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Pubblicazioni recenti - peripartum cardiomyopathy
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Peripartum cardiomyopathy mimicking COVID-19 infection.
J Anaesthesiol Clin Pharmacol2020 Aug;36(Suppl 1):S44-S47. doi: 10.4103/joacp.JOACP_267_20.
Garg Shaloo, Singh Archana, Kalita Mukesh, Siddiqui Ayesha Zafar, Kapoor Mukul Chandra,
Abstract
A pregnant patient presented with fever and desaturation, without breathlessness. She was suspected to have COVID-19 but SARS-CoV-2 was negative. She developed fetal distress and underwent an uneventful Cesarean section. Postoperatively, she developed respiratory distress and needed mechanical ventilation support. The clinical features suggested COVID-19 infection and antiviral treatment were empirically initiated. Repeat SARS-CoV-2 was negative. Echocardiography, computed tomography scans, and biochemical investigations supported a diagnosis of peripartum cardiomyopathy. She was successfully managed with decongestive therapy and could be discharged home on the fifth day.
Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology.
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Pattern of Heart Diseases in Gombe and Environs: A 5-Year Echocardiographic Review.
Niger Med J;61(3):126-128. doi: 10.4103/nmj.NMJ_150_19.
Omoaghe Christian Ekholose, Okolie Henry Ifeanyichukwu, Yekeen Ayoola, Adamu Adamu, Okezie Ejeagba,
Abstract
Background:
Heart disease in the developing world is mainly due to nonischemic causes-hypertensive heart disease, valvular and myocardial damage from rheumatic fever, and heart muscle diseases caused by certain infectious agents, for example, cardiomyopathy from HIV infection. Peripartum cardiomyopathy is also a well-recognized cause of heart disease in developing countries. However, there is evidence of epidemiological transition toward the increasing prevalence of atherosclerotic cardiovascular disease in Sub-Saharan Africa largely because of the increasing prevalence of traditional risk factors, such as hypertension, diabetes mellitus, dyslipidemia, obesity, and cigarette smoking.
Aim:
The aim of this study was to determine the pattern of heart diseases among patients undergoing transthoracic echocardiographic evaluation between February 2012 and February 2017 at the Cardiology Unit of the Department of Medicine, Federal Teaching Hospital, Gombe, Gombe State.
Materials and Methods:
Echocardiographic data of patients from February 2012 to February 2017 were retrieved. A total of 2265 patient records were analyzed. All patients had standard resting transthoracic echocardiography including Doppler modalities where appropriate. Descriptive statistics were used in assessing the distribution of different heart diseases.
Results:
The age range of the 2265 patients was 14-89 years, with a mean age of 47.3 ± 20.1 years and a female preponderance (58%). The most common heart disease among these patients was hypertensive heart disease (41.8%) followed by cardiomyopathies (15.4%). Ischemic heart disease remains rare (0.7%) probably due to the investigative modality used in this study (resting transthoracic echocardiography).
Conclusion:
Hypertensive heart disease remains the most common heart disease among men and women in Gombe and its environs. Cardiomyopathies, although rare in certain regions of Nigeria, are quite common in Northeast Nigeria.
Copyright: © 2020 Nigerian Medical Journal.
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Peripartum cardiomyopathy with preeclampsia in a parturient: A case report with literature review.
Turk J Emerg Med;20(4):202-205. doi: 10.4103/2452-2473.297467.
Sethi Divya, Kumar Naveen,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare disease of unknown cause that affects women of childbearing age. A high index of suspicion should be maintained in the pregnant and peripartum woman who presents with sudden cardiac decompensation without any prior history of cardiac disease. The diagnosis can be confirmed with echocardiographic evidence of global left ventricular dysfunction. Timely diagnosis and institution of therapy for heart failure can avoid adverse outcomes in a parturient with PPCM. In this case report, we describe the management of primigravida presenting to the hospital's emergency department with acute cardiac failure and respiratory distress due to PPCM. The case also highlights that though preeclampsia and PPCM are two separate entities, these can coexist in the same parturient due to the common pathophysiological mechanism. In the review, the recommended medical management of heart failure in PPCM with the "BOARD" (Bromocriptine, Oral heart failure drugs, Anticoagulants, Vasorelaxing agents, and Diuretics) scheme is discussed.
Copyright: © 2020 Turkish Journal of Emergency Medicine.
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Selenium supplementation in patients with peripartum cardiomyopathy: a proof-of-concept trial.
BMC Cardiovasc Disord2020 Oct;20(1):457. doi: 10.1186/s12872-020-01739-z.
Karaye Kamilu M, Sa'idu Hadiza, Balarabe Suleiman A, Ishaq Naser A, Sanni Bushra, Abubakar Haruna, Mohammed Baba Lawan, Abdulsalam Tijjani, Tukur Jamilu, Mohammed Idris Y,
Abstract
BACKGROUND:
We studied the efficacy and safety of selenium supplementation in patients who had peripartum cardiomyopathy (PPCM) and selenium deficiency.
METHODS:
We randomly assigned 100 PPCM patients with left ventricular ejection fraction (LVEF)?
RESULTS:
Over a median of 19 months, the primary outcome occurred in 36 of 46 patients (78.3%) in the selenium group and in 43 of 54 patients (79.6%) in the control group (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.43-1.09; p?=?0.113). Persistence of HF symptoms occurred in 18 patients (39.1%) in the selenium group and in 37 patients (68.5%) in the control group (HR 0.53; 95% CI 0.30-0.93; p?=?0.006). LVEF?
CONCLUSIONS:
In this study, selenium supplementation did not reduce the risk of the primary outcome, but it significantly reduced HF symptoms, and there was a trend towards a reduction of all-cause mortality.
CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov Identifier: NCT03081949.
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Burden, predictors and short-term outcomes of peripartum cardiomyopathy in a black African cohort.
PLoS One2020 ;15(10):e0240837. doi: 10.1371/journal.pone.0240837.
Nabbaale Juliet, Okello Emmy, Kibirige Davis, Ssekitoleko Isaac, Isanga Joseph, Karungi Patience, Sebatta Elias, Zhu Zhang Wan, Nakimuli Annettee, Omagino John, Kayima James,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with acute heart failure during the peripartum period. It is common in patients of African ancestry. Currently, there is paucity of data on the burden, predictors and outcomes of PPCM in Uganda. This study aimed to investigate the prevalence, predictors and six-month outcomes of PPCM in an adult cohort attending a tertiary specialised cardiology centre in Kampala, Uganda.
METHODS:
This study consecutively enrolled 236 women presenting with features of acute heart failure in the peripartum period. Clinical evaluation and echocardiography were performed on all the enrolled women. PCCM was defined according to recommendations of the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Poor outcome at six months of follow-up was defined as presence of any of the following: death of a mother or her baby, New York Heart Association (NYHA) functional class III-IV or failure to achieve complete recovery of left ventricular function (left ventricular ejection fraction ?55%).
RESULTS:
The median age, BMI and parity of the study participants was 31.5 (25.5-38.0) years, 28.3 (26.4-29.7) and 3 (2-4) respectively. The prevalence of PPCM was 17.4% (n = 41/236). Multiple pregnancy was the only predictor of PPCM in this study population (OR 4.3 95% CI 1.16-16.05, p = 0.029). Poor outcome at six-months was observed in about 54% of the patients with PPCM (n = 4, 9.8% in NYHA functional class III-IV and n = 22, 53.7% with LVEF <55%). No maternal or foetal mortality was documented.
CONCLUSION:
PPCM is relatively common in Uganda and is associated with multiple pregnancy. Poor outcomes especially absence of complete recovery of left ventricular function are also common. Large studies to further investigate long-term maternal and foetal outcomes in Uganda are justified.
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Peripartum cardiomyopathy - a cardiovascular disease in pregnancy and puerperium. The actual state of knowledge, challenges, and perspectives.
Ginekol Pol2020 Oct;():. doi: 10.5603/GP.a2020.0171.
Kryczka Karolina E, Demkow Marcin, Dzielinska Zofia,
Abstract
Peripartum cardiomyopathy (PPCM) is an idiopathic, multifactor cause of heart failure occurring at the end of pregnancy or in the first months after delivery. Although the prevalence of the disease is increasing, the awareness of both physicians and patients is rather low. Symptoms of PPCM are unspecific, making a prompt diagnosis even more difficult. In severe functional insufficiency and dilatation of the left ventricle, the recovery rate is particularly low. Therefore, the later PPCM is diagnosed, the more severe heart failure, and the worse the patient's outcome. Despite the increasing frequency of PPCM, the exact pathophysiology and predictors of outcome are still not well determined. Therapeutic management in patients with PPCM remains a challenge, requiring a multidisciplinary approach. At the base of the disease lies dysfunction of microcirculation with 16-kDa prolactin as the main trigger of this state. Therefore, adding bromocriptine to standard heart failure pharmacotherapy may be particularly beneficial. In this review, we present the current state of knowledge and diagnostic and management recommendations and perspectives.
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Increased arterial stiffness and reduced left ventricular long axis function in patients recovered from peripartum cardiomyopathy.
Clin Physiol Funct Imaging2020 Oct;():. doi: 10.1111/cpf.12671.
Johansson Magnus C, Barasa Anders, Basic Carmen, Nyberg Gunnar, Schaufelberger Maria,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is idiopathic pregnancy-associated heart failure (HF) with reduced left ventricular ejection fraction (LVEF). We aimed to assess arterial stiffness and left ventricular (LV) function in women recovered from PPCM compared with controls.
METHODS:
Twenty-two PPCM patients were compared with 15 age-matched controls with previous uncomplicated pregnancies. Eleven of the patients were at inclusion in the study recovered and off medication since at least 6 months and still free from cardiovascular symptoms with normal LVEF and normal NT-proBNP. All underwent echocardiography, including LV strain, left atrial (LA) reservoir strain and tissue Doppler early diastolic velocity (e´) and non-invasive assessment for arterial stiffness and central aortic systolic blood pressure (AoBP) at rest and immediately post-exercise.
RESULTS:
The patients off medication showed alterations compared with controls. AoBP was higher (120±9 mmHg versus 104±13 mmHg; P=0.001), a difference which persisted post exercise. The arterial elastance was higher (1.9±0.4 mmHg/ml versus 1.3±0.2 mmHg/ml; P<0.001). While there were lower e´ septal (8.9±1.7 cm/s versus 11.0±1.1 cm/s; P= 0. 002), LV global strain (18.7±3.9 % versus 23.1±1.6 %; P= 0.004), and LA reservoir strain (24.8±9.1% versus 37.7±6.3%; P=0.002) CONCLUSIONS: Compared with healthy controls, PPCM patients considered recovered and off medication had increased arterial stiffness, decreased LV longitudinal function and reduced LA function.
This article is protected by copyright. All rights reserved.
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Systematic review and meta-analysis of prolactin and iron deficiency in peripartum cardiomyopathy.
Open Heart2020 Oct;7(2):. doi: e001430.
Cherubin Sinaida, Peoples Taylar, Gillard Jessica, Lakhal-Littleton Samira, Kurinczuk Jennifer J, Nair Manisha,
Abstract
OBJECTIVES:
We conducted a systematic review and meta-analysis of studies that compared levels of molecular biomarkers in women with peripartum cardiomyopathy (PPCM) to those in healthy pregnant and postpartum women to: (1) assess the evidence for prolactin (PRL) metabolism in PPCM, (2) ascertain the evidence for biomarkers of iron deficiency in PPCM, (3) identify other biomarkers associated with PPCM.
METHODS:
We searched Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and the Global Health Library from inception without language restriction for studies that compared biomarkers levels in PPCM cases to healthy controls. Pooled standardised mean difference (SMD) was generated using a random effects model for the difference in levels of biomarkers.
RESULTS:
Two studies assessed the association of PRL with PPCM, and reported that PPCM cases have higher levels of total PRL. No studies investigated iron metabolism in PPCM. Other biomarkers associated with PPCM included serum levels of natriuretic peptides (SMD=3.77, 95% CI 0.71 to 6.82), albumin (SMD=-0.67, 95% CI -1.01 to -0.32), C-reactive protein (SMD=1.67, 95% CI 0.22 to 3.12), selenium (SMD=-0.73, 95% CI -1.58 to 0.12), cardiac troponins (SMD=1.06, 95% CI 0.33 to 1.80), creatinine (SMD=0.51, 95% CI 0.33 to 0.69), white bloodcells (SMD=0.44, 95 % CI 0.07 to 0.82), haemoglobin (SMD=-0.45, 95% CI -0.64 to-0.26).
CONCLUSIONS:
More robust molecular studies are needed to explore the association between prolactin and PPCM in human subjects and to determine the extent to which iron deficiency (with or without anaemia) contributes to the risk of PPCM.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
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Unveiling the Mystery of Peripartum Cardiomyopathy: A Traditional Review.
Cureus2020 Oct;12(10):e10790. doi: 10.7759/cureus.10790.
Chinweuba Goodness C, Rutkofsky Ian H,
Abstract
Peripartum cardiomyopathy (PPCM) can be classified as a variant of dilated cardiomyopathy identified usually within the first five months of delivery or during the last month of pregnancy. This condition presents as systolic heart failure. PPCM affects thousands of women in the United States each year. Even though it was first noticed in the 1800s, its etiology remains unknown. This study aims to review the pathophysiology and management of PPCM and explore the possible outcomes of peripartum cardiomyopathy. PPCM can lead to maternal death if diagnosis or treatment is delayed. Diagnosing PPCM has been challenging because it can be misdiagnosed or perceived as a sign of pregnancy since most of the symptoms of PPCM strongly match those within the typical pregnancy continuum and postpartum cycle. Patients' implications are fatal and carry a high mortality rate when PPCM is misdiagnosed or treatment is delayed. To accurately identify PPCM, using echocardiography, the left ventricular end-diastolic size and the ejection fraction should be measured to determine the severity of PPCM. Managing peripartum cardiomyopathy involves using traditional treatments for heart failure. Therapeutic recommendations are made depending on the patient's status (pregnancy, breastfeeding, postpartum) while considering the drug-safety profiles before administration. Some other treatments have also been used to control PPCM depending on how severe it has become; for example, antiarrhythmics have been used to treat cardiac arrhythmias when they ensue. In extreme cases, mechanical assistance and transplantation could be required. Based on the proposed pathophysiology involving the 16kDA anti-angiogenic sub-fragment, bromocriptine may be used even though it still needs more assessment due to limited evidence. Using PubMed as a major search resource, a thorough analysis of publications was carried out after incorporating this review's inclusion and exclusion criteria. A total of 455,141 publications were found using keywords and keyword combinations. With a careful selection of articles, 31 publications provided relevant information on our primary endpoint. All articles in this examination were chosen without limitation to the type of study, including clinical trials, review articles, meta-analyses, and so on. Our review suggests that, based on factors such as early detection and management, disease severity, ethnicity, and quality of patient care, patients with PPCM presented different outcomes and prognosis. However, despite PPCM's high mortality rate and its risk of recurrence, most patients tend to recover within six months of disease onset.
Copyright © 2020, Chinweuba et al.
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Being responsible for someone else: a shared duty for parents and heart failure specialists during the COVID-19 pandemic.
ESC Heart Fail2020 Oct;():. doi: 10.1002/ehf2.12898.
Mapelli Massimo,
Abstract
A pandemic by a novel coronavirus disease (COVID-19) has been declared by the World Health Organization. Lombardy, the region of our tertiary referral centre for heart diseases in Northern Italy, has been particularly hit by the pandemic. According to the government's prescriptions, all elective activities and procedures in the last months were suspended in order to concentrate our efforts on COVID-19 patients' care. Entire departments have been turned into 'COVID-19 units', where healthcare professionals are daily involved in supporting critically ill patients. On a personal level, this was a period of special feelings and peculiar unexpected events. People close to healthcare workers have been affected, and our lives have been turned upside down. Furthermore, right in this period, few colleagues (and friends) are facing entirely new events in their lives, such as fatherhood with its load of joy and concern. Through the case of a young woman recently admitted to our department with a severe heart failure due to a peripartum cardiomyopathy, described in narrative form, this manuscript would help all those involved in the front line in the fight against the pandemic in these difficult times.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Postpartum Polymyositis Following Intrauterine Fetal Death.
Indian J Crit Care Med2020 Aug;24(8):731-734. doi: 10.5005/jp-journals-10071-23541.
Borse Manmohan P, Sahoo Tapas K, Anand Kumar V, Kumar Manoj, Panda Debasish,
Abstract
Polymyositis (PM) is an uncommon inflammatory myopathy that affects striated muscles. It causes weakness of the limb girdles, neck, and pharyngeal muscles. We are presenting a case of PM which manifested after intrauterine death (IUD). The patient was referred to our hospital for breathing difficulty, 4 days after delivery of a dead fetus. Initially, she was treated in line of puerperal sepsis and peripartum cardiomyopathy. Patient's cardiopulmonary functions improved but she had persistent high-grade fever. Gross muscle weakness was found on day 5 of admission, involving all four limbs, predominantly in proximal muscles and she had dark colored urine. Laboratory tests revealed myoglobinuria, high serum creatine phosphokinase (CPK) levels, and high lactate dehydrogenase (LDH) levels. Polymyositis diagnosed on the basis of high CPK levels, magnetic resonance imaging (MRI) of cervical spine, electromyography (EMG), and muscle biopsy findings. We question, whether the PM could be pathogenically related to the pregnancy? Literature review of the previously reported cases of PM/dermatomyositis and our case report suggests that pregnancy can trigger the new onset of PM.
How to cite this article:
Borse MP, Sahoo TK, Anand KV, Kumar M, Panda D. Postpartum Polymyositis Following Intrauterine Fetal Death. Indian J Crit Care Med 2020;24(8):731-734.
Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.
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Effect of natron administration on the antioxidant status and lipid profile of rats.
J Food Sci2020 Sep;():. doi: 10.1111/1750-3841.15480.
Saidu Yusuf, Olaosebikan Rihanat Olawumi, Isa Suleiman Ahmed, Malami Ibrahim, Muhammad Suleiman Alhaji,
Abstract
Natron consumption has been implicated in the pathogenesis of peripartum cardiomyopathy. This work evaluates the effect of natron on the antioxidant status and lipid profile of postpartum rats administered graded doses of natron for four consecutive weeks. After treatment, the rats were assessed for antioxidant status, malondialdehyde level, and lipid profile. The results revealed that natron caused a significant decrease (P ? 0.05) in the activity of catalase in rats administered with 300 mg/kg of natron compared to control. The activities of superoxide dismutase and glutathione peroxidase decreased in a dose-dependent manner; however, the difference was not statistically significant when compared with control. Serum levels of antioxidant minerals were also significantly decreased (P ? 0.05) at higher doses of natron in comparison to control. There was a significant increase (P < 0.05) in the malondialdehyde level in rats administered with 200 and 300 mg/kg of natron when compared with control. Natron at higher doses caused a significant increase (P ? 0.05) in the level of the lipid profile parameters except for high-density lipoprotein-cholesterol that decrease significantly (P ? 0.05). This study demonstrated that the administration of natron at high doses induced dyslipidemia and oxidative stress in postpartum rats. PRACTICAL APPLICATION: This research reports the implication of a high intake of natron to health and to establish the relationship between natron intake and peripartum cardiomyopathy (PPCM) using an animal model. Natron has health benefits; however, its consumption at high doses should be discouraged as it can lead to oxidative stress (OS) and dyslipidemia. The results suggest that OS due to natron may contribute to the pathogenesis of PPCM. A high concentration of natron can be used to induce an animal model of PPCM, which would be of practical application in studying the molecular basis and possible discovery of therapeutics for the disease.
© 2020 Institute of Food Technologists®.
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Severe Peripartum Cardiomyopathy: A Case Report of Successful Recovery with Personalized Treatment Approach.
Hellenic J Cardiol2020 Sep;():. doi: S1109-9666(20)30202-5.
Sisakian Hamayak S, Shahnazaryan Syuzanna, Pepoyan Sergey,
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Peripartum cardiomyopathy in a COVID-19-infected woman: differential diagnosis with acute myocarditis-A case report from a Hub Institution during the COVID-19 outbreak.
Echocardiography2020 Oct;37(10):1673-1677. doi: 10.1111/echo.14873.
De Vita Stefano, Ippolito Sonia, Caracciolo Maria Michela, Barosi Alberto,
Abstract
We report the case of a healthy 35-year-old woman who had experienced a flu-like syndrome during the week before childbirth and heart failure symptoms 10 days before the current hospitalization and presented to our emergency department with clinical signs of congestive heart failure, echocardiographic evidence of a severely dilated and hypokinetic heart, laboratory evidence of SARS-CoV-2 disease, and radiologic findings consistent with both virus-related pneumonia and heart failure. Early cardiac magnetic resonance was crucial for the diagnosis of postpartum cardiomyopathy and for the exclusion of virus-related myocarditis, allowing us to decide on a prudent and supportive clinical approach.
© 2020 Wiley Periodicals LLC.
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Cardiovascular disease in women: insights from magnetic resonance imaging.
J Cardiovasc Magn Reson2020 Sep;22(1):71. doi: 10.1186/s12968-020-00666-4.
Bucciarelli-Ducci Chiara, Ostenfeld Ellen, Baldassarre Lauren A, Ferreira Vanessa M, Frank Luba, Kallianos Kimberly, Raman Subha V, Srichai Monvadi B, McAlindon Elisa, Mavrogeni Sophie, Ntusi Ntobeko A B, Schulz-Menger Jeanette, Valente Anne Marie, Ordovas Karen G,
Abstract
The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement.This article reviews the sex differences in cardiovascular disease, explores the diagnostic and prognostic role of cardiovascular magnetic resonance (CMR) in the spectrum of cardiovascular disorders in women, and proposes the added value of CMR compared to other imaging modalities. In addition, this article specifically reviews the role of CMR in cardiovascular diseases occurring more frequently or exclusively in female patients, including Takotsubo cardiomyopathy, connective tissue disorders, primary pulmonary arterial hypertension and peripartum cardiomyopathy. Gaps in knowledge and opportunities for further investigation of sex-specific cardiovascular differences by CMR are also highlighted.
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Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries.
ESC Heart Fail2020 Sep;():. doi: 10.1002/ehf2.13030.
Salam Amar M, Ahmed Mohamed Badie, Sulaiman Kadhim, Singh Rajvir, Alhashemi Mohammed, Carr Alison S, Alsheikh-Ali Alawi A, AlHabib Khalid F, Al-Zakwani Ibrahim, Panduranga Prashanth, Asaad Nidal, Shehab Abdulla, AlMahmeed Wael, Al Suwaidi Jassim,
Abstract
AIMS:
Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East.
METHODS AND RESULTS:
From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and after 1 year of follow-up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%).
CONCLUSIONS:
A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Assessment of major mental disorders in a German peripartum cardiomyopathy cohort.
ESC Heart Fail2020 Sep;():. doi: 10.1002/ehf2.12967.
Pfeffer Tobias J, Herrmann Julian, Berliner Dominik, König Tobias, Winter Lotta, Ricke-Hoch Melanie, Ponimaskin Evgeni, Schuchardt Sven, Thum Thomas, Hilfiker-Kleiner Denise, Bauersachs Johann, Kahl Kai G,
Abstract
AIMS:
Peripartum cardiomyopathy (PPCM) is a heart disease affecting women during the last month of pregnancy or in the first months after delivery. The impact of the disease on mental health is largely unknown.
METHODS AND RESULTS:
Major mental disorders were assessed by a structured clinical interview in 40 patients with a confirmed PPCM diagnosis, and the data were compared with published prevalence in postpartum women. Circulating biomarkers associated with mental health, such as kynurenine, serotonin, and microRNA (miR)-30e, were evaluated in PPCM and compared with matched healthy pregnancy-matched postpartum controls (PP-Ctrl). Major mental disorders were diagnosed in 65% (26/40) of the PPCM cohort. The prevalence for major depressive disorders was 4-fold, for post-traumatic stress disorder 14-fold, and for panic disorder 6-fold higher in PPCM patients compared with postpartum women without a PPCM diagnosis. Compared with PP-Ctrl, PPCM patients displayed elevated levels of serum kynurenine (P < 0.01), reduced levels of serum serotonin (P < 0.05), and elevated levels of plasma miR-30e (P < 0.05).
CONCLUSIONS:
The majority of PPCM patients in the present cohort displayed mental disorders with a higher prevalence of major depressive disorders, post-traumatic stress disorder (PTBS), and panic disorder, compared with postpartum women without a PPCM diagnosis. This higher prevalence was associated with an impaired tryptophan metabolism and elevated levels of the depression-associated miR-30e, suggesting a potential predisposition for mental disorders at the time of PPCM diagnosis. Consequently, physicians should be aware of the increased risk for mental disorders in PPCM patients, and psychiatric assessment should be included in the diagnosis and management of PPCM patients.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Easily Missed: A Case Series of New Heart Failure in Young Adults.
Case Rep Med2020 ;2020():7251609. doi: 10.1155/2020/7251609.
Hall Eric J, Menachem Jonathan, Stevenson Lynne Warner, Huston Jessica,
Abstract
. While uncommon, heart failure (HF) can present in young adults from a variety of causes. Identifying HF in a young patient presents many challenges, the foremost of which is recognition of the signs and symptoms of HF. . We present four cases of new diagnosis of HF (due to familial cardiomyopathy, tachycardia-induced cardiomyopathy, spontaneous coronary artery dissection, and peripartum cardiomyopathy) to highlight the range of etiologies and presentations requiring recognition in this patient population. . A high index of suspicion is needed to diagnose HF in young adults, who may not present with classic signs and symptoms. Young adults represent a unique patient population that differs from the older patients with HF. Young adults with newly diagnosed HF should be promptly referred to a center offering full diagnostic capabilities and advanced cardiac therapies.
Copyright © 2020 Eric J. Hall et al.
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Peripartum cardiomyopathy: one disease with many faces.
Eur Heart J -
Clinical characteristics and long-term outcomes of peripartum takotsubo cardiomyopathy and peripartum cardiomyopathy.
ESC Heart Fail2020 Sep;():. doi: 10.1002/ehf2.12889.
Kim Dong-Yeon, Kim So Ree, Park Sung-Ji, Seo Jeong-Hun, Kim Eun Kyoung, Yang Jeong Hoon, Chang Sung-A, Choi Jin-Oh, Lee Sang-Chol, Park Seung Woo,
Abstract
AIMS:
Although some peripartum-associated cardiomyopathy patients present with features that are clinically and echocardiographically similar to those of takotsubo cardiomyopathy (TCM), little is known about the diagnosis and clinical course of peripartum TCM.
METHODS AND RESULTS:
In a tertiary hospital in Seoul, Korea, we searched the hospital database to find cardiomyopathy cases that were associated with pregnancy from January 1995 to May 2019. Applying the published diagnostic criteria, we sought peripartum cardiomyopathy (PPCM) and peripartum TCM patients for comparison. Of 31 pregnancy-associated cardiomyopathy patients, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-miss death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 57.1%, P = 0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricular dysfunction. One death and one heart transplantation occurred in the PPCM group, while neither occurred in the peripartum TCM group. There was no difference between the two groups in terms of the rate of major adverse clinical events at 3 years of follow-up [PPCM group: 26.3% (5/19) vs. TCM group: 33.3% (3/9), P = 0.750].
CONCLUSIONS:
One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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