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Jose T, Maiti G, Gupta S, Kundu P. Early-onset peri-partum cardiomyopathy in a twin gestation: A rare presentation. Med J Armed Forces India 2023; 79:348-351. [PMID: 37193526 PMCID: PMC10182283 DOI: 10.1016/j.mjafi.2021.05.015] [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: 07/06/2020] [Accepted: 05/14/2021] [Indexed: 11/24/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare pregnancy-associated dilated cardiomyopathy occurring in the last month of pregnancy and five months postdelivery, which presents with features of cardiac failure. Diagnosis is based on characteristic echocardiographic findings and elevated cardiac biomarkers and has significant mortality and morbidity when undiagnosed and untreated. Atypical presentations in earlier gestations are rare and associated with risk factors. Here we present a case of PPCM diagnosed in the second trimester in a post in vitro fertilization (IVF) twin pregnancy to emphasize the importance of considering the diagnosis of PPCM in all cases of unexplained cardiac failures during pregnancy in previously healthy patients, especially in the presence of risk factors.
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Affiliation(s)
- Tony Jose
- Senior Advisor & Gynaec Oncologist, Professor & Head (Obst & Gynaec), Command Hospital (Southern Command), Pune, India
| | - G.D. Maiti
- Consultant & Head (Obst & Gynaec), INHS Asvini, Colaba, Mumbai, India
| | - Shilpa Gupta
- Classified Specialist (Obst & Gynaec), Command Hospital (Eastern Command), Kolkata, India
| | - Payel Kundu
- Resident (Obst & Gynaec), Command Hospital (Eastern Command), Kolkata, India
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2
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Rene C, Faustin M, Bonhomme J, Deschamps MM, Jean-Gilles M, Rosenberg R, Ibrahim M, McNairy M, Pape JW, Devieux JG. An Adapted Self-screening Tool for Peripartum Cardiomyopathy in Haiti. Crit Pathw Cardiol 2023; 22:19-24. [PMID: 36812340 PMCID: PMC9976336 DOI: 10.1097/hpc.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is considered rare in the United States; however, the literature notes that the disease has a higher prevalence in developing countries such as Haiti. Dr. James D. Fett, a US cardiologist, developed and validated a self-assessment measure for PPCM in the United States to aid women to easily differentiate the signs and symptoms of heart failure from those related to a normal pregnancy. Although this instrument was validated, it lacks the adaptation necessary to account for the language, culture, and education of the Haitian population. OBJECTIVE The aim of this study was to translate and culturally adapt the Fett PPCM self-assessment measure for use among a Haitian Creole speaking population. METHODS A preliminary Haitian Creole direct translation was developed from the original English Fett self-test. A total of four focus groups with medical professionals and 16 cognitive interviews with members of a community advisory board were conducted to refine the preliminary Haitian Creole translation and adaptation. RESULTS The adaptation focused on incorporating cues that would be tangible and connected to the reality of the Haitian population while maintaining the intended meaning of the original Fett measure. CONCLUSIONS The final adaptation provides an instrument suitable for administration by auxiliary health providers and community health workers to help patients distinguish symptoms of heart failure from symptoms related to normal pregnancy and further quantify the severity of signs and symptoms that might be indicative of heart failure.
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Affiliation(s)
- Cassandra Rene
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | - Mikerlyne Faustin
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | | | | | | | - Rhonda Rosenberg
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
| | | | - Margaret McNairy
- Weill Cornell Medical Center, Center for Global Health & Division of Medicine, New York, NY
| | - Jean W Pape
- The GHESKIO Centers, Port-au-Prince, Haiti
- Weill Cornell Medical Center, Center for Global Health & Division of Medicine, New York, NY
| | - Jessy G Devieux
- From the Robert Stempel College of Public Health & Social Work, Miami, FL
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3
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Kuć A, Kubik D, Kościelecka K, Szymanek W, Męcik-Kronenberg T. The Relationship Between Peripartum Cardiomyopathy and Preeclampsia – Pathogenesis, Diagnosis and Management. J Multidiscip Healthc 2022; 15:857-867. [PMID: 35496718 PMCID: PMC9045831 DOI: 10.2147/jmdh.s357872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a condition with an incompletely understood etiology, although many risk factors for this disorder have been mentioned. Preeclampsia (PE) is a rare but undoubtedly very important cause of PPCM. Early recognition and prompt treatment of preeclampsia and peripartum cardiomyopathy are essential to optimize pregnancy outcomes. An extensive manual search of major electronic databases was conducted in November 2021. The following literature review provides a comprehensive discussion of peripartum cardiomyopathy and preeclampsia and quantifies the prevalence of PE in women with PPCM. The authors highlighted aspects such as epidemiology, risk factors, cardiovascular changes, diagnosis and clinical presentation, and management and complications. Accumulating data indicate that both conditions have a similar pathogenesis characterized by vascular abnormalities. In both conditions we can observe an increase in interleukin-6 and gamma interferon, CCL2/MCP1, and decreased SOD activity. sFLT1 (a soluble form of fms-like tyrosine kinase 1), a substance with antiangiogenic and probably cardiotoxic effects, may be important. Preeclampsia and peripartum cardiomyopathy are characterized by recurrence rates that follow a similar pattern in subsequent pregnancies, and mortality remains a concern. Our analysis highlights the need to better understand the co-morbidity of PE and PPCM, and the need to qualify patients for the same clinical trials because of the common origin of these conditions.
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Affiliation(s)
- Aleksandra Kuć
- Student Research Group at the Chair and Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
- Correspondence: Aleksandra Kuć, 1E Street, Siedlce, 08-110, Poland, Tel +48 504 188 178, Email
| | - Daria Kubik
- Student Research Group at the Chair and Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Klaudia Kościelecka
- Student Research Group at the Chair and Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Wojciech Szymanek
- Hospital Emergency Department, St. John Paul II Mazovia Regional Hospital in Siedlce, Siedlce, Poland
- Nursing at Collegium Mazovia Innovative University in Siedlce, Siedlce, Poland
| | - Tomasz Męcik-Kronenberg
- Chair and Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
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Fett JD. Promoting Full Recovery and Improved Relapse-Free Prognosis in the Diagnosis and Treatment of Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 76:2365-2367. [DOI: 10.1016/j.jacc.2020.09.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
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5
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Fett JD. Promoting awareness of peripartum cardiomyopathy (PPCM). Int J Cardiol 2020; 305:113-114. [PMID: 32035690 DOI: 10.1016/j.ijcard.2020.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- James D Fett
- Co-Director of IPAC, center at University Pittsburgh Medical Center, Pittsburgh, PA, USA; Hospital Albert Schweitzer, Deschapelles, Haiti.
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Arnaout R, Nah G, Marcus G, Tseng Z, Foster E, Harris IS, Divanji P, Klein L, Gonzalez J, Parikh N. Pregnancy complications and premature cardiovascular events among 1.6 million California pregnancies. Open Heart 2019; 6:e000927. [PMID: 30997125 PMCID: PMC6443129 DOI: 10.1136/openhrt-2018-000927] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/08/2018] [Accepted: 01/20/2019] [Indexed: 01/23/2023] Open
Abstract
Background Cardiovascular complications of pregnancy present an opportunity to assess risk for subsequent cardiovascular disease. We sought to determine whether peripartum cardiomyopathy and hypertensive disorder of pregnancy subtypes predict future myocardial infarction, heart failure or stroke independent of one another and of other risks such as gestational diabetes, preterm birth and intrauterine growth restriction. Methods and results The California Healthcare Cost and Utilization Project database was used to identify all hospitalised pregnancies from 2005 to 2009, with follow-up through 2011, for a retrospective cohort study. Pregnancies, exposures, covariates and outcomes were defined by International Classification of Diseases, Ninth Revision codes. Among 1.6 million pregnancies (mean age 28 years; median follow-up time to event excluding censoring 2.7 years), 558 cases of peripartum cardiomyopathy, 123 603 hypertensive disorders of pregnancy, 107 636 cases of gestational diabetes, 116 768 preterm births and 23 504 cases of intrauterine growth restriction were observed. Using multivariable Cox proportional hazards models, peripartum cardiomyopathy was independently associated with a 39.2-fold increase in heart failure (95% CI 30.0 to 51.9), resulting in ~1 additional hospitalisation per 1000 person-years. There was a 13.0-fold increase in myocardial infarction (95% CI 4.1 to 40.9) and a 7.7-fold increase in stroke (95% CI 2.4 to 24.0). Hypertensive disorders of pregnancy were associated with 1.4-fold (95% CI 1.0 to 2.0) to 7.6-fold (95% CI 5.4 to 10.7) higher risk of myocardial infarction, heart failure and stroke, resulting in a maximum of ~1 additional event per 1000 person-years. Gestational diabetes, preterm birth and intrauterine growth restriction had more modest associations. Conclusion These findings support close monitoring of women with cardiovascular pregnancy complications for prevention of early cardiovascular events and study of mechanisms underlying their development.
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Affiliation(s)
- Rima Arnaout
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gregory Nah
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Greg Marcus
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Zian Tseng
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Elyse Foster
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ian S Harris
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Punag Divanji
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Liviu Klein
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Juan Gonzalez
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Nisha Parikh
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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7
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Abstract
Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.
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Affiliation(s)
- Michael C Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
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8
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Bollen IAE, Ehler E, Fleischanderl K, Bouwman F, Kempers L, Ricke-Hoch M, Hilfiker-Kleiner D, Dos Remedios CG, Krüger M, Vink A, Asselbergs FW, van Spaendonck-Zwarts KY, Pinto YM, Kuster DWD, van der Velden J. Myofilament Remodeling and Function Is More Impaired in Peripartum Cardiomyopathy Compared with Dilated Cardiomyopathy and Ischemic Heart Disease. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 187:2645-2658. [PMID: 28935576 DOI: 10.1016/j.ajpath.2017.08.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 01/09/2023]
Abstract
Peripartum cardiomyopathy (PPCM) and dilated cardiomyopathy (DCM) show similarities in clinical presentation. However, although DCM patients do not recover and slowly deteriorate further, PPCM patients show either a fast cardiac deterioration or complete recovery. The aim of this study was to assess if underlying cellular changes can explain the clinical similarities and differences in the two diseases. We, therefore, assessed sarcomeric protein expression, modification, titin isoform shift, and contractile behavior of cardiomyocytes in heart tissue of PPCM and DCM patients and compared these with nonfailing controls. Heart samples from ischemic heart disease (ISHD) patients served as heart failure control samples. Passive force was only increased in PPCM samples compared with controls, whereas PPCM, DCM, and ISHD samples all showed increased myofilament Ca2+ sensitivity. Length-dependent activation was significantly impaired in PPCM compared with controls, no impairment was observed in ISHD samples, and DCM samples showed an intermediate response. Contractile impairments were caused by impaired protein kinase A (PKA)-mediated phosphorylation because exogenous PKA restored all parameters to control levels. Although DCM samples showed reexpression of EH-myomesin, an isoform usually only expressed in the heart before birth, PPCM and ISHD did not. The lack of EH-myomesin, combined with low PKA-mediated phosphorylation of myofilament proteins and increased compliant titin isoform, may explain the increase in passive force and blunted length-dependent activation of myofilaments in PPCM samples.
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Affiliation(s)
- Ilse A E Bollen
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Elisabeth Ehler
- Randall Division of Cell and Molecular Biophysics and Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Karin Fleischanderl
- Randall Division of Cell and Molecular Biophysics and Cardiovascular Division, British Heart Foundation Centre of Research Excellence, King's College London, London, United Kingdom
| | - Floor Bouwman
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Lanette Kempers
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Cristobal G Dos Remedios
- Bosch Institute, Discipline of Anatomy and Histology, University of Sydney, Sydney, New South Wales, Australia
| | - Martina Krüger
- Institute of Cardiovascular Physiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Division Heart and Lungs, Department of Cardiology, University of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands; Durrer Center for Cardiogenetic Research, Netherlands Heart Institute, Utrecht, the Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Karin Y van Spaendonck-Zwarts
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Clinical Genetics, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Yigal M Pinto
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Amsterdam Medical Center Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederik W D Kuster
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jolanda van der Velden
- Department of Physiology, VU University Medical Center, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
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9
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Mahfouz RA, El-Awady WS, Dewedar A. Ventricular dyssynchrony in pregnant women: A tissue Doppler study. Echocardiography 2017; 34:968-972. [PMID: 28692143 DOI: 10.1111/echo.13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women. METHODS One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated. RESULTS Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P<.01, Tps-LV-SD; P<.03, Tpe-LV, P<.05 and Tpe-LV-SD; P<.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (>34.4 msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP). CONCLUSIONS Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy.
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Affiliation(s)
- Ragab A Mahfouz
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
| | | | - Ashraf Dewedar
- Cardiology Department, Zagazig University Hospital, Zagazig, Egypt
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10
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Fett JD. Reducing the risks for relapse of heart failure in a subsequent pregnancy after peripartum cardiomyopathy? Future Cardiol 2017. [PMID: 28621169 DOI: 10.2217/fca-2017-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- James D Fett
- Peripartum Cardiomyopathy Network Co-Investigations of Pregnancy Associated Cardiomyopathy (IPAC), Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.,Dept Adult Medicine, Hospital Albert Schweitzer, Deschapelles, Haiti
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11
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Cardiomyopathy - An approach to the autoimmune background. Autoimmun Rev 2017; 16:269-286. [PMID: 28163240 DOI: 10.1016/j.autrev.2017.01.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/20/2016] [Indexed: 12/15/2022]
Abstract
Autoimmunity is increasingly accepted as the origin or amplifier of various diseases. In contrast to classic autoantibodies (AABs), which induce immune responses resulting in the destruction of the affected tissue, an additional class of AABs is directed against G-protein-coupled receptors (GPCRs; GPCR-AABs). GPCR-AABs functionally affect their related GPCRs for activation of receptor mediated signal cascades. Diseases which are characterized by the presence of GPCR-AABs with evidence for disease-specific pathogenic activity could be named "functional autoantibody disease". We briefly summarize here the historical view on autoimmunity in cardiomyopathy, followed by an approach to the mechanistic autoimmunity background. Furthermore, autoantibodies with outstanding importance for cardiomyopathies as a functional autoantibody disease, such as GPCR-AABs, and mainly those directed against the beta1-adrenergic and muscarinic 2 receptor autoantibodies, are introduced. Anti-cardiac myosin and anti-cardiac troponin autoantibodies, as further potential players in autoimmune cardiomyopathy, are additionally taken into account. The basic view on the autoantibodies, their related receptor interactions and pathogenic consequences are presented. Focused specifically on GPCR-AABs, "pros and cons" of assays such as indirect assays (functional changes of cell preparations are monitored after GPCR-AAB receptor binding) and direct assays based on the ELISA technologies (GPCR epitope mimics for GPCR-AAB binding) are critically discussed. Last but not least, treatment strategies for "functional autoantibody disease", such as for GPCR-AAB removal (therapeutic plasma exchange, immunoadsorption) and in vivo GPCR-AAB attack such as intravenous IgG treatment (IVIG), B-cell depletion and GPCR-AAB binding and neutralization, are critically reflected with respect to their patient benefits.
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Golia E, Gravino R, Rea A, Masarone D, Rubino M, Cirillo A, Pacileo R, Fratta F, Russo MG, Pacileo G, Limongelli G. Management of pregnancy in cardiomyopathies and heart failure. Future Cardiol 2017; 13:81-96. [DOI: 10.2217/fca-2015-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pregnancy exposes women with inherited cardiomyopathies to increased risk for arrhythmias and heart failure. In asymptomatic patients with inherited cardiomyopathies, pregnancy is generally well tolerated. Preconception evaluation, risk assessment and proper counseling by a team of experienced physicians are mandatory in managing women with inherited cardiomyopathies planning pregnancy. In this paper, we reviewed the clinical course, risk assessment and management during pregnancy of women with cardiomyopathies.
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Affiliation(s)
- Enrica Golia
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Rita Gravino
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Alessandra Rea
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Daniele Masarone
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Marta Rubino
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Annapaola Cirillo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Roberta Pacileo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Fiorella Fratta
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
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Myocardial Recovery in Peripartum Cardiomyopathy After Hyperprolactinemia Treatment on BIVAD. ASAIO J 2017; 63:109-111. [DOI: 10.1097/mat.0000000000000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Affiliation(s)
- James D. Fett
- Hospital Albert Schweitzer, Adult Medicine, Deschapelles, Haiti
- Peripartum Cardiomyopathy Network, Cardiovascular Institute, Coordinating Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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15
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Mechanical circulatory support for patients with peripartum cardiomyopathy. J Artif Organs 2016; 19:305-9. [DOI: 10.1007/s10047-016-0891-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/04/2016] [Indexed: 11/25/2022]
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16
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Fett JD, McNamara DM. Peripartum Cardiomyopathy in 2015. Can J Cardiol 2016; 32:286-8. [DOI: 10.1016/j.cjca.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 01/20/2023] Open
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Li W, Li H, Long Y. Clinical Characteristics and Long-term Predictors of Persistent Left Ventricular Systolic Dysfunction in Peripartum Cardiomyopathy. Can J Cardiol 2016; 32:362-8. [DOI: 10.1016/j.cjca.2015.07.733] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 12/29/2022] Open
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18
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Davis MB. Pregnancy and Heart Disease Updates: Current Knowledge and Future Directions. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maternal cardiac evaluation during uncomplicated twin pregnancy with emphasis on the diastolic function. Am J Obstet Gynecol 2015; 213:376.e1-8. [PMID: 25957018 DOI: 10.1016/j.ajog.2015.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/16/2015] [Accepted: 05/02/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the longitudinal changes in maternal systolic and diastolic function in a series of women carrying an uncomplicated twin pregnancy. STUDY DESIGN A series of women carrying a twin pregnancy underwent standard M-mode, 2-dimensional color Doppler, and tissue Doppler transthoracic echocardiography during the first (11-13 weeks), the second (20-23 weeks), the third (28-32 weeks) trimesters, and the postpartum (6 months after delivery). RESULTS From January 2012 to September 2013, 30 women with an uncomplicated twin pregnancy were included in this prospective study. All the pregnancies were diamniotic including 24 dichorionic and 6 monochorionic sets. Overall, 60 live births were observed with a mean gestational age at delivery of 37 ± 1 weeks and a mean birthweight of 2532 ± 313 g. During pregnancy a significant worsening of left ventricle systolic function expressed by ejection fraction, fractional shortening and S1 longitudinal contractility decrease was observed. These findings also persisted at postpartum assessment. Regarding diastolic function, our data showed a significant progressive reduction of pulsed Doppler E-wave velocity and an increase of A-wave from the first to the third trimester. Similar changes were documented for tissue Doppler E1 and A1 peak velocities assessed at the level of the mitral and tricuspid annulus. After delivery diastolic findings returned to values comparable with those obtained in the first trimester. CONCLUSION In uncomplicated twin gestations, significant changes in maternal systolic and diastolic function occur from the first to the third trimester. Moreover, although diastolic parameters normalize after pregnancy, a relative systolic dysfunction seems to persist after delivery.
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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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Mennuni MG, Zavalloni D, Presbitero P. Role, risk and benefit of interventional cardiology procedures during pregnancy. Interv Cardiol 2015. [DOI: 10.2217/ica.14.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Benzidi Y, Jourdain M. Complications cardiovasculaires de la grossesse et du peripartum. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bollen IAE, Van Deel ED, Kuster DWD, Van Der Velden J. Peripartum cardiomyopathy and dilated cardiomyopathy: different at heart. Front Physiol 2015; 5:531. [PMID: 25642195 PMCID: PMC4295435 DOI: 10.3389/fphys.2014.00531] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/29/2014] [Indexed: 12/27/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a severe cardiac disease occurring in the last month of pregnancy or in the first 5 months after delivery and shows many similar clinical characteristics as dilated cardiomyopathy (DCM) such as ventricle dilation and systolic dysfunction. While PPCM was believed to be DCM triggered by pregnancy, more and more studies show important differences between these diseases. While it is likely they share part of their pathogenesis such as increased oxidative stress and an impaired microvasculature, discrepancies seen in disease progression and outcome indicate there must be differences in pathogenesis as well. In this review, we compared studies in DCM and PPCM to search for overlapping and deviating disease etiology, pathogenesis and outcome in order to understand why these cardiomyopathies share similar clinical features but have different underlying pathologies.
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Affiliation(s)
- Ilse A E Bollen
- Department of Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center Amsterdam, Netherlands
| | - Elza D Van Deel
- Department of Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center Amsterdam, Netherlands
| | - Diederik W D Kuster
- Department of Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center Amsterdam, Netherlands
| | - Jolanda Van Der Velden
- Department of Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center Amsterdam, Netherlands
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Fett JD, Markham DW. Discoveries in peripartum cardiomyopathy. Trends Cardiovasc Med 2014; 25:401-6. [PMID: 25557957 DOI: 10.1016/j.tcm.2014.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/23/2014] [Accepted: 10/25/2014] [Indexed: 01/10/2023]
Abstract
The past decade has seen remarkable gains for outcomes in peripartum cardiomyopathy (PPCM), one of the leading causes of maternal mortality and morbidity in the USA and many other countries, including the high-incidence areas of Haiti and South Africa. This review article emphasizes the importance of continuing the process of increasing awareness of PPCM and presents details of this evolving picture, including important discoveries that point the way to full recovery for almost all PPCM subjects. In addition, new interventions will be highlighted, which may facilitate recovery. Numerous studies have demonstrated that when the diagnosis of PPCM is made with LVEF > 0.30, the probability is that recovery to LVEF ≥ 0.50 will occur in the overwhelming majority of subjects. PPCM patients diagnosed with severely depressed systolic function (LVEF < 0.30) and a remodeled left ventricle with greater dilatation (LVEDd ≥ 60mm) are least likely to reach the outcome recovery goals. These are the patients with the greatest need for newer interventional strategies.
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Affiliation(s)
- James D Fett
- Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Adult Medicine, Hospital Albert Schweitzer, Deschapelles, Haiti.
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