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Pubblicazioni recenti - peripartum cardiomyopathy
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Genetic and Phenotypic Landscape of Peripartum Cardiomyopathy.
Circulation2021 Apr;():. doi: 10.1161/CIRCULATIONAHA.120.052395.
Goli Rahul, Li Jian, Brandimarto Jeff, Levine Lisa D, Riis Valerie, McAfee Quentin, DePalma Steven, Haghighi Alireza, Seidman J G, Seidman Christine E, Jacoby Daniel, Macones George, Judge Daniel P, Rana Sarosh, Margulies Kenneth B, Cappola Thomas P, Alharethi Rami, Damp Julie, Hsich Eileen, Elkayam Uri, Sheppard Richard, Alexis Jeffrey D, Boehmer John, Kamiya Chizuko, Gustafsson Finn, Damm Peter, Ersbøll Anne S, Goland Sorel, Hilfiker-Kleiner Denise, McNamara Dennis M, Arany Zolt, ,
Abstract
Peripartum cardiomyopathy (PPCM) occurs in approximately 1:2000 deliveries in the US and worldwide. The genetic underpinnings of PPCM remain poorly defined. Approximately 10% of women with PPCM harbor truncating variants in (TTNtvs). Whether mutations in other genes can predispose to PPCM is not known. It is also not known if the presence of TTNtvs predicts clinical presentation or outcomes. Nor is it known if the prevalence of TTNtvs differs in women with PPCM and preeclampsia, the strongest risk factor for PPCM. Women with PPCM were retrospectively identified from several US and international academic centers, and clinical information and DNA samples were acquired. Next-generation sequencing was performed on 67 genes, including , and evaluated for burden of truncating and missense variants. The impact of TTNtvs on severity of clinical presentation, and on clinical outcomes, was evaluated. 469 women met inclusion criteria. 10.4% of women with PPCM bore TTNtvs (Odds ration [OR]=9.4 compared with 1.2% in reference population; Bonferroni-corrected P [P*] =1.2x10). We additionally identified overrepresentation of truncating variants in FLNC (OR=24.8, P*=7.0x10), DSP (OR=14.9, P*=1.0x10-8), and BAG3 (OR=53.1, P*=0.02), genes not previously associated with PPCM. This profile is highly similar to that found in non-ischemic dilated cardiomyopathy (DCM). Women with TTNtvs had lower left ventricular ejection fraction (LVEF) on presentation than did women without TTNtvs (23.5% vs 29%, P=2.5x10), but did not differ significantly in timing of presentation after delivery, in prevalence of preeclampsia, or in rates of clinical recovery. This study provides the first extensive genetic and phenotypic landscape of PPCM, and demonstrates that predisposition to heart failure is an important risk factor for PPCM. The work reveals a degree of genetic similarity between PPCM and DCM, suggesting that gene-specific therapeutic approaches being developed for DCM may also apply to PPCM, and that approaches to genetic testing in PPCM should mirror those taken in DCM. Finally, the clarification of genotype/phenotype associations has important implications for genetic counseling.
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Genotype phenotype analysis in a family carrying truncating mutations in the titin gene.
Acta Myol2021 Mar;40(1):61-65. doi: 10.36185/2532-1900-043.
Peddareddygari Leema Reddy, Baisre-de León Ada, Grewal Raji P,
Abstract
We report a family carrying a previously described truncating mutation, NM_001267550.2(TTN):c.107889del p.(Lys35963Asnfs*9) in exon 364, and a novel truncating mutation, NM_001267550.1:c.100704C > A p.(Tyr33568*) in exon 358 in the gene. The c.107889del mutation, which was maternally transmitted, has been previously described in patients from the Iberian Peninsula. The mother was of Peruvian descent suggesting a potential European ancestral origin of this mutation. In this family, a daughter, who is a compound heterozygote carrying both these mutations, developed a peripartum cardiomyopathy during her second pregnancy. Subsequently, she was diagnosed with a myopathy following electromyography testing and a muscle biopsy which showed fiber type disproportion. Her brother, who carries only the paternally inherited c.100704C > A mutation, developed a cardiomyopathy following a suspected viral illness. Their father, who transmitted this mutation, has no evidence of a cardiomyopathy. We hypothesize that the c.100704C > A mutation confers susceptibility to the development of cardiomyopathy which may be brought on by cardiovascular stress. Our study of this family expands the genotype and phenotype spectrum of disorders that can be associated with mutations in the gene.
©2021 Gaetano Conte Academy - Mediterranean Society of Myology, Naples, Italy.
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Neighborhood education status drives racial disparities in clinical outcomes in PPCM.
Am Heart J2021 Apr;():. doi: S0002-8703(21)00088-0.
Getz Kelly D, Lewey Jennifer, Tam Vicky, Irizarry Olga Corazon, Levine Lisa D, Aplenc Richard, Arany Zolt,
Abstract
IMPORTANCE:
Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry. Additionally, clinical outcomes are worse in this subpopulation compared to White women with PPCM. The extent to which socioeconomic parameters contribute to these racial disparities is not known.
OBJECTIVE:
To quantify the association between area-based proxies of socioeconomic status (SES) and clinical outcomes in PPCM, and to determine the potential contribution of these factors to racial disparities in outcomes.
DESIGN, SETTING, AND PARTICIPANTS:
A retrospective cohort study was performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of Black individuals. The cohort included 220 women with PPCM, 55% of whom were Black or African American. Available data included clinical and demographic characteristics as well as residential address georeferenced to US Census-derived block group measures of SES.
MAIN OUTCOMES AND MEASURES:
Rates of sustained cardiac dysfunction (defined as persistent LVEF <50%, LVAD placement, transplant, or death) were compared by race and block group-level measures of SES, and a composite neighborhood concentrated disadvantage index (NDI). The contributions of area-based socioeconomic parameters to the association between race and sustained cardiac dysfunction were quantified.
RESULTS:
Black race and higher NDI were both independently associated with sustained cardiac dysfunction (relative risk [RR] 1.63, confidence interval [CI] 1.13-2.36; and RR 1.29, CI 1.08-1.53, respectively). Following multivariable adjustment, effect size for NDI remained statistically significant, but effect size for Black race did not. The impact of low neighborhood education on racial disparities in outcomes was stronger than that of low neighborhood income (explaining 45% and 0% of the association with black race, respectively). After multivariate adjustment, only low area-based education persisted as significantly correlating with sustained cardiac dysfunction (RR 1.49; CI 1.02-2.17).
CONCLUSIONS:
Both Black race and NDI independently associate with adverse outcomes in women with PPCM in a single center study. Of the specific components of NDI, neighborhood low education was most strongly associated with clinical outcome and partially explained differences in race. These results suggest interventions targeting social determinants of health in disadvantaged communities may help to mitigate outcome disparities.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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[Special pathologies of pregnant patients in intensive care medicine].
Anaesthesist2021 Apr;():. doi: 10.1007/s00101-021-00946-3.
Neuhaus Sophie, Neuhaus Christopher, Weigand Markus A, Bremerich Dorothee,
Abstract
As the incidence of diseases during pregnancy that necessitate intensive medical care is very low, intensive care physicians are faced with a multitude of unfamiliar challenges in the treatment of these patients. The physiological and pathophysiological alterations during pregnancy induce some specific features with respect to the intensive medical treatment of pregnant or postpartum patients. After the most important principles and current recommendations on the care of pregnant or postpartum patients who need intensive medical treatment were dealt with in the first article in this CME series, the second article focuses on the diagnostics and treatment of special selected pathologies.
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ECG and arrhythmias in peripartum cardiomyopathy.
Herzschrittmacherther Elektrophysiol2021 Mar;():. doi: 10.1007/s00399-021-00760-9.
Duncker David, Pfeffer Tobias J, Bauersachs Johann, Veltmann Christian,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery. Extensive studies on the burden of supraventricular and ventricular arrhythmias are lacking. Patients with PPCM present with electrocardiographic findings typical in acute heart failure. Management of arrhythmias in PPCM depends on the severity and the onset (during pregnancy or after delivery). Studies on the use of the wearable cardioverter-defibrillator in patients with PPCM show a substantial burden of ventricular tachyarrhythmias and sudden death in patients with severely reduced left ventricular function. The aim of the present article is to summarize actual knowledge on electrocardiogram findings, arrhythmias, and sudden cardiac death in patients with PPCM.
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Peripartum Cardiomyopathy: Management Strategies for Pregnancy Termination.
Womens Health Rep (New Rochelle)2020 ;1(1):463-467. doi: 10.1089/whr.2020.0078.
Darlington Ashley M, Fleisher Jonah D, Briller Joan E,
Abstract
Some women have underlying cardiovascular disease that leads to increased morbidity and mortality with pregnancy. These women may choose to terminate a pregnancy rather than face this increased risk. The optimal approach for pregnancy termination in women with cardiomyopathy is not well defined. We present two women with peripartum cardiomyopathy, both modified World Health Organization (mWHO) class IV and with elevated Cardiac Disease in Pregnancy (CARPREG II) pregnancy risk stratification scores who are at the highest risk for pregnancy continuation. Both underwent induced abortion, although the procedure was performed in very different settings. These cases illustrate factors that influence the mode and setting of pregnancy termination performance.
© Ashley M. Darlington et al., 2020; Published by Mary Ann Liebert, Inc.
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Cardiomyopathy in the peripartum period due to left ventricular non-compaction and association with Ebstein's anomaly: a case report.
Eur Heart J Case Rep2021 Mar;5(3):ytab088. doi: 10.1093/ehjcr/ytab088.
Evans Emily, McDonald Mandy, Adamson Dawn L, Khan Jamal Nasir,
Abstract
Background:
Left ventricular non-compaction (LVNC) cardiomyopathy is a persistence of abnormal foetal myocardium and is a rare cause of cardiomyopathy in the peripartum period. Unlike other causes of peripartum cardiomyopathy which typically improve, LVNC has significant long-term personal and family implications and needs lifelong follow-up.
Case summary:
We describe a unique case of a 30-year-old woman who developed cardiomyopathy in the peripartum period which was revealed on cardiovascular magnetic resonance imaging to be due to occult LVNC. Our patient also had Ebstein's anomaly, which is a known LVNC association.
Discussion:
Cardiomyopathy in the peripartum period can be a decompensation of previously asymptomatic subclinical cardiomyopathy. It is important to assess for LVNC in patients presenting with this. Cardiovascular magnetic resonance imaging is the gold-standard imaging modality and allows accurate diagnosis of LVNC, associated structural complications and rare associations such as Ebstein's anomaly. Left ventricular non-compaction is irreversible and has implications for patients and their family members.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Extracorporeal life support for cardiogenic shock during pregnancy and postpartum: a single center experience.
Perfusion2021 Mar;():2676591211004369. doi: 10.1177/02676591211004369.
Desai Mehul, Osborn Erik, King Christopher, Shlobin Oksana A, Psotka Mitchell, Ryan Liam, Javid Akhtar Saba, Singh Ramesh,
Abstract
BACKGROUND:
The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock in pregnant and postpartum patients remains limited by concerns of bleeding, hemolysis, and fetal risks. This case series examines the underlying characteristics and management strategies for this high-risk population.
METHODS:
All pregnant and post-partum patients who underwent VA ECMO in the cardiovascular intensive care unit between January 1, 2016 and November 1, 2019, were included in this retrospective study. Management of maternal and fetal O delivery, left ventricular (LV) unloading, anticoagulation, and ECMO circuit characteristics were evaluated.
RESULTS:
Five patients required veno-arterial ECMO for restoration of systemic perfusion. Three patients developed peripartum cardiomyopathy, one septic cardiomyopathy, and one acute right ventricular (RV) failure. The median age was 30.6?years, with median gestational age in pregnant patients of 31?weeks. Maternal and fetal survival to discharge was 80%. Bleeding was the primary complication, with two patients requiring blood transfusions; one requiring interventional radiology (IR) embolization and the other requiring surgical intervention to control bleeding. One patient was successfully delivered on VA ECMO. No fetal complications were directly attributed to VA ECMO.
CONCLUSIONS:
VA ECMO can be employed successfully in obstetric patients with cardiogenic shock with appropriate patient selection. Further research is needed to determine if VA ECMO provides a survival advantage over traditional management strategies in this vulnerable population.
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Postpartum pheochromocytoma-induced takotsubo syndrome.
BMJ Case Rep2021 Mar;14(3):. doi: e240098.
Itagane Masaki, Nakazato Jun, Kinjo Mitsuyo,
Abstract
A postpartum patient with acute-onset dyspnoea and hypotention, associated with reduced left ventricular function requiring intensive blood pressure control, was initially misdiagnosed as having peripartum cardiomyopathy. Her clinical symptoms rapidly resolved. Echocardiography revealed reversible left ventricular dysfunction with apical ballooning and coronary angiography was normal. Based on these findings, we diagnosed takotsubo syndrome. Over the next two months, the patient experienced repeated bouts of elevated sympathetic activity. On workup, we found an adrenal mass and elevated urine metanephrines. After adrenalectomy, histology confirmed pheochromocytoma. Our patient had the rare diagnosis of postpartum pheochromocytoma-induced takotsubo syndrome.
© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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Severe acute respiratory syndrome coronavirus-2- or pregnancy-related cardiomyopathy, a differential to be considered in the current pandemic: a case report.
J Med Case Rep2021 Mar;15(1):143. doi: 10.1186/s13256-021-02751-3.
Nejadrahim Rahim, Khademolhosseini Sara, Kavandi Hadiseh, Hajizadeh Reza,
Abstract
BACKGROUND:
There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis.
CASE PRESENTATION:
In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection.
CONCLUSIONS:
The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.
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Challenges in the diagnosis of peripartum cardiomyopathy: a case series.
Eur Heart J Case Rep2021 Feb;5(2):ytab001. doi: 10.1093/ehjcr/ytab001.
Chirillo Fabio, Baritussio Anna, Cucchini Umberto, Toniolli Ermanno, Polo Angela, Iavernaro Antonio,
Abstract
Background:
Peripartum cardiomyopathy (PPCM) is usually characterized by overt heart failure, but other clinical scenarios are possible, sometimes making the diagnosis challenging.
Case summary:
We report a case series of four patients with PPCM. The first patient presented with acute heart failure due to left ventricular (LV) systolic dysfunction. Following medical treatment, LV function recovered completely at 1?month. The second patient had systemic and pulmonary thromboembolism, secondary to severe biventricular dysfunction with biventricular thrombi. The third patient presented with myocardial infarction with non-obstructed coronary arteries and evidence of an aneurysm of the mid-anterolateral LV wall. The fourth patient, diagnosed with PPCM 11?years earlier, presented with sustained ventricular tachycardia. A repeat cardiac magnetic resonance, compared to the previous one performed 11?years earlier, showed an enlarged LV aneurysm in the mid-LV anterolateral wall with worsened global LV function.
Discussion:
Peripartum cardiomyopathy may have different clinical presentations. Attentive clinical evaluation and multimodality imaging can provide precise diagnostic and prognostic information.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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FONTAN CIRCULATION MIGHT BE ASSOCIATED WITH PERIPARTUM CARDIOMYOPATHY: A REVIEW OF MECHANISTIC AND CLINICAL ASPECTS.
Curr Cardiol Rev2021 Mar;():. doi: 10.2174/1573403X17666210316121842.
Yalta Kenan, Yetkin Ertan, Taylan Gokay,
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 placenta and inflammation-oxidation stress. Importantly, diagnosis of superimposed PPCM in women with FC might be a diagnostic challenge, and requires 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.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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An integrated model of preeclampsia: a multifaceted syndrome of the maternal cardiovascular-placental-fetal array.
Am J Obstet Gynecol2021 Mar;():. doi: S0002-9378(20)31197-2.
Yagel Simcha, Cohen Sarah M, Goldman-Wohl Debra,
Abstract
Maternal tolerance of the semiallogenic fetus necessitates conciliation of competing interests. Viviparity evolved with a placenta to mediate the needs of the fetus and maternal adaptation to the demands of pregnancy and to ensure optimal survival for both entities. The maternal-fetal interface is imagined as a 2-dimensional porous barrier between the mother and fetus, when in fact it is an intricate multidimensional array of tissues and resident and circulating factors at play, encompassing the developing fetus, the growing placenta, the changing decidua, and the dynamic maternal cardiovascular system. Pregnancy triggers dramatic changes to maternal hemodynamics to meet the growing demands of the developing fetus. Nearly a century of extensive research into the development and function of the placenta has revealed the role of placental dysfunction in the great obstetrical syndromes, among them preeclampsia. Recently, a debate has arisen questioning the primacy of the placenta in the etiology of preeclampsia, asserting that the maternal cardiovascular system is the instigator of the disorder. It was the clinical observation of the high rate of preeclampsia in hydatidiform mole that initiated the focus on the placenta in the etiology of the disease. Over many years of research, shallow trophoblast invasion with deficient remodeling of the maternal spiral arteries into vessels of higher capacitance and lower resistance has been recognized as hallmarks of the preeclamptic milieu. The lack of the normal decrease in uterine artery resistance is likewise predictive of preeclampsia. In abdominal pregnancies, however, an extrauterine pregnancy develops without remodeling of the spiral arteries, yet there is reduced resistance in the uterine arteries and distant vessels, such as the maternal ophthalmic arteries. Proponents of the maternal cardiovascular model of preeclampsia point to the observed maternal hemodynamic adaptations to pregnancy and maladaptation in gestational hypertension and preeclampsia and how the latter resembles the changes associated with cardiac disease states. Recognition of the importance of the angiogenic-antiangiogenic balance between placental-derived growth factor and its receptor soluble fms-like tyrosine kinase-1 and disturbance in this balance by an excess of a circulating isoform, soluble fms-like tyrosine kinase-1, which competes for and disrupts the proangiogenic receptor binding of the vascular endothelial growth factor and placental-derived growth factor, opened new avenues of research into the pathways to normal adaptation of the maternal cardiovascular and other systems to pregnancy and maladaptation in preeclampsia. The significance of the "placenta vs heart" debate goes beyond the academic: understanding the mutuality of placental and maternal cardiac etiologies of preeclampsia has far-reaching clinical implications for designing prevention strategies, such as aspirin therapy, prediction and surveillance through maternal hemodynamic studies or serum placental-derived growth factor and soluble fms-like tyrosine kinase-1 testing, and possible treatments to attenuate the effects of insipient preeclampsia on women and their fetuses, such as RNAi therapy to counteract excess soluble fms-like tyrosine kinase-1 produced by the placenta. In this review, we will present an integrated model of the maternal-placental-fetal array that delineates the commensality among the constituent parts, showing how a disruption in any component or nexus may lead to the multifaceted syndrome of preeclampsia.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Outcomes of pregnancy and delivery in women with cardiac disease compared to matched healthy controls.
J Matern Fetal Neonatal Med2021 Mar;():1-7. doi: 10.1080/14767058.2021.1895739.
Tsaitlin-Mor L, Nir A, Elchalal U, Bdolah-Abram T, Weiniger C F,
Abstract
OBJECTIVE:
We compared pregnancy and delivery outcomes between women with cardiac disease versus matched healthy controls. The primary outcome was the frequency of unplanned cesarean delivery.
METHODS:
In this single-center retrospective case-control study, women with cardiac disease were identified and matched (1:2 ratio, according to maternal age, parity, number of prior cesareans, gestational age, delivery onset and fetal presentation) to healthy controls who delivered within the same year. Outcomes were frequency of unplanned cesarean delivery, complications during pregnancy and postpartum course, intensive care unit (ICU) admissions, and length of hospitalization.
RESULTS:
One hundred and twelve women with cardiac disease (exposed group, 225 deliveries) were identified and matched with 450 healthy women (controls, 2003-2014). The cohort comprised of 103 women (204 deliveries) with acquired heart disease (valve disease [?=?69], arrhythmia [?=?31], 3 with cardiomyopathy and peri/myocarditis, and 9 women (21 deliveries) with congenital heart disease. The frequency of unplanned cesarean was 14 (7.9%) for the exposed group as compared with 12 (3.4%) in controls with an odds ratio of 2.33 (95% CI = 1.0.2-5.32, ?=?.045). This difference was accentuated in a sub-group of women with severe cardiac disease (15% vs. 4.2% in matched control group, ?=?.028). Seventy-one (31.6%) exposed women exhibited obstetric and cardiovascular complications during pregnancy as compared with 65 (14.4%) controls, ?
CONCLUSIONS:
Women with a background cardiac condition, particularly those with severe disease, are at a higher risk for an unplanned cesarean delivery and other peripartum complications as compared with matched healthy controls.
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Risk stratification and management of women with cardiomyopathy/heart failure planning pregnancy or presenting during/after pregnancy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy.
Eur J Heart Fail2021 Feb;():. doi: 10.1002/ejhf.2133.
Sliwa Karen, van der Meer Peter, Petrie Mark C, Frogoudaki Alexandra, Johnson Mark R, Hilfiker-Kleiner Denise, Hamdan Righab, Jackson Alice M, Ibrahim Bassem, Mbakwem Amam, Tschöpe Carsten, Regitz-Zagrosek Vera, Omerovic Elmir, Roos-Hesselink Jolien, Gatzoulis Michael, Tutarel Oktay, Price Susanna, Heymans Stephane, Coats Andrew J S, Müller Christian, Chioncel Ovidiu, Thum Thomas, de Boer Rudolf A, Jankowska Ewa, Ponikowski Piotr, Lyon Alexander R, Rosano Guiseppe, Seferovic Petar M, Bauersachs Johann,
Abstract
This position paper focusses on the pathophysiology, diagnosis and management of women diagnosed with a cardiomyopathy, or at risk of heart failure (HF), who are planning to conceive or present with (de novo or previously unknown) HF during or after pregnancy. This includes the heterogeneous group of heart muscle diseases such as hypertrophic, dilated, arrhythmogenic right ventricular and non-classified cardiomyopathies, left ventricular non-compaction, peripartum cardiomyopathy, Takotsubo syndrome, adult congenital heart disease with HF, and patients with right HF. Also, patients with a history of chemo-/radiotherapy for cancer or haematological malignancies need specific pre-, during and post-pregnancy assessment and counselling. We summarize the current knowledge about pathophysiological mechanisms, including gene mutations, clinical presentation, diagnosis, and medical and device management, as well as risk stratification. Women with a known diagnosis of a cardiomyopathy will often require continuation of drug therapy, which has the potential to exert negative effects on the foetus. This position paper assists in balancing benefits and detrimental effects.
© 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Cardioembolic Stroke with Peripartum Cardiomyopathy: An Unusual Presentation.
Indian J Crit Care Med2021 Jan;25(1):97-99. doi: 10.5005/jp-journals-10071-23708.
Nasa Prashant, Mortada Mohamed, Ali Alaeldin, Malhotra Vickrant, Koul Kandy, Singh Aanchal,
Abstract
Cardioembolic stroke in a patient with peripartum cardiomyopathy (PPCM) patient is rare despite a higher incidence of thromboembolic events. We report a case of acute right middle cerebral artery territory cardioembolic stroke in a postpartum female as the initial presenting feature of PPCM. The patient was thrombolyzed with intravenous alteplase and had an almost complete neurological recovery. Nasa P, Mortada M, Ali A, Malhotra V, Koul K, Singh A. Cardioembolic Stroke with Peripartum Cardiomyopathy: An Unusual Presentation. Indian J Crit Care Med 2021;25(1):97-99.
Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.
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'The bubble heart': an unusual natural history told by multimodality imaging- a case report.
Eur Heart J Case Rep2021 Feb;5(2):ytaa533. doi: 10.1093/ehjcr/ytaa533.
Locorotondo Gabriella, Fedele Elisa, Napolitano Carmela, Galiuto Leonarda,
Abstract
Background:
Intracardiac thrombosis is a relatively common pathological condition. Often, it is diagnosed at echocardiography during the subacute or chronic phase. In the very acute phase, tissue composition can make thrombus appearance very different from that usually seen. Fresh thrombosis has been previously found also in peripartum cardiomyopathy (PPC), but with imaging features different from our case.
Case summary:
A 27-year-old woman was referred to our hospital for PPC, with echocardiographic finding of intraventricular masses, resembling big bubbles. Cardiac magnetic resonance (CMR) allowed definitively diagnosing intracardiac 'very acute' thrombosis, which is rarely detected.
Discussion:
Our case provides a practical lesson about management of an unusual presentation of a common problem. When early echocardiography does not allow making a certain diagnosis, CMR can be helpful and decisive, due to its unique ability to provide characterization of intracardiac masses.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Peripartum Cardiomyopathy and Pregnancy-Associated Heart Failure with Preserved Ejection Fraction: More Similar Than Different.
J Card Fail -
Heart Failure and Pregnancy: Thinking Beyond Peripartum Cardiomyopathy.
J Card Fail -
Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM).
Clin Res Cardiol2021 Feb;():. doi: 10.1007/s00392-021-01808-z.
Hoevelmann J, Muller E, Azibani F, Kraus S, Cirota J, Briton O, Ntsekhe M, Ntusi N A B, Sliwa K, Viljoen C A,
Abstract
INTRODUCTION:
Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function.
METHODS:
Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF).
RESULTS:
This study of 35 women with PPCM (mean age 30.0?±?5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2-1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD??50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of???900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05-0.95, P?=?0.043) or LVEF (OR 0.20 [95% CI 0.04-0.89], p?=?0.035) at follow-up.
CONCLUSIONS:
We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of???900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.
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