1
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Polsinelli VB, Koczo A, Johnson AE, Elkayam U, Cooper LT, Gorcsan J, Briller J, Fett J, McNamara DM. Race, hypertensive disorders of pregnancy and outcomes in peripartum cardiomyopathy. Am Heart J 2024; 276:60-69. [PMID: 38996860 DOI: 10.1016/j.ahj.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Black women with peripartum cardiomyopathy (PPCM) have a higher prevalence of hypertensive disorders of pregnancy (HDP) and worse clinical outcomes compared with non-Black women. We examined the impact of HDP on myocardial recovery in Black women with PPCM. METHODS A total of 100 women were enrolled into the Investigation in Pregnancy Associated Cardiomyopathy (IPAC) study. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6, and 12-months post-partum (PP). Women were followed for 12 months postpartum and outcomes including persistent cardiomyopathy (LVEF ≤35%), left ventricular assist device, (LVAD), cardiac transplantation, or death were examined in subsets based on race and the presence of HDP. RESULTS Black women with HDP were more likely to present earlier compared to Black women without HDP (days PP HDP: 34 ± 21 vs 54 ± 27 days, P = .03). There was no difference in LVEF at study entry for Black women based on HDP, but better recovery with HDP at 6 (HDP: 52 ± 11% vs no HDP: 40 ± 14%, P = .03) and 12-months (HDP:53 ± 10% vs no HDP:40 ± 16%, P = .02). At 12-months, Black women overall had a lower LVEF than non-Black women (P < .001), driven by less recovery in Black women without HDP compared to non-Black women (P < .001). In contrast, Black women with HDP had a similar LVEF at 12 months compared to non-Black women (P = .56). CONCLUSIONS In women with PPCM, poorer outcomes evident in Black women were driven by women without a history of HDP. In Black women, a history of HDP was associated with earlier presentation and recovery which was comparable to non-Black women.
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Affiliation(s)
| | - Agnes Koczo
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Uri Elkayam
- University of Southern California, Los Angeles, CA
| | | | | | | | - James Fett
- University of Pittsburgh Medical Center, Pittsburgh, PA
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2
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Li S, Girgla S, Sherman A, Alpay-Savasan Z, Mehta N. Atrial fibrillation considerations in the fourth trimester (postpartum period). J Interv Card Electrophysiol 2024; 67:901-914. [PMID: 38363430 DOI: 10.1007/s10840-023-01611-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/18/2023] [Indexed: 02/17/2024]
Abstract
Postpartum atrial fibrillation is an uncommon but increasingly prevalent tachyarrhythmia that merits special management considerations with regards to the safety and efficacy of anticoagulation, rate and rhythm control as well as drug exposure to infants throughout breastfeeding. In this state-of-the-art review, we examine the demographics of postpartum atrial fibrillation with its associated risk factors, describe the safety of commonly used atrial fibrillation therapies, and discuss important considerations for women considering subsequent pregnancies.
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Affiliation(s)
- Shuo Li
- Internal Medicine Residency, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Saavia Girgla
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Andrew Sherman
- Internal Medicine Residency, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Zeynep Alpay-Savasan
- Division of Maternal and Fetal Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Nishaki Mehta
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA.
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3
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El Marraki Z, Mounaouir K, Fellat N, Fellat R. Postpartum dilated cardiomyopathy and antiphospholipid syndrome: A rare association revealed by a pulmonary embolism (case report). Radiol Case Rep 2024; 19:1298-1303. [PMID: 38292781 PMCID: PMC10825536 DOI: 10.1016/j.radcr.2023.11.056] [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: 10/27/2022] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024] Open
Abstract
Antiphospholipid syndrome is a rare entity that must be systematically evoked in front of recurrent miscarriages associated with venous or arterial thrombosis, its diagnosis is based on a set of clinico-biological arguments. In rare cases, it can be associated with postpartum cardiomyopathy, which is defined by a dysfunction of the left ventricle with an LVEF<45%, which may or may not be associated with a dilation of the left ventricle. This association is rare and poorly described in the literature, which makes management difficult and uncodified. In this context we report the case of a 33-year-old patient with cardiovascular risk factors such as arterial hypertension 2 previous miscarriages and repeated phlebitis, she was admitted to the emergency room for the management of acute dyspnea related to a proximal right pulmonary embolism and in whom the transthoracic echocardiography had objectivated a dilated left ventricle and an alteration of the ejection fraction of the left ventricle, the coronary angiography came back without particularity as part of the etiological work-up, a biological work-up was carried out, which came back in favor of an antiphospholipid syndrome. This case shows diagnostic difficulties and management of this disease.
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Affiliation(s)
- Zakaria El Marraki
- Department of Cardiac Intensive Care, Cardiology Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - Karim Mounaouir
- Department of Cardiac Intensive Care, Faculty of Medicine and Pharmacy, Casablanca, Morocco
| | - Nadia Fellat
- Department of Cardiac Intensive Care, Cardiology Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - Rokaya Fellat
- Department of Clinical Cardiology, Faculty of Medicine and Pharmacy, Rabat, Morocco
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4
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Koerber D, Khan S, Kirubarajan A, Spivak A, Wine R, Matelski J, Sobel M, Harris K. Meta-Analysis of Long-Term (>1 Year) Cardiac Outcomes of Peripartum Cardiomyopathy. Am J Cardiol 2023; 194:71-77. [PMID: 36989549 DOI: 10.1016/j.amjcard.2023.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/31/2023]
Abstract
Peripartum cardiomyopathy is the development of heart failure toward the end of pregnancy or in the months after delivery in the absence of other attributable causes, with left ventricular systolic dysfunction and a left ventricular ejection fraction (LVEF) generally <45%. Given that patients are relatively young at the time of diagnosis, this study was performed to summarize current evidence surrounding the long-term cardiac outcomes. MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched for original studies that reported long-term (>1 year) patient outcomes. Of the 3,144 total records identified, 62 studies involving 4,282 patients met the selection criteria. The mean LVEF was 28% at diagnosis and 47% at the time of the last follow-up. Approximately half of the patients achieved myocardial recovery (47%), most commonly defined as an LVEF >50% (n = 21). The prevalence of implantable cardioverter-defibrillator use, left ventricular assist device implantation, and heart transplantation was 12%, 7%, and 11%, respectively. The overall all-cause mortality was 9%, and despite having more cardiovascular risk factors, patients residing in high-income countries had superior outcomes, including reduced rates of mortality.
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Affiliation(s)
- Daniel Koerber
- Faculty of Medicine, University of Alberta, Edmonton, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Spivak
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Wine
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Mara Sobel
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kristin Harris
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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5
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Carlson S, Schultz J, Ramu B, Davis MB. Peripartum Cardiomyopathy: Risks Diagnosis and Management. J Multidiscip Healthc 2023; 16:1249-1258. [PMID: 37163197 PMCID: PMC10164389 DOI: 10.2147/jmdh.s372747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.
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Affiliation(s)
- Selma Carlson
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Cardiology, Minneapolis VA Medical Center, Minneapolis, MN, USA
- Correspondence: Selma Carlson, Division of Cardiology, Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA, Email
| | - Jessica Schultz
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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6
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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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7
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Abstract
Peripartum cardiomyopathy is a form of idiopathic systolic heart failure which occurs during the end of pregnancy or the early post-partum in the absence of an identifiable etiology. The exact pathogenesis remains unknown, and the incidence is higher in African ancestry, multiparous and hypertensive women, or older maternal age. Delay in diagnosis is common, mainly because symptoms of heart failure mimic those of normal pregnancy. Echocardiography showing decreased myocardial function is at the center of the diagnosis. Management relies on the general guidelines of management of other forms of non-ischemic cardiomyopathy; however, special attention should be paid when choosing medications to ensure fetal safety. Outcomes can be variable and can range from complete recovery to persistent heart failure requiring transplant or even death. High rates of relapse with subsequent pregnancies can occur, especially with incomplete myocardial recovery. Additional research about the etiology, experimental drugs, prognosis, and duration of treatment after recovery are needed.
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8
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Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 75:207-221. [DOI: 10.1016/j.jacc.2019.11.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 01/13/2023]
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9
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de la Hoz Suárez J, Cabezas Palacios MN, Novo Cabrera J. H1N1 influenza virus as a cause of peripartum cardiomyopathy. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Sliwa K, Petrie MC, Hilfiker-Kleiner D, Mebazaa A, Jackson A, Johnson MR, van der Meer P, Mbakwem A, Bauersachs J. Long-term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy. Eur J Heart Fail 2018; 20:951-962. [PMID: 29578284 DOI: 10.1002/ejhf.1178] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/11/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022] Open
Abstract
Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine & Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa.,Mary McKillop Institute, ACU, Melbourne, Australia
| | | | | | - Alexandre Mebazaa
- Hôpital Lariboisière, Université Paris Diderot, Inserm U942, Paris, France
| | | | - Mark R Johnson
- Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Amam Mbakwem
- Department of Cardiology, Lagos University Hospital, Lagos
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Hannover, Germany
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11
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Frantz S, Falcao-Pires I, Balligand JL, Bauersachs J, Brutsaert D, Ciccarelli M, Dawson D, de Windt LJ, Giacca M, Hamdani N, Hilfiker-Kleiner D, Hirsch E, Leite-Moreira A, Mayr M, Thum T, Tocchetti CG, van der Velden J, Varricchi G, Heymans S. The innate immune system in chronic cardiomyopathy: a European Society of Cardiology (ESC) scientific statement from the Working Group on Myocardial Function of the ESC. Eur J Heart Fail 2018; 20:445-459. [PMID: 29333691 PMCID: PMC5993315 DOI: 10.1002/ejhf.1138] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/03/2017] [Accepted: 12/18/2017] [Indexed: 12/11/2022] Open
Abstract
Activation of the immune system in heart failure (HF) has been recognized for over 20 years. Initially, experimental studies demonstrated a maladaptive role of the immune system. However, several phase III trials failed to show beneficial effects in HF with therapies directed against an immune activation. Preclinical studies today describe positive and negative effects of immune activation in HF. These different effects depend on timing and aetiology of HF. Therefore, herein we give a detailed review on immune mechanisms and their importance for the development of HF with a special focus on commonalities and differences between different forms of cardiomyopathies. The role of the immune system in ischaemic, hypertensive, diabetic, toxic, viral, genetic, peripartum, and autoimmune cardiomyopathy is discussed in depth. Overall, initial damage to the heart leads to disease specific activation of the immune system whereas in the chronic phase of HF overlapping mechanisms occur in different aetiologies.
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Affiliation(s)
- Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Germany; Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ines Falcao-Pires
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean-Luc Balligand
- Pole of Pharmacology and Therapeutics, Institut de Recherche Experimentale et Clinique (IREC), and Clinique Universitaire Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medizinische Hochschule, Hannover, Germany
| | | | - Michele Ciccarelli
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland
| | - Leon J de Windt
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mauro Giacca
- International Centre for Genetic Engineering and Biotechnology (ICGEB) and Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nazha Hamdani
- Department of Cardiovascular Physiology, Ruhr University Bochum, Bochum, Germany
| | - Denise Hilfiker-Kleiner
- Molecular Cardiology, Department of Cardiology and Angiology, Medizinische Hochschule, Hannover, Germany
| | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery and Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Mayr
- The James Black Centre and King's British Heart Foundation Centre, King's College, University of London, London, UK
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, and REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Jolanda van der Velden
- Department of Physiology, VU University Medical Center, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Gilda Varricchi
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Cardiovascular Sciences, Leuven University, Leuven, Belgium
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12
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McTiernan CF, Morel P, Cooper LT, Rajagopalan N, Thohan V, Zucker M, Boehmer J, Bozkurt B, Mather P, Thornton J, Ghali JK, Hanley-Yanez K, Fett J, Halder I, McNamara DM. Circulating T-Cell Subsets, Monocytes, and Natural Killer Cells in Peripartum Cardiomyopathy: Results From the Multicenter IPAC Study. J Card Fail 2017; 24:33-42. [PMID: 29079307 DOI: 10.1016/j.cardfail.2017.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 10/16/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this work was to evaluate the hypothesis that the distribution of circulating immune cell subsets, or their activation state, is significantly different between peripartum cardiomyopathy (PPCM) and healthy postpartum (HP) women. BACKGROUND PPCM is a major cause of maternal morbidity and mortality, and an immune-mediated etiology has been hypothesized. Cellular immunity, altered in pregnancy and the peripartum period, has been proposed to play a role in PPCM pathogenesis. METHODS The Investigation of Pregnancy-Associated Cardiomyopathy (IPAC) study enrolled 100 women presenting with a left ventricular ejection fraction of <0.45 within 2 months of delivery. Peripheral T-cell subsets, natural killer (NK) cells, and cellular activation markers were assessed by flow cytometry in PPCM women early (<6 wk), 2 months, and 6 months postpartum and compared with those of HP women and women with non-pregnancy-associated recent-onset cardiomyopathy (ROCM). RESULTS Entry NK cell levels (CD3-CD56+CD16+; reported as % of CD3- cells) were significantly (P < .0003) reduced in PPCM (6.6 ± 4.9% of CD3- cells) compared to HP (11.9 ± 5%). Of T-cell subtypes, CD3+CD4-CD8-CD38+ cells differed significantly (P < .004) between PPCM (24.5 ± 12.5% of CD3+CD4-CD8- cells) and HP (12.5 ± 6.4%). PPCM patients demonstrated a rapid recovery of NK and CD3+CD4-CD8-CD38+ cell levels. However, black women had a delayed recovery of NK cells. A similar reduction of NK cells was observed in women with ROCM. CONCLUSIONS Compared with HP control women, early postpartum PPCM women show significantly reduced NK cells, and higher CD3+CD4-CD8-CD38+ cells, which both normalize over time postpartum. The mechanistic role of NK cells and "double negative" (CD4-CD8-) T regulatory cells in PPCM requires further investigation.
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Affiliation(s)
- Charles F McTiernan
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Penelope Morel
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Vinay Thohan
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Mark Zucker
- Cardiac Transplant Center, Beth Israel Newark Medical Center, New Jersey
| | - John Boehmer
- Division of Cardiology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Biykem Bozkurt
- Winters Center for Heart Failure Research, Baylor College of Medicine, Houston, Texas
| | - Paul Mather
- Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Thornton
- Division of Cardiology, Georgia Regents University in Augusta, Augusta, Georgia
| | - Jalal K Ghali
- Division of Cardiology, Mercer University School of Medicine, Macon, Georgia
| | - Karen Hanley-Yanez
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James Fett
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Indrani Halder
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis M McNamara
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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13
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Ersbøll AS, Damm P, Gustafsson F, Vejlstrup NG, Johansen M. Peripartum cardiomyopathy: a systematic literature review. Acta Obstet Gynecol Scand 2017; 95:1205-1219. [PMID: 27545093 DOI: 10.1111/aogs.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/16/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We aim to raise awareness of the condition and give the clinician an overview of current knowledge on the mechanisms of pathophysiology, diagnostics and clinical management. MATERIAL AND METHODS Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews that provided comprehensive overviews were included, too. RESULTS New research on the pathophysiological mechanisms of PPCM points towards a two-hit multifactorial cause involving genetic factors and an antiangiogenic hormonal environment of late gestation with high levels of prolactin and sFlt-1. The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis. Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy. CONCLUSIONS PPCM has a huge impact on cardiovascular health and reproductive life perspective. New insights into genetics, molecular pathophysiological mechanisms and clinical studies have resulted in potential disease-specific therapies, but many questions remain unanswered.
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Affiliation(s)
- Anne S Ersbøll
- Center for Pregnancy and Heart Disease, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels G Vejlstrup
- Center for Pregnancy and Heart Disease, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Johansen
- Center for Pregnancy and Heart Disease, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Rafii DC, Park P, Resta CA. Autoimmune Polyglandular Syndrome Type 2 In A Patient With Peripartum Cardiomyopathy. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161326.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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15
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Basu J, Redman C, Ormerod O. Immunosuppression therapy in the management of peripartum cardiomyopathy: A case series and literature review. Obstet Med 2016; 9:174-176. [PMID: 27829880 DOI: 10.1177/1753495x16655915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 11/15/2022] Open
Abstract
Peripartum cardiomyopathy is a heart failure syndrome occurring late in pregnancy or during the early post-natal period. The pathophysiology of peripartum cardiomyopathy is not fully understood and various mechanisms have been postulated including an underlying inflammatory process. We here report four cases presenting with acute left ventricular systolic dysfunction. Three out of four of the patients presented with a left ventricular ejection fraction <30% and one with a left ventricular ejection fraction of 35%. All made a full clinical recovery following treatment with high-dose intravenous steroids. This case series adds to the growing body of evidence for the role for immunosuppressants in the management of peripartum cardiomyopathy.
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Affiliation(s)
- Joyee Basu
- Department of Cardiology, The Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Christopher Redman
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - Oliver Ormerod
- Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, UK
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16
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Sheppard R, Hsich E, Damp J, Elkayam U, Kealey A, Ramani G, Zucker M, Alexis JD, Horne BD, Hanley-Yanez K, Pisarcik J, Halder I, Fett JD, McNamara DM. GNB3 C825T Polymorphism and Myocardial Recovery in Peripartum Cardiomyopathy: Results of the Multicenter Investigations of Pregnancy-Associated Cardiomyopathy Study. Circ Heart Fail 2016; 9:e002683. [PMID: 26915373 DOI: 10.1161/circheartfailure.115.002683] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Black women are at greater risk for peripartum cardiomyopathy (PPCM). The guanine nucleotide-binding proteins β-3 subunit (GNB3) has a polymorphism C825T. The GNB3 TT genotype more prevalent in blacks is associated with poorer outcomes. We evaluated GNB3 genotype and myocardial recovery in PPCM. METHODS AND RESULTS A total of 97 women with PPCM were enrolled and genotyped for the GNB3 T/C polymorphism. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6 and 12 months postpartum. LVEF over time in subjects with the GNB3 TT genotype was compared with those with the C allele overall and in black and white subsets. The cohort was 30% black, age 30+6, LVEF 0.34+0.10 at entry 31+25 days postpartum. The % GNB3 genotype for TT/CT/CC=23/41/36 and differed markedly by race (blacks=52/38/10 versus whites=10/44/46, P<0.001). In subjects with the TT genotype, LVEF at entry was lower (TT=0.31+0.09; CT+CC=0.35+0.09, P=0.054) and this difference increased at 6 (TT=0.45+0.15; CT+CC=0.53+0.08, P=0.002) and 12 months (TT=0.45+0.15; CT+CC=0.56+0.07, P<0.001.). The difference in LVEF at 12 months by genotype was most pronounced in blacks (12 months LVEF for GNB3 TT=0.39+0.16; versus CT+CC=0.53+0.09, P=0.02) but evident in whites (TT=0.50++0.11; CT+CC=0.56+0.06, P=0.04). CONCLUSIONS The GNB3 TT genotype was associated with lower LVEF at 6 and 12 months in women with PPCM, and this was particularly evident in blacks. Racial differences in the prevalence and impact of GNB3 TT may contribute to poorer outcomes in black women with PPCM.
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Affiliation(s)
- Richard Sheppard
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.).
| | - Eileen Hsich
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Julie Damp
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Uri Elkayam
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Angela Kealey
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Gautam Ramani
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Mark Zucker
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Jeffrey D Alexis
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Benjamin D Horne
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Karen Hanley-Yanez
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Jessica Pisarcik
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Indrani Halder
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - James D Fett
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
| | - Dennis M McNamara
- From the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (R.S.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.H.); Department of Cardiology, Vanderbilt University, Nashville, TN (J.D.); Division of Cardiovascular Medicine, University of Southern California, Los Angeles (U.E.); Department of Medicine and Cardiovascular Sciences, University of Calgary, Calgary, AB, Canada (A.K.); Department of Cardiology, University of Maryland, Baltimore (G.R.); Cardiac Transplant Center, Beth Israel Newark Medical Center, NJ (M.Z.); Department of Cardiology, University of Rochester, NY (J.D.A.); Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah (B.D.H.); and Division of Cardiology, Heart, Lung, Blood, and Vascular Medicine Institute, University of Pittsburgh, PA (K.H.-Y., J.P., I.H., J.D.F., D.M.M.N.)
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Characteristics and In-Hospital Outcomes of Peripartum Cardiomyopathy Diagnosed During Delivery in the United States From the Nationwide Inpatient Sample (NIS) Database. J Card Fail 2016; 22:512-9. [PMID: 26923643 DOI: 10.1016/j.cardfail.2016.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/11/2016] [Accepted: 02/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is associated with advanced maternal age, African-American race, hypertensive disorders of pregnancy, and multiple-gestation pregnancies. Less is known regarding racial differences in risk factors and predictors of adverse in-hospital outcomes. METHODS AND RESULTS A total of 1,337 women with PPCM were identified with the use of the Nationwide Inpatient Sample (2004-2011). Clinical profiles and maternal outcomes in delivering mothers with and without PPCM were compared and stratified by race. In multivariate analysis, established risk factors for PPCM were confirmed. Anemia (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.5; P < .0001), asthma (OR 2.2, 95% CI 1.5-3.2; P = .0002), smoking (OR 33.6, 95% CI 9.3-159.4; P < .0001), and thyroid disease (OR 5.9; 95% CI 1.5-21.3; P = .01) were associated with PPCM. Risk factors significant in whites, African Americans, and Hispanics were hypertension during pregnancy and anemia. Patients with PPCM had higher rates of in-hospital adverse outcomes (P < .0001), but no differences in race or comorbidities predicted adverse events. CONCLUSIONS Hypertensive disorders during pregnancy and anemia were associated with PPCM in whites, African Americans, and Hispanics, providing further evidence that vascular stress may play a role in the pathogenesis of PPCM. Thyroid disorders may represent a novel risk factor for PPCM.
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18
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Evidence of autoantibodies against cardiac troponin I and sarcomeric myosin in peripartum cardiomyopathy. Basic Res Cardiol 2015; 110:60. [PMID: 26519371 DOI: 10.1007/s00395-015-0517-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a major cause of pregnancy-related maternal heart failure that develops towards the end of pregnancy or in the months following delivery. In small retrospective case series, autoimmune responses in the pathogenesis of PPCM have been proposed upon identification of autoantibodies (AABs) to cardiac antigens. However, their clinical and prognostic relevance still remain unclear. In this study, we evaluated the presence of circulating AABs against cardiac sarcomeric myosin (MHC) and troponin I (TnI) in the sera of PPCM patients and in relation to clinical presentation. In this case-control study, 70 patients diagnosed with PPCM and 50 pregnancy-matched healthy women with normal cardiac function were enrolled. Clinical assessment, echocardiography and blood tests were performed at baseline and at 6 ± 2 months follow-up. The presence of serum AABs against MHC (anti-MHC) and TnI (anti-TnI) was determined with a custom-made enzyme-linked immunosorbent assay (ELISA). The seropositivity for these AABs was correlated with the severity of LV dysfunction and the occurrence of pericardial effusion indicative of perimyocardial inflammation at baseline. Potential impact of these AABs on disease progression was evaluated with regard to functional (left ventricular ejection fraction) and clinical improvement at follow-up. Either anti-MHC or anti-TnI or both AABs were detected in the serum of 46 % of PPCM patients and in 8 % of healthy controls. In PPCM the presence of either one of these AABs was associated with significantly lower baseline LVEF and lower rate of full cardiac recovery at follow-up. Patients who were seropositive for anti-TnI AABs showed more frequently pericardial effusion indicative of a more pronounced immune response of the peri-/myocardium in these patients. Further studies are required to clarify cellular and molecular circuits leading to elevated levels of AABs and their pathophysiological relevance for disease initiation and progression in PPCM.
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Haghikia A, Röntgen P, Vogel-Claussen J, Schwab J, Westenfeld R, Ehlermann P, Berliner D, Podewski E, Hilfiker-Kleiner D, Bauersachs J. Prognostic implication of right ventricular involvement in peripartum cardiomyopathy: a cardiovascular magnetic resonance study. ESC Heart Fail 2015; 2:139-149. [PMID: 27774259 PMCID: PMC5054874 DOI: 10.1002/ehf2.12059] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/18/2015] [Accepted: 07/27/2015] [Indexed: 01/04/2023] Open
Abstract
Aims Peripartum cardiomyopathy (PPCM) is a major cause of acute heart failure in the peripartum period and considered potentially life threatening. While many aspects of its clinical profiles have been frequently reported, functional analysis, in particular of the right ventricle, and tissue characterization by cardiovascular magnetic resonance (CMR) imaging have been only sporadically described. The aim of the present study was to analyse pathological alterations and their prognostic relevance found in CMR imaging of patients newly diagnosed with PPCM. Methods and results In this multicenter study 34 patients with confirmed PPCM underwent CMR imaging at the time of diagnosis and at 5 ± 1 months follow‐up. Cine imaging of PPCM patients showed moderate to severe reduction of systolic left ventricular (LV) function (mean LVEF: 29.7 ± 12.8%). In 35% of the patients right ventricular (RV) systolic function was also reduced with a mean RVEF of 42.9 ± 13.9%. Dilatation of the LV was observed in 91% (mean LV‐EDV/BSA 128.5 ± 32.1 mL/m2), and dilatation of the RV was present in 24% (mean RV‐EDV/BSA 87.4 ± 18.5 mL/m2) of the patients. Focal non‐ischemic late gadolinium enhancement (LGE) was visible in 71%, and regional wall motion abnormalities were evident in 88% of the patients. LGE and wall motion abnormalities were predominantly located in the anteroseptal and basal to midventricular segments. RV dysfunction at baseline was associated with reduced probability of full cardiac recovery at 5 ± 1 months follow‐up. Conclusions Besides LV systolic dysfunction, RV dysfunction and dilatation are observed in about one third of PPCM patients at the time of diagnosis. RV dysfunction is associated with unfavourable outcome. A distinct pattern of LV wall motion abnormalities and myocardial scar is evident in most PPCM patients. The present study may help to establish a set of CMR criteria suitable for diagnosis in patients with suspected PPCM and may add further knowledge to the pathology of the disease.
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Affiliation(s)
- Arash Haghikia
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Philipp Röntgen
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
| | - Johannes Schwab
- Department of Cardiology Paracelsus Medical University, General Hospital Nuernberg Nuernberg Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty University Duesseldorf Germany
| | - Philipp Ehlermann
- Department of Cardiology, Pulmonology, and Vascular Medicine University of Heidelberg Heidelberg Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Edith Podewski
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
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Ntusi NBA, Badri M, Gumedze F, Sliwa K, Mayosi BM. Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy. PLoS One 2015; 10:e0133466. [PMID: 26252951 PMCID: PMC4529210 DOI: 10.1371/journal.pone.0133466] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/28/2015] [Indexed: 01/26/2023] Open
Abstract
Aims There is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM), as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP) (i.e., peripartum cardiac failure associated with any form of hypertension) and PPCM have similar or different clinical features and outcome. Methods and Results We compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features) and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years) and PPCM (n = 30; age 31.5 ± 7.5 years). The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001). PPCM was more significantly associated with the following features than HHFP (p<0.05): twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05) to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05). There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005) during follow-up. Conclusion There are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.
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Affiliation(s)
- Ntobeko B. A. Ntusi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Motasim Badri
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Freedom Gumedze
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Bongani M. Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
- * E-mail:
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Abstract
The peripartum cardiomyopathy is a rare form of dilated cardiomyopathy resulting from alteration of angiogenesis toward the end of pregnancy. The diagnosis is based on the association of clinical heart failure and systolic dysfunction assessed by echocardiography or magnetic resonance imaging. Diagnoses to rule out are myocardial infarction, amniotic liquid embolism, myocarditis, inherited cardiomyopathy, and history of treatment by anthracycline. Risk factors are advance maternal age (>30), multiparity, twin pregnancy, African origin, obesity, preeclampsia, gestational hypertension, and prolonged tocolytic therapy. Treatment of acute phase is identical to usual treatment of acute systolic heart failure. After delivery, VKA treatment should be discussed in case of systolic function <25% because of higher risk of thrombus. A specific treatment by bromocriptine can be initiated on a case-by-case basis. Complete recovery of systolic function is observed in 50% of cases. The mortality risk is low. Subsequent pregnancy should be discouraged, especially if systolic function did not recover.
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Affiliation(s)
- Frédéric Mouquet
- Polyclinique du Bois, soins intensifs et cardiologie, 59000 Lille, France; Institut pasteur de Lille, Inserm UMR 1011, 59000 Lille, France.
| | - Nadia Bouabdallaoui
- AP-HP, université Pierre-et-Marie-Curie, Paris VI, hôpital de la Pitié-Salpêtrière, département de chirurgie thoracique et cardovasculaire, 75013 Paris, France
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Davis M, Duvernoy C. Peripartum Cardiomyopathy: Current Knowledge and Future Directions. WOMENS HEALTH 2015; 11:565-73. [DOI: 10.2217/whe.15.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Peripartum cardiomyopathy is a form of heart failure occurring at the end of pregnancy or early in the postpartum period. Women may recover, have persistent cardiac dysfunction or suffer complications and death. Women who are African-American, older, hypertensive or have multiple gestation pregnancies have increased risk. Diagnosis and treatment may be delayed due to similarities between symptoms of normal pregnancy and heart failure. Echocardiography is essential for the diagnosis, and B-type natriuretic peptide can be helpful. Treatment for systolic heart failure must be adjusted during pregnancy, and anticoagulation may be indicated. Even after recovery, subsequent pregnancy confers substantial risk of worsening heart failure. Further investigations into the etiology, duration of treatment and risks for relapse are needed.
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Affiliation(s)
- Melinda Davis
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Claire Duvernoy
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA
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Affiliation(s)
- Sarah Grixti
- Foundation Year Doctor in the Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Caroline J Magri
- Higher Specialist Trainee, in the Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Robert Xuereb
- Consultant Cardiologist in the Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Stephen Fava
- Head of the Diabetes and Endocrine Centre, Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
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Sheppard R, Rajagopalan N, Safirstein J, Briller J. An update on treatments and outcomes in peripartum cardiomyopathy. Future Cardiol 2014; 10:435-47. [DOI: 10.2217/fca.14.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
ABSTRACT: Peripartum cardiomyopathy (PPCM) is a well-established complication of pregnancy. Criteria include heart failure that presents with reduced left ventricular function, signs and symptoms of heart failure either late in pregnancy or early in the postpartum period. The incidence varies widely depending geography and ethnicity. The pathophysiology of PPCM is still an area of active investigation, but includes immune and inflammatory mechanisms, which are the subject of several investigations. Therapies for chronic heart failure from PPCM are similar to those patients with nonischemic cardiomyopathy from different etiologies, however novel therapies may include bromocriptine, pentoxifylline or other potential therapies influencing the immune system. The need for implantable defibrillators, left ventricular assist devices and cardiac transplant in women with PPCM is rare, and prognosis is better than other forms of nonischemic cardiomyopathy. Despite this, further information about the epidemiology, prognosis and potential therapies are required to better manage and diagnose PPCM in women with signs and symptoms of heart failure.
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Affiliation(s)
- Richard Sheppard
- Jewish General Hospital, McGill University, Montreal H3T1E2, Canada
| | - Navin Rajagopalan
- University of Kentucky, Division of Cardiovascular Medicine, KY, USA
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Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2014; 12:767-78. [PMID: 20675664 DOI: 10.1093/eurjhf/hfq120] [Citation(s) in RCA: 592] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karen Sliwa
- Hatter Cardiovascular Research Institute; University of Cape Town; Cape Town South Africa
| | | | - Mark C. Petrie
- Golden Jubilee National Hospital; West of Scotland Regional Heart Centre; Glasgow UK
| | - Alexandre Mebazaa
- Inserm U 942, Hôpital Lariboisière; Université Paris Diderot; Paris France
| | - Burkert Pieske
- Deparment of Cardiologie; Medical University Graz; Graz Austria
| | - Eckhart Buchmann
- Department of Obstetrics and Gynaecology; University of the Witwatersrand and Chris Hani Baragwanath Hospital; Johannesburg South Africa
| | | | - Maria Schaufelberger
- Department of Medicine; Sahlgrenska University Hospital Ostra; Gothenburg Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital - GVM Care & Research; Ettore Sansavini Health Science Foundation; Cotignola Italy
| | - Dirk J. van Veldhuisen
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Hugh Watkins
- University of Oxford; John Radcliffe Hospital; Oxford UK
| | - Ajay J. Shah
- BHF Centre of Excellence; UK King's College London; UK
| | | | - Uri Elkayam
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Sabine Pankuweit
- Department of Internal Medicine/Cardiology; Philipp's University Marburg; Marburg Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Faculty of Medicine, Institute of Cardiology; University of Debrecen, Medical and Health Science Center; Debrecen Hungary
| | - Frederic Mouquet
- Polyclinique du Bois, et Pole des maladies cardiovasculaires; Hoptial Cardiologique, Centre Hospitalier Universitaire; Lille France
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre; University of Glasgow; Glasgow UK
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A change of heart: case series of peripartum cardiomyopathy. Case Rep Obstet Gynecol 2013; 2013:563158. [PMID: 24455352 PMCID: PMC3881380 DOI: 10.1155/2013/563158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is an uncommon disease of pregnancy, occurring in about 1 in 2000 live births, and is characterized by the development of heart failure, due to left ventricular systolic dysfunction. It is associated with high rates of maternal and neonatal mortality. Cardiac disease is the leading cause of maternal death in the UK: PPCM accounts for about 17% of these. Clinical findings of decompensated heart failure (HF) are often masked by the normal physiological changes seen in pregnancy making the diagnosis challenging. A high index of suspicion is essential-prompting referral for echocardiogram, which is crucial for diagnosis. Favourable prognosis is dependent on the early initiation of HF medications. Although full recovery occurs in around half of cases, left ventricular systolic dysfunction persists in a significant proportion of patients with PPCM and the risk of recurrence in subsequent pregnancies is high. The pathophysiology of PPCM is under intense research. We present four patients with PPCM and a review of the literature. Owing to the diagnostic challenge of PPCM and decompensated HF in pregnant mothers and its high mortality rate without treatment, prompt investigation and referral are key to improving maternal survival.
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Shah T, Ather S, Bavishi C, Bambhroliya A, Ma T, Bozkurt B. Peripartum cardiomyopathy: a contemporary review. Methodist Debakey Cardiovasc J 2013; 9:38-43. [PMID: 23519269 DOI: 10.14797/mdcj-9-1-38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Peripartum cardiomyopathy is a rare and potentially fatal disease. Though approximately half of the patients recover, the clinical course is highly variable and some patients develop refractory heart failure and persistent left ventricular systolic dysfunction. It is diagnosed when women present with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. Etiology remains unclear, and treatment is similar to other cardiomyopathies and includes evidence-based standard heart failure management strategies. Experimental strategies such as intravenous immunoglobulin and bromocriptine await further clinical validation.
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Affiliation(s)
- Tina Shah
- Baylor College of Medicine, Houston, Texas, USA
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Löser B, Tank S, Hillebrand G, Goldmann B, Diehl W, Biermann D, Schirmer J, Reuter DA. [Peripartum cardiomyopathy: interdisciplinary challenge]. Anaesthesist 2013; 62:343-54. [PMID: 23584315 DOI: 10.1007/s00101-013-2167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare type of heart failure which presents towards the end of pregnancy or in the first 5 months after delivery. Depending on the geographical location the incidence is reported in the literature as 1:300 up to 1:15,000. There are a number of known risk factors, such as multiparity and age of the mother over 30 years. The symptoms of PPCM correspond to those of idiopathic cardiomyopathy. The diagnosis is mainly carried out using echocardiography which shows a clear reduction of systolic left ventricular function. The therapeutic approach is the same as for idiopathic cardiomyopathy and in this context it is absolutely necessary to show caution concerning the state of pregnancy and the resulting contraindications for therapeutic drugs. The prognosis is dependent on recovery from the heart failure during the first 6 months postpartum. The lethality of the disease is high and is given in the literature as up to 28 %. Because of its complexity PPCM is an interdisciplinary challenge. In the peripartum phase a close cooperation between the disciplines of cardiology, cardiac surgery, neonatology, obstetrics and anesthesiology is indispensable. For anesthesiology the most important aspects are the mostly advanced unstable hemodynamic condition of the mother and the planning and implementation of the perioperative management. This article presents the case of a patient in advanced pregnancy with signs of acute severe heart failure and a suspected diagnosis of PPCM. The patient presented as an emergency case and delivery of the child was carried out using peridural anesthesia with a stand-by life support machine.
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Affiliation(s)
- B Löser
- Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Deutschland.
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Krejci J, Hude P, Spinarova L, Zampachova V, Sirotkova A, Freiberger T, Nemcova E, Vitovec J. The variable clinical course of peripartum cardiomyopathy. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 158:92-7. [PMID: 23128823 DOI: 10.5507/bp.2012.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In Europe, peripartum cardiomyopathy (PPCM) is a rare disorder, often difficult to diagnose and it has a variable clinical course. The aim of this report was to describe and discuss the individual variability of this disorder and its management. PATIENTS AND METHODS Three cases of PPCM manifesting as severe heart failure are compared. Common was the presence of myocardial inflammation detected by endomyocardial biopsy. Different were treatment methods and clinical course. Modern therapeutic concepts such as immunosuppressive therapy and bromocriptin administration are discussed, as well as non-pharmacological approaches. CONCLUSION In the differential diagnostics of dyspnea associated with pregnancy and childbirth, PPCM should be considered. The potentially severe course of the disease requires hospitalization with the possibility of comprehensive heart failure treatment, including non-pharmacological approaches such as device therapy and heart transplantation.
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Affiliation(s)
- Jan Krejci
- International Clinical Research Center - 1st Internal Cardio-Angiological Clinic, St. Anne's University Hospital Brno, Czech Republic
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Peripartum cardiomyopathy: Post-transplant outcomes from the united network for organ sharing database. J Heart Lung Transplant 2012; 31:180-6. [DOI: 10.1016/j.healun.2011.11.018] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 11/11/2011] [Accepted: 11/25/2011] [Indexed: 11/20/2022] Open
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Leone O, Veinot JP, Angelini A, Baandrup UT, Basso C, Berry G, Bruneval P, Burke M, Butany J, Calabrese F, d'Amati G, Edwards WD, Fallon JT, Fishbein MC, Gallagher PJ, Halushka MK, McManus B, Pucci A, Rodriguez ER, Saffitz JE, Sheppard MN, Steenbergen C, Stone JR, Tan C, Thiene G, van der Wal AC, Winters GL. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol 2011; 21:245-74. [PMID: 22137237 DOI: 10.1016/j.carpath.2011.10.001] [Citation(s) in RCA: 361] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/28/2011] [Accepted: 10/07/2011] [Indexed: 01/04/2023] Open
Abstract
The Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology have produced this position paper concerning the current role of endomyocardial biopsy (EMB) for the diagnosis of cardiac diseases and its contribution to patient management, focusing on pathological issues, with these aims: • Determining appropriate EMB use in the context of current diagnostic strategies for cardiac diseases and providing recommendations for its rational utilization • Providing standard criteria and guidance for appropriate tissue triage and pathological analysis • Promoting a team approach to EMB use, integrating the competences of pathologists, clinicians, and imagers.
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Affiliation(s)
- Ornella Leone
- U.O. di Anatomia ed Istologia Patologica, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy.
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Horne BD, Rasmusson KD, Alharethi R, Budge D, Brunisholz KD, Metz T, Carlquist JF, Connolly JJ, Porter TF, Lappé DL, Muhlestein JB, Silver R, Stehlik J, Park JJ, May HT, Bair TL, Anderson JL, Renlund DG, Kfoury AG. Genome-wide significance and replication of the chromosome 12p11.22 locus near the PTHLH gene for peripartum cardiomyopathy. ACTA ACUST UNITED AC 2011; 4:359-66. [PMID: 21665988 DOI: 10.1161/circgenetics.110.959205] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peripartum (PP) cardiomyopathy (CM) is a rare condition of unknown etiology that occurs in late pregnancy or early postpartum. Initial evidence suggests that genetic factors may influence PPCM. This study evaluated and replicated genome-wide association of single nucleotide polymorphisms with PPCM. METHODS AND RESULTS Genome-wide single nucleotide polymorphisms in women with verified PPCM diagnosis (n=41) were compared separately with local control subjects (n=49 postmenopausal age-discordant women with parity ≥1 and no heart failure) and iControls (n=654 women ages 30 to 84 years with unknown phenotypes). A replication study of independent population samples used new cases (PPCM2, n=30) compared with new age-discordant control subjects (local2, n=124) and with younger control subjects (n=89) and obstetric control subjects (n=90). A third case set of pregnancy-associated CM cases not meeting strict PPCM definitions (n=29) was also studied. In the genome-wide association study, 1 single nucleotide polymorphism (rs258415) met genome-wide significance for PPCM versus local control subjects (P=2.06×10(-8); odds ratio [OR], 5.96). This was verified versus iControls (P=7.92×10(-19); OR, 8.52). In the replication study for PPCM2 cases, rs258415 (ORs are per C allele) replicated at P=0.009 versus local2 control subjects (OR, 2.26). This replication was verified for PPCM2 versus younger control subjects (P=0.029; OR, 2.15) and versus obstetric control subjects (P=0.013; OR, 2.44). In pregnancy-associated cardiomyopathy cases, rs258415 had a similar effect versus local2 control subjects (P=0.06; OR, 1.79), younger control subjects (P=0.14; OR, 1.65), and obstetric control subjects (P=0.038; OR, 1.99). CONCLUSIONS Genome-wide association with PPCM was discovered and replicated for rs258415 at chromosome 12p11.22 near PTHLH. This study indicates a role of genetic factors in PPCM and provides a new locus for further pathophysiological and clinical investigation.
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Affiliation(s)
- Benjamin D Horne
- Cardiovascular Department, Intermountain Medical Center, Genetic Epidemiology Division, University of Utah, USA.
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Bhakta P, Mishra P, Bakshi A, Langer V. Case report and mini literature review: anesthetic management for severe peripartum cardiomyopathy complicated with preeclampsia using sufetanil in combined spinal epidural anesthesia. Yonsei Med J 2011; 52:1-12. [PMID: 21155028 PMCID: PMC3017683 DOI: 10.3349/ymj.2011.52.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.
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Affiliation(s)
- Pradipta Bhakta
- Department of Anesthesiology, Sultan Quaboos University Hospital, Muscat, Sultanate of Oman
| | - Pragnyadipta Mishra
- Department of Anesthesiology, University of Florida College of Medicine-Jacksonville, Fl, USA
| | - Anamika Bakshi
- Department of Anesthesiology, Moolchand Hospital, New Delhi, India
| | - Vijay Langer
- Department of Anesthesiology, Moolchand Hospital, New Delhi, India
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Gentry MB, Dias JK, Luis A, Patel R, Thornton J, Reed GL. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol 2010; 55:654-9. [PMID: 20170791 PMCID: PMC3814012 DOI: 10.1016/j.jacc.2009.09.043] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 08/26/2009] [Accepted: 09/21/2009] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether African-American women are at increased risk of having peripartum cardiomyopathy. BACKGROUND Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions. METHODS A case-control study was performed at a regional center that provides medical care to a racially heterogeneous population. For each case, 3 healthy control patients were randomly selected who delivered babies within the same month. RESULTS African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non-African Americans (odds ratio [OR]: 15.7, 95% confidence interval [CI]: 3.5 to 70.6). Other significant univariate risk factors were hypertension (OR: 10.8, 95% CI: 2.6 to 44.4), being unmarried (OR: 4.2, 95% CI: 1.4 to 12.3), and having had >2 previous pregnancies (OR: 2.9, 95% CI: 1.1 to 7.4). African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable (OR: 31.5, 95% CI: 3.6 to 277.6) and stratified analyses (OR: 12.9 to 29.1, p < 0.001). Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women. CONCLUSIONS African-American women have significantly higher odds of having peripartum cardiomyopathy that could not be explained by several other factors. Further research will be necessary to determine the potential environmental and/or genetic factors associated with African descent that confer this risk.
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Affiliation(s)
- Mindy B Gentry
- Cardiovascular Center, Department of Medicine, Medical College of Georgia, Augusta, Georgia 30912, USA.
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Sliwa K, Forster O, Tibazarwa K, Libhaber E, Becker A, Yip A, Hilfiker-Kleiner D. Long-term outcome of peripartum cardiomyopathy in a population with high seropositivity for human immunodeficiency virus. Int J Cardiol 2009; 147:202-8. [PMID: 19751951 DOI: 10.1016/j.ijcard.2009.08.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 08/13/2009] [Accepted: 08/19/2009] [Indexed: 12/24/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy with a high risk of mortality. The present study assessed clinical outcome and mortality over a 2-year period in an African cohort of 80 PPCM patients. METHODS A prospective study over a 2-year period at a tertiary center, where 80 consecutive women presenting with PPCM were enrolled on first diagnosis. Patients obtained standard heart failure therapy. Detailed assessments included echocardiography, NYHA functional class, left ventricular ejection fraction (LVEF), mortality and serum levels for hemoglobin, CRP, IL-6, TNF-alpha, Fas/Apo-1, and T-cell count at each 6-month intervals for 24 months. RESULTS Baseline mean age was 30 ± 7 years; 38% were primigravidas and 34% were co-infected with HIV. NYHA functional class III-IV was present in 89% patients with a mean LVEF of 30 ± 9%. Four patients were lost to follow-up, 9 moved to remote areas, 7 were excluded due to subsequent pregnancy. The 2-year mortality rate was 28%. Eight of 80 (10%) died by 6 months. Mean LVEF of surviving patients was: 44 ± 11% at 6-months, 46 ± 13% at 12-months and 50 ± 14% at 24-months follow-up. Of the 69 patients still enrolled at 6 months 14 (20%) died over the remaining 18-month period, despite functional recovery. No statistically significant difference in LVEF and mortality was observed between PPCM patients with or without HIV co-infection. CONCLUSION The novel finding of this study is the continuous high mortality of PPCM patients occurring beyond 6 months independent of HIV infection and subsequent pregnancy. This finding strongly encourages the need for long-term clinical follow-up and management of women with PPCM.
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Affiliation(s)
- Karen Sliwa
- Soweto Cardiovascular Research Unit, Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
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Bouabdallaoui N, de Groote P, Mouquet F. Cardiomyopathie du péripartum. Presse Med 2009; 38:995-1000. [DOI: 10.1016/j.lpm.2009.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/23/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022] Open
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Selle T, Renger I, Labidi S, Bultmann I, Hilfiker-Kleiner D. Reviewing peripartum cardiomyopathy: current state of knowledge. Future Cardiol 2009; 5:175-89. [DOI: 10.2217/14796678.5.2.175] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a serious, potentially life-threatening heart disease of unknown etiology in previously healthy women that develops between the last month of pregnancy and 5–6 months after delivery. PPCM is a distinct clinical entity in which echocardiography demonstrates the features of an idiopathic dilated cardiomyopathy with a high morbidity and mortality, but in addition, patients suffering with PPCM have a chance of reaching full recovery. A variety of potential risk factors related to PPCM have been suggested over the last decades, which may help to identify women at risk in the future. Recent advances in understanding the pathophysiology of PPCM assign a key role to unbalanced oxidative stress and the generation of a cardiotoxic prolactin subfragment. In this regard, pharmacological blockade of prolactin holds the promise of novel, more disease-specific therapy options. The present article provides an overview on the clinical appearance and management, risk factors and potential pathophysiological mechanisms of PPCM.
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Affiliation(s)
- Tina Selle
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Isabelle Renger
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Saida Labidi
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Insa Bultmann
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Hannover Medical School (MHH), Department of Cardiology & Agiology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Kajiya T, Lee S, Yamashita M, Sasaki Y, Kamizono Y, Imamura M, Toyonaga K, Toda H, Koriyama N, Tei C. Peripartum cardiomyopathy in a patient with Graves' disease. Int J Cardiol 2009; 145:e23-5. [PMID: 19167107 DOI: 10.1016/j.ijcard.2008.12.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 12/13/2008] [Indexed: 10/21/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown etiology that occurs during the peripartum period in previously healthy women. Autoimmune and viral factors have been suggested to be involved in PPCM. Here we describe a patient with Graves' disease, which is one of the organ-specific autoimmune diseases, who developed acute heart failure due to PPCM at 2 weeks after her first delivery. The patient recovered completely with conservative treatment for heart failure. An association between PPCM and Graves' disease has not been reported before. PPCM may be an organ-specific autoimmune disease, so the coexistence of other autoimmune diseases should be considered in PPCM patients.
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Caforio ALP, Vinci A, Iliceto S. Anti-heart autoantibodies in familial dilated cardiomyopathy. Autoimmunity 2008; 41:462-9. [PMID: 18781472 DOI: 10.1080/08916930802031546] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Familial aggregation is a feature of myocarditis and dilated cardiomyopathy (DCM). Myocarditis, a clinically polymorphic inflammatory disease of the myocardium, is diagnosed by endomyocardial biopsy (EMB) and may lead to DCM. Mutations in several genes encoding myocyte structural proteins are known monogenic DCM causes, but because of high etiologic and genetic heterogeneity, the gene defects identified so far account for a minority of cases. In the last decade, it has been discovered that autoimmunity plays a pivotal role in myocarditis and DCM that are thought to represent different stages of an organ-specific autoimmune disease in genetically predisposed individuals. None of the available genetic studies in familial DCM has taken into account the autoimmune phenotype markers in the characterization of index patients and relatives, thus it is not known whether or not the described gene defects are involved in the autoimmune form of the disease. In animal models autoimmune myocarditis/DCM can be induced by viral infection, immunization with heart-specific autoantigens, or develop spontaneously in genetically predisposed strains. It may be cell or antibody-mediated; susceptibility is based upon multiple MHC and non-MHC genes. In patients, the diagnosis of autoimmune myocarditis/DCM requires exclusion of viral genome on EMB and detection of serum heart-reactive autoantibodies. They are found in index patients and relatives from about 60% of both familial and non-familial pedigrees and predict DCM development among healthy relatives. Some antibodies have functional effects on cardiac myocytes in vitro, in animal models and possibly in a DCM subset without inflammation, responsive to extracorporeal immunoadsorption. Cardiac-specific autoantibodies, which are shown to be disease-specific for myocarditis/DCM, can be used as biomarkers for identifying patients in whom, in the absence of active infection of the myocardium, immunosuppression and/or immunomodulation may be beneficial and their relatives at risk. Future studies should clarify genetic basis of human autoimmune myocarditis/DCM as well as genotype/immune phenotype correlations.
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Affiliation(s)
- Alida L P Caforio
- Department of Cardiological, Division of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
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Gleicher N, Elkayam U. Peripartum cardiomyopathy, an autoimmune manifestation of allograft rejection? Autoimmun Rev 2008; 8:384-7. [PMID: 19087892 DOI: 10.1016/j.autrev.2008.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2008] [Accepted: 12/10/2008] [Indexed: 01/26/2023]
Abstract
The timing of peripartum cardiomyopathy (PPCM) in association with pregnancy is typical of autoimmune conditions. This review addresses this fact by presenting PPCM as an organ specific autoimmune response (though not necessarily as an outright autoimmune condition), akin to autoimmune responses seen with complications of allogeneic organ transplantations. Since pregnancy represents a semi-allograft (representing paternal alloantigens), pregnancy and allogeneic organ transplants can be expected to be subject to similar allograft tolerance mechanisms, and also to share potential complications of normal allograft tolerance. This review suggests that PPCM represents a cardio-toxic autoimmune component within a more general immunological malfunction of tolerance of the fetal allograft by the maternal immune system. Treatment of PPCM with therapies, proven successful in graft versus host disease and organ rejection, may, therefore, be successful. Their success would also be confirmatory of such a concept.
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Affiliation(s)
- Norbert Gleicher
- Center for Human Reproduction and the Foundation for Reproductive Medicine, New York, NY, USA.
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Fett JD. Diagnosis of viral cardiomyopathy by analysis of peripheral blood? Expert Opin Ther Targets 2008; 12:1073-5. [DOI: 10.1517/14728222.12.9.1073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE OF REVIEW Myocarditis is a clinically heterogeneous myocardial inflammatory disease, diagnosed by endomyocardial biopsy; it may be idiopathic, infectious, or autoimmune and may lead to dilated cardiomyopathy. Myocarditis and dilated cardiomyopathy represent different stages of an organ-specific autoimmune disease in genetically predisposed individuals. RECENT FINDINGS In animal models, cell-mediated or antibody-mediated autoimmune myocarditis/dilated cardiomyopathy can be induced by viral infection or immunization with heart-specific autoantigens, or can develop spontaneously in genetically predisposed strains. Susceptibility is based on multiple major histocompatibility complex and nonmajor histocompatibility complex genes. In patients the diagnosis of autoimmune myocarditis/dilated cardiomyopathy requires exclusion of viral genome on endomyocardial biopsy and detection of serum heart-reactive autoantibodies. They are directed against multiple antigens that are found in patients and relatives from about 60% of familial and nonfamilial pedigrees. They predict dilated cardiomyopathy development among relatives, years before disease. Some antibodies have functional effects on cardiac myocytes in vitro, in animals and possibly in a dilated cardiomyopathy subset, responsive to extracorporeal immunoadsorption. SUMMARY In myocarditis/dilated cardiomyopathy, cardiac-specific and disease-specific antibodies of IgG class are potential biomarkers for identifying 'at risk' relatives as well as those patients in whom, in the absence of active infection of the myocardium, immunosuppression, and/or immunomodulation may be beneficial. Future studies should better define the genetic basis of human autoimmune myocarditis/dilated cardiomyopathy.
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Mouquet F, Lions C, de Groote P, Bouabdallaoui N, Willoteaux S, Dagorn J, Deruelle P, Lamblin N, Bauters C, Beregi JP. Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging. Eur Radiol 2008; 18:2765-9. [PMID: 18642002 DOI: 10.1007/s00330-008-1067-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 05/07/2008] [Accepted: 06/04/2008] [Indexed: 12/17/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure. Only half of the patients recover normal cardiac function. We assessed the usefulness of magnetic resonance imaging (MRI) and late enhancement imaging to detect myocardial fibrosis in order to predict cardiac function recovery in patients with peripartum cardiomyopathy. Among a consecutive series of 1,037 patients referred for heart failure treatment or prognostic evaluation between 1999 and 2006, eight women had confirmed PPCM. They all underwent echocardiography and cardiac MRI for assessment of left ventricular anatomy, systolic function and detection of myocardial fibrosis through late enhancement imaging. Mean (+/- SD) baseline left ventricular ejection fraction (LVEF) was 28 +/- 4%. After a follow-up of 50 +/- 9 months, half the patients recovered normal cardiac function (LVEF = 58 +/- 4%) and four did not (LVEF = 35 +/- 6%). None of the eight patients exhibited abnormal myocardial late enhancement. No difference in MRI characteristics was observed between the two groups. Patients with PPCM do not exhibit a specific cardiac MRI pattern and particularly no myocardial late enhancement. It suggests that myocardial fibrosis does not play a major role in the limitation of cardiac function recovery after PPCM.
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Affiliation(s)
- Frederic Mouquet
- Pôle de Cardiologie et Maladies Vasculaires, CHRU Lille et Université Lille 2, Bvd Pr J Leclercq, 59037, Lille Cedex, France.
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Kawano H, Tsuneto A, Koide Y, Tasaki H, Sueyoshi E, Sakamoto I, Hayashi T. Magnetic resonance imaging in a patient with peripartum cardiomyopathy. Intern Med 2008; 47:97-102. [PMID: 18195498 DOI: 10.2169/internalmedicine.47.0316] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a form of heart failure that affects women late in pregnancy or early in peripartum. The present report describes a case of a patient with PPCM demonstrated by magnetic resonance imaging (MRI) with late gadolinium enhancement of the left ventricle (LV). The late gadolinium enhancement of MRI improved associated with recovery of cardiac function. Endomyocardial biopsy showed mild cell infiltration and fibrosis. Thus, MRI may be useful for the evaluation of myocardial damage and to predict the outcome of PPCM.
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
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Rasmusson KD, Stehlik J, Brown RN, Renlund DG, Wagoner LE, Torre-Amione G, Folsom JW, Silber DH, Kirklin JK. Long-term Outcomes of Cardiac Transplantation for Peri-partum Cardiomyopathy: A Multiinstitutional Analysis. J Heart Lung Transplant 2007; 26:1097-104. [DOI: 10.1016/j.healun.2007.08.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 08/01/2007] [Accepted: 08/07/2007] [Indexed: 11/26/2022] Open
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