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Hamdan R, Abdallah Y, Gafar S, ElSaeidi E, Kadri Z, Al Nooryani A. [Succès de traitement par Cabergoline d'une série de cas de cardiomyopathie du péripartum, incluant un cas critique nécessitant une assistance circulatoire mécanique]. Ann Cardiol Angeiol (Paris) 2023; 72:101610. [PMID: 37300904 DOI: 10.1016/j.ancard.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
Peripartum cardiomyopathy is a life-threatening condition that requires urgent diagnosis and management. Bromocriptine was established as disease specific therapy; less data is known about Cabergolin which is another prolactin secretion inhibitor. In this paper we report 4 peripartum cardiomyopathy cases treated successfully with Cabergoline, including a cardiogenic shock case requiring mechanical circulatory support.
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Affiliation(s)
- R Hamdan
- Head of Heart Failure Unit, Cardiology Department, Al Qassimi Hospital, Sharjah, UAE.
| | - Y Abdallah
- Data Scientist, Ecole polytechnique Palaiseau, France
| | - S Gafar
- Cardiology Department, Al Qassimi hospital, Sharjah, UAE
| | - E ElSaeidi
- Cardiology Department, Al Qassimi hospital, Sharjah, UAE
| | - Z Kadri
- Cardiology Department, Hotel Dieu de France, Beirut, Lebanon
| | - A Al Nooryani
- Head of Cardiology Department, CEO of Al Qassimi Hospital, Sharjah, UAE
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2
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Pfeffer TJ, Mueller JH, Haebel L, Erschow S, Yalman KC, Talbot SR, Koenig T, Berliner D, Zwadlo C, Scherr M, Hilfiker‐Kleiner D, Bauersachs J, Ricke‐Hoch M. Cabergoline treatment promotes myocardial recovery in peripartum cardiomyopathy. ESC Heart Fail 2022; 10:465-477. [PMID: 36300679 PMCID: PMC9871652 DOI: 10.1002/ehf2.14210] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/16/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Peripartum cardiomyopathy (PPCM) is a rare heart disease, occurring in previously heart-healthy women during the last month of pregnancy or the first months after delivery due to left ventricular (LV) systolic dysfunction. A common pathomechanistic pathway of PPCM includes increased oxidative stress and the subsequent generation of a cleaved prolactin fragment (16 kDa PRL), which promotes the onset of heart failure (HF) in a microRNA (miR)-146a-dependent manner. Inhibition of prolactin secretion with the dopamine D2 receptor (D2R) agonist bromocriptine combined with standard HF therapy supports cardiac recovery. This study examined whether treatment with the more selective D2R agonist cabergoline prevents HF development in an experimental PPCM mouse model and might be used as an alternative treatment regime for PPCM. METHODS AND RESULTS Postpartum (PP) female PPCM-prone mice with a cardiomyocyte restricted STAT3-deficiency (αMHC-Cretg/+ ; Stat3fl/fl ; CKO) were treated over two consecutive nursing periods with cabergoline (CKO Cab, 0.5 mg/kg/day) and were compared with bromocriptine treated CKO (CKO Br) and postpartum-matched WT and CKO mice. Cabergoline treatment in CKO PP mice preserved cardiac function [fractional shortening (FS): CKO Cab: 34.5 ± 9.4% vs. CKO: 22.1 ± 9%, P < 0.05] and prevented the development of cardiac hypertrophy, fibrosis, and inflammation as effective as bromocriptine therapy (FS: CKO Br: 33.4 ± 5.6%). The myocardial up-regulation of the PPCM biomarkers plasminogen inhibitor activator 1 (PAI-1) and miR-146a were prevented by both cabergoline and bromocriptine therapy. A small cohort of three PPCM patients from the German PPCM Registry was treated with cabergoline (1 mg per week for 2 weeks, followed by 0.5 mg per week for another 6 weeks) due to a temporary unavailability of bromocriptine. All PPCM patients initially presented with a severely reduced LV ejection fraction (LVEF: 26 ± 2%). However, at 6 months of follow-up, LV function (LVEF: 56 ± 2%) fully recovered in all three PPCM patients, and no adverse events were detected. CONCLUSIONS In the experimental PPCM mouse model, the selective D2R agonist cabergoline prevents the onset of postpartum HF similar to bromocriptine. In PPCM patients, cabergoline treatment was safe and effective as all patients fully recovered. Cabergoline might serve as a promising alternative to bromocriptine. However, these findings are based on experimental data and a small case series and thus have to be interpreted with caution and should be validated in a larger clinical trial.
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Affiliation(s)
- Tobias J. Pfeffer
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Julia H. Mueller
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Lea Haebel
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Sergej Erschow
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Kuebra C. Yalman
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Steven R. Talbot
- Institute for Laboratory Animal Science and Central Animal FacilityHannover Medical SchoolHannoverGermany
| | - Tobias Koenig
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Dominik Berliner
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Carolin Zwadlo
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Michaela Scherr
- Department of Hematology, Hemostasis, Oncology and Stem Cell TransplantationHannover Medical SchoolHannoverGermany
| | - Denise Hilfiker‐Kleiner
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany,Department of Cardiovascular Complications of Oncologic Therapies, Medical FacultyPhilipps University MarburgMarburgGermany
| | - Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Melanie Ricke‐Hoch
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
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3
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Yalta K, Yetkin E, Taylan G. Fontan Circulation Might be Associated with Peripartum Cardiomyopathy: A Review of Mechanistic and Clinical Aspects. Curr Cardiol Rev 2021; 17:e051121192311. [PMID: 33726653 PMCID: PMC8950506 DOI: 10.2174/1573403x17666210316121842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/30/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022] Open
Abstract
Fontan operation has been defined as a palliative surgery connecting systemic venous return and pulmonary circulation in patients with certain forms of complex congenital heart disease (CHD). Fortunately, it has improved overall survival and chance of successful pregnancies among these patients. However, Fontan circulation (FC), as a potential trade-off, might be associated with specific late or post-gestational complications, including peripartum cardiomyopathy (PPCM) largely through its adverse effects on the placenta and inflammation-oxidation stress. Importantly, diagnosis of superimposed PPCM in women with FC might be a diagnostic challenge, requiring a high index of suspicion. Accordingly, the present paper aims to highlight the potential association of FC with PPCM evolution largely based on certain mechanistic and clinical perspectives.
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Affiliation(s)
- Kenan Yalta
- Cardiology Department, Trakya University, Edirne, Turkey;
| | - Ertan Yetkin
- Cardiology Department, Derindere Hospital, Istanbul, Turkey,Address correspondence to this author at the Cardiology Department, Derindere Hospital, Istanbul, Turkey; Tel: +905327136721; E-mail:
| | - Gokay Taylan
- Cardiology Department, Trakya University, Edirne, Turkey;
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4
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Caruso G, Scopelliti A, Scaramuzzino S, Perrone G, Galoppi P, Palaia I, Muzii L, Panici PB, Brunelli R. Cabergoline as an adjuvant to standard heart failure treatment in peripartum cardiomyopathy: A case report and review of the literature. Case Rep Womens Health 2020; 29:e00277. [PMID: 33344177 PMCID: PMC7736906 DOI: 10.1016/j.crwh.2020.e00277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 11/09/2022] Open
Abstract
Introduction Peripartum cardiomyopathy (PPCM) is a rare and idiopathic form of dilated cardiomyopathy presenting late in pregnancy or early postpartum. Since the 16-kDa fragment of prolactin has been identified as a key factor in the pathophysiology of PPCM, prolactin inhibitors have been used as an adjuvant to standard heart failure treatment. Although bromocriptine is the current first choice, promising results have been reported with cabergoline, albeit scant. Case Presentation We presented the case of a 41-year-old woman who received a diagnosis of PPCM one week after delivery and was successfully treated with cabergoline, finally experiencing a complete recovery. Conclusion The case adds to the scant evidence supporting the use of cabergoline in PPCM patients. We argue that the favorable pharmacokinetic and metabolic profiles of this drug should prompt its consideration as a valid alternative prolactin inhibitor in these critical patients. Peripartum cardiomyopathy is a rare and life-threatening form of dilated cardiomyopathy. The management relies on the standard recommendations for heart failure with systolic dysfunction. The use of prolactin inhibitors represents the only specific and evidence-based treatment available. Given the favorable pharmacokinetics, cabergoline should be considered as the first-line prolactin inhibitor.
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Key Words
- CPAP, continuous positive airway pressure
- CRP, C-reactive protein
- Cabergoline
- FFA, free fatty acids
- Heart failure
- ICU, intensive care unit
- IGF-1, insulin-like growth factor 1
- LVEF, left ventricular ejection fraction
- NST, non-stress test
- PPCM, peripartum cardiomyopathy
- PRL, prolactin
- Peripartum cardiomyopathy
- Prolactin inhibitor
- SHFT, standard heart failure treatment
- TTE, transthoracic echocardiogram
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Annalisa Scopelliti
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Sara Scaramuzzino
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Giuseppina Perrone
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Paola Galoppi
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
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5
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Avila WS, Alexandre ERG, Castro MLD, Lucena AJGD, Marques-Santos C, Freire CMV, Rossi EG, Campanharo FF, Rivera IR, Costa MENC, Rivera MAM, Carvalho RCMD, Abzaid A, Moron AF, Ramos AIDO, Albuquerque CJDM, Feio CMA, Born D, Silva FBD, Nani FS, Tarasoutchi F, Costa Junior JDR, Melo Filho JXD, Katz L, Almeida MCC, Grinberg M, Amorim MMRD, Melo NRD, Medeiros OOD, Pomerantzeff PMA, Braga SLN, Cristino SC, Martinez TLDR, Leal TDCAT. Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease - 2020. Arq Bras Cardiol 2020; 114:849-942. [PMID: 32491078 PMCID: PMC8386991 DOI: 10.36660/abc.20200406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Marildes Luiza de Castro
- Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Minas gerais (UFMG),Belo Horizonte, MG - Brasil
| | | | - Celi Marques-Santos
- Universidade Tiradentes,Aracaju, SE - Brasil.,Hospital São Lucas, Rede D'Or Aracaju,Aracaju, SE - Brasil
| | | | - Eduardo Giusti Rossi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Felipe Favorette Campanharo
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein,São Paulo, SP - Brasil
| | | | - Maria Elizabeth Navegantes Caetano Costa
- Cardio Diagnóstico,Belém, PA - Brasil.,Centro Universitário Metropolitano da Amazônia (UNIFAMAZ),Belém, PA - Brasil.,Centro Universitário do Estado Pará (CESUPA),Belém, PA - Brasil
| | | | | | - Alexandre Abzaid
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Antonio Fernandes Moron
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Carlos Japhet da Mata Albuquerque
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil,Hospital Barão de Lucena, Recife, PE – Brazil,Hospital EMCOR, Recife, PE – Brazil,Diagnósticos do Coração LTDA, Recife, PE – Brazil
| | | | - Daniel Born
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM),São Paulo, SP - Brasil
| | | | - Fernando Souza Nani
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | - José de Ribamar Costa Junior
- Hospital do Coração (HCor),São Paulo, SP - Brasil.,Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | - Leila Katz
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE – Brazil
| | | | - Max Grinberg
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
| | | | - Nilson Roberto de Melo
- Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP – Brazil
| | | | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP),São Paulo, SP - Brasil
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6
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Bauersachs J, König T, Meer P, Petrie MC, Hilfiker‐Kleiner D, Mbakwem A, Hamdan R, Jackson AM, Forsyth P, Boer RA, Mueller C, Lyon AR, Lund LH, Piepoli MF, Heymans S, Chioncel O, Anker SD, Ponikowski P, Seferovic PM, Johnson MR, Mebazaa A, Sliwa K. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2019; 21:827-843. [DOI: 10.1002/ejhf.1493] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/21/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Tobias König
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Peter Meer
- Department of CardiologyUniversity Medical Center Groningen Groningen The Netherlands
| | - Mark C. Petrie
- Department of CardiologyInstitute of Cardiovascular and Medical Sciences, Glasgow University Glasgow UK
| | | | - Amam Mbakwem
- Department of MedicineCollege of Medicine, University of Lagos Nigeria
| | - Righab Hamdan
- Department of CardiologyBeirut Cardiac Institute Lebanon
| | - Alice M. Jackson
- Department of CardiologyInstitute of Cardiovascular and Medical Sciences, Glasgow University Glasgow UK
| | - Paul Forsyth
- Department of CardiologyInstitute of Cardiovascular and Medical Sciences, Glasgow University Glasgow UK
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen Groningen The Netherlands
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Switzerland
| | | | - Lars H. Lund
- Department of MedicineKarolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | | | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life SciencesMaastricht University Maastricht The Netherlands
- Department of Cardiovascular SciencesCentre for Molecular and Vascular Biology Leuven Belgium
- The Netherlands Heart InstituteNl‐HI Utrecht The Netherlands
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular DiseaseUniversity of Medicine Carol Davila Bucharest Romania
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site BerlinCharité Universitätsmedizin Berlin Berlin Germany
| | - Piotr Ponikowski
- Department of CardiologyMedical University, Clinical Military Hospital Wroclaw Poland
| | - Petar M. Seferovic
- University of Belgrade Faculty of Medicine and Heart Failure CenterBelgrade University Medical Center Belgrade Serbia
| | - Mark R. Johnson
- Department of Obstetrics, Imperial College School of MedicineChelsea and Westminster Hospital London UK
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP‐HPSaint Louis Lariboisière University Hospitals, University Paris Diderot Paris France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Cardiology and MedicineUniversity of Cape Town Cape Town South Africa
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7
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Koenig T, Bauersachs J, Hilfiker-Kleiner D. Bromocriptine for the Treatment of Peripartum Cardiomyopathy. Card Fail Rev 2018; 4:46-49. [PMID: 29892477 DOI: 10.15420/cfr.2018:2:2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a life-threatening, pregnancy-associated heart disease that develops towards the end of pregnancy or in the first months following delivery in previously healthy women. Understanding of the pathophysiology has progressed in recent years, highlighting an oxidative-stress mediated cleavage of the nursing hormone prolactin into a toxic 16-kDa prolactin fragment as a major factor driving the disease. The 16-kDa prolactin fragment induces detrimental but potentially reversible effects on heart function. Bromocriptine, a clinically-approved drug to block prolactin release, was initially tested in a PPCM mouse model where it efficiently prevented the onset of PPCM. Consequently, this treatment concept was transferred to and successfully used in humans as a bench-tobedside approach. Encouraging proof-of-concept studies led to a randomised trial that further strengthens the role of bromocriptine in addition to standard heart failure therapy in clinical practice. The aim of this article is to summarise this novel and disease-specific medical treatment, along with current knowledge on the epidemiology and pathophysiology of PPCM.
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Affiliation(s)
- Tobias Koenig
- 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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8
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Melo MAME, Carvalho JS, Feitosa FEDL, Araujo Júnior E, Peixoto AB, Costa Carvalho FH, Carvalho RCM. Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2016; 38:308-13. [PMID: 27399926 PMCID: PMC10374231 DOI: 10.1055/s-0036-1584567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022] Open
Abstract
Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.
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Affiliation(s)
- Maria Adélia Medeiros e Melo
- Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Jordão Sousa Carvalho
- Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Regina Coeli Marques Carvalho
- Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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10
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Biteker M, Kayatas K, Duman D, Turkmen M, Bozkurt B. Peripartum cardiomyopathy: current state of knowledge, new developments and future directions. Curr Cardiol Rev 2014; 10:317-26. [PMID: 24646160 PMCID: PMC4101196 DOI: 10.2174/1573403x10666140320144048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 11/22/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a form of idiopathic dilated cardiomyopathy affecting women in late pregnancy or early puerperium. Although initially described in the late 1800s, it has only recently been recognized as a distinct cardiac condition. The reported incidence and prognosis varies according to geography. The clinical course varies between complete recovery to rapid progression to chronic heart failure, heart transplantation or death. In spite of significant improvements in understanding the pathophysiology and management of the PPCM many features of this unique disease are poorly understood, including incidence, etiology, epidemiology, pathophysiology, predictors of prognosis and optimal therapy. The present article revisits these concepts and recent advances in PPCM.
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Affiliation(s)
| | | | | | | | - Biykem Bozkurt
- Bankalar Caddesi, Horoz Apt, 4/7 Cevizli/Kartal, Istanbul/Turkey.
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11
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Abstract
PURPOSE OF REVIEW Heart disease is a leading cause of maternal death worldwide. In western countries, the principal causes of death from heart disease are myocardial infarction, cardiomyopathy and congenital heart disease, whereas in developing countries, rheumatic heart disease and its long-term consequences are more important. RECENT FINDINGS There are few prospective studies upon which to base the management of these complex cases. However, best practice includes the assessment of women prepregnancy by a multidisciplinary team, with the aim of optimizing the clinical state, changing therapy to avoid teratogenic treatments and advising the patient and her relatives about the potential risks and possible complications that may arise. During pregnancy, the multidisciplinary team should define the level of care/surveillance required in each case. Some women may be safely looked after in a peripheral hospital, whereas others may need to be seen by the multidisciplinary team in the tertiary centre at regular intervals along with close echocardiographic monitoring. SUMMARY The majority of women with preexisting heart disease can go through pregnancy safely, however, close attention to detail must be paid to avoid potential complications.
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12
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Peripartum cardiomyopathy presenting with predominant left ventricular diastolic dysfunction: efficacy of bromocriptine. Case Rep Med 2012; 2012:476903. [PMID: 23251175 PMCID: PMC3521613 DOI: 10.1155/2012/476903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 07/14/2012] [Accepted: 09/18/2012] [Indexed: 11/18/2022] Open
Abstract
Management of patients with peripartum cardiomyopathy (PPCM) is still a major clinical problem, as only half of them or slightly more show complete recovery of left ventricular (LV) function despite conventional evidence-based treatment for heart failure. Recent observations suggested that bromocriptine might favor recovery of LV systolic function in patients with PPCM. However, no evidence exists regarding its effect on LV diastolic dysfunction, which is commonly observed in these patients. Tissue Doppler (TD) is an echocardiographic technique that provides unique information on LV diastolic performance. We report the case of a 37-year-old white woman with heart failure (NYHA class II), moderate LV systolic dysfunction (ejection fraction 35%), and severe LV diastolic dysfunction secondary to PPCM, who showed no improvement after 2 weeks of treatment with ramipril, bisoprolol, and furosemide. At 6-week followup after addition of bromocriptine, despite persistence of LV systolic dysfunction, normalization of LV diastolic function was shown by TD, together with improvement in functional status (NYHA I). At 18-month followup, the improvement in LV diastolic function was maintained, and normalization of systolic function was observed. This paper might support the clinical utility of bromocriptine in patients with PPCM by suggesting a potential benefit on LV diastolic dysfunction.
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13
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Johnson-Coyle L, Jensen L, Sobey A. Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 2012; 21:89-98. [PMID: 22381985 DOI: 10.4037/ajcc2012163] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Peripartum cardiomyopathy, a type of dilated cardiomyopathy of unknown origin, occurs in previously healthy women in the final month of pregnancy and up to 5 months after delivery. Although the incidence is low-less than 0.1% of pregnancies -morbidity and mortality rates are high at 5% to 32%. The outcome of peripartum cardiomyopathy is also highly variable. For some women, the clinical and echocardiographic status improves and sometimes returns to normal, whereas for others, the disease progresses to severe cardiac failure and even sudden cardiac death. In acute care, treatment may involve the use of intravenous vasodilators, inotropic medications, an intra-aortic balloon pump, ventricular-assist devices, and/or extracorporeal membrane oxygenation. Survivors of peripartum cardiomyopathy often recover from left ventricular dysfunction; however, they may be at risk for recurrence of heart failure and death in subsequent pregnancies. Women with chronic left ventricular dysfunction should be managed according to guidelines of the American College of Cardiology Foundation and the American Heart Association.
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Affiliation(s)
- Leah Johnson-Coyle
- Leah Johnson-Coyle is a nurse practitioner in cardiac sciences and Alan Sobey is an intensive care physician in the cardiovascular surgery intensive care unit at the Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada. Louise Jensen is a professor in the Faculty of Nursing at the University of Alberta in Edmonton
| | - Louise Jensen
- Leah Johnson-Coyle is a nurse practitioner in cardiac sciences and Alan Sobey is an intensive care physician in the cardiovascular surgery intensive care unit at the Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada. Louise Jensen is a professor in the Faculty of Nursing at the University of Alberta in Edmonton
| | - Alan Sobey
- Leah Johnson-Coyle is a nurse practitioner in cardiac sciences and Alan Sobey is an intensive care physician in the cardiovascular surgery intensive care unit at the Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada. Louise Jensen is a professor in the Faculty of Nursing at the University of Alberta in Edmonton
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Abe T, Amano I, Sawa R, Akira S, Nakai A, Takeshita T. Recovery from peripartum cardiomyopathy in a Japanese woman after administration of bromocriptine as a new treatment option. J NIPPON MED SCH 2011; 77:226-30. [PMID: 20818143 DOI: 10.1272/jnms.77.226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a form of heart failure that occurs in women within 1 month before delivery and 5 months after delivery. The outcome of PPCM is variable but improves significantly when appropriate medication is administered in the acute phase; furthermore, the outcome does not worsen even after discontinuation of therapy in the chronic phase. The symptoms and signs of PPCM are similar to those of idiopathic dilated cardiomyopathy. The medical management of patients with PPCM is similar to that for other other forms of heart failure. Recent experimental data implicate a casual role of prolactin in the development of PPCM. Prolactin secretion can be reduced with bromocriptine which had beneficial effects in a small study. We present a Japanese woman with acute PPCM treated with bromocriptine as a therapeutic option. Following treatment, the serum prolactin levels dropped swiftly. Concurrently, LV function improved, and heart failure symptoms decreased, accompanied by a decrease in the BNP level.
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Affiliation(s)
- Takashi Abe
- Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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Lucreziotti S, Belletti S, Massironi L, Lombardi F. Rapid recovery from peripartum cardiomyopathy after inhibition of prolactin. Int J Cardiol 2011; 151:e105-6. [PMID: 20934224 DOI: 10.1016/j.ijcard.2010.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/16/2010] [Indexed: 11/28/2022]
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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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Safirstein JG, Ro AS, Grandhi S, Wang L, Fett JD, Staniloae C. Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet. Int J Cardiol 2010; 154:27-31. [PMID: 20863583 DOI: 10.1016/j.ijcard.2010.08.065] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 07/01/2010] [Accepted: 08/19/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is the onset of acute heart failure without demonstrable cause during the last month of pregnancy or within five months after delivery. The purpose of this study was to create a prospective registry of PPCM patients with the assistance of the internet and identify clinical factors predictive of ejection fraction (EF) recovery. METHODS Patients with PPCM were identified by novel web-based methods. Subjects were categorized as recovered (EF>50) or nonrecovered (EF<50) and compared on the basis of demographic and clinical variables. RESULTS Fifty-five subjects met criteria for inclusion. There was a statistically significant association between diagnosis during third trimester and persistent systolic dysfunction (25% vs. 4.7%, p=0.03). Gestational hypertension and breastfeeding were significantly associated with EF recovery (48.8% vs. 16.7%, p=0.046, and 39.5% vs. 8.3%, p=0.04, respectively). EF normalization occurred in all patients with EF(1) ≥ 35%. CONCLUSIONS Presence of gHTN, EF ≥ 35% at diagnosis, breastfeeding, and postpartum diagnosis were all significantly associated with recovery of systolic function. Internet recruitment may be a valuable tool for studying PPCM.
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Affiliation(s)
- Jordan G Safirstein
- Department of Cardiology, The Gagnon Cardiovascular Institute at Morristown Memorial Hospital, Morristown, NJ 07960, United States.
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Desai P. Peripartum Cardiomyopathy: A review. J Obstet Gynaecol India 2010. [DOI: 10.1007/s13224-010-0013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Prolactin fragmentation by trophoblastic matrix metalloproteinases as a possible contributor to peripartum cardiomyopathy and pre-eclampsia. Med Hypotheses 2009; 74:348-52. [PMID: 19748190 DOI: 10.1016/j.mehy.2009.08.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 08/17/2009] [Indexed: 11/21/2022]
Abstract
Although peripartum cardiomyopathy (PPCM) is a rare disease, it has very serious consequences for both mother and child. No single cause has been held responsible for the pathogenesis. Recent studies have indicated that increased proteolytic cathepsin D activity in cardiomyocytes results in16kDa prolactin fragments with anti-angiogenic and apoptotic properties, which may contribute to the development of PPCM. In support of these findings, lowering full-length prolactin production by bromocriptine therapy has been reported to prevent impairment of cardiac function. PPCM is associated with an increased co-existence of pre-eclampsia, however, a causal relationship has been disputed. We hypothesize that the pathophysiology of PPCM and pre-eclampsia share the same molecular pathway: increased activity of trophoblastic matrix metalloproteinases at the feto-maternal interface may aggravate proteolysis of full-length prolactin, and subsequently the formed 16kDa prolactin fragments may contribute to deterioration of PPCM and pre-eclampsia. Therefore, we argue that it may be worthwhile to explore wether prolactin inhibition is not only beneficial for PPCM patients, but also for the much more prevalent pre-eclamptic women.
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