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Banmala S, Awal S, Bata L, Adhikari P, Basnet S, Chaudhary B. Heart failure due to peripartum cardiomyopathy presenting in the first week of puerperium-A case series from Nepal. Clin Case Rep 2024; 12:e9043. [PMID: 38827942 PMCID: PMC11142894 DOI: 10.1002/ccr3.9043] [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: 07/04/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 06/05/2024] Open
Abstract
Key Clinical Message Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. With a prognosis that can vary from the complete recovery of left ventricular function to maternal mortality as well as recurrence with subsequent pregnancies, early diagnosis and treatment of PPCM is important in management. Bromocriptine treatment is beneficial effects on LVEF and mortality in women with severe acute PPCM in addition to standard heart failure therapy. However, further study is required to establish its effect in PPCM. Abstract Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. Most of the clinical presentation is similar to symptoms of advanced pregnancy making the diagnosis difficult. Reported are three patients who developed dyspnea, orthopnea, and dry cough during the first week of puerperium. On examination, bilateral lower limb edema and bilateral basal lung crepitation were present in all patients. Chest radiograph showed pulmonary edema in cases two and three, and pleural effusion in case one. All patients had reduced left ventricular ejection fraction and raised N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels. Case two developed PPCM in the background of left pyelonephritis. Case three was complicated by acute kidney injury. All patients were managed with bromocriptine, diuretics, beta-blockers, ACE inhibitors, and fluid restriction. Hence, PPCM though rare should be considered as a differential in women presenting with features of heart failure in later months of pregnancy or within 5 months of delivery.
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Affiliation(s)
- Sabin Banmala
- Department of General Practice and Emergency MedicineSindhuli HospitalSindhuliNepal
| | - Shila Awal
- Department of General Practice and Emergency MedicineSuryabinayak Municipal HospitalBhaktapurNepal
| | - Lokendra Bata
- Department of Obstetrics and GynecologyShree Birendra HospitalKathmanduNepal
| | - Priya Adhikari
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sarita Basnet
- Department of AnaesthesiologyDhulikhel HospitalDhulikhelNepal
| | - Babita Chaudhary
- Department of Obstetrics and GynecologyShree Birendra HospitalKathmanduNepal
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Rao RA, Bhardwaj A, Munagala M, Abraham S, Adig S, Shen A, Hamad E. Sex Differences in Circulating Biomarkers of Heart Failure. Curr Heart Fail Rep 2024; 21:11-21. [PMID: 38060191 DOI: 10.1007/s11897-023-00634-w] [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: 10/30/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVSIEW Evidence is scaling up for sex differences in heart failure; however, clinical relevance of sex-specific differential thresholds for biomarkers is not clearly known. Current ambiguity warrants a further look into the sex-specific studies on cardiac biomarkers and may facilitate understanding of phenotypic presentations, clinical manifestations, and pathophysiologic pathway differences in men and women. RECENT FINDINGS Recent studies have confirmed the fact that females have differential threshold for biomarkers, with lower troponin and higher NT proBNP levels. Ambiguity continues to exist in the clinical relevance of ST-2, Galectin 3, and other biomarkers. Novel biomarkers, proteomic biomarkers, and circulating micro RNAs with machine learning are actively being explored. Biomarkers in HFpEF patients with higher female representation are evolving. In recent clinical trials, sex-related difference in biomarkers is not seen despite therapeutic intervention being more effective in females compared to males. Sex-related difference exists in the expression of biomarkers in health and in various disease states of heart failure. However, this differentiation has not effectively translated into the clinical practice in terms of diagnostic studies or prognostication. Active exploration to bridge the knowledge gap and novel technologies can shed more light in this area.
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Affiliation(s)
- Roopa A Rao
- Division of Cardiovascular Medicine, Indiana University School of Medicine, 1801, N Senate Blvd, Indianapolis, IN, 46202, USA.
| | - Anju Bhardwaj
- Department of Cardiology, McGovern Medical School, University of Texas, Texas Medical Center Houston, Houston, TX, USA
| | - Mrudula Munagala
- Department of Cardiology, Miller School of Medicine, University of Miami, Miami, USA
| | - Sonu Abraham
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sanjana Adig
- Department of Cardiology, Indiana University, Indianapolis, IN, USA
| | - Arden Shen
- Indiana University Health Methodist Hospital, Indianapolis, IN, USA
- Weldon School of Biomedical Engineering, West Lafayette, IN, USA
| | - Eman Hamad
- Lewis Katz School of Medicine at, Temple University, Philadelphia, PA, 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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Kodogo V, Viljoen C, Hoevelmann J, Chakafana G, Tromp J, Farhan HA, Goland S, van der Meer P, Karaye K, Kryczka K, Hilfiker-Kleiner D, Jackson A, Mebazaa A, Böhm M, Pieske B, Bauersachs J, Bell L, Sliwa K. Proteomic Profiling in Patients With Peripartum Cardiomyopathy: A Biomarker Study of the ESC EORP PPCM Registry. JACC. HEART FAILURE 2023; 11:1708-1725. [PMID: 37804308 DOI: 10.1016/j.jchf.2023.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/14/2023] [Accepted: 07/25/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) remains an important cause of maternal morbidity and mortality globally. The pathophysiology remains incompletely understood, and the diagnosis is often missed or delayed. OBJECTIVES This study explored the serum proteome profile of patients with newly diagnosed PPCM, as compared with matched healthy postpartum mothers, to unravel novel protein biomarkers that would further an understanding of the pathogenesis of PPCM and improve diagnostic precision. METHODS Study investigators performed untargeted serum proteome profiling using data-independent acquisition-based label-free quantitative liquid chromatography-tandem mass spectrometry on 84 patients with PPCM, as compared with 29 postpartum healthy controls (HCs). Significant changes in protein intensities were determined with nonpaired Student's t-tests and were further classified by using the Boruta algorithm. The proteins' diagnostic performance was evaluated by area under the curve (AUC) and validated using the 10-fold cross-validation. RESULTS Patients with PPCM presented with a mean left ventricular ejection fraction of 33.5% ± 9.3% vs 57.0% ± 8.8% in HCs (P < 0.001). Study investigators identified 15 differentially up-regulated and 14 down-regulated proteins in patients with PPCM compared with HCs. Seven of these proteins were recognized as significant by the Boruta algorithm. The combination of adiponectin, quiescin sulfhydryl oxidase 1, inter-α-trypsin inhibitor heavy chain, and N-terminal pro-B-type natriuretic peptide had the best diagnostic precision (AUC: 0.90; 95% CI: 0.84-0.96) to distinguish patients with PPCM from HCs. CONCLUSIONS Salient biologic themes related to immune response proteins, inflammation, fibrosis, angiogenesis, apoptosis, and coagulation were predominant in patients with PPCM compared with HCs. These newly identified proteins warrant further evaluation to establish their role in the pathogenesis of PPCM and potential use as diagnostic markers.
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Affiliation(s)
- Vitaris Kodogo
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Charle Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Internal Medicine III-Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Graham Chakafana
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Chemistry and Biochemistry, Hampton University, Hampton, Virginia, USA
| | - Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and the National University Health System, Singapore; Duke-National University of Singapore Medical School, Singapore
| | | | - Sorel Goland
- Heart Institute, Kaplan Medical Center, Rehovot, affiliated with the Hebrew University, Jerusalem, Israel
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Kamilu Karaye
- Department of Medicine, Bayero University, Kano, Nigeria
| | | | | | - Alice Jackson
- Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom
| | - Alexandre Mebazaa
- Paris Cité University, French National Institute of Health and Medical Research (INSERM) Cardiovascular MArkers in Stress Conditions (MASCOT), Paris, France; Department of Anesthesiology and Critical Care, Saint Louis Lariboisière Hospitals, Public Assistance Hospital of Paris, Paris, France
| | - Michael Böhm
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Internal Medicine Clinic III -Cardiology, Angiology, and Internist Intensive Medicine, Saarland University Hospital, Saarland University, Homburg, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Liam Bell
- Centre for Proteomic and Genomic Research, Cape Town, South Africa, Cape Town, South Africa
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa.
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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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Abstract
PURPOSE OF REVIEW Peripartum cardiomyopathy (PPCM) contributes significantly to maternal morbidity and mortality worldwide. In this review, we describe the present-day epidemiology and current understanding of the pathogenesis of PPCM. We provide an updated approach to diagnosis and management of PPCM, and discuss risk factors and predictors of outcome. RECENT FINDINGS The highest incidences of PPCM have been reported in African, Asian, and Caribbean populations. Contemporary literature supports a 'two-hit' hypothesis, whereby the 'first hit' implies a predisposition, and the 'second hit' refers to an imbalanced peripartal hormonal milieu that results in cardiomyopathy. Whereas a half of patients will have left ventricular (LV) recovery, a tenth do not survive. Clinical findings and special investigations (ECG, echocardiography, cardiac MRI, biomarkers) can be used for risk stratification. Frequent prescription of guideline-directed medical therapy is associated with improved outcomes. SUMMARY Despite advances in elucidating the pathogenesis of PPCM, it remains unclear why only certain women develop the disease. Moreover, even with better diagnostic work-up and management, it remains unknown why some patients with PPCM have persistent LV dysfunction or die. Future research should be aimed at better understanding of the mechanisms of disease and finding new therapies that could improve survival and LV recovery.
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Eggleton EJ, McMurrugh KJ, Aiken CE. Perinatal outcomes in pregnancies complicated by maternal cardiomyopathy: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 228:283-291. [PMID: 36150520 DOI: 10.1016/j.ajog.2022.09.025] [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: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to systematically assess perinatal outcomes of pregnancies complicated by maternal cardiomyopathy. DATA SOURCES PubMed, Ovid Embase, Ovid MEDLINE, the Cochrane Library, and ClinicalTrials.gov were systematically searched from inception to August 25, 2022. STUDY ELIGIBILITY CRITERIA Observational cohort, case-control, and case-cohort studies in human populations were included if they reported predefined perinatal outcomes in pregnant women with cardiomyopathy (any subtype) and an appropriate control population (either pregnant women with no known cardiac disease or pregnant women with noncardiomyopathy cardiac disease). METHODS Of note, 2 reviewers independently assessed the articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesized according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines. RESULTS Here, 13 studies (representing 2,291,024 pregnancies) were eligible for inclusion. Perinatal death was more likely in neonates born to women with cardiomyopathy than in (1) neonates born to women with no cardiac disease (stillbirth: odds ratio, 20.82; 95% confidence interval, 6.68-64.95; I2 = not available; P<.00001; neonatal mortality: odds ratio, 6.75; 95% confidence interval, 3.54-12.89; I2=0%; P<.00001) and (2) neonates born to women with other forms of cardiac disease (stillbirth: odds ratio, 3.75; 95% confidence interval, 1.86-7.59; I2=0%; P=.0002; neonatal mortality: odds ratio, 2.42; 95% confidence interval, 1.39-4.21; I2=0%; P=.002). Pregnancies affected by maternal cardiomyopathy were significantly more likely to result in preterm birth (odds ratio, 2.21; 95% confidence interval, 1.31-3.73; I2=77%; P=.003) and small-for-gestational-age neonates (odds ratio, 2.97; 95% confidence interval, 2.38-3.70; I2=47%; P<.00001), both major causes of short- and long-term morbidities, than pregnancies affected by other forms of cardiac disease. CONCLUSION There was an increased likelihood of adverse perinatal outcomes in pregnancies affected by maternal cardiomyopathy compared with both pregnancies affected by noncardiomyopathy cardiac disease and pregnancies without cardiac disease. Women with cardiomyopathy who plan to get pregnant should receive detailed counseling regarding these risks and have their pregnancies managed by experienced multidisciplinary teams that can provide close fetal monitoring and neonatology expertise.
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Affiliation(s)
- Elizabeth J Eggleton
- The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, United Kingdom
| | - Kate J McMurrugh
- East Surrey Hospital, Surrey and Sussex Healthcare NHS Trust, Canada Avenue, Surrey, United Kingdom
| | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, Rosie Hospital and NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom.
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Chaudhari K, Choudhary M, Chaudhary K, Verma N, Kumar S, Madaan S, Talwar D. Advancement in Current Therapeutic Modalities in Postpartum Cardiomyopathy. Cureus 2022; 14:e22813. [PMID: 35382200 PMCID: PMC8976525 DOI: 10.7759/cureus.22813] [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] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Pregnancy is considered one of the most delicate conditions for the woman and her fetus, rendering physiological stress on her body. Sometimes, this leads to unwelcomed incidences of certain systemic disorders which further complicate the course of pregnancy. Cardiovascular conditions associated with pregnancy have major morbidity amongst the general population. Peripartum cardiomyopathy, one such condition associated with cardiac dysfunction during pregnancy, is one of the major causes of increased morbidity and mortality in pregnant women. It has been the leading cause of non-obstetric maternal mortality. Due to the stress on the cardiovascular system, further functioning of the body in the milieu gets compromised and thus, the occurrence of fetomaternal mortality is not rare in the prognosis of this condition. Certain studies have noted not only familial but also geographical variations in the prevalence of peripartum cardiomyopathy in certain areas. Although the occurrence of the condition is quite common, there still needs to be a better understanding of this topic for avoiding the abysmal prognosis of this pathology. A peculiar presentation on the electrogram is needed to make an accurate diagnosis of the condition. The therapeutic options of this condition, particularly incline towards medical management. Various new drugs have been formulated and are in clinical trials for testing their effectiveness. Bromocriptine therapy, along with the neoadjuvant combination of anticoagulant drugs and non-pharmacological measures, makes a good treatment regimen that helps avert the progressive pathology. In this article, we discuss the knowledge regarding the etiology, factors contributing to the severity, pathogenesis, treatment options, and the particular outcomes of the therapy.
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Zhang Y, Liu W, Yu H, Chen Z, Zhang C, Ti Y, Bu P. Value of the Systemic Immune-Inflammatory Index (SII) in Predicting the Prognosis of Patients With Peripartum Cardiomyopathy. Front Cardiovasc Med 2022; 9:811079. [PMID: 35252391 PMCID: PMC8891526 DOI: 10.3389/fcvm.2022.811079] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Peripartum cardiomyopathy (PPCM) is a potentially life-threatening complication of pregnancy. The identification of early prognostic markers in patients diagnosed with PPCM is very important. The systemic immune-inflammation index (SII) is a new inflammatory biomarker, and the aim of this study was to evaluate the prognostic value of SII in patients with PPCM. Methods A total of 61 patients with PPCM who were admitted in our hospital from 2015 to 2020 were retrospectively analyzed in this study. The follow-up period of all patients was at least 6 months after diagnosis. Recovery of left ventricular (LV) systolic function was defined as the presence of left ventricular ejection fraction > 45%. The second endpoint was defined as composite adverse cardiac events, including cardiac death or hospitalization due to worsening heart failure. Univariate and multivariate logistic regression analysis were used to determine the independent predictors of non-recovery of LV systolic function. The receiver operating characteristic (ROC) curve analysis was used to establish a cut-off level of SII value to predict persistent LV systolic dysfunction. Results The follow-up duration was 40.5 ± 16.3 months. Among the 61 patients, 43 patients showed left ventricular recovery and 18 patients did not at the last follow-up visit. The baseline SII levels were significantly higher in the non-recovery group (P < 0.05). Multivariate logistic regression showed that the SII and left ventricular end-diastolic dimension (LVEDD) were independent predictors of persistent LV systolic dysfunction (OR: 1.177, 95% CI: 1.038–1.335, P = 0.011 and OR: 1.148, 95% CI: 1.011–1.304, P = 0.033, respectively). A SII value of 876 was the best cut-off value (the area under the curve was 0.791, 95% CI: 0.667–0.915, P < 0.05), and the sensitivity and specificity were 73 and 71%, respectively. Conclusions The SII and LVEDD are independent prognostic factors for persistent LV systolic dysfunction in patients with PPCM. The SII may be a useful tool for identifying high-risk PPCM patients.
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Bouhaddoune Y, Hbali A, Aissaoui H, Mrabet A, Ismaili N, El Ouafi N. Peripartum cardiomyopathy: alluring challenge - case series and review of literature. Pan Afr Med J 2021; 40:119. [PMID: 34887993 PMCID: PMC8627143 DOI: 10.11604/pamj.2021.40.119.29168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/03/2021] [Indexed: 11/11/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare disease responsible for heart failure that usually occurs in the last month of pregnancy or within five months postpartum, without any other known cause. A case series of five PPCM patients admitted at the Department of Cardiology of the University Hospital Mohammed VI of Oujda, Morocco, between 2017 and 2019. All cases were represented by young (case 1: 35-year-old; case 2: 28-year-old; case 3: 30-year-old; case 4: 36-year-old; case 5: 34-year-old). All patients were multiparous who were admitted to our department with a severely reduced left ventricular ejection fraction. Case 1 and 4 were admitted 3 days after delivery for heart failure. Case 2 was admitted for cardiogenic shock after 3 months of delivery. Case 3 was admitted twelve days after delivery for acute heart failure with pulmonary embolism and multiple venous thrombosis. Case 5 had a history of PPCM was admitted for cardiogenic shock with a course marked by recurrent thromboembolic events. Case 1 and 2 responded to treatment at an early stage, case 4 has evolved to chronicity, the third patient died from an unclear cause, and the fifth patient died from a contraindicated pregnancy leading to the recurrence of fatal thromboembolic events. Above reported cases confirming the great heterogeneity in clinical presentation and course of peripartum cardiomyopathy and seems to confirm that a delayed diagnosis, as well thromboembolic complications are bad prognosis factors of these patients. Early diagnosis, multidisciplinary collaboration, prompt treatment of heart failure and continued monitoring are the keys to improve maternal survival.
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Affiliation(s)
- Youssra Bouhaddoune
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Anas Hbali
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Hanane Aissaoui
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Asmae Mrabet
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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Pavithran P, Chandran P. A case of peripartum cardiomyopathy in acute heart failure for emergency surgery. Indian J Anaesth 2021; 65:627-629. [PMID: 34584288 PMCID: PMC8445217 DOI: 10.4103/ija.ija_1527_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 12/22/2020] [Accepted: 03/02/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Preetha Chandran
- Department of Anaesthesiology, Aster MIMS, Calicut, Kerala, India
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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: 509] [Impact Index Per Article: 169.7] [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.
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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.
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Chakafana G, Spracklen TF, Kamuli S, Zininga T, Shonhai A, Ntusi NAB, Sliwa K. Heat Shock Proteins: Potential Modulators and Candidate Biomarkers of Peripartum Cardiomyopathy. Front Cardiovasc Med 2021; 8:633013. [PMID: 34222357 PMCID: PMC8241919 DOI: 10.3389/fcvm.2021.633013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/06/2021] [Indexed: 12/31/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition in which heart failure and systolic dysfunction occur late in pregnancy or within months following delivery. To date, no reliable biomarkers or therapeutic interventions for the condition exist, thus necessitating an urgent need for identification of novel PPCM drug targets and candidate biomarkers. Leads for novel treatments and biomarkers are therefore being investigated worldwide. Pregnancy is generally accompanied by dramatic hemodynamic changes, including a reduced afterload and a 50% increase in cardiac output. These increased cardiac stresses during pregnancy potentially impair protein folding processes within the cardiac tissue. The accumulation of misfolded proteins results in increased toxicity and cardiac insults that trigger heart failure. Under stress conditions, molecular chaperones such as heat shock proteins (Hsps) play crucial roles in maintaining cellular proteostasis. Here, we critically assess the potential role of Hsps in PPCM. We further predict specific associations between the Hsp types Hsp70, Hsp90 and small Hsps with several proteins implicated in PPCM pathophysiology. Furthermore, we explore the possibility of select Hsps as novel candidate PPCM biomarkers and drug targets. A better understanding of how these Hsps modulate PPCM pathogenesis holds promise in improving treatment, prognosis and management of the condition, and possibly other forms of acute heart failure.
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Affiliation(s)
- Graham Chakafana
- Department of Medicine, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Timothy F Spracklen
- Department of Medicine, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen Kamuli
- Department of Medicine, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Tawanda Zininga
- Department of Biochemistry, Stellenbosch University, Stellenbosch, South Africa
| | - Addmore Shonhai
- Department of Biochemistry, University of Venda, Thohoyandou, South Africa
| | - Ntobeko A B Ntusi
- Department of Medicine, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Kotit S, Yacoub M. Cardiovascular adverse events in pregnancy: A global perspective. Glob Cardiol Sci Pract 2021; 2021:e202105. [PMID: 34036091 PMCID: PMC8133785 DOI: 10.21542/gcsp.2021.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022] Open
Abstract
Pregnant women with heart disease are vulnerable to many adverse cardiovascular events (AE). AEs during and after pregnancy continue to be important causes of maternal mortality and morbidity worldwide, with huge variations in burden in different countries and regions. These AEs are classified as having direct or indirect causes, depending on whether they are directly caused by pregnancy or due to some pre-existing disease and/or non-obstetric cause, respectively. The risks continue throughout pregnancy and even after childbirth. Apart from immediate complications during pregnancy, there is increasing evidence of a significant link between several events and the risk of cardiovascular disease (CVD) later in life. A significant number of pregnancy-related deaths caused by cardiovascular disease are preventable. This prevention can be realized through increasing awareness of cardiovascular AE in pregnancy, coupled with the application of strategies for prevention and treatment. Knowledge of the risks associated with CVD and pregnancy is of extreme importance in that regard. We discuss the global distribution of cardiovascular maternal mortality, adverse events during and after pregnancy, their predictors and risk stratification. In addition, we enumerate possible solutions, particularly the role of cardio-obstetric clinics.
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Acute kidney injury predicts poor left ventricular function for patients with peripartum cardiomyopathy. BMC Cardiovasc Disord 2021; 21:205. [PMID: 33888084 PMCID: PMC8063442 DOI: 10.1186/s12872-021-02021-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background The aim of this study was to explore the risk factors associated with a poor left ventricular (LV) function among patients with peripartum cardiomyopathy (PPCM) and to determine the influence of acute kidney injury (AKI) on the LV function of the patients. Methods Sixty patients with PPCM were recruited between January 2007 and June 2018, among which 11 had AKI. The participants were divided into two groups, the recovery group (32 cases) and the nonrecovery group (28 cases), with their clinical features, echocardiography and electrocardiogram findings, laboratory results, and treatments compared between groups. We further determined the risk factors associated with nonrecovery and the influence posed by AKI on the LV function of the patients. Results Compared with the patients in the recovery group, those in the nonrecovery group had higher proportions of multiparity [78.6% (22/28) vs. 43.8% (14/32)], function class III– IV heart failure [92.9% (26/28) vs. 71.9% (23/32)], and a higher incidence of AKI [35.7% (10/28) vs. 3.1% (1/32)]. Logistic regression analysis showed that having AKI [odds ratio (OR): 10.556; 95% confidence interval (CI) 1.177–94.654; P = 0.035] and left ventricular ejection fraction (LVEF) < 40% [OR: 4.533; 95% CI 1.118–18.382; P = 0.034] were independently associated with nonrecovery of PPCM. Conclusions The prognosis of patients with PPCM and AKI during hospitalization was poor compared to those without AKI; therefore, clinicians should pay more attention to this phenomenon.
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Arnolds DE, Dean C, Minhaj M, Schnettler WT, Banayan J, Chaney MA. Cardiac Disease in Pregnancy: Hypertrophic Obstructive Cardiomyopathy and Pulmonic Stenosis. J Cardiothorac Vasc Anesth 2021; 35:3806-3818. [PMID: 33926782 DOI: 10.1053/j.jvca.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 11/11/2022]
Affiliation(s)
- David E Arnolds
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Chad Dean
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Mohammed Minhaj
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - William T Schnettler
- Division of Maternal-Fetal Medicine, TriHealth: Good Samaritan Hospital, Cincinnati, OH
| | | | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
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Post-Traumatic Stress, Depression, and Quality of Life in Women with Peripartum Cardiomyopathy. MCN Am J Matern Child Nurs 2020; 45:176-182. [PMID: 32341249 DOI: 10.1097/nmc.0000000000000614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Peripartum cardiomyopathy, a traumatic life-threatening type of heart failure, occurs in the last trimester of pregnancy or shortly after childbirth. Little is known about psychological or emotional conditions women experience with peripartum cardiomyopathy. The purpose of this study was to examine relationships among post-traumatic stress, depression, and quality of life in women with peripartum cardiomyopathy. DESIGN AND METHODS This cross-sectional, correlational survey study included 28 participants recruited via public notice on Facebook. Participants completed the Horowitz Impact of Events Scale, the Center for Epidemiology Scale-Depression 20, and the Ferrans & Powers Quality of Life Index-Cardiac Version-IV. RESULTS Post-traumatic stress correlated significantly and positively with depression (r = .809, p < .001). Post-traumatic stress and depression correlated significantly and inversely with quality of life (r = -.455, p = .015), (r = -.544, p = .003), respectively. All participants measured positive for depression. Participants with lower education scored higher on post-traumatic stress and depression, whereas those unemployed or disabled registered a lower quality of life. CLINICAL IMPLICATIONS Nurses, midwives, and physicians caring for women with cardiomyopathies must be vigilant for evidence of post-traumatic stress, depression, and poor quality of life. Targeted antenatal and postnatal support could be vital to emotional and psychological recovery.
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O’Kelly AC, Honigberg MC. Sex Differences in Cardiovascular Disease and Unique Pregnancy-Associated Risk Factors in Women. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00860-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Padkins MR, Bell MR. 33-Year-Old Woman With Postpartum Acute Shortness of Breath. Mayo Clin Proc 2020; 95:2000-2004. [PMID: 32861341 DOI: 10.1016/j.mayocp.2020.01.045] [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: 10/25/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Mitchell R Padkins
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Malcolm R Bell
- Advisor to resident and Consultant in Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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The neutrophil to lymphocyte ratio in heart failure: a comprehensive review. ACTA ACUST UNITED AC 2020; 57:296-314. [PMID: 31301680 DOI: 10.2478/rjim-2019-0018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Heart failure (HF) and systemic inflammation are interdependent processes that continuously potentiate each other. Distinct pathophysiological pathways are activated, resulting in increased neutrophil count and reduced lymphocyte numbers, making the neutrophil to lymphocyte ratio (NLR) a potential indirect marker of severity. We conducted this comprehensive review to characterize the role of NLR in HF. METHODS We searched the PubMed (MEDLINE) database using the key words "neutrophil", "lymphocyte", "heart failure", "cardiomyopathy", "implantable cardioverter defibrillator", "cardiac resynchronization therapy" and "heart transplant". RESULTS We identified 241 publications. 31 were selected for this review, including 12,107 patients. NLR was correlated to HF severity expressed by clinical, biological, and imaging parameters, as well as to short and long-term prognosis. Most studies reported its survival predictive value. Elevated NLR (>2.1-7.6) was an independent predictor of in-hospital mortality [adjusted HR 1.13 (95% CI 1.01-1.27) - 2.8 (95% CI 1.43-5.53)] as well as long-term all-cause mortality [adjusted HR 1.43 (95% CI 1.1-1.85) - 2.403 (95% CI 1.076-5.704)]. Higher NLR levels also predicted poor functional capacity [NLR > 2.26/2.74, HR 3.93 (95% CI 1.02-15.12) / 3.085 (95% CI 1.52-6.26)], hospital readmissions [NLR > 2.9/7.6, HR 1.46 (95% CI 1.10-1.93) / 3.46 (95% CI 2.11-5.68)] cardiac resynchronization therapy efficacy [NLR > 3.45/unit increase, HR 12.22 (95% CI 2.16-69.05) / 1.51 (95% CI 1.01-2.24)] and appropriate implantable cardioverter defibrillator shocks (NLR > 2.93), as well as mortality after left ventricular assist device implantation [NLR > 4.4 / quartiles, HR 1.67 (95% CI 1.03-2.70) / 1.22 (95% CI 1.01-1.47)] or heart transplant (NLR > 2.41, HR 3.403 (95% CI 1.04-11.14)]. CONCLUSION Increased NLR in HF patients can be a valuable auxiliary biomarker of severity, and most of all, of poor prognosis.
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Aryan L, Medzikovic L, Umar S, Eghbali M. Pregnancy-associated cardiac dysfunction and the regulatory role of microRNAs. Biol Sex Differ 2020; 11:14. [PMID: 32252821 PMCID: PMC7137306 DOI: 10.1186/s13293-020-00292-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022] Open
Abstract
Many crucial cardiovascular adaptations occur in the body during pregnancy to ensure successful gestation. Maladaptation of the cardiovascular system during pregnancy can lead to complications that promote cardiac dysfunction and may lead to heart failure (HF). About 12% of pregnancy-related deaths in the USA have been attributed to HF and the detrimental effects of cardiovascular complications on the heart can be long-lasting, pre-disposing the mother to HF later in life. Indeed, cardiovascular complications such as gestational diabetes mellitus, preeclampsia, gestational hypertension, and peripartum cardiomyopathy have been shown to induce cardiac metabolic dysfunction, oxidative stress, fibrosis, apoptosis, and diastolic and systolic dysfunction in the hearts of pregnant women, all of which are hallmarks of HF. The exact etiology and cardiac pathophysiology of pregnancy-related complications is not yet fully deciphered. Furthermore, diagnosis of cardiac dysfunction in pregnancy is often made only after clinical symptoms are already present, thus necessitating the need for novel diagnostic and prognostic biomarkers. Mounting data demonstrates an altered expression of maternal circulating miRNAs during pregnancy affected by cardiovascular complications. Throughout the past decade, miRNAs have become of growing interest as modulators and biomarkers of pathophysiology, diagnosis, and prognosis in cardiac dysfunction. While the association between pregnancy-related cardiovascular complications and cardiac dysfunction or HF is becoming increasingly evident, the roles of miRNA-mediated regulation herein remain poorly understood. Therefore, this review will summarize current reports on pregnancy-related cardiovascular complications that may lead to cardiac dysfunction and HF during and after pregnancy in previously healthy women, with a focus on the pathophysiological role of miRNAs.
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Affiliation(s)
- Laila Aryan
- Department of Anesthesiology, Division of Molecular Medicine, David Geffen School of Medicine at University of California, Los Angeles, BH-550 CHS, Los Angeles, CA, 90095-7115, USA
| | - Lejla Medzikovic
- Department of Anesthesiology, Division of Molecular Medicine, David Geffen School of Medicine at University of California, Los Angeles, BH-550 CHS, Los Angeles, CA, 90095-7115, USA
| | - Soban Umar
- Department of Anesthesiology, Division of Molecular Medicine, David Geffen School of Medicine at University of California, Los Angeles, BH-550 CHS, Los Angeles, CA, 90095-7115, USA
| | - Mansoureh Eghbali
- Department of Anesthesiology, Division of Molecular Medicine, David Geffen School of Medicine at University of California, Los Angeles, BH-550 CHS, Los Angeles, CA, 90095-7115, USA.
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Rohacek M, Burkard T. [Heart Failure in Africa]. PRAXIS 2019; 108:983-990. [PMID: 31771489 DOI: 10.1024/1661-8157/a003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Heart Failure in Africa Abstract. In Africa, mortality due to heart failure is twice as high as in other low- to middle-income countries and five times as high as in high-income countries. Arterial hypertension is by far the most common cause of heart failure, followed by cardiomyopathies and rheumatic heart diseases. At diagnosis, most patients suffer already from an advanced disease stage. Only a few patients are aware of arterial hypertension, and few are treated and have their hypertension well controlled. Only a minority of patients have a well-controlled hypertension. The neglect of chronic non-communicable diseases on the health agenda leads to poor awareness, poor diagnostic resources, preventions strategies and treatment options. International guidelines cannot be properly followed in these circumstances. Information at community level and in healthcare facilities is urgently needed as well as training of healthcare staff, implementation of improved diagnostics and treatment of arterial hypertension and heart failure.
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Affiliation(s)
- Martin Rohacek
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Schweizerisches Tropen- und Public Health-Institut (Swiss TPH)
- Universität Basel, Basel
| | - Thilo Burkard
- Universität Basel, Basel
- Kardiologie, Universitätsspital, Basel
- Medical Outpatient Department and Hypertension Clinic, Universitätsspital, Basel
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Soomro S, Kumar R, Shaikh AA. Twenty-eight Pregnant Women with Cardiac Diseases: A Review of Maternal and Fetal Outcomes in Pakistan. Cureus 2019; 11:e6034. [PMID: 31824801 PMCID: PMC6886654 DOI: 10.7759/cureus.6034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction In the western world, 0.2%-4% of pregnancies are complicated by heart diseases. The United Kingdom Obstetric Surveillance System (UKOSS) conducted a study on acute myocardial infarction (MI) in pregnant women. It estimated an incidence of 0.7 cases of acute MI per 100,000 pregnancies. In this study, we review the maternal and fetal outcomes of pregnant women with a cardiac disorder. Methods This retrospective analysis included all maternal records of the women registered in the obstetrics and gynecology department of Ghulam Muhammad Meher Medical Hospital, Sukkur, from January 1 to December 31, 2018. The study was approved by the institutional review board. Results The most common cardiac disease among our patients was peripartum cardiomyopathy (n=12; 42.9%) followed by rheumatic heart disease in nine (32.1%) women. The rate of maternal mortality was 14.2% (n=4). There were eight (28.6%) cases of intrauterine devices (IUDs) and the remaining 20 (71.4%) babies were born alive and healthy. Conclusion The prevalence of cardiac diseases in pregnancy in Pakistan is comparable to that in our neighboring countries. These cardiac diseases are responsible for fetal and maternal adverse outcomes.
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Affiliation(s)
- Shoaibunnisa Soomro
- Obstetrics and Gynecology, Ghulam Muhammad Mahar Medical College and Hospital, Sukkur, PAK
| | - Raj Kumar
- Cardiology, Ghulam Muhammad Mahar Medical College and Hospital, Sukkur, PAK
| | - Altaf A Shaikh
- Internal Medicine, Ghulam Muhammad Mahar Medical College and Hospital, Sukkur, PAK
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Kodogo V, Azibani F, Sliwa K. Role of pregnancy hormones and hormonal interaction on the maternal cardiovascular system: a literature review. Clin Res Cardiol 2019; 108:831-846. [PMID: 30806769 DOI: 10.1007/s00392-019-01441-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/04/2019] [Indexed: 12/14/2022]
Abstract
Hormones have a vital duty in the conservation of physiological cardiovascular function during pregnancy. Alterations in oestrogen, progesterone and prolactin levels are associated with changes in the cardiovascular system to support the growing foetus and counteract pregnancy stresses. Pregnancy hormones are, however, also linked to numerous pathophysiological outcomes on the cardiovascular system. The expression and effects of the three main pregnancy hormones (oestrogen, prolactin and progesterone) vary depending on the gestation period. However, the reaction of a target cell also depends on the abundance of hormone receptors and impacts put forth by other hormones. Hormonal interaction may be synergistic, antagonistic or permissive. It is crucial to explore the cross talk of pregnancy hormones during gestation, as this may have a greater impact on the overall changes to the cardiovascular system.
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Affiliation(s)
- Vitaris Kodogo
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, 4th floor Chris Barnard Building, Observatory, Cape Town, 7935, South Africa
| | - Feriel Azibani
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, 4th floor Chris Barnard Building, Observatory, Cape Town, 7935, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, 4th floor Chris Barnard Building, Observatory, Cape Town, 7935, South Africa.
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