Pubblicazioni recenti - peripartum cardiomyopathy
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Reverse takotsubo induced cardiogenic shock in the peripartum period: A case report and literature review.
Int J Gynaecol Obstet2024 Jul;():. doi: 10.1002/ijgo.15819.
Gregory James, Uzuner Cansu,
Abstract
Reverse takotsubo cardiomyopathy is a rare variant of a rare disease characterized by basal ballooning and dysfunction of the left ventricle. While it can render patients profoundly unwell and reliant on intensivist care, it is a transient phenomenon, with the worst symptoms subsiding after 2-3?days. At term, a young woman spontaneously entered labor prior to a planned repeat cesarean section. After experiencing physical and psychological distress during labor and a vacuum extraction, she developed cardiogenic shock from reverse takotsubo cardiomyopathy, quickly diagnosed with transthoracic echocardiogram. She required 2?days of intensive care support and made an excellent recovery. This very rare condition should be considered in systemically unwell women in the peripartum as it can be quickly diagnosed, providing patients with the best appropriate care.
© 2024 International Federation of Gynecology and Obstetrics.
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Temporary mechanical support in the peripartum patient as a bridge to postpartum recovery: A report of three cases.
Artif Organs2024 Jul;():. doi: 10.1111/aor.14832.
Jimenez Yomary, Elzeneini Mohammed, Siddique Nasir F, Vilaro Juan, Aranda Juan, Al-Ani Mohammad, Park Ki, Wen Tony S, Egerman Robert S, Jeng Eric I, Ahmed Mustafa M, Parker Alex M,
Abstract
Cardiogenic shock (CS) is a severe complication of peripartum cardiomyopathy (PPCM). Patients with deteriorating CS often require temporary mechanical circulatory support. In PPCM, this can be used as a bridge to postpartum recovery or bridge to decision. The outcomes are unclear, especially if prolonged utilization is required. We present a case series of three patients with PPCM in deteriorating CS who were successfully supported with a ventricular assist device or veno-arterial extracorporeal membrane oxygenation as a bridge to postpartum recovery.
© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
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Results of comprehensive genetic testing in patients presenting to a multidisciplinary inherited heart disease clinic in India.
Indian Heart J2024 Jul;():. doi: S0019-4832(24)00154-8.
Chockalingam Priya, Geetha Thenral S, Nair Sandhya, Rajakumar Nivedita, Raja Deep Chandh, Lokhandwala Yash, Chaturvedi Vivek, Selvaraj Raja J, Ramasamy Sakthivel, Sharda Sheetal, Sundar C, Anantharaman R,
Abstract
OBJECTIVES:
This study aims to analyze the results of comprehensive genetic testing in patients presenting to a dedicated multidisciplinary inherited heart disease clinic in India.
METHODS:
All patients presenting to our clinic from August 2017 to October 2023 with a suspected inherited heart disease and consenting for genetic testing were included. The probands were grouped into familial cardiomyopathies namely hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ACM) and peripartum cardiomyopathy (PPCM), channelopathies namely congenital long QT syndrome (LQTS) and Brugada syndrome (BrS), and heritable connective tissue disorder namely Marfan Syndrome (MFS). Next generation sequencing (NGS) was used, and pre-test and post-test counseling were provided to probands and cascade screening offered to relatives.
RESULTS:
Mean age of the subjects (n = 77; 48 probands, 29 relatives) was 43 ± 18 years, 68 % male and 44 % symptomatic, with 36 HCM, 3 DCM, 3 ACM, 1 PPCM, 3 LQTS, 1 BrS and 1 MFS probands. The diagnostic yield of NGS-based genetic testing was 31 %; variants of uncertain significance (VUS) were identified in 54 %; and 15 % were genotype-negative. Twenty-nine relatives from 18 families with HCM (n = 12), DCM (n = 3), ACM (n = 2) and MFS (n = 1) underwent genetic testing. The genotype positive probands/relatives and VUS carriers with strong disease phenotype and/or high risk variant were advised periodic follow-up; the remaining probands/relatives were discharged from further clinical surveillance.
CONCLUSIONS:
Genetic testing guides treatment and follow-up of patients with inherited heart diseases and should be carried out in dedicated multidisciplinary clinics with expertise for counseling and cascade screening of family members.
Copyright © 2024 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.
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Race, Hypertensive Disorders of Pregnancy and Outcomes in Peripartum Cardiomyopathy.
Am Heart J2024 Jul;():. doi: S0002-8703(24)00168-6.
Polsinelli Vincenzo B, Koczo Agnes, Johnson Amber E, Elkayam Uri, Cooper Leslie, Gorcsan John, Briller Joan, Fett James, McNamara Dennis M, ,
Abstract
BACKGROUND:
Black women with peripartum cardiomyopathy (PPCM) have a higher prevalence of hypertensive disorders of pregnancy (HDP) and worse clinical outcomes compared with non-Black women. We examined the impact of HDP on myocardial recovery in Black women with PPCM.
METHODS:
A total of 100 women were enrolled into the Investigation in Pregnancy Associated Cardiomyopathy (IPAC) study. Left ventricular ejection fraction (LVEF) was assessed by echocardiography at entry, 6, and 12-months post-partum (PP). Women were followed for 12 months postpartum and outcomes including persistent cardiomyopathy (LVEF?35%), left ventricular assist device, (LVAD), cardiac transplantation, or death were examined in subsets based on race and the presence of HDP.
RESULTS:
Black women with HDP were more likely to present earlier compared to Black women without HDP (days PP HDP: 34±21 vs 54±27 days, P=0.03). There was no difference in LVEF at study entry for Black women based on HDP, but better recovery with HDP at 6 (HDP:52±11% vs no HDP: 40±14%, P=0.03) and 12-months (HDP:53±10% vs no HDP:40±16%, P=0.02). At 12-months, Black women overall had a lower LVEF than non-Black women (P
CONCLUSIONS:
In women with PPCM, poorer outcomes evident in Black women were driven by women without a history of HDP. In Black women, a history of HDP was associated with earlier presentation and recovery which was comparable to non-Black women.
Copyright © 2024 Elsevier Ltd. All rights reserved.
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Current Knowledge and Challenges in the Clinical Management of Spontaneous Coronary Artery Dissection (SCAD): A Case Series.
Cureus2024 Jun;16(6):e61847. doi: e61847.
Jnani Jack, Dejanovic Ilja, Leung Christian, Singh Avneet,
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare condition in which there is coronary dissection that is not due to atherosclerosis or iatrogenic causes. It is more common in young women and is associated with risk factors such as the peripartum period and connective tissue disorders. We present five unique cases of SCAD to illustrate the variety of presentations and clinical management. The youngest and oldest patients in our series were 34 and 63 years old, respectively. The majority of our patients (60%) were of African American ethnicity. Two of the patients in the case series developed a new-onset congestive heart failure, and one patient had an iatrogenic complication after intervention. The majority of the patients were treated with conservative medical management (60%), while the others were treated with primary percutaneous coronary intervention (PCI). SCAD is a rare but life-threatening disease that may have varying presentations and precipitating risk factors. As demonstrated in our case series, SCAD may present atypically, and clinicians should maintain a high degree of suspicion in a relevant presentation. Treatment of SCAD may involve conservative management, primary PCI, or coronary artery bypass grafting (CABG) depending on the case. Clinicians may also have to address complications from SCAD, such as cardiomyopathy, that may arise.
Copyright © 2024, Jnani et al.
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Connecting the Dots: Exploring the Interplay Between Preeclampsia and Peripartum Cardiomyopathy.
J Pregnancy2024 ;2024():7713590. doi: 7713590.
Gumilar Khanisyah Erza, Rauf Khairunnisa Binti Abd, Akbar Muhammad Ilham Aldika, Imanadha Nareswari Cininta, Atmojo Susetyo, Putri Alisia Yuana, Dachlan Erry Gumilar, Dekker Gus,
Abstract
Preeclampsia and peripartum cardiomyopathy (PPCM) are significant obstetric problems that can arise during or after pregnancy. Both are known to be causes of maternal mortality and morbidity. Several recent studies have suggested a link between preeclampsia and the pathophysiology of PPCM. However, the common thread that connects the two has yet to be thoroughly and fully articulated. Here, we investigate the complex dynamics of preeclampsia and PPCM in this review. Our analysis focuses mainly on inflammatory and immunological responses, endothelial dysfunction as a shared pathway, and potential genetic predisposition to both diseases. To begin, we will look at how excessive inflammatory and immunological responses can lead to clinical symptoms of both illnesses, emphasizing the role of proinflammatory cytokines and immune cells in modifying vascular and tissue responses. Second, we consider endothelial dysfunction to be a crucial point at which endothelial damage and activation contribute to pathogenesis through increased vascular permeability, vascular dysfunction, and thrombus formation. Finally, we examine recent information suggesting genetic predispositions to preeclampsia and PPCM, such as genetic variants in genes involved in the management of blood pressure, the inflammatory response, and heart structural integrity. With this synergistic study, we seek to encourage more research and creative therapy solutions by emphasizing the need for an interdisciplinary approach to understanding and managing the connection between preeclampsia and PPCM.
Copyright © 2024 Khanisyah Erza Gumilar et al.
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Cardiovascular complications during delivery hospitalizations in inflammatory bowel disease patients.
Clin Res Cardiol2024 Jul;():. doi: 10.1007/s00392-024-02476-5.
Niu Chengu, Zhang Jing, Zhu Kaiwen, Agbakoba George, Dunnigan Karin, Okolo Patrick I,
Abstract
BACKGROUND:
The relationship between inflammatory bowel disease (IBD) and cardiovascular outcomes among pregnant women has yet to be thoroughly investigated. Our aim is to assess the odds of cardiovascular disease and cardiac arrhythmias during hospital admissions for delivery and identify contributing factors associated with cardiovascular complications in pregnant women with IBD.
METHODS:
We performed a retrospective analysis of data from the National Inpatient Sample, obtained from delivery admissions of pregnant women with and without IBD, identified via International Classification of Diseases codes, from 2009 to 2019. Using a regression model, we compared the odds of cardiovascular complications between these two groups, adjusting for traditional cardiovascular risk factors as confounding variables.
RESULTS:
Our study included 71,361 pregnancies with IBD and 41,117,443 pregnancies without this condition. The incidence of IBD in pregnancy rose near three-fold increase over the decade. In comparison to pregnancies without IBD, those involving pregnant patients with IBD exhibited an increased likelihood of encountering cardiovascular complications, with an adjusted odds ratio (AOR) of 1.37 (95% CI, 1.29-1.46). This heightened risk encompasses a range of conditions, including peripartum cardiomyopathy (AOR, 9.45; 95% CI, 3.86-23.15), cardiac arrhythmias (AOR, 2.03; 95% CI, 1.59-2.60), and hypertensive disorders of pregnancy (AOR, 1.51; 95% CI, 1.37-1.66), notably preeclampsia, eclampsia, and the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Pregnancies with IBD were also associated with three-fold higher odds of venous thromboembolism (AOR, 3.91; 95% CI, 1.45-10.48).
CONCLUSIONS:
Pregnant patients with IBD had an increased odds of cardiovascular complications during delivery admissions, independent of traditional cardiovascular risk factors. Further research is needed to elucidate the underlying mechanisms and develop targeted prevention strategies for this high-risk population.
© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.
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Peripartum HFpEF: Identification of a Novel Phenotype and the Need for Cardio-Obstetrics Management.
JACC Adv2024 Feb;3(2):100799. doi: 100799.
Yurista Salva, Wadhera Priya, Eder Robert A, Elkayam Uri, Siddiqi Omar K,
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Cardiovascular Complications Associated With COVID-19 During Delivery Hospitalizations in Pandemic Year 2020.
JACC Adv2023 Jun;2(4):100386. doi: 100386.
Zahid Salman, Agrawal Ankit, Rai Devesh, Khan Muhammad Zia, Michos Erin D,
Abstract
BACKGROUND:
Persons with COVID-19 infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular (CV) complications during delivery admissions remain limited.
OBJECTIVES:
The purpose of this study was to determine whether pregnant individuals with COVID-19 have an increased risk of acute peripartum CV complications during their delivery admission.
METHODS:
This population-based retrospective cohort study used the 2020 National Inpatient Sample database. The International Classification of Diseases, 10th Revision codes were used to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was performed to determine the association between COVID-19 and acute peripartum CV complications at delivery.
RESULTS:
A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n = 46,375). Persons with COVID-19 were younger (median 28 vs 29 years,
CONCLUSIONS:
In the year 2020, pregnant persons with COVID-19 had a higher risk of preeclampsia, in-hospital mortality, and other serious CV complication during delivery hospitalizations compared to pregnant individuals without COVID-19.
© 2023 The Authors.
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Pulmonary Embolism in Patients Admitted With Peripartum Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events.
Cureus2024 May;16(5):e60953. doi: e60953.
Elkattawy Omar, Hamlet Casey A, Dikdan Ryan, Mohamed Omar, Lee Thomas J, Hussain Aysha, Elkattawy Sherif, Afriyie Felix, Hossain Afif, Gardin Julius M,
Abstract
Introduction Peripartum cardiomyopathy (PPCM) is defined as an idiopathic left ventricular failure with reduced ejection fraction (EF
Copyright © 2024, Elkattawy et al.
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Incident stroke in individuals with peripartum cardiomyopathy.
Am Heart J2024 Jun;275():138-140. doi: 10.1016/j.ahj.2024.06.006.
Ibeh Chinwe, Kulick Erin R, Boehme Amelia K, Friedman Alexander M, Miller Eliza C, Bello Natalie A,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM), a form of heart failure with reduced ejection fraction (HFrEF) that occurs during the final month of pregnancy through the first 5 months postpartum, is associated with heightened risk for maternal morbidity and mortality. Stroke is a common complication of HFrEF but there is limited data on the incidence of stroke in PPCM.
METHODS:
Using statewide, nonfederal administrative data from 2000 to 2015, we analyzed age-adjusted risk of stroke within 3 years after PPCM-associated pregnancies.
RESULTS:
PPCM was associated with a greater than 4-fold increased risk of pregnancy-related stroke (aHR 4.7, 95% CI: 3.0-7.5). This risk was highest at the time of PPCM diagnosis but remained elevated in the first postpartum year.
CONCLUSION:
Our findings confirm the strong association between PPCM and stroke, with risk that persists throughout and after the peripartum period.
Copyright © 2024 Elsevier Inc. All rights reserved.
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Temporal Trends in Clinical Characteristics and Outcomes for Peripartum Cardiomyopathy: The Nationwide Multicenter Registry Over 20?Years.
J Am Heart Assoc2024 Jul;13(13):e034055. doi: e034055.
Bak Minjung, Youn Jong-Chan, Bae Dae-Hwan, Lee Ju-Hee, Lee Sunki, Cho Dong-Hyuk, Choi Jin-Oh, ,
Abstract
BACKGROUND:
Although peripartum cardiomyopathy (PPCM) is a fatal disease affecting young patients and fetuses, little is known about its recent prognosis and risk factors. This study investigated temporal trends in clinical characteristics and outcomes for PPCM in a nationwide multicenter registry.
METHODS AND RESULTS:
The study population comprised 340 patients (mean age, 33?years) who were diagnosed with PPCM between January 2000 and September 2022 in 26 tertiary hospitals in South Korea. PPCM was defined as heart failure with left ventricular ejection fraction ?45% and no previously known cardiac disease. The main study outcomes included time to the first occurrence of all-cause death, heart transplantation, and cardiovascular hospitalization. The diagnosis of PPCM cases increased notably during the study period (
CONCLUSIONS:
While the incidence of PPCM has increased over the past 20?years, the prognosis has not improved significantly. Timely management and close follow-up are necessary for high-risk patients with PPCM with high body mass index, gestational diabetes, or large left ventricular end-diastolic dimension.
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The concentration of maternal sacubitril/valsartan transferred into human milk is negligible.
Front Public Health2024 ;12():1389513. doi: 1389513.
Falconi Sirin, Okimi Abiodun, Wesley Shaun, Sethi Pooja, Datta Palika, Krutsch Kaytlin,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is a common cause of heart failure (HF) in the peripartum. Some medications are considered safe while breastfeeding. However, sacubitril/valsartan (Entresto), while efficacious, is not recommended in breastfeeding women due to concerns about adverse infant development, and no published data suggest otherwise.
OBJECTIVES:
This study aimed to assess the transfer of sacubitril/valsartan into human milk and evaluate the infant's risk of drug exposure.
METHODS:
The InfantRisk Human Milk Biorepository released samples and corresponding health information from five breastfeeding maternal-infant dyads exposed to sacubitril/valsartan. Sacubitril, valsartan, and LBQ657 (sacubitril active metabolite) concentrations were determined using liquid chromatography-mass spectrometry (LC/MS/MS) from timed samples 0, 1, 2, 4, 6, 8, 10, and 12?h following medication administration at steady state conditions.
RESULTS:
Valsartan levels were below the detection limit of 0.19?ng/mL in all milk samples. Sacubitril was measurable in all milk samples of the five participants, peaking 1?h after drug administration at a mean concentration of 1.52?ng/mL for a total infant dose of 0.00049?mg/kg/12?h and a relative infant dose (RID) calculated at 0.01%. The maximum concentration of its active metabolite LBQ657 in the milk samples was observed 4?h after medication administration and declined over the remaining 12-h dosing interval, for an average concentration of 9.5?ng/mL. The total infant dose was 0.00071?mg/kg/12?h, and the RID was 0.22%. Two mothers reported continuing to breastfeed while taking sacubitril/valsartan; both mothers stated observing no negative effects in their breastfed infants.
CONCLUSION:
The transfer of sacubitril/valsartan into human milk is minimal. These concentrations are unlikely to pose a significant risk to breastfeeding infants, with a combined calculated RID of
Copyright © 2024 Falconi, Okimi, Wesley, Sethi, Datta and Krutsch.
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Peripartum ventricular tachycardia and PVC-induced cardiomyopathy: delivering optimal care when it's time to deliver.
BMJ Case Rep2024 Jun;17(6):. doi: e259075.
Martin Gabrielle, Narvaez-Guerra Offdan, Aurigemma Gerard, Kovell Lara,
Abstract
Ventricular tachycardia (VT) is a rare but potentially fatal complication in pregnancy. We present a case of a pregnant woman with cardiomyopathy due to frequent premature ventricular complexes (PVCs) and VT originating from the left ventricular outflow tract. After presenting late in the third trimester, the decision was made to deliver the fetus after 4?days of medication titration due to continued sustained episodes of VT. After delivery, the patient continued to have frequent PVCs and VT several months after discharge, and she ultimately underwent a PVC ablation with dramatic reduction in PVC burden and improvement in cardiomyopathy. Multidisciplinary planning with a pregnancy heart team led to appropriate contingency planning and a successful delivery. This case highlights how multidisciplinary management is best practice in pregnancy complicated by VT and the need for better diagnostic guidelines for PVC-induced cardiomyopathy in the setting of pregnancy.
© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.
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Heart failure due to peripartum cardiomyopathy presenting in the first week of puerperium-A case series from Nepal.
Clin Case Rep2024 Jun;12(6):e9043. doi: e9043.
Banmala Sabin, Awal Shila, Bata Lokendra, Adhikari Priya, Basnet Sarita, Chaudhary Babita,
Abstract
KEY CLINICAL MESSAGE:
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. With a prognosis that can vary from the complete recovery of left ventricular function to maternal mortality as well as recurrence with subsequent pregnancies, early diagnosis and treatment of PPCM is important in management. Bromocriptine treatment is beneficial effects on LVEF and mortality in women with severe acute PPCM in addition to standard heart failure therapy. However, further study is required to establish its effect in PPCM.
ABSTRACT:
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. Most of the clinical presentation is similar to symptoms of advanced pregnancy making the diagnosis difficult. Reported are three patients who developed dyspnea, orthopnea, and dry cough during the first week of puerperium. On examination, bilateral lower limb edema and bilateral basal lung crepitation were present in all patients. Chest radiograph showed pulmonary edema in cases two and three, and pleural effusion in case one. All patients had reduced left ventricular ejection fraction and raised N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels. Case two developed PPCM in the background of left pyelonephritis. Case three was complicated by acute kidney injury. All patients were managed with bromocriptine, diuretics, beta-blockers, ACE inhibitors, and fluid restriction. Hence, PPCM though rare should be considered as a differential in women presenting with features of heart failure in later months of pregnancy or within 5?months of delivery.
© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.
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High intracardiac clot burden in a young mother with peripartum cardiomyopathy in Uganda.
Cardiovasc J Afr2024 Apr;34():1-4. doi: 10.5830/CVJA-2024-008.
Nabbaale Juliet, Okello Emmy, Sliwa Karen, Nakimuli Annette,
Abstract
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with a reduction in left ventricular systolic function towards the end of pregnancy or in the months after delivery. It is a life-threatening condition with a substantial mortality rate ranging from six to 25%, commonly due to heart failure or sudden cardiac death. Pregnancy is a prothrombotic state. Due to poor systolic function, women with PPCM are prone to intracardiac thrombi and a high risk of thromboembolic events. Early diagnosis with echocardiography and treatment plays a critical role. We describe a case of a woman with PPCM and biventricular thrombi, with the aim of creating awareness for early echocardiographic screening for thrombi and appropriate implementation of care.
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The Impact of Coronary Artery Disease on Outcomes in Patients With Peripartum Cardiomyopathy.
Cureus2024 Apr;16(4):e59269. doi: e59269.
Elkattawy Omar, Phansalkar Jay V, Elkattawy Sherif, Mohamed Omar, Javed Jahanzeb, Hossain Afif, Larry Kulsum, Patel Shriya, Shah Yash, Shamoon Fayez,
Abstract
Introduction The purpose of this study was to determine the prevalence of coronary artery disease (CAD) among patients admitted with peripartum cardiomyopathy (PPCM) as well as to analyze the independent association of CAD with in-hospital outcomes among PPCM patients. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We assessed the independent association of CAD with outcomes in patients admitted with PPCM. Predictors of mortality in patients admitted with PPCM were also analyzed. Results There was a total of 4,730 patients with PPCM, 146 of whom had CAD (3.1%). Multivariate analysis demonstrated that CAD in patients with PPCM was independently associated with several outcomes, and, among them, ST-segment elevation myocardial infarction (STEMI) (adjusted odds ratio (aOR): 58.457, 95% CI: 5.403-632.504, p= 0.001) was positively associated with CAD. CAD was found to be protective against preeclampsia (aOR: 0.351, 95% CI: 0.126-0.979, p = 0.045). Predictors of in-hospital mortality for patients with PPCM include cardiogenic shock (aOR: 12.818, 95% CI: 7.332-22.411, p = 0.001), non-ST elevation myocardial infarction (NSTEMI) (OR: 3.429, 95% CI: 1.43-8.22, p = 0.006), chronic kidney disease (OR: 2.851, 95% CI: 1.495-5.435, p = 0.001), and atrial fibrillation (OR: 2.326, 95% CI: 1.145-4.723, p = 0.020). Conclusion In a large cohort of patients admitted with PPCM, we found the prevalence of CAD to be 3.1%. CAD was associated with several adverse outcomes, including STEMI, but protective against preeclampsia.
Copyright © 2024, Elkattawy et al.
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Cardiovascular Complications With Delivery Hospitalizations in Patients With Pulmonary Hypertension: A Nationwide Study From 2011 to 2020.
J Am Heart Assoc2024 Jun;13(11):e031632. doi: e031632.
Agrawal Ankit, Bajaj Suryansh, Bhagat Umesh, Yesilyaprak Abdullah, Chandna Sanya, Arockiam Aro Daniela, Jamil Yasser, El Iskandarani Mahmoud, Gupta Rahul, Majid Muhammad, Nayar Divya, Michos Erin D,
Abstract
BACKGROUND:
Pregnancy in patients with pulmonary hypertension (PH) is associated with a heightened risk of medical complications including right heart failure, pulmonary edema, and arrhythmias. Our study investigated the association between PH and these complications during delivery.
METHODS AND RESULTS:
The National Inpatient Sample was used to identify delivery hospitalizations from 2011 to 2020. Multivariable logistic regression was performed to study the association of PH with the primary outcomes of in-hospital medical and obstetric complications. A total of 37?482?207 delivery hospitalizations in women ?18?years of age were identified, of which 9593 patients had PH. Pregnant patients with PH had higher incidence of complications during delivery including preeclampsia/eclampsia, arrhythmias, and pulmonary edema among others, compared with those without PH. Pregnant patients with PH also had a higher incidence of in-hospital mortality compared with those without PH (0.51% versus 0.007%). In propensity-matched analyses, PH was still significantly associated with a higher risk of in-hospital mortality (odds ratio [OR], 5.02 [95% CI, 1.82-13.90]; =0.001), pulmonary edema (OR, 9.11 [95% CI, 6.34-13.10];
CONCLUSIONS:
Delivery hospitalizations in patients with PH are associated with a high risk of mortality, pulmonary edema, peripartum cardiomyopathy, venous thromboembolism, arrhythmias, acute kidney injury, preeclampsia/eclampsia, and acute coronary syndrome.
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Age-related disparities in complications among women with peripartum cardiomyopathy.
Curr Probl Cardiol2024 Aug;49(8):102647. doi: 10.1016/j.cpcardiol.2024.102647.
Behary Paray Nitish, Ramphul Kamleshun, Picker Sarah Mackenzie, Akkaramani Sudhamai, Memon Rahat Ahmed, Ahmed Mushood, Aggarwal Shruti, Dhaliwal Jasninder Singh, Mactaggart Sebastian, Jeelani Saddam, Sombans Shaheen, Sakthivel Hemamalini, Lohana Petras, Kunadian Vijay, Ahmed Raheel,
Abstract
INTRODUCTION:
While the exact pathogenesis of peripartum cardiomyopathy, a potentially life-threatening condition, is still unknown, its incidence is rising globally. We sought to understand the differences in outcomes and complications based on age.
METHODS:
Records from the 2016-2020 National Inpatient Sample were used for our study. The sample consisted of females diagnosed with peripartum cardiomyopathy that required hospitalization care. They were divided into two age-based cohorts: 15-29 years and 30-40 years. We evaluated differences in in-hospital complications between the two groups using multivariable regression.
RESULTS:
The analysis consisted of 20520 females diagnosed with peripartum cardiomyopathy, of whom 57.3 % were in the 30-40 years cohort and 42.7 % in the 15-29 years group. The prevalence of cardiovascular risk factors such as smoking, obesity, hypertension, diabetes and lipid disorder was higher among women aged 30-40 years (p
CONCLUSION:
Peripartum cardiomyopathy is a serious condition that requires appropriate care and management. Our study linked cases of ages 30-40 years with increased odds of acute ischemic stroke but lower odds of cardiogenic shock.
Copyright © 2024 Elsevier Inc. All rights reserved.
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