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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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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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Benson B, Theret P, Tonini F, Marang A, Sergent F, Gondry J, Foulon A. [Peripartum cardiomyopathy: A review of the literature]. ACTA ACUST UNITED AC 2021; 50:266-271. [PMID: 34481099 DOI: 10.1016/j.gofs.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Peripartum cardiomyopathy is a rare and unpredictable pregnancy-related pathology. Idiopathic cardiomyopathy is characterized by a heart failure secondary to left ventricular systolic dysfunction appearing towards the end of pregnancy or in the months following delivery with a non-specific clinic presentation. Through reviewing previous research, our critical literature review wishes to bring a concise and objective summarize for a better understanding of physiopathology, evocative symptoms and knowing of factors influencing prognosis in order to standardize peripartum management. The treatment remains mainly symptomatic but other promising treatments are still in development. In conclusion, early detection and treatment allow a better cardiac function recovery reducing cardiac transplantation.
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Affiliation(s)
- B Benson
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - P Theret
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Service de gynécologie-obstétrique, centre hospitalier de Saint-Quentin, 1, avenue Michel-de-l'Hospital, BP 608, 02321 Saint-Quentin, France
| | - F Tonini
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France
| | - A Marang
- Service de cardiologie, centre hospitalier régional universitaire Tours, avenue de la République, 37170 Chambray-les-Tours, France
| | - F Sergent
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France; Faculté de médecine, université Picardie Jules-Verne, 3, rue des Louvels, 80000 Amiens, France
| | - A Foulon
- Service de gynécologie-obstétrique, CHU d'Amiens Picardie, 1, rond-point du Professeur-Christian-Cabrol, 80000 Amiens, France.
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Ramaccini D, Montoya-Uribe V, Aan FJ, Modesti L, Potes Y, Wieckowski MR, Krga I, Glibetić M, Pinton P, Giorgi C, Matter ML. Mitochondrial Function and Dysfunction in Dilated Cardiomyopathy. Front Cell Dev Biol 2021; 8:624216. [PMID: 33511136 PMCID: PMC7835522 DOI: 10.3389/fcell.2020.624216] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022] Open
Abstract
Cardiac tissue requires a persistent production of energy in order to exert its pumping function. Therefore, the maintenance of this function relies on mitochondria that represent the “powerhouse” of all cardiac activities. Mitochondria being one of the key players for the proper functioning of the mammalian heart suggests continual regulation and organization. Mitochondria adapt to cellular energy demands via fusion-fission events and, as a proof-reading ability, undergo mitophagy in cases of abnormalities. Ca2+ fluxes play a pivotal role in regulating all mitochondrial functions, including ATP production, metabolism, oxidative stress balance and apoptosis. Communication between mitochondria and others organelles, especially the sarcoplasmic reticulum is required for optimal function. Consequently, abnormal mitochondrial activity results in decreased energy production leading to pathological conditions. In this review, we will describe how mitochondrial function or dysfunction impacts cardiac activities and the development of dilated cardiomyopathy.
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Affiliation(s)
- Daniela Ramaccini
- University of Hawaii Cancer Center, Honolulu, HI, United States.,Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Laboratory of Technologies for Advanced Therapy (LTTA), Technopole of Ferrara, Ferrara, Italy
| | | | - Femke J Aan
- University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Lorenzo Modesti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Laboratory of Technologies for Advanced Therapy (LTTA), Technopole of Ferrara, Ferrara, Italy
| | - Yaiza Potes
- Laboratory of Mitochondrial Biology and Metabolism, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland
| | - Mariusz R Wieckowski
- Laboratory of Mitochondrial Biology and Metabolism, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Warsaw, Poland
| | - Irena Krga
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Marija Glibetić
- Center of Research Excellence in Nutrition and Metabolism, Institute for Medical Research, University of Belgrade, Belgrade, Serbia
| | - Paolo Pinton
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Laboratory of Technologies for Advanced Therapy (LTTA), Technopole of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Carlotta Giorgi
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Laboratory of Technologies for Advanced Therapy (LTTA), Technopole of Ferrara, Ferrara, Italy
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Ramachandra CJA, Chua J, Cong S, Kp MMJ, Shim W, Wu JC, Hausenloy DJ. Human-induced pluripotent stem cells for modelling metabolic perturbations and impaired bioenergetics underlying cardiomyopathies. Cardiovasc Res 2020; 117:694-711. [PMID: 32365198 DOI: 10.1093/cvr/cvaa125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 12/17/2022] Open
Abstract
Normal cardiac contractile and relaxation functions are critically dependent on a continuous energy supply. Accordingly, metabolic perturbations and impaired mitochondrial bioenergetics with subsequent disruption of ATP production underpin a wide variety of cardiac diseases, including diabetic cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, anthracycline cardiomyopathy, peripartum cardiomyopathy, and mitochondrial cardiomyopathies. Crucially, there are no specific treatments for preventing the onset or progression of these cardiomyopathies to heart failure, one of the leading causes of death and disability worldwide. Therefore, new treatments are needed to target the metabolic disturbances and impaired mitochondrial bioenergetics underlying these cardiomyopathies in order to improve health outcomes in these patients. However, investigation of the underlying mechanisms and the identification of novel therapeutic targets have been hampered by the lack of appropriate animal disease models. Furthermore, interspecies variation precludes the use of animal models for studying certain disorders, whereas patient-derived primary cell lines have limited lifespan and availability. Fortunately, the discovery of human-induced pluripotent stem cells has provided a promising tool for modelling cardiomyopathies via human heart tissue in a dish. In this review article, we highlight the use of patient-derived iPSCs for studying the pathogenesis underlying cardiomyopathies associated with metabolic perturbations and impaired mitochondrial bioenergetics, as the ability of iPSCs for self-renewal and differentiation makes them an ideal platform for investigating disease pathogenesis in a controlled in vitro environment. Continuing progress will help elucidate novel mechanistic pathways, and discover novel therapies for preventing the onset and progression of heart failure, thereby advancing a new era of personalized therapeutics for improving health outcomes in patients with cardiomyopathy.
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Affiliation(s)
- Chrishan J A Ramachandra
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Jasper Chua
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Faculty of Science, National University of Singapore, 6 Science Drive 2, Singapore 117546, Singapore
| | - Shuo Cong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Xuhui District, Shanghai 200032, China
| | - Myu Mai Ja Kp
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Winston Shim
- Health and Social Sciences Cluster, Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore
| | - Joseph C Wu
- Cardiovascular Institute, Stanford University School of Medicine, 265 Campus Drive, Stanford, CA 94305, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.,Department of Medicine, Stanford University, Stanford, CA 94305, USA.,Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Derek J Hausenloy
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore.,Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.,Yong Loo Lin Medical School, National University of Singapore, 10 Medical Drive, Singapore 11759, Singapore.,The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, Bloomsbury, London WC1E 6HX, UK.,Cardiovascular Research Centre, College of Medical and Health Sciences, Asia University, No. 500, Liufeng Road, Wufeng District, Taichung City 41354,Taiwan
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6
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Glöcklhofer CR, Steinfurt J, Franke G, Hoppmann A, Glantschnig T, Perez-Feliz S, Alter S, Fischer J, Brunner M, Rainer PP, Köttgen A, Bode C, Odening KE. A novel LMNA nonsense mutation causes two distinct phenotypes of cardiomyopathy with high risk of sudden cardiac death in a large five-generation family. Europace 2019; 20:2003-2013. [PMID: 29947763 DOI: 10.1093/europace/euy127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022] Open
Abstract
Aims Characterization of the cardiac phenotype associated with the novel LMNA nonsense mutation c.544C>T, p.Q182*, which we have identified in a large five-generation family. Methods and results A family tree was constructed. Clinical data [arrhythmia, syncope, sudden cardiac death (SCD), New York Heart Association (NYHA) class] were collected from living and deceased family members. DNA of 23 living family members was analysed for mutations in LMNA. Additionally, dilated cardiomyopathy multi-gene-panel testing and whole exome sequencing were performed in some family members to identify potential phenotype-modifiers. In this five-generation family (n = 65), 17 SCDs occurred at 49.3 ± 10.0 years. Furthermore, we identified eight additional mutation-carriers, seven symptomatic (44 ± 13 years), and one asymptomatic (44 years). First signs of disease [sinus bradycardia with atrioventricular (AV)-block I°] occurred at 36.5 ± 8.1 years. Paroxysmal atrial fibrillation (AF) (onset at 41.8 ± 5.7 years) rapidly progressed to permanent AF (46.2 ± 9.8 years). Subsequently, AV-conduction worsened, syncope, pacemaker-dependence, and non-sustained ventricular tachycardia (43.3 ± 8.2 years) followed. Ventricular arrhythmia caused SCD in patients without implantable cardioverter-defibrillator (ICD). Patients protected by ICD developed rapidly progressive heart failure (45.2 ± 10.6 years). A different phenotype was seen in a sub-family in three patients with early onset of rapidly decompensating heart failure and only minor prior arrhythmia-related symptoms. One patient received high-urgency heart transplantation (HTX) at 32 years, while two died prior to HTX. One of them developed lethal peripartum-associated heart failure. Possible disease-modifiers were identified in this 'heart failure sub-family'. Conclusion The novel LMNA nonsense mutation c.544C>T causes a severe arrhythmogenic phenotype manifesting with high incidence of SCD in most patients; and in one sub-family, a distinct phenotype with fast progressing heart failure, indicating the need for early consideration of ICD-implantation and listing for heart-transplantation.
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Affiliation(s)
- Christina R Glöcklhofer
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Steinfurt
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerlind Franke
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anselm Hoppmann
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Genetic Epidemiology, Medical Center University of Freiburg, Freiburg, Germany.,Genetics and Experimental Bioinformatics, Faculty of Biology, University of Freiburg, Freiburg, Germany
| | | | - Stefanie Perez-Feliz
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svenja Alter
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Human Genetics, Medical Center University of Freiburg, Freiburg, Germany
| | - Judith Fischer
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Human Genetics, Medical Center University of Freiburg, Freiburg, Germany
| | - Michael Brunner
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Anna Köttgen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Genetic Epidemiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Hugstetter Str. 55, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract
Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening disease that occurs toward the end of pregnancy or in the months following delivery in previously heart-healthy women. The incidence varies widely depending on geographical region and ethnic background, with an estimated number of 1 in 1000–1500 pregnancies in Germany. The course of the disease ranges from mild forms with minor symptoms to severe forms with acute heart failure and cardiogenic shock. The understanding of the etiology of PPCM has evolved in recent years. An oxidative stress-mediated cleaved 16-kDa fragment of the nursing hormone prolactin is thought to damage endothelial cells and cardiomyocytes. Bromocriptine, a dopamine-receptor agonist, effectively blocks prolactin release from the pituitary gland. In addition to standard heart failure therapy, this disease-specific treatment reduces morbidity and mortality in PPCM patients. This review summarizes the current knowledge on PPCM and the disease-specific treatment options.
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Affiliation(s)
- T Koenig
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - D Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - J Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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8
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Robbins KS, Krause M, Nguyen AP, Almehlisi A, Meier A, Schmidt U. Peripartum Cardiomyopathy: Current Options for Treatment and Cardiovascular Support. J Cardiothorac Vasc Anesth 2019; 33:2814-2825. [PMID: 31060943 DOI: 10.1053/j.jvca.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 12/17/2022]
Abstract
Peripartum cardiomyopathy is a rare form of acute heart failure but the major cause of all deaths in pregnant patients with heart failure. Improved survival rates in recent years, however, emphasize the importance of early recognition and initiation of heart failure treatment. This article, therefore, attempts to raise awareness among cardiac and obstetric anesthesiologists as well as intensivists of this often fatal diagnosis. This review summarizes theories of the pathophysiology and outcome of peripartum cardiomyopathy. Based on the most recent literature, it further outlines diagnostic criteria and treatment options including medical management, mechanical circulatory support devices, and heart transplantation. Earlier recognition of this rare condition and a new generation of mechanical circulatory devices has contributed to the improved outcome. More frequently, patients in cardiogenic shock who fail medical management are successfully bridged to recovery on extracorporeal circulatory devices or survive with a long-lasting implantable ventricular assist device. The outcome of transplanted patients with peripartum cardiomyopathy, however, is worse compared to other recipients of heart transplants and warrants further investigation in the future.
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Affiliation(s)
- Kimberly S Robbins
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Martin Krause
- Department of Anesthesiology, Division of Critical Care, University of Colorado, Aurora, CO.
| | - Albert P Nguyen
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Abdulaziz Almehlisi
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Angela Meier
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
| | - Ulrich Schmidt
- Department of Anesthesiology, Division of Critical Care, University of California San Diego, San Diego, CA
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9
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Identification and Functional Characterization of an ISL1 Mutation Predisposing to Dilated Cardiomyopathy. J Cardiovasc Transl Res 2018; 12:257-267. [DOI: 10.1007/s12265-018-9851-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023]
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