hillmann HAK, Eiringhaus J, Bauersachs J, Veltmann C, Duncker D. Delayed Improvement of Left Ventricular Function in Newly Diagnosed Heart Failure Depends on Etiology—A PROLONG-II Substudy. SENSORS 2022; 22:s22052037. [PMID: 35271182 PMCID: PMC8914738 DOI: 10.3390/s22052037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/11/2022]
Abstract
In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF), three months of optimal therapy are recommended before considering a primary preventive implantable cardioverter-defibrillator (ICD). It is unclear which patients benefit from a prolonged waiting period under protection of the wearable cardioverter-defibrillator (WCD) to avoid unnecessary ICD implantations. This study included all patients receiving a WCD for newly diagnosed HFrEF (n = 353) at our center between 2012 and 2017. Median follow-up was 2.7 years. From baseline until three months, LVEF improved in patients with all peripartum cardiomyopathy (PPCM), myocarditis, dilated cardiomyopathy (DCM), or ischemic cardiomyopathy (ICM). Beyond this time, LVEF improved in PPCM and DCM only (10 ± 8% and 10 ± 12%, respectively), whereas patients with ICM showed no further improvement. The patients with newly diagnosed HFrEF were compared to 29 patients with a distinct WCD indication, which is an explantation of an infected ICD. This latter group had a higher incidence of WCD shocks and poorer overall survival. All-cause mortality should be considered when deciding on WCD prescription. In patients with newly diagnosed HFrEF, the potential for delayed LVEF recovery should be considered when timing ICD implantation, especially in patients with PPCM and DCM.
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Abstract
Peripartum cardiomyopathy (PPCM) is a potentially fatal form of idiopathic heart failure with variable prevalence across different countries and ethnic groups. The cause of PPCM is unclear, but environmental and genetic factors and pregnancy-associated conditions such as pre-eclampsia can contribute to the development of PPCM. Furthermore, animal studies have shown that impaired vascular and metabolic function might be central to the development of PPCM. A better understanding of the pathogenic mechanisms involved in the development of PPCM is necessary to establish new therapies that can improve the outcomes of patients with PPCM. Pregnancy hormones tightly regulate a plethora of maternal adaptive responses, including haemodynamic, structural and metabolic changes in the cardiovascular system. In patients with PPCM, the peripartum period is associated with profound and rapid hormonal fluctuations that result in a brief period of disrupted cardiovascular (metabolic) homeostasis prone to secondary perturbations. In this Review, we discuss the latest studies on the potential pathophysiological mechanisms of and risk factors for PPCM, with a focus on maternal cardiovascular changes associated with pregnancy. We provide an updated framework to further our understanding of PPCM pathogenesis, which might lead to an improvement in disease definition.
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Jawad K, Koziarz A, Dieterlen MT, Garbade J, Etz CD, Saeed D, Langer E, Stepan H, Scholz U, Krause M, Brenner P, Schulz U, Borger MA, Eifert S. Long-Term Follow-Up of Mechanical Circulatory Support in Peripartum Cardiomyopathy (PPCM) Refractory to Medical Management: A Multicenter Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12010087. [PMID: 35054480 PMCID: PMC8778047 DOI: 10.3390/life12010087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 01/04/2023]
Abstract
Background: Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart disease, frequently associated with gene alterations and, in some cases, presenting with advanced heart failure. Little is known about ventricular assist device (VAD) implantation in severe PPCM cases. We describe long-term follow-up of PPCM patients who were resistant to medical therapy and received mechanical circulatory support or heart transplant. Methods and results: A total of 13 patients were included with mean follow-up of eight years. Mean age of PPCM onset was 33.7 ± 7.7 years. All patients were initially treated with angiotensin-converting enzyme inhibitors and beta-blockers, and four received bromocriptine. Overall, five patients received VADs (three biventricular, two isolated left ventricular) at median 27 days (range: 3 to 150) following childbirth. Two patients developed drive line infection. Due to the short support time, none of those patients had a stroke or VAD thrombosis. In total, five patients underwent heart transplantation, of which four previously had implanted VADs. Median time to transplantation from PPCM onset was 140 days (range: 43 to 776), and time to transplantation from VAD implantation were 7, 40, 132, and 735 days, respectively. All patients survived until most recent follow up, with the exception of one patient who died following unrelated abdominal surgery two years after PPCM recovery. Conclusions: In patients with severe, life-threatening PPCM refractory to medical management, mechanical circulatory support with or without heart transplantation is a safe therapeutic option.
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Affiliation(s)
- Khalil Jawad
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
- Peter Munk Cardiac Center, University of Toronto, Cardiac Surgery, Toronto, ON M5S 1A1, Canada;
- Correspondence: ; Tel.: +49-341-8651421; Fax: +49-341-8651452
| | - Alex Koziarz
- Peter Munk Cardiac Center, University of Toronto, Cardiac Surgery, Toronto, ON M5S 1A1, Canada;
| | - Maja-Theresa Dieterlen
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Jens Garbade
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Christian D. Etz
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Diyar Saeed
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Elena Langer
- Department of Obstetrics, University of Leipzig, 04109 Leipzig, Germany; (E.L.); (H.S.)
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, 04109 Leipzig, Germany; (E.L.); (H.S.)
| | - Ute Scholz
- Centre of Coagulation Disorders, 04109 Leipzig, Germany; (U.S.); (M.K.)
| | - Michael Krause
- Centre of Coagulation Disorders, 04109 Leipzig, Germany; (U.S.); (M.K.)
| | - Paolo Brenner
- Department of Cardiac Surgery, University of Munich, 80539 Munich, Germany;
| | - Uwe Schulz
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Michael A. Borger
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
| | - Sandra Eifert
- Leipzig Heart Center Leipzig, University Clinic of Cardiac Surgery, 04289 Leipzig, Germany; (M.-T.D.); (J.G.); (C.D.E.); (D.S.); (U.S.); (M.A.B.); (S.E.)
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Castro CN, Lopes PPM, Mayrink J. Dyspnea and COVID-19: A Review of Confounding Diagnoses during the Postpartum Period. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:862-869. [PMID: 34872145 PMCID: PMC10183873 DOI: 10.1055/s-0041-1736304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.
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Affiliation(s)
- Clara Nunes Castro
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Pedro Paulo Machado Lopes
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Jussara Mayrink
- Department of Gynecology and Obstetrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Fett JD. Promoting Full Recovery and Improved Relapse-Free Prognosis in the Diagnosis and Treatment of Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 76:2365-2367. [DOI: 10.1016/j.jacc.2020.09.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
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12
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Phadke R, Hedberg-Oldfors C, Scalco RS, Lowe DM, Ashworth M, Novelli M, Vara R, Merwick A, Amer H, Sofat R, Sugarman M, Jovanovic A, Roberts M, Nakou V, King A, Bodi I, Jungbluth H, Oldfors A, Murphy E. RBCK1-related disease: A rare multisystem disorder with polyglucosan storage, auto-inflammation, recurrent infections, skeletal, and cardiac myopathy-Four additional patients and a review of the current literature. J Inherit Metab Dis 2020; 43:1002-1013. [PMID: 32187699 DOI: 10.1002/jimd.12234] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/24/2020] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
In this article, we report four new patients, from three kindreds, with pathogenic variants in RBCK1 and a multisystem disorder characterised by widespread polyglucosan storage. We describe the clinical presentation of progressive skeletal and cardiac myopathy, combined immunodeficiencies and auto-inflammation, illustrate in detail the histopathological findings in multiple tissue types, and report muscle MRI findings.
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Affiliation(s)
- Rahul Phadke
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, Great Ormond Street Hospital, London, UK
- MRC Centre for Neuromuscular Diseases, University College London, Queen Square, London, UK
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Carola Hedberg-Oldfors
- Department of Pathology and Genetics, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Renata S Scalco
- MRC Centre for Neuromuscular Diseases, University College London, Queen Square, London, UK
- CAPES Foundation, Ministry of Education of Brazil, Brasilia DF, Brazil
| | - David M Lowe
- Department of Immunology, Royal Free Hospital, London, UK and Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - Michael Ashworth
- Department of Histopathology, Great Ormond Street Hospital, London, UK
| | - Marco Novelli
- Department of Histopathology, University College London NHS Foundation Trust, London, UK
| | - Roshni Vara
- Department of Paediatric Inherited Metabolic Disease, Evelina London Children's Hospital, London, UK
| | - Aine Merwick
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Halima Amer
- Department of Clinical Pharmacology, University College London NHS Foundation Trust, London, UK
| | - Reecha Sofat
- Department of Clinical Pharmacology, University College London NHS Foundation Trust, London, UK
| | - Max Sugarman
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ana Jovanovic
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Mark Roberts
- Great Manchester Neurosciences Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Vasiliki Nakou
- Department of Paediatric Neurology, Neuromuscular Service, Evelina London Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Andrew King
- Department of Clinical Neuropathology, King's College Hospital, London, UK
| | - Istvan Bodi
- Department of Clinical Neuropathology, King's College Hospital, London, UK
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina London Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
- Randall Division for Cell and Molecular Biophysics, Muscle Signaling Section, King's College London, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anders Oldfors
- Department of Pathology and Genetics, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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13
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Zhu RR, Chen Q, Liu ZB, Ruan HG, Wu QC, Zhou XL. Inhibition of the Notch1 pathway induces peripartum cardiomyopathy. J Cell Mol Med 2020; 24:7907-7914. [PMID: 32529705 PMCID: PMC7348138 DOI: 10.1111/jcmm.15423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 04/14/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022] Open
Abstract
Increased expression and activity of cardiac and circulating cathepsin D and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) have been demonstrated to induce and promote peripartum cardiomyopathy (PPCM) via promoting cleavage of 23‐kD prolactin (PRL) to 16‐kD PRL and neutralizing vascular endothelial growth factor (VEGF), respectively. We hypothesized that activation of Hes1 is proposed to suppress cathepsin D via activating Stat3, leading to alleviated development of PPCM. In the present study, we aimed to investigate the role of Notch1/Hes1 pathway in PPCM. Pregnant mice between prenatal 3 days and postpartum 3 weeks were fed with LY‐411575 (a notch inhibitor, 10 mg/kg/d). Ventricular function and pathology were evaluated by echocardiography and histological analysis. Western blotting analysis was used to examine the expression at the protein level. The results found that inhibition of Notch1 significantly promoted postpartum ventricular dilatation, myocardial hypertrophy and myocardial interstitial fibrosis and suppressed myocardial angiogenesis. Western blotting analysis showed that inhibition of Notch1 markedly increased cathepsin D and sFlt‐1, reduced Hes1, phosphorylated Stat3 (p‐Stat3), VEGFA and PDGFB, and promoted cleavage of 23k‐D PRL to 16‐kD PRL. Collectively, inhibition of Notch1/Hes1 pathway induced and promoted PPCM via increasing the expressions of cathepsin D and sFlt‐1. Notch1/Hes1 was a promising target for prevention and therapeutic regimen of PPCM.
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Affiliation(s)
- Rong-Rong Zhu
- Department of Obstetrics and Gynecology, High-Tech Hospital, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Qian Chen
- Department of Cardiology, the Second Medical Center, Chinese PLA General Hospital, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Zhi-Bo Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Han-Guang Ruan
- Department of Medical Oncology, The Third Hospital of Nanchang City, Nanchang University, Nanchang, China
| | - Qi-Cai Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xue-Liang Zhou
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
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14
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15
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Chaudhari S, Cushen SC, Osikoya O, Jaini PA, Posey R, Mathis KW, Goulopoulou S. Mechanisms of Sex Disparities in Cardiovascular Function and Remodeling. Compr Physiol 2018; 9:375-411. [PMID: 30549017 DOI: 10.1002/cphy.c180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Epidemiological studies demonstrate disparities between men and women in cardiovascular disease prevalence, clinical symptoms, treatments, and outcomes. Enrollment of women in clinical trials is lower than men, and experimental studies investigating molecular mechanisms and efficacy of certain therapeutics in cardiovascular disease have been primarily conducted in male animals. These practices bias data interpretation and limit the implication of research findings in female clinical populations. This review will focus on the biological origins of sex differences in cardiovascular physiology, health, and disease, with an emphasis on the sex hormones, estrogen and testosterone. First, we will briefly discuss epidemiological evidence of sex disparities in cardiovascular disease prevalence and clinical manifestation. Second, we will describe studies suggesting sexual dimorphism in normal cardiovascular function from fetal life to older age. Third, we will summarize and critically discuss the current literature regarding the molecular mechanisms underlying the effects of estrogens and androgens on cardiac and vascular physiology and the contribution of these hormones to sex differences in cardiovascular disease. Fourth, we will present cardiovascular disease risk factors that are positively associated with the female sex, and thus, contributing to increased cardiovascular risk in women. We conclude that inclusion of both men and women in the investigation of the role of estrogens and androgens in cardiovascular physiology will advance our understanding of the mechanisms underlying sex differences in cardiovascular disease. In addition, investigating the role of sex-specific factors in the development of cardiovascular disease will reduce sex and gender disparities in the treatment and diagnosis of cardiovascular disease. © 2019 American Physiological Society. Compr Physiol 9:375-411, 2019.
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Affiliation(s)
- Sarika Chaudhari
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Spencer C Cushen
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Oluwatobiloba Osikoya
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Paresh A Jaini
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rachel Posey
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Keisa W Mathis
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Styliani Goulopoulou
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, Texas, USA
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