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Pubblicazioni recenti - peripartum cardiomyopathy
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A Premature Ventricular Contraction Associated With Transient Worsening Pulsus Alternans: A Case Report.
Cureus2021 Dec;13(12):e20284. doi: 10.7759/cureus.20284.
Trongtorsak Angkawipa, Thangjui Sittinun, Chaisidhivej Natapat, Sharma Alisha, Ariyachaipanich Aekarach,
Abstract
Pulsus alternans is a rare condition characterized by alternation between strong and weak pulses during regular heart rhythm. Although pulsus alternans occurs mostly in severe heart failure, it can also be seen in other conditions that alternate ventricular contraction such as rapid tachycardia and extrasystole. Here, we report the case of a patient with peripartum cardiomyopathy who developed worsening pulsus alternans after a premature ventricular contraction.
Copyright © 2021, Trongtorsak et al.
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Pathophysiology and risk factors of peripartum cardiomyopathy.
Nat Rev Cardiol2022 Jan;():. doi: 10.1038/s41569-021-00664-8.
Hoes Martijn F, Arany Zoltan, Bauersachs Johann, Hilfiker-Kleiner Denise, Petrie Mark C, Sliwa Karen, van der Meer Peter,
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially fatal form of idiopathic heart failure with variable prevalence across different countries and ethnic groups. The cause of PPCM is unclear, but environmental and genetic factors and pregnancy-associated conditions such as pre-eclampsia can contribute to the development of PPCM. Furthermore, animal studies have shown that impaired vascular and metabolic function might be central to the development of PPCM. A better understanding of the pathogenic mechanisms involved in the development of PPCM is necessary to establish new therapies that can improve the outcomes of patients with PPCM. Pregnancy hormones tightly regulate a plethora of maternal adaptive responses, including haemodynamic, structural and metabolic changes in the cardiovascular system. In patients with PPCM, the peripartum period is associated with profound and rapid hormonal fluctuations that result in a brief period of disrupted cardiovascular (metabolic) homeostasis prone to secondary perturbations. In this Review, we discuss the latest studies on the potential pathophysiological mechanisms of and risk factors for PPCM, with a focus on maternal cardiovascular changes associated with pregnancy. We provide an updated framework to further our understanding of PPCM pathogenesis, which might lead to an improvement in disease definition.
© 2022. Springer Nature Limited.
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Detecting cardiomyopathies in pregnancy and the postpartum period with an electrocardiogram-based deep learning model.
Eur Heart J Digit Health2021 Dec;2(4):586-596. doi: 10.1093/ehjdh/ztab078.
Adedinsewo Demilade A, Johnson Patrick W, Douglass Erika J, Attia Itzhak Zachi, Phillips Sabrina D, Goswami Rohan M, Yamani Mohamad H, Connolly Heidi M, Rose Carl H, Sharpe Emily E, Blauwet Lori, Lopez-Jimenez Francisco, Friedman Paul A, Carter Rickey E, Noseworthy Peter A,
Abstract
Aims:
Cardiovascular disease is a major threat to maternal health, with cardiomyopathy being among the most common acquired cardiovascular diseases during pregnancy and the postpartum period. The aim of our study was to evaluate the effectiveness of an electrocardiogram (ECG)-based deep learning model in identifying cardiomyopathy during pregnancy and the postpartum period.
Methods and results:
We used an ECG-based deep learning model to detect cardiomyopathy in a cohort of women who were pregnant or in the postpartum period seen at Mayo Clinic. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. We compared the diagnostic probabilities of the deep learning model with natriuretic peptides and a multivariable model consisting of demographic and clinical parameters. The study cohort included 1807 women; 7%, 10%, and 13% had left ventricular ejection fraction (LVEF) of 35% or less,
Conclusions:
An ECG-based deep learning model effectively identifies cardiomyopathy during pregnancy and the postpartum period and outperforms natriuretic peptides and traditional clinical parameters with the potential to become a powerful initial screening tool for cardiomyopathy in the obstetric care setting.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Successful pregnancy with left ventricular assist device failure in the setting of peripartum cardiomyopathy.
Proc (Bayl Univ Med Cent)2022 ;35(1):98-100. doi: 10.1080/08998280.2021.1967020.
Vargas Aurelio, Armin Sabiha, Yeomans Edward,
Abstract
Pregnancy is contraindicated for women with left ventricular dysfunction due to high maternal and fetal mortality. We present a case of a pregnant 31-year-old woman with a history of heart failure due to peripartum cardiomyopathy from a previous pregnancy. She had a left ventricular assist device (LVAD) and was on warfarin due to recurrent thrombosis of her device. During her course, she had multiple cardiac complications, including thrombosis of the LVAD, which required deactivation. At 32 weeks, a cesarean section was performed due to acute decompensation, and a transthoracic echocardiogram revealed a left ventricular ejection fraction of 30% to 34%, a dilated left ventricle, and moderate global hypokinesis. This case highlights the need for coordinated care from cardiologists and maternal-fetal medicine specialists to minimize symptoms to obtain ideal outcomes for mother and infant despite LVAD deactivation.
Copyright © 2021 Baylor University Medical Center.
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Impact of autoantibodies against the M2-muscarinic acetylcholine receptor on clinical outcomes in peripartum cardiomyopathy patients with standard treatment.
BMC Cardiovasc Disord2021 12;21(1):619. doi: 10.1186/s12872-021-02414-7.
Ma Guiling, Chen Long, Yue Yin, Liu Xiyan, Wang Yidan, Shi Cheng, Song Fei, Shi Wei, Lo Yingshih, Zhang Lin,
Abstract
OBJECTIVES:
To evaluate the impact of autoantibodies against the M2-muscarinic receptor (anti-M2-R) on the clinical outcomes of patients receiving the standard treatment for peripartum cardiomyopathy (PPCM).
METHODS:
A total of 107 PPCM patients who received standard heart failure (HF) treatment between January 1998 and June 2020 were enrolled in this study. According to anti-M2-R reactivity, they were classified into negative (n?=?59) and positive (n?=?48) groups, denoted as the anti-M2-R (-) and anti-M2-R (+) groups. Echocardiography, 6-min walk distance, serum digoxin concentration (SDC), and routine laboratory tests were performed regularly for 2 years. The all-cause mortality, cardiovascular mortality, and rehospitalisation rate for HF were compared between the two groups.
RESULTS:
A total of 103 patients were included in the final data analysis, with 46 in the anti-M2-R (+) group and 57 in the anti-M2-R (-) group. Heart rate was lower in the anti-M2-R (+) group than in the anti-M2-R (-) group at the baseline (102.7?±?6.1?bpm vs. 96.0?±?6.4?bpm, p?0.001). The initial SDC was higher in the anti-M2-R (+) group than in the anti-M2-R (-) group with the same dosage of digoxin (1.25?±?0.45 vs. 0.78?±?0.24?ng/mL, p?0.001). The dosages of metoprolol and digoxin were higher in the anti-M2-R (-) patients than in the anti-M2-R (+) patients (38.8?±?4.6?mg b.i.d. vs. 27.8?±?5.3?mg b.i.d., p?0.0001, respectively, for metoprolol; 0.12?±?0.02?mg/day vs. 0.08?±?0.04?mg/day, p?0.0001, respectively, for digoxin). Furthermore, there was a greater improvement in cardiac function in the anti-M2-R (-) patients than in the anti-M2-R (+) patients. Multivariate analysis identified negativity for anti-M2-R as the independent predictor for the improvement of cardiac function. Rehospitalisation for HF was lower in the anti-M2-R (-) group, but all-cause mortality and cardiovascular mortality were the same.
CONCLUSIONS:
There were no differences in all-cause mortality or cardiovascular mortality between the two groups. Rehospitalisation rate for HF decreased in the anti-M2-R (-) group. This difference may be related to the regulation of the autonomic nervous system by anti-M2-R.
© 2021. The Author(s).
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A Case of Postpartum Pulmonary Edema Induced by Oxytocin.
Cureus2021 Nov;13(11):e19590. doi: 10.7759/cureus.19590.
Zaw May, Lim William, Latif Amber,
Abstract
Postpartum dyspnea can be due to many causes, such as pulmonary embolism, amniotic fluid embolism, peripartum cardiomyopathy, but less frequently due to acute pulmonary edema. The incidence of acute pulmonary edema during pregnancy and in the postpartum period has been estimated to be around 0.08%. About half of the cases are attributed to tocolytic therapy. Herein, we present a case of a young woman presenting with acute hypoxia after induction of labor with oxytocin and found to have acute pulmonary edema. This case aims to illustrate and add to a growing body of literature regarding oxytocin-induced acute pulmonary edema and highlights the importance of recognizing the rare complication of oxytocin and necessary interventions to avoid complications. Oxytocin-induced pulmonary edema is a relatively uncommon condition, but physicians should have a high index of suspicion to initiate timely intervention and to avoid fetal complications.
Copyright © 2021, Zaw et al.
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Perioperative management of emergent cesarean section in a patient with peripartum cardiomyopathy and orthopnea: a case report.
J Int Med Res2021 Dec;49(12):3000605211063077. doi: 10.1177/03000605211063077.
Kawamoto Yuko, Nishihara Tasuku, Aono Jun, Nandate Hideyuki, Hamada Taisuke, Yasuoka Toshiaki, Matsumoto Takashi, Yamaguchi Osamu, Sugiyama Takashi, Yorozuya Toshihiro,
Abstract
Perioperative management of pregnant women with heart failure is difficult. Management of anesthesia in pregnant women is especially difficult because all of the currently available choices present challenges. We report a patient with peripartum cardiomyopathy (PPCM) who required an emergent cesarean section and discuss the possible tactics for managing anesthesia. A 40-year-old primipara with severe cardiac and respiratory failure required an emergent cesarean section at 39 gestational weeks. Her left ventricular ejection fraction was between 10% and 15%, and she had orthopnea. General anesthesia was planned after inserting sheaths for percutaneous cardiopulmonary support from the femoral artery and vein. However, when the patient was asked to lie down on the operation bed, she panicked and resisted because of labor pain and dyspnea. Therefore, anesthesia was induced instead of the initial plan. Finally, we successfully managed the anesthesia and delivered the newborn. There are no alternatives to general anesthesia in patients with PPCM presenting with orthopnea. Anesthesia induction in the supine position is impossible in such patients owing to dyspnea. Anesthesia should be started with light sedation in the sitting position, and ketamine or low-dose remifentanil may be an option to maintain maternal hemodynamics and prevent neonatal asphyxia.
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Peripartum cardiomyopathy: alluring challenge - case series and review of literature.
Pan Afr Med J2021 ;40():119. doi: 10.11604/pamj.2021.40.119.29168.
Bouhaddoune Youssra, Hbali Anas, Aissaoui Hanane, Mrabet Asmae, Ismaili Nabila, El Ouafi Noha,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare disease responsible for heart failure that usually occurs in the last month of pregnancy or within five months postpartum, without any other known cause. A case series of five PPCM patients admitted at the Department of Cardiology of the University Hospital Mohammed VI of Oujda, Morocco, between 2017 and 2019. All cases were represented by young (case 1: 35-year-old; case 2: 28-year-old; case 3: 30-year-old; case 4: 36-year-old; case 5: 34-year-old). All patients were multiparous who were admitted to our department with a severely reduced left ventricular ejection fraction. Case 1 and 4 were admitted 3 days after delivery for heart failure. Case 2 was admitted for cardiogenic shock after 3 months of delivery. Case 3 was admitted twelve days after delivery for acute heart failure with pulmonary embolism and multiple venous thrombosis. Case 5 had a history of PPCM was admitted for cardiogenic shock with a course marked by recurrent thromboembolic events. Case 1 and 2 responded to treatment at an early stage, case 4 has evolved to chronicity, the third patient died from an unclear cause, and the fifth patient died from a contraindicated pregnancy leading to the recurrence of fatal thromboembolic events. Above reported cases confirming the great heterogeneity in clinical presentation and course of peripartum cardiomyopathy and seems to confirm that a delayed diagnosis, as well thromboembolic complications are bad prognosis factors of these patients. Early diagnosis, multidisciplinary collaboration, prompt treatment of heart failure and continued monitoring are the keys to improve maternal survival.
Copyright: Youssra Bouhaddoune et al.
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Imaging-Based Risk Stratification for Recurrence Risk in Women with a History of Peripartum Cardiomyopathy.
Am J Perinatol2021 Dec;():. doi: 10.1055/s-0041-1740016.
Ma'ayeh Marwan, Slivnick Jeremy A, McKiever Monique E, Garrett Zachary D, Lim Woobeen, Cackovic Michael, Rood Kara M, Bradley Elisa A,
Abstract
OBJECTIVE:
?Peripartum cardiomyopathy (PPCM) affects 1:1,000 U.S. pregnancies, and while many recover from the disease, the risk of recurrence in subsequent pregnancy (SSP) is high. This study aims to evaluate the utility of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) to predict the risk of recurrence of PPCM in SSP.
STUDY DESIGN:
?We retrospectively evaluated outcomes in women with a history of PPCM and SSP at a large-volume cardioobstetrics program (2008-2019).
RESULTS:
?There were 18 women who had incident PPCM and pursued SSP. Of 24 pregnancies in these women, 8 (33%) were complicated by the development of recurrent PPCM. LVEF???52% or GLS???-16 was associated with a low risk of recurrent PPCM.
CONCLUSION:
?Approximately one-third of women with PPCM developed recurrent PPCM in SSP. LVEF and GLS on prepregnancy echocardiography may predict the risk of recurrence. Additional studies evaluating risk for recurrence are required to better understand which women are the safest to consider SSP.
KEY POINTS:
· Peripartum cardiomyopathy affects 1:1000 US pregnancies.. · Approximately one third of women with a history of peripartum cardiomyopathy developed recurrent disease in a subsequent pregnancy. · A left ventricular ejection fraction ?52% or global longitudinal strain ?-16 on echocardiogram is associated with a low risk of recurrence.
Thieme. All rights reserved.
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Recent Findings Related to Cardiomyopathy and Genetics.
Int J Mol Sci2021 Nov;22(22):. doi: 12522.
Yamada Takanobu, Nomura Seitaro,
Abstract
With the development and advancement of next-generation sequencing (NGS), genetic analysis is becoming more accessible. High-throughput genetic studies using NGS have contributed to unraveling the association between cardiomyopathy and genetic background, as is the case with many other diseases. Rare variants have been shown to play major roles in the pathogenesis of cardiomyopathy, which was empirically recognized as a monogenic disease, and it has been elucidated that the clinical course of cardiomyopathy varies depending on the causative genes. These findings were not limited to dilated and hypertrophic cardiomyopathy; similar trends were reported one after another for peripartum cardiomyopathy (PPCM), cancer therapy-related cardiac dysfunction (CTRCD), and alcoholic cardiomyopathy (ACM). In addition, as the association between clinical phenotypes and the causative genes becomes clearer, progress is being made in elucidating the mechanisms and developing novel therapeutic agents. Recently, it has been suggested that not only rare variants but also common variants contribute to the development of cardiomyopathy. Cardiomyopathy and genetics are approaching a new era, which is summarized here in this overview.
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Peripartum cardiomyopathy and cardiac resynchronization therapy: Case reports and literature review.
HeartRhythm Case Rep2021 Nov;7(11):767-772. doi: 10.1016/j.hrcr.2021.08.011.
Wang Norman C, Jain Sandeep K,
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Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy.
J Community Hosp Intern Med Perspect2021 ;11(6):839-842. doi: 10.1080/20009666.2021.1978155.
Bendaram Snigdha, Elkattawy Sherif, Atif Masood Noori Muhammad, Fichadiya Hardik, Ayad Sarah, Kaur Parminder, Pullatt Raja, Shamoon Fayez,
Abstract
Wolf-Parkinson-White (WPW) syndrome is a congenital heart condition in which the atrioventricular (AV) node is bypassed by an accessory pathway that connects the atria and ventricle directly along with symptoms of syncope or palpitations. WPW syndrome in patients with a history of peripartum cardiomyopathy (pregnancy-related cardiomyopathy) is associated with a high risk of morbidity and mortality secondary to failure of the pump and the conduction system of the heart. Management of these cases deals with arrhythmia and systolic heart failure, which becomes more challenging in pregnant patients as it requires treatment methods that minimize risks to the fetus. We report a case of a young female patient with WPW syndrome and peripartum cardiomyopathy presenting with symptomatic arrhythmias (tachycardia).
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Greater Baltimore Medical Center.
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Peripartum cardiomyopathy.
CMAJ2021 11;193(45):E1733. doi: 10.1503/cmaj.210468.
Bews Hilary, Saeed Mahwash, Liu Shuangbo,
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Postpartum Respiratory Depression.
Anesthesiol Clin2021 Dec;39(4):687-709. doi: S1932-2275(21)00064-1.
Himmelwright Rebecca S, Dominguez Jennifer E,
Abstract
Postpartum respiratory depression is a complex, multifactorial issue that encompasses a patient's baseline preexisting conditions, certain pregnancy-specific conditions or complications, as well as the iatrogenic element of various medications given in the peripartum period. In this review, we discuss many of these factors including obesity, sleep-disordered breathing, chronic lung disease, neuromuscular disorders, opioids, preeclampsia, peripartum cardiomyopathy, postpartum hemorrhage, amniotic fluid embolism, sepsis, acute respiratory distress syndrome (ARDS), and medications such as analgesics, sedatives, anesthetics, and magnesium. Current recommendations for screening, treatment, and prevention are also discussed.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Cardiac Function in Women With Peripartum Cardiomyopathy: The Tip of the Iceberg.
JACC Case Rep2021 Nov;3(15):1654-1655. doi: 10.1016/j.jaccas.2021.07.003.
Davis Melinda B, Rameez Rabel, Joseph Megan S,
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Exercise Ventricular Reserve Among Women With a History of Peripartum Cardiomyopathy.
JACC Case Rep2021 Nov;3(15):1649-1653. doi: 10.1016/j.jaccas.2021.05.021.
Yucel Evin, Davis Esther F, Scott Nandita, Lewis Gregory D, DeFaria Yeh Doreen,
Abstract
Peripartum cardiomyopathy (PPCM) is associated with highly variable clinical outcomes. Small series suggest postpartum variation in exercise capacity and ventricular reserve. We describe limitations in exercise capacity and/or ventricular reserve in asymptomatic women who had recovered from PPCM and underwent a detailed physiologic assessment by cardiopulmonary exercise testing. ().
© 2021 The Authors.
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Effects of bromocriptine in peripartum cardiomyopathy: a systematic review and meta-analysis.
Heart Fail Rev2021 Nov;():. doi: 10.1007/s10741-021-10185-8.
Trongtorsak Angkawipa, Kittipibul Veraprapas, Mahabir Sunita, Ibrahim Michel, Saint Croix Garly R, Hernandez Gabriel A, Chaparro Sandra,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening form of heart failure (HF). Bromocriptine, a dopamine D2 agonist, has been used as an adjunctive treatment for PPCM with controversial benefits. A comprehensive literature search was conducted through June 2021. We included studies comparing the outcomes of PPCM with or without bromocriptine use. Pooled risk ratio (RR) with 95% confidence intervals (CI) and I statistics were calculated. Composite major adverse outcomes were defined by a composite of death, need for advanced HF therapies, persistent New York Heart Association (NYHA) functional class III/V, or left ventricular ejection fraction (LVEF)???35% at 6-month follow-up. LVEF recovery was defined by improvement of LVEF to more than 50%. Eight studies (two randomized-controlled, six observational) involving 593 PPCM patients were included. Bromocriptine use was associated with significantly higher survival (91.6% vs. 83.9%, RR 1.11 p?=?0.02). Baseline LVEF was not significantly different between the groups. LVEF at follow-up was significantly higher in the bromocriptine group (53.3% vs. 41.8%, p?0.001). There was no significant association between bromocriptine use and lower composite major adverse outcomes (13.7% vs. 33.3%, RR 0.60 p?=?0.54) or LVEF recovery (46.9% vs. 46.8%, RR 0.94 p?=?0.74). In conclusion, the addition of bromocriptine to standard HF treatment in PPCM was associated with significantly higher survival and higher LVEF improvement. No association with lower composite adverse clinical outcomes or LVEF recovery was seen. The findings, although encouraging, warrant larger randomized-controlled studies.
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Outcomes of severe peripartum cardiomyopathy and mechanical circulatory support: a case series.
JA Clin Rep2021 Nov;7(1):80. doi: 10.1186/s40981-021-00484-2.
Kiriyama Yuki, Kinishi Yuki, Hiramatu Daisuke, Uchiyama Akinori, Fujino Yuji, Toda Koichi, Ootaki Chiyo,
Abstract
BACKGROUND:
We present three cases of severe peripartum cardiomyopathy (PPCM) that required mechanical circulatory supports.
CASE PRESENTATION:
Case 1: A 33-year-old woman developed acute heart failure (AHF) after normal spontaneous delivery. Intra-aortic balloon pump (IABP) was inserted on postpartum day (PD) 10 with a peripartum cardiomyopathy (PPCM), which was withdrawn on PD 30 after medical treatment including anti-prolactin drugs. Case 2: A 44-year-old woman developed AHF 1?month after vaginal delivery. IABP or extra-corporeal membrane oxygenation (ECMO) was not effective and a biventricular assist device was inserted. It was withdrawn on PD 85 after improvement of left ventricular ejection fraction (LVEF). Case3: A 37-year-old woman was transferred with a diagnosis of PPCM. Cardiac function unimproved by IABP or ECMO, and a left ventricular assist device was implanted. It was withdrawn on PD 386 after recovery of LVEF.
CONCLUSION:
All the cases with PPCM recovered after mechanical circulatory supports and resumed social lives.
© 2021. The Author(s).
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Cardiovascular Magnetic Resonance in Peripartum Cardiomyopathy: Comparison with Idiopathic Dilated Cardiomyopathy.
Diagnostics (Basel)2021 Sep;11(10):. doi: 1752.
Petryka-Mazurkiewicz Joanna, Kryczka Karolina, Mazurkiewicz ?ukasz, Mi?osz-Wieczorek Barbara, ?piewak Mateusz, Marczak Magdalena, Henzel Jan, Grzybowski Jacek, Demkow Marcin, Dzieli?ska Zofia,
Abstract
BACKGROUND:
Peripartum (PPCM) and dilated (DCM) cardiomyopathies are distinct forms of cardiac disease that share certain aspects in clinical presentation.
AIM:
We hypothesized that different cardiac structural changes underlie PPCM and DCM, and we aimed to investigate them with cardiovascular magnetic resonance (CMR).
METHODS:
We included 21 PPCM patients (30.5 ± 5.9 years) and 30 female DCM patients (41.5 ± 16.8 years) matched for left ventricular ejection fraction. Biventricular and biatrial volumetric and functional parameters were assessed along with ventricular and atrial strain indices based on feature-tracking techniques. The presence of late gadolinium enhancement (LGE) was also assessed.
RESULTS:
In PPCM, the left ventricular (LV) stroke volume index was lower ( = 0.04), right atrial (RA) minimal and pre-systolic volumes were higher (
CONCLUSIONS:
Subtle differences appear on CMR between PPCM and DCM. Most importantly, the RA is larger and more impaired, and LV global longitudinal strain is less reduced in PPCM than in DCM. Furthermore, similarly to DCM, PPCM patients with LGE have more dilated and impaired ventricles than patients without LGE.
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