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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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2
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Wang NC, Jain SK. Peripartum cardiomyopathy and cardiac resynchronization therapy: Case reports and literature review. HeartRhythm Case Rep 2021; 7:767-772. [PMID: 34820277 PMCID: PMC8602398 DOI: 10.1016/j.hrcr.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Norman C Wang
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sandeep K Jain
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Dodeja AK, Siegel F, Dodd K, Ma'ayeh M, Mehta LS, Fuchs MM, Rood KM, Mah ML, Bradley EA. Heart failure in pregnancy: what is the long-term impact of pregnancy on cardiac function? A tertiary care centre experience and systematic review. Open Heart 2021; 8:openhrt-2021-001587. [PMID: 34344721 PMCID: PMC8336161 DOI: 10.1136/openhrt-2021-001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 11/04/2022] Open
Abstract
Background Women with cardiomyopathy (CM) are often advised against pregnancy due to risk for major adverse cardiovascular events (MACE). However, the impact of CM subtype on maternal MACE is not understood, and so we sought to evaluate the influence of CM phenotype on maternal outcomes, as well as the effect on immediate and late left ventricular function. Methods We evaluated all pregnant women in our high-risk maternal cardiovascular programme (2009–2019). Composite maternal MACE included: death, inotrope use, left ventricular assist device, orthotopic heart transplant and/or escalation in transplant listing status, acute decompensated heart failure and sustained ventricular arrhythmia. Results Among 875 women followed, 32 had CM (29±7 years old, left ventricular ejection fraction (LVEF) 41%±12%): 3 ischaemic CM (ICM), 10 peripartum CM (PPCM) and 19 non-ICM (NICM). MACE events occurred in 6 (18%) women (PPCM: 2 (33%), NICM: 4 (67%)). There was no difference in LVEF at baseline, however, women with MACE had significantly lower LVEF both early (LVEF: 27±5% vs. 41±2%, p<0.05) and late post partum (LVEF: 28±5% vs. 44±2%, p<0.01). Conclusions In this contemporary cohort of women with CM, maternal MACE rates were lower than previously reported, and were less common in PPCM as compared with ICM and NICM. Heart function in women with MACE was negatively impacted immediately after delivery and in late postpartum follow-up, suggesting that pregnancy itself likely has influence on future left ventricular function in women with underlying CM.
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Affiliation(s)
- Anudeep K Dodeja
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA .,Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Francesca Siegel
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katherine Dodd
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Marwan Ma'ayeh
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, OH, USA
| | - Laxmi S Mehta
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Margaret M Fuchs
- Mayo Clinic Division of Cardiovascular Diseases, Rochester, Minnesota, USA
| | - Kara M Rood
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, The Ohio State University, Columbus, OH, USA
| | - May Ling Mah
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Elisa A Bradley
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
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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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Early Use of Cardiac Resynchronization Therapy to Accelerate Symptomatic Relief and Complete Left Ventricular Function Recovery in Peripartum Cardiomyopathy. ACTA ACUST UNITED AC 2019; 55:medicina55060246. [PMID: 31195624 PMCID: PMC6631786 DOI: 10.3390/medicina55060246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/07/2019] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure that develops during the last month of pregnancy or within first months of delivery. We report the case of a 40-year-old woman diagnosed with severely symptomatic PPCM characterized by left ventricular ejection fraction (LVEF) of 10% and significant dyssynchrony secondary to a left bundle branch block (LBBB). Early cardiac resynchronization therapy (CRT) was used to achieve remarkable functional and LVEF recovery. This case suggests that early CRT must be considered for patients suffering from severely symptomatic PPCM despite optimal medical therapy for whom advanced heart failure therapies are proposed.
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Peripartum cardiomyopathy-diagnosis, management, and long term implications. Trends Cardiovasc Med 2018; 29:164-173. [PMID: 30111492 DOI: 10.1016/j.tcm.2018.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/02/2018] [Accepted: 07/20/2018] [Indexed: 01/26/2023]
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period. While the disease is relatively uncommon, its incidence is rising. It is a form of idiopathic dilated cardiomyopathy, defined as pregnancy-related left ventricular dysfunction, diagnosed either towards the end of pregnancy or in the months following delivery, in women without any other identifiable cause. The clinical presentation, diagnostic assessment and treatment usually mirror that of other forms of cardiomyopathy. Timing of delivery and management require a multidisciplinary approach and individualization. Subsequent pregnancies generally carry risk, but individualization is required depending on the pre-pregnancy left ventricular function. Recovery occurs in most women on standard medical therapy for heart failure with reduced ejection fraction, more frequently than in other forms of nonischemic cardiomyopathy. The purpose of this review is to summarize the current state of knowledge with regard to diagnosis, treatment and management, with a focus on long term implications.
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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: 85] [Impact Index Per Article: 14.2] [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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Bouabdallaoui N, Demondion P, Maréchaux S, Varnous S, Lebreton G, Mouquet F, Leprince P. Heart Transplantation for Peripartum Cardiomyopathy: A Single-Center Experience. Arq Bras Cardiol 2018; 110:181-187. [PMID: 29466490 PMCID: PMC5855912 DOI: 10.5935/abc.20180014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/29/2017] [Indexed: 12/28/2022] Open
Abstract
Background Peripartum cardiomyopathy is an idiopathic disorder defined by the occurrence
of acute heart failure during late pregnancy or post-partum period in the
absence of any other definable cause. Its clinical course is variable and
severe cases might require heart transplantation. Objective To investigate long-term outcomes after heart transplantation (HT) for
peripartum cardiomyopathy (PPCM). Methods Out of a single-center series of 1938 HT, 14 HT were performed for PPCM. We
evaluated clinical characteristics, transplant-related complications, and
long-term outcomes, in comparison with 28 sex-matched controls. Primary
endpoint was death from any cause; secondary endpoints were
transplant-related complications (rejection, infection, cardiac allograft
vasculopathy). A value of p < 0.05 was considered of statistical
significance. Results PPCM patients and matched controls were comparable for most variables (all p
values > 0.05), except for a higher use of inotropes at the time of HT in
PPCM group (p = 0.03). During a median follow-up of 7.7 years, 16 patients
died, 3 (21.5%) in PPCM group and 13 (46.5%) in control group. Mortality was
significantly lower in PPCM group (p = 0.03). No significant difference was
found in terms of transplant-related complications (p > 0.05). Conclusions Long-term outcomes following HT for PPCM are favorable. Heart transplantation
is a valuable option for PPCM patients who did not recover significantly
under medical treatment.
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Affiliation(s)
- Nadia Bouabdallaoui
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Pierre Demondion
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Cardiology Department and Heart Valve Center, Faculté Libre de Médecine/Université Catholique de Lille, France
| | - Shaida Varnous
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Guillaume Lebreton
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
| | - Frédéric Mouquet
- Service de Cardiologie, Pôle Cardio-vasculaire et Pulmonaire, Hôpital Cardiologique, CHRU Lille, Lille Cedex, France
| | - Pascal Leprince
- Department of Cardiac Surgery, La Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie-Paris 6, France
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Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM, Pahl E, Vasan RS, Ramasubbu K, Rasmusson K, Towbin JA, Yancy C. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e579-e646. [PMID: 27832612 DOI: 10.1161/cir.0000000000000455] [Citation(s) in RCA: 449] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Laliberte B, Reed BN, Ather A, Devabhakthuni S, Watson K, Lardieri AB, Baker-Smith CM. Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy. Pharmacotherapy 2016; 36:955-70. [DOI: 10.1002/phar.1795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Benjamin Laliberte
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Brent N. Reed
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Ayesha Ather
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Sandeep Devabhakthuni
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Kristin Watson
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
| | - Allison B. Lardieri
- Department of Pharmacy Practice and Science; University of Maryland School of Pharmacy; Baltimore Maryland
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Bauersachs J, Arrigo M, Hilfiker-Kleiner D, Veltmann C, Coats AJ, Crespo-Leiro MG, De Boer RA, van der Meer P, Maack C, Mouquet F, Petrie MC, Piepoli MF, Regitz-Zagrosek V, Schaufelberger M, Seferovic P, Tavazzi L, Ruschitzka F, Mebazaa A, Sliwa K. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2016; 18:1096-105. [DOI: 10.1002/ejhf.586] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/27/2016] [Accepted: 05/08/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Mattia Arrigo
- Department of Cardiology, AP-HP; Lariboisière University Hospital; Paris France
- Department of Cardiology; University Heart Center, University Hospital Zurich; Zurich Switzerland
| | | | - Christian Veltmann
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Andrew J.S. Coats
- Monash-Warwick Alliance; Monash University, Australia, and University of Warwick; UK
| | | | - Rudolf A. De Boer
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Peter van der Meer
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Christoph Maack
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg Germany
| | | | - Mark C. Petrie
- Department of Cardiology; Golden Jubilee National Hospital and Glasgow University; Glasgow UK
| | - Massimo F. Piepoli
- Department of Cardiology; Guglielmo da Saliceto Hospital; Piacenza Italy
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine; Charité Universitaetsmedizin Berlin, and German Center for Cardiovascular Research; Berlin Germany
| | - Maria Schaufelberger
- Section of Acute and Cardiovascular Medicine, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy; University of Gothenburg, Sahlgrenska University Hospital/Östra; Gothenburg Sweden
| | | | - Luigi Tavazzi
- Maria Cecilia Hospital, Gruppo Villa Maria Care and Research; Ettore Sansavini Health Science Foundation Cotignola Italy
| | - Frank Ruschitzka
- Department of Cardiology; University Heart Center, University Hospital Zurich; Zurich Switzerland
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP; Saint Louis Lariboisière University Hospitals; Paris France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & IDM, Inter-Cape Heart Group, Medical Research Council South Africa, Department of Medicine; University of Cape Town; Cape Town South Africa
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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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Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J 2015; 36:1090-7. [PMID: 25636745 PMCID: PMC4422973 DOI: 10.1093/eurheartj/ehv009] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/08/2015] [Indexed: 01/06/2023] Open
Abstract
Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management.
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Affiliation(s)
- Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Arash Haghikia
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Justus Nonhoff
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Pillarisetti J, Kondur A, Alani A, Reddy M, Reddy M, Vacek J, Weiner CP, Ellerbeck E, Schreiber T, Lakkireddy D. Peripartum Cardiomyopathy. J Am Coll Cardiol 2014; 63:2831-9. [DOI: 10.1016/j.jacc.2014.04.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 03/08/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
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Bachelier-Walenta K, Hilfiker-Kleiner D, Sliwa K. Article Commentary: Acute Heart Failure: Is it Peripartum Cardiomyopathy or Not? Obstet Med 2013; 6:42-44. [PMID: 27757154 PMCID: PMC5052784 DOI: 10.1258/om.2012.120042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 03/27/2024] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening disease that occurs in women of childbearing age.
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Affiliation(s)
- Katrin Bachelier-Walenta
- Department of Medicine, Cardiology, Angiology and Internal Intensive Care, Homburg/Saar, Germany
| | | | - Karen Sliwa
- Department of Medicine, Medical School, Hatter Institute for Cardiovascular Research in Africa, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
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Stewart GC. Management of Peripartum Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:622-36. [DOI: 10.1007/s11936-012-0210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail 2012; 14:895-901. [PMID: 22588321 DOI: 10.1093/eurjhf/hfs070] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS Persistence of left ventricular (LV) systolic dysfunction after 6 months of diagnosis is believed to be a marker of an irreversible cardiomyopathy in peripartum cardiomyopathy (PPCM). We sought to determine the length of time required for recovery of LV systolic function (LVSF) in patients with PPCM. METHODS AND RESULTS Forty-two consecutive women with PPCM were enrolled in this prospective study. The minimum required time of follow-up for inclusion was 30 months. Each patient underwent transthoracic echocardiography, and plasma brain natriuretic peptide (BNP) and C-reactive protein measurement at admission, and every 3 months. Early recovery was defined as normalization of LVSF at 6 months post-diagnosis. Delayed recovery was defined if the length of time required for recovery of LVSF was longer than 6 months. Persistent left ventricular dysfunction (PLVD) was defined as an ejection fraction of <50% at the end of follow-up. Twenty patients (47.6%) recovered completely, 10 died (23.8%), and 12 (28.6%) had PLVD. Average time to complete recovery was 19.3 months after initial diagnosis (3-42 months). Early recovery was observed only in six patients (30%), whereas delayed recovery was observed in 14 out of 20 patients (70%). Patients with complete recovery were more likely to have a higher LV ejection fraction and smaller LV end-systolic dimensions at baseline. CONCLUSION Full recovery of LVSF in PPCM patients often requires longer than 6 months.
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Affiliation(s)
- Murat Biteker
- Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, Turkey.
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