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Kamdem F, Nganou-Gnindjio CN, Ymele HK, Eboutibe POM, Djomou A, Léle ECB, Hamadou B, Mouliom S, Viché L, Ngoté H, Kenmegne C, Ebongue MSN, Djibrilla S, Essome H. Epidemiological features and mortality risk factors of peripartum cardiomyopathy in a group of Sub-Saharan African population. Ann Cardiol Angeiol (Paris) 2023; 72:101615. [PMID: 37348442 DOI: 10.1016/j.ancard.2023.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure occurring during pregnancy. Its prevalence seems more frequent in Africa but its epidemiological, clinical and evolutionary particularities remain unknown. This study aimed to evaluate the epidemiological features and mortality risk factors of PPCM. MATERIAL AND METHOD We conducted a retrospective cross-sectional study over 38 months (January 2018 to March 2021) in 3 hospitals in the city of Douala(Cameroon). We included all patients with heart failure between the last month of pregnancy and 5 months after delivery without an identified cause. Were excluded, files not containing data on echocardiography, patients with heart failure without dilation or with LVEF≥ 45% and patients with a history of heart disease of known aetiology. Chi² tests and binary logistic regression were used for data analysis; the survival curve according to Kaplan Meier was drawn for the evolution. The threshold of significance was set at 0.05. RESULTS A total of 2102 medical records of women with heart failure were searched. In these records, a total of 59 patients showed signs of peripartum heart failure and only 29 fulfilled the inclusion criteria. From a socio-demographic point of view, the average age was 29 ± 7 years and 51.7% of patients were over 30 years old. Among these patients, 79.3% of patients lived in urban areas and 10.3% of patients had a low socio-economic level. The hospital frequency of PPCM was 1.3%. Clinically, primiparous and pauciparous women were the most affected; the diagnosis was made after more than a month of progression in 65.5% of patients. Dyspnea was present in all patients. In addition, 89.7% of patients had a left ventricular end-diastolic diameter ≥ 62 m, 48.3 % had a left ventricular ejection fraction (LVEF) between 30% and 45%, and 51.7% had an LVEF < 30%. The associated mortality rate was 27.7%. The only prognostic factor independently associated with mortality was age < 30 years. CONCLUSION The frequency of PPCM is relatively low in Cameroonian urban settings. Moreover, its diagnosis is generally delayed and it induces high mortality. Its occurrence in a woman under the age of 30 is a factor of poor prognosis.
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Affiliation(s)
- Félicité Kamdem
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | | | | | | | - Armel Djomou
- Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
| | | | - Ba Hamadou
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon
| | - Sidick Mouliom
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
| | - Lade Viché
- Department of Internal Medicine, Douala General Hospital, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Garoua, Cameroon
| | - Henri Ngoté
- Department of Internal Medicine, Douala General Hospital, Cameroon
| | | | - Marie Solange Ndom Ebongue
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
| | - Siddikatou Djibrilla
- Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon; Faculty of Health Sciences, University of Buea, Cameroon
| | - Henri Essome
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon; Department of Internal Medicine, Douala Laquintinie Hospital, Cameroon
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Koziol KJ, Aronow WS. Peripartum Cardiomyopathy: Current Understanding of Pathophysiology, Diagnostic Workup, Management, and Outcomes. Curr Probl Cardiol 2023; 48:101716. [PMID: 36972860 DOI: 10.1016/j.cpcardiol.2023.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
Peripartum cardiomyopathy (PPCM) is a relatively rare, potentially life-threatening, idiopathic form of cardiomyopathy that affects previously healthy young women during late pregnancy or in the early postpartum period and is characterized by left ventricular (LV) systolic dysfunction in the absence of any other identifiable cardiac causes. Morbidity and mortality with PPCM are remarkably high and it continues to be one of the leading causes of maternal death. Although remarkable advances have been made in our understanding of PPCM in the last few decades, unanswered questions remain regarding its pathophysiology, diagnostic workup, and management options. In this article, we will complete an updated, comprehensive review of PPCM, including the epidemiology and risk factors, proposed etiology, presentation and complications, management, prognostic indicators and outcomes. In addition, we will identify current challenges and gaps in knowledge.
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Affiliation(s)
- Klaudia J Koziol
- New York Medical College, School of Medicine, Valhalla, New York.
| | - Wilbert S Aronow
- New York Medical College, School of Medicine, Valhalla, New York; Department of Cardiology, Westchester Medical Center, Valhalla, NY.
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Ghoreshi ZAS, Akbari H, Sharif-Zak M, Arefinia N, Abbasi-Jorjandi M, Asadikaram G. Recent findings on hyperprolactinemia and its pathological implications: a literature review. J Investig Med 2022; 70:1443-1451. [PMID: 35768141 DOI: 10.1136/jim-2022-002351] [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: 05/26/2022] [Indexed: 11/03/2022]
Abstract
The prolactin hormone (PRL) is often secreted by lactotrophic cells of the anterior pituitary and has been shown to play a role in various biological processes, including breast feeding and reproduction. The predominant form of this hormone is the 23 kDa form and acts through its receptor (PRLR) on the cell membrane. This receptor is a member of the superfamily of hematopoietic/cytokine receptors. PRL also has a 16 kDa subunit with anti-angiogenic, proapoptotic, and anti-inflammatory effects which is produced by the proteolytic breakdown of this hormone under oxidative stress. Although the common side effects of hyperprolactinemia are exerted on the reproductive system, new studies have shown that hyperprolactinemia has a wide variety of effects, including playing a role in the development of autoimmune diseases and increasing the risk of cardiovascular disease, peripartum cardiomyopathy, and diabetes among others. The range of PRL functions is increasing with the discovery of multiple sites of PRL secretion as well as PRLR expression in various tissues. This review summarizes current knowledge of the biology of PRL and its receptor, as well as the role of PRL in human pathophysiology.
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Affiliation(s)
- Zohreh Al-Sadat Ghoreshi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Institute of Basic and Clinical Physiology Sciences, Kerman, The Islamic Republic of Iran
| | - Hamed Akbari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Institute of Basic and Clinical Physiology Sciences, Kerman, The Islamic Republic of Iran.,Department of Clinical Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Mohsen Sharif-Zak
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Institute of Basic and Clinical Physiology Sciences, Kerman, The Islamic Republic of Iran.,Neuroscience Research Center, Institute of Neuropharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Nasir Arefinia
- Neuroscience Research Center, Institute of Neuropharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Mojtaba Abbasi-Jorjandi
- Department of Clinical Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Gholamreza Asadikaram
- Department of Clinical Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran .,Neuroscience Research Center, Institute of Neuropharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
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De Vita S, Ippolito S, Caracciolo MM, Barosi A. Peripartum cardiomyopathy in a COVID-19-infected woman: differential diagnosis with acute myocarditis-A case report from a Hub Institution during the COVID-19 outbreak. Echocardiography 2020; 37:1673-1677. [PMID: 32986881 PMCID: PMC7537062 DOI: 10.1111/echo.14873] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 01/28/2023] Open
Abstract
We report the case of a healthy 35‐year‐old woman who had experienced a flu‐like syndrome during the week before childbirth and heart failure symptoms 10 days before the current hospitalization and presented to our emergency department with clinical signs of congestive heart failure, echocardiographic evidence of a severely dilated and hypokinetic heart, laboratory evidence of SARS‐CoV‐2 disease, and radiologic findings consistent with both virus‐related pneumonia and heart failure. Early cardiac magnetic resonance was crucial for the diagnosis of postpartum cardiomyopathy and for the exclusion of virus‐related myocarditis, allowing us to decide on a prudent and supportive clinical approach.
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Affiliation(s)
- Stefano De Vita
- Cardiac Imaging Lab., Luigi Sacco University Hospital, Milan, Italy
| | - Sonia Ippolito
- Radiology Department, Luigi Sacco University Hospital, Milan, Italy
| | | | - Alberto Barosi
- Cardiac Imaging Lab., Luigi Sacco University Hospital, Milan, Italy
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Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol 2020; 17:718-731. [PMID: 32518358 DOI: 10.1038/s41569-020-0390-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.
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Affiliation(s)
- Karishma P Ramlakhan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mark R Johnson
- Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Shi L, Liu J, Zhang Y, Chen M, Liu J. β1 adrenoceptor antibodies induce myocardial apoptosis via inhibiting PGC-1α-related pathway. BMC Cardiovasc Disord 2020; 20:269. [PMID: 32503464 PMCID: PMC7275518 DOI: 10.1186/s12872-020-01492-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background Peripartum cardiomyopathy (PPCM) is life-threatening heart disease. However, the causes and pathogenesis of PPCM remain unclear. Previous studies found that β1 adrenoceptor antibodies (β1AA) had possible involvement in the development of PPCM. In the present study, we determined the potential relationship between PPCM and β1AA, including the mechanism of β1AA leading to PPCM. Methods We extracted the β1AA from the postpartum Wistar rats that were injected by the antigen peptide segment of the β1 adrenoceptor to produce PPCM. We tested the effects of β1AA on H9C2 cell line by CCK-8, LDH, TUNEL, SA-ELISA, qRT-PCR, and western blot methods. Furthermore, PGC-1α was overexpressed to rescue the effect of β1AA on H9C2 cells. Results We found that the extracted β1AA induced apoptosis of cardiac myocytes of H9C2 cell line. Moreover, the expression of peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), which is a master regulator of mitochondrial metabolism, and its downstream transcript vascular endothelial growth factor (VEGF) got decreased in H9C2 cells after β1AA treatment. In addition, the effect of β1AA could be inhibited by atenolol, the antagonist of β1 adrenoceptors (β1AR) and imitated by isoprenaline, the agonist of β1AR. Furthermore, overexpression of PGC-1α in the H9C2 cells rescued the apoptosis of cells and inhibitory expression of VEGF induced by β1AA. Conclusions Our results suggest that the symptoms of PPCM due to myocardial cell apoptosis induced by β1AA inhibiting the PGC-1α-related pathway impairs mitochondrial energy metabolism. Therefore, our results uncover a previously unknown role of the β1AA pathway in the etiology of PPCM and provide a novel potential target for the treatment of PPCM.
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Affiliation(s)
- Linying Shi
- Heart Failure Center, Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongrentiyuchangnan Rd, Beijing, 100020, China
| | - Jia Liu
- Heart Failure Center, Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongrentiyuchangnan Rd, Beijing, 100020, China
| | - Yuan Zhang
- Heart Failure Center, Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongrentiyuchangnan Rd, Beijing, 100020, China
| | - Mulei Chen
- Heart Failure Center, Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongrentiyuchangnan Rd, Beijing, 100020, China.
| | - Jiamei Liu
- Heart Failure Center, Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongrentiyuchangnan Rd, Beijing, 100020, China.
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Affiliation(s)
- Oscar Jolobe
- Division of medicine, Manchester Medical Society, Manchester, Lancashire, UK
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Affiliation(s)
- Lucia Baris
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Obstetric Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jérôme Cornette
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mark R Johnson
- Chelsea and Westminster Hospital, Imperial College London, London, UK
| | - Karen Sliwa
- Department of Medicine, Hatter Institute, Cape Town, South Africa
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