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Pubblicazioni recenti - peripartum cardiomyopathy
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Peripartum Cardiomyopathy-Induced Cardiogenic Shock Causing Hypoxic-Ischemic Encephalopathy in a COVID-19 Patient.
Case Rep Crit Care2022 ;2022():7114732. doi: 7114732.
Le Minh Khoi, Nguyen Thanh Hieu,
Abstract
BACKGROUND:
Cardiogenic shock complicating peripartum cardiomyopathy (PPCM) is a rare but lethal syndrome. The etiology of PPCM is not fully elucidated and is probably multifactorial, and viral infection might play some role. It has been documented that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly invades the cardiomyocytes and most commonly damages this vital organ via complex systemic devastating mechanisms. . A 28-year-old pregnant female was admitted to a COVID-19 field hospital due to a SARS-CoV-2 infection. She gave birth by spontaneous vaginal delivery at 34 gestational weeks. Six hours after the delivery, she presented signs of hemodynamic collapse and became comatosed, requiring a transfer to the COVID-19 intensive care center. The brain magnetic resonance imaging excluded thromboembolism, intracerebral hemorrhage, and central nervous system infection and revealed a hypoxic-ischemic encephalopathy. Bedside echocardiography documented a dilated left ventricle and severely reduced left ventricular systolic function with an ejection fraction of 24%. The management was aimed at a cardiogenic shock secondary to peripartum cardiomyopathy. The clinical course was favorable: the hemodynamics stabilized, the cognitive function fully recovered, and the patient was extubated on the second day of admission to the intensive care unit. The patient was discharged from the hospital ten days after admission. Neurological and cardiovascular checkups six months after discharge showed full recovery.
CONCLUSION:
Peripartum cardiomyopathy-induced cardiogenic shock with severe neurological consequences in COVID-19 patients was rare but did exist. A systemic approach and vigorous efforts to pinpoint the accurate diagnosis played important roles in the prompt and appropriate management.
Copyright © 2022 Minh Khoi Le and Thanh Hieu Nguyen.
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Peripartum Cardiomyopathy.
J Obstet Gynaecol India2022 Oct;72(5):377-381. doi: 10.1007/s13224-022-01621-2.
Shrikhande Laxmi, Shrikhande Aditya, Shrikhande Bhushan,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM. While there are numerous potential mechanisms for Peripartum (post-partum) cardiomyopathy, its exact cause remains unknown, but the etiopathogenesis is likely to be multifactorial. PPCM is uncommon before 36 weeks of pregnancy, and afflicted women generally present during the first month after delivery. PPCM should be differentiated from pre-existing cardiomyopathy, undiagnosed congenital heart disease, pre-existing valvular heart disease, myocardial infarction, pulmonary embolism and diastolic heart failure due to hypertensive heart disease. The principles for treating acute HF caused by PPCM are the same as those for acute HF caused by any other cause with some limitations during pregnancy. Prompt treatment is critical. There is no necessity for an early delivery unless the maternal or foetal health has deteriorated. In women who present with advanced HF with haemodynamic instability, urgent delivery, regardless of gestation, may be considered. Because women with PPCM have a significant chance of relapse in subsequent pregnancies, they need comprehensive contraceptive counselling. In general, the prognosis is good, with more than half of the patients regaining LV function spontaneously within six months of giving birth. Our aim is to put forth an in-depth review of the Peripartum Cardiomyopathy in contemporary practice.
© Federation of Obstetric & Gynecological Societies of India 2022.
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The outcome of peripartum cardiomyopathy patients-single center experience.
Echocardiography2022 Nov;():. doi: 10.1111/echo.15498.
Demir Emre, Ceylan Naim, Bayraktaro?lu Selen, Çinkoo?lu Ak?n, Candemir Aytaç, Candemir Ye?im B, Güne? Mustafa Talha, Yeniyol ?evket, Y?lmaz Elfin B, Zoghi Mehdi, Ak?ll? Azem, Gürgün Cemil, Nalbantgil Sanem,
Abstract
OBJECTIVE:
Peripartum cardiomyopathy (PPCM) diagnosis made by excluding identifiable causes of heart failure (HF) and occurs end of the pregnancy or during the postpartum period of five months. It presents a clinical HF spectrum with left ventricular systolic dysfunction.
BACKGROUND:
The purpose of this study is to retrospectively evaluate the clinical characteristics, cardiac magnetic resonance (CMR) imaging features, and end-points consisting of left ventricle recovery, left ventricular assist device implantation, heart transplantation, and all-cause mortality.
METHOD:
Outpatient HF records between 2008 to 2021 were screened. Thirty-seven patients were defined as PPCM. Twenty-five patients had CMR evaluation at the time of diagnosis, and six patients were re-evaluated with CMR.
RESULTS:
The mean age was 30.5 ± 5.6 years, and the mean LVEF was 28.2% ± 6.7%. In 13(35.7%) patients, LVEF recovered during the follow-up course. The median recovery time was 281(IQR [78-358]) days. LVEF on CMR was 35.3 ± 10.5, and three patients exhibited late gadolinium enhancement(LGE) patterns. Sub-endocardial and mid-wall uptake pattern types were detected. 18(75%) patients met the Petersen left ventricle non-compaction cardiomyopathy(LVNC) criteria. Patients with NC/C ratio lower than 2.3 had lower LVEDVi and LVESVi (124.9 ± 35.4, 86.4 ± 7.5, p = .003; 86.8 ± 34.6, 52.6 ± 7.6, p = .006), respectively. The median follow-up time was 2129 (IQR [911-2634]) days. The primary endpoint-free 1-year survival was 88.9% (event rate 11.1%), and 5-year survival was 75.7% (event rate 24.3%).
CONCLUSION:
In a retrospective cohort of PPCM patients, 35.7% of patients' LVEF recovered, and the primary end-point of free-5-year survival was 75%. Twenty-five patients were assessed with CMR; three of four met the Petersen CMR-derived LVNC at initial evaluation.
© 2022 Wiley Periodicals LLC.
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Analysis of Cardiovascular Complications During Delivery Admissions Among Patients With Systemic Lupus Erythematosus, 2004-2019.
JAMA Netw Open2022 Nov;5(11):e2243388. doi: 10.1001/jamanetworkopen.2022.43388.
Zahid Salman, Mohamed Mohamed S, Wassif Heba, Nazir Noreen T, Khan Sadiya S, Michos Erin D,
Abstract
IMPORTANCE:
Individuals with systemic lupus erythematosus (SLE) have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited.
OBJECTIVE:
To investigate whether SLE is associated with an increased risk of acute peripartum cardiovascular complications during delivery hospitalization among individuals giving birth.
DESIGN, SETTING, AND PARTICIPANTS:
This population-based cross-sectional study was conducted with data from the National Inpatient Sample (2004-2019) by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify delivery hospitalizations among birthing individuals with a diagnosis of SLE. A multivariable logistic regression model was developed to report an adjusted odds ratio (OR) for the association between SLE and acute peripartum cardiovascular complications. Data were analyzed from May 1 through September 1, 2022.
EXPOSURE:
Diagnosed SLE.
MAIN OUTCOMES AND MEASURES:
Primary study end points were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary end points included ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury (AKI), venous thromboembolism (VTE), length of stay, and cost of hospitalization.
RESULTS:
A total of 63?115?002 weighted delivery hospitalizations (median [IQR] age, 28 [24-32] years; all were female patients) were identified, of which 77?560 hospitalizations (0.1%) were among individuals with SLE and 63?037?442 hospitalizations (99.9%) were among those without SLE. After adjustment for age, race and ethnicity, comorbidities, insurance, and income level, SLE remained an independent risk factor associated with peripartum cardiovascular complications, including preeclampsia (adjusted OR [aOR], 2.12; 95% CI, 2.07-2.17), peripartum cardiomyopathy (aOR, 4.42; 95% CI, 3.79-5.13), heart failure (aOR, 4.06; 95% CI, 3.61-4.57), cardiac arrhythmias (aOR, 2.06; 95% CI, 1.94-2.21), AKI (aOR, 7.66; 95% CI, 7.06-8.32), stroke (aOR, 4.83; 95% CI, 4.18-5.57), and VTE (aOR, 6.90; 95% CI, 6.11-7.80). For resource use, median (IQR) length of stay (3 [2-4] days vs 2 [2-3] days; P?.001) and cost of hospitalization ($4953 [$3305-$7517] vs $3722 [$2606-$5400]; P?.001) were higher for deliveries among individuals with SLE.
CONCLUSIONS AND RELEVANCE:
This study found that SLE was associated with increased risk of complications, including preeclampsia, peripartum cardiomyopathy, heart failure, arrhythmias, AKI, stroke, and VTE during delivery hospitalization and an increased length and cost of hospitalization.
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Association Between Right Ventricular Dysfunction and Adverse Outcomes in Peripartum Cardiomyopathy: Insights From the BRO-HF Quebec Cohort Study.
CJC Open2022 Nov;4(11):913-920. doi: 10.1016/j.cjco.2022.05.004.
Pacheco Christine, Tremblay-Gravel Maxime, Marquis-Gravel Guillaume, Couture Etienne, Avram Robert, Desplantie Olivier, Bibas Lior, Simard François, Malhamé Isabelle, Poulin Anthony, Tran Dan, Senechal Mario, Afilalo Jonathan, Farand Paul, Bérubé Lyne, Jolicoeur E Marc, Ducharme Anique, Tournoux François,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is associated with severe morbidity and mortality, and the significance of right ventricular (RV) involvement is unclear. We sought to determine whether RV systolic dysfunction or dilatation is associated with adverse clinical outcomes in women with PPCM.
METHODS:
We conducted a multicentre retrospective cohort study examining the association between echocardiographic RV systolic dysfunction or dilatation at the time of PPCM diagnosis and clinical outcomes. Clinical endpoints of interest were the need for mechanical support, recovery of left ventricular ejection fraction at follow-up, and a combined endpoint of hospitalization for heart failure, cardiac transplant, or death.
RESULTS:
A total of 67 women, median age 30 years (interquartile range: 7), were diagnosed with PPCM between 1994 and 2015 in 17 participating centres. Twin pregnancies occurred in 11%; 62% of women were multiparous; and 24% had preeclampsia. RV systolic function was impaired in 18 (27%) and dilated in 8 (12%). Seven women required ventricular assistance, and 8 experienced the composite outcome during follow-up (25 [interquartile range 61] months). RV dysfunction was associated with the need for mechanical support (odds ratio 10.10 (95% confidence interval: 1.86-54.81), = 0.007), but neither RV dysfunction nor dilatation was associated with left ventricular ejection fraction recovery, the need for cardiac transplant, heart failure hospitalization, or death.
CONCLUSIONS:
RV dysfunction is associated with the need for mechanical support in women with PPCM. These findings may improve risk stratification of complications and clinical management.
© 2022 The Authors.
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Clinical outcomes and maternal associated conditions between antepartum and postpartum-onset of peripartum cardiomyopathy.
Taiwan J Obstet Gynecol2022 Nov;61(6):999-1003. doi: 10.1016/j.tjog.2022.03.046.
Chen Po-Cheng, Chueh Ho-Yen, You Shu-Han,
Abstract
OBJECTIVE:
Peripartum cardiomyopathy (PPCM) developed from late pregnancy to five months after delivery. Women with PPCM have the risk of mortality or non-recovered cardiac function. We aimed to investigate women with PPCM in Taiwan.
MATERIALS AND METHODS:
The retrospective study recruited patients with PPCM from January 2002 to October 2018 in a tertiary center. We evaluated the presentations, onset, associated conditions, maternal and fetal outcomes, follow-up cardiac function, and subsequent pregnancies. The clinical data were compared between antepartum and postpartum-onset of PPCM.
RESULTS:
Thirty women were identified and seventeen (56.6%) patients were antepartum-onset. The delivery time, ranged from 26 to 40 weeks, was mostly at 35 weeks. Twenty-one patients had cardiac function follow-up and seven (33.3%) were non-recovered in six months. The associated conditions of PPCM included age >30, primiparity, preeclampsia or hypertension, obesity, twin pregnancy, and tocolysis. The maternal characteristics and associated conditions were not significant different, but early preterm (32.8 ± 3.6 vs. 35.5 ± 2.4 weeks, p = 0.042) and lower Apgar scores in one (7 vs. 9, p = 0.002) and 5 min (9 vs. 10, p = 0.005) were observed in the antepartum-onset group.
CONCLUSION:
In conclusion, PPCM commonly occurred around 35 weeks of gestation, ranged from 26 to 40 weeks. Additionally, there were risks of early preterm and low Apgar scores in women with antepartum-onset of PPCM.
Copyright © 2022. Published by Elsevier B.V.
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Peripartum Cardiomyopathy with the Cardiac Function Restored by Cabergoline.
Intern Med2022 Nov;():. doi: 10.2169/internalmedicine.0988-22.
Shibuya Yuki, Shiba Mikio, Hayashi Takaharu, Iwai Sayuri, Mitake Amane, Mori Naoki, Ichibori Yasuhiro, Minamiguchi Hitoshi, Makino Nobuhiko, Hirayama Atsushi, Higuchi Yoshiharu,
Abstract
Peripartum cardiomyopathy (PPCM) is a left ventricular systolic dysfunction associated with heart failure (HF) in late-term pregnancy or peripartum. A 29-year-old pregnant woman with no history of cardiac disease noted lower extremity edema around 34 weeks' gestation with significant weight gain. She delivered twins via caesarean section, and the edema regressed postpartum. On postpartum day 4, however, she experienced difficulty breathing at night and was diagnosed with HF owing to PPCM. HF treatment along with cabergoline was initiated. With low prolactin blood levels, her symptoms and cardiac function improved over time. This case demonstrated the usefulness of anti-prolactin therapy with cabergoline in PPCM.
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A Rare Case of Reverse Takotsubo Cardiomyopathy in a 28-Year-Old Female in Peripartum Period.
Cureus2022 Oct;14(10):e30504. doi: e30504.
Khaja Misbahuddin, Stastka Petr, Kandhi Sameer, Itare Vikram, Latif Amber, Dileep Arundhati,
Abstract
Reverse Takotsubo cardiomyopathy is a rare variant of Takotsubo cardiomyopathy in which ballooning occurs at the base of the heart rather than the apex, which is hyperkinetic. Takotsubo cardiomyopathy is usually considered in postmenopausal women, but a growing number of cases of the reverse variant are emerging in peripartum women. We present a case of peripartum reverse Takotsubo cardiomyopathy in a 23-year-old G1P0 female at 38 weeks gestation, induced by preeclampsia with severe features. An echocardiogram performed in the immediate post-cesarean period demonstrated a severely reduced ejection fraction of 25%, which was improved to 43% over the next 48 hours with diuresis. Therefore, it is imperative to differentiate Takotsubo cardiomyopathy occurring in the peripartum period from peripartum cardiomyopathy, which has a similar clinical presentation, to diagnose this condition and improve patient outcomes.
Copyright © 2022, Khaja et al.
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Peripartum dilated cardiomyopathy complicated by miliary tuberculosis-a maternal near miss (MNM): Case report.
J Family Med Prim Care2022 Jul;11(7):4010-4015. doi: 10.4103/jfmpc.jfmpc_1623_21.
Mohammad Shazia, Acharya Neema, Acharya Sourya, Jajoo Shubhada, Joshi Ketav,
Abstract
The term 'Maternal Near Miss' (MNM) refers to women who have survived serious life-threatening complications during pregnancy, labour or within 6 weeks after termination of pregnancy, either by chance or due to good health care. The goal of this report is to emphasise the need for patients' education, emergency transportation and availability of multidisciplinary tools at all levels of the health care system. Severe acute maternal morbidity (SAMM) is a measure of maternal mortality that may also be used to assess the quality of obstetric treatment in a certain facility. Also, the motive of this report is to give an idea to primary care physicians of all the preliminary risk factors to be taken into consideration while treating the patient on arrival.
Copyright: © 2022 Journal of Family Medicine and Primary Care.
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[Peripartum Cardiomyopathy].
Dtsch Med Wochenschr2022 Nov;147(23):1537-1544. doi: 10.1055/a-1810-9318.
Pfeffer Tobias Jonathan, König Tobias, Berliner Dominik, Bauersachs Johann,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery in previously heart-healthy women. PPCM patients typically present with heart failure due to left ventricular (LV) dysfunction with an LV ejection fraction (EF) 45?%. In the last years clinical and experimental studies contributed to a better understanding of the pathophysiology and the clinical course of PPCM. In the context of oxidative stress, the nursing hormone prolactin is cleaved into a smaller antiangiogenic and proapoptotic 16k Da form, leading to myocardial dysfunction. In an animal model this can be prevented by treatment with the dopamine agonist bromocriptine, which suppresses prolactin release. This therapeutic approach was confirmed in several clinical studies. Therefore, the current guidelines recommend a treatment consisting of a heart failure treatment according to current guidelines in combination with the dopamine agonist bromocriptine. If the diagnosis is made early and the treatment is started immediately, the prognosis is good compared to other forms of cardiomyopathies, as LV function recovers in most cases.In the acute phase the severity of heart failure differs among PPCM patients. Some patients present with mild forms, whereas some PPCM patients display severely reduced LV function and cardiogenic shock. Especially the latter cases are still challenging, as treatment with ?1-adrenergic receptor agonists is associated with progression of heart failure and a worse cardiac outcome. Therefore, patients with cardiogenic shock complicating PPCM should be treated in centers experienced in mechanical circulatory support in combination with bromocriptine treatment.
Thieme. All rights reserved.
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Peripartum cardiomyopathy: a rare cause of acute heart failure.
BMJ Case Rep2022 Nov;15(11):. doi: e244821.
Vogel Tabea Cornelia Elisabeth, Schneiter Stephan, Fehr Thomas,
Abstract
A woman in her early 30s presented herself with acute dyspnoea and elevated D-dimers 5?weeks after delivery of her second child. Echocardiographic findings showed signs of acute left ventricular failure, and an MRI confirmed a non-ischaemic dilated left heart failure compatible with peripartum cardiomyopathy. The antihormonal therapy with bromocriptine during 6?weeks and an intensive heart failure therapy led to an amelioration of the heart function within 3?years, but full recovery was not yet observed.
© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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Pathological features of biopsied myocardium in patients clinically diagnosed with peripartum cardiomyopathy.
Med Mol Morphol2022 Nov;():. doi: 10.1007/s00795-022-00340-x.
Kawano Hiroaki, Kawamura Koichi, Ishijima Mitsuaki, Abe Kuniko, Hayashi Tomayoshi, Eguchi Masamichi, Miura Kiyonori, Maemura Koji,
Abstract
The etiology of peripartum cardiomyopathy (PPCM) is unknown. Therefore, we evaluated the etiology of patients clinically diagnosed with PPCM using endomyocardial biopsy. We studied five patients diagnosed with PPCM following endomyocardial biopsy (age, 28-42 years; mean age, 35 years). Biopsied samples were evaluated using microscopy, including immunostaining and electron microscopy. The pathological findings were as follows: myocardial hypertrophy, myocardial fibrosis, and cell infiltration. Two patients were diagnosed with lymphocytic myocarditis, one with eosinophilic myocarditis, one with hypertensive heart disease, and one with a combination of hypertension and myocarditis. Endomyocardial biopsy suggested that the causes of PPCM were varied and related to myocarditis and myocardial overload due to hypertension.
© 2022. The Author(s) under exclusive licence to The Japanese Society for Clinical Molecular Morphology.
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Sleep disordered breathing and the risk of severe maternal morbidity in women with preeclampsia: A population-based study.
Pregnancy Hypertens2022 Dec;30():215-220. doi: 10.1016/j.preghy.2022.10.013.
Malhamé Isabelle, Bublitz Margaret H, Wilson Danielle, Sanapo Laura, Rochin Elizabeth, Bourjeily Ghada,
Abstract
OBJECTIVE:
Obstructive sleep apnea (OSA) may exacerbate the widespread endothelial dysfunction seen in preeclampsia, potentially worsening clinical outcomes. We aimed to assess whether OSA is associated with an increased risk of severe maternal morbidity, cardiovascular morbidity, and healthcare utilization among women with preeclampsia.
STUDY DESIGN:
We performed a retrospective cohort study utilizing data from the National Perinatal Information Center (2010-2014) in the United States.The cohort comprised women with preeclampsia. We estimated the association between OSA and the outcomes using logistic regression analyses and determined odds ratio adjusted for demographic factors and comorbidities (OR) and associated 95% confidence intervals (CI).
MAIN OUTCOME MEASURES:
The primary outcome was a composite of mortality and severe maternal morbidity comprising intensive care unit (ICU) admission, acute renal failure, pulmonary edema, pulmonary embolism, congestive heart failure, cardiomyopathy, and stroke. Secondary outcomes comprised the subset of cardiovascular events, as well as increased healthcare utilization (including Cesarean delivery, preterm birth, ICU admission, and prolonged length of hospital stay).
RESULTS:
In total, 71,159 women had preeclampsia, including 270 (0.4 %) with OSA. Women with preeclampsia and OSA were more likely to experience severe maternal morbidity than women without OSA (OR 2.65, 95 % CI [1.94-3.61]). Moreover, women with concomitant OSA had more severe cardiovascular morbidity than women without OSA (OR 5.05, 95 % CI [2.28-11.17]). Accordingly, OSA was associated with increased healthcare utilization in women with preeclampsia (OR. 2.26, 95 % CI [1.45-3.52]).
CONCLUSION:
In women with preeclampsia, OSA increases the risk for severe maternal morbidity, cardiovascular morbidity, and healthcare utilization.
Copyright © 2022 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
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Role of inhaled levosimendan in peripartum cardiomyopathy.
Saudi J Anaesth2022 ;16(4):500-503. doi: 10.4103/sja.sja_297_22.
Kaur Parminder, Kundra Tanveer S,
Abstract
Levosimendan is an inodilator agent, which was initially widely used in low contractility states. However, its use has been restricted because of the invariable need to use a vasoconstrictor like norepinephrine, since it causes a marked fall in systemic vascular resistance (SVR). Hence its beneficial effects on the heart are compromised by the excessive fall in SVR. The inhalational route provides a better opportunity to exploit the positive cardiac effects, with a minimal effect on SVR. In this case report, we present a postpartum patient presenting with heart failure, in which inhalational levosimendan improved the hemodynamics and cardiac function, which was associated with relief of symptoms, with no need for other inotropes. As per our knowledge and extensive literature search, this is the first documented use of inhaled levosimendan in peripartum cardiomyopathy.
Copyright: © 2022 Saudi Journal of Anesthesia.
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Reversible Cerebral Vasoconstriction Syndrome and Ischemic Stroke Secondary to Peripartum Cardiomyopathy - Report a Rare Case.
Cureus2022 Sep;14(9):e29640. doi: e29640.
Hang Stephanie, Dixit Priyadarshini, Alam Dilnaz, Fatima Sarah, Madhavan Ramesh,
Abstract
Acute cardioembolic stroke is a rare presentation of peripartum cardiomyopathy. We present an unusual case of peripartum cardiomyopathy, that subsequently developed cardioembolic ischemic stroke and reversible cerebral vasospasms. A 26-year-old G1P1 caucasian woman presented to the emergency department 10 days after a spontaneous vaginal delivery with the clinical and physical presentation of acute heart failure. Brain natriuretic peptide (BNP) level was >8000 pg/mL. Transthoracic echocardiogram (TTE) demonstrated global left ventricular hypokinesis, reduced ejection fraction (EF) 22% with grade I diastolic dysfunction and apical thrombus. On hospital day two of her heart failure exacerbation admission, a code stroke was activated for aphasia and confusion. She received an IV tissue plasminogen activator (tPA) and underwent a mechanical thrombectomy. On hospital day three, she developed worsening of neurological symptoms, and a computed tomography (CT) angiogram revealed vasospasm in the region of the left middle cerebral artery (MCA), which subsequently resulted in nimodipine therapy. Furthermore, her hospital course was complicated by persistent hypotension, and with our concern for vasospasm that was noted in the CT angiogram instead of guideline-directed therapy for heart failure, digoxin was given to control heart rate and to improve cardiac output. Ultimately, her neurological symptoms improved, and she was discharged on hospital day 10. This case highlights the combination of rare presentations - postpartum cardiomyopathy, ischemic stroke, and reversible cerebral vasospasms, which suggests that the time and size of the stroke are of the essence in terms of promptness of aggressive treatment.
Copyright © 2022, Hang et al.
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Geographic disparities in peripartum cardiomyopathy outcomes.
Am J Obstet Gynecol MFM2022 Oct;5(2):100788. doi: 10.1016/j.ajogmf.2022.100788.
Robbins Lindsay S, Szychowski Jeff M, Nassel Ariann, Arora Gazal, Armour Emily K, Walker Zachary, Rajapreyar Indranee N, Kraus Abigayle, Wingate Martha, Tita Alan T, Sinkey Rachel G,
Abstract
BACKGROUND:
Cardiomyopathy causes more than a third of late postpartum pregnancy-related deaths in the United States, and racial disparities in outcomes among pregnant individuals with cardiomyopathy exist. Underlying community factors may contribute to disparities in peripartum cardiomyopathy outcomes.
OBJECTIVE:
This study aimed to identify the geographic distribution of and disparities in peripartum cardiomyopathy outcomes, hypothesizing that patients living in communities with higher social vulnerability may have worse outcomes.
STUDY DESIGN:
This was a retrospective cohort study of patients with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 at a single center, excluding those with a post office box address as a post office box address may not reflect the census tract in which a patient resides. Severe peripartum cardiomyopathy (vs less severe peripartum cardiomyopathy) was defined as ejection fraction
RESULTS:
Of 95 patients in the original cohort, 5 were excluded because of the use of a post office box address. Of the remaining 90 patients, 56 met severe peripartum cardiomyopathy criteria. At baseline, individuals with and without severe peripartum cardiomyopathy had similar ages, marital status, payor type, tobacco use, gestational age at delivery, and mode of delivery; however, individuals with severe peripartum cardiomyopathy were more likely to be Black (vs White) (59% vs 29%; P<.007 and less likely to recover ejection fraction by months vs p=".02)" than individuals with severe peripartum cardiomyopathy. patients cardiomyopathy were more live in areas a higher social vulnerability index residents who unemployed impoverished without high school diploma single-parent households of minority status vehicle institutionalized group quarters the median income was lower communities>
CONCLUSION:
Patients with severe peripartum cardiomyopathy outcomes were more likely to live in communities with greater social vulnerability than patients with less severe peripartum cardiomyopathy outcomes. To reduce disparities and maternal mortality rates, resources may need to be directed to socially vulnerable communities.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Cabergoline treatment promotes myocardial recovery in peripartum cardiomyopathy.
ESC Heart Fail2022 Oct;():. doi: 10.1002/ehf2.14210.
Pfeffer Tobias J, Mueller Julia H, Haebel Lea, Erschow Sergej, Yalman Kuebra C, Talbot Steven R, Koenig Tobias, Berliner Dominik, Zwadlo Carolin, Scherr Michaela, Hilfiker-Kleiner Denise, Bauersachs Johann, Ricke-Hoch Melanie,
Abstract
AIMS:
Peripartum cardiomyopathy (PPCM) is a rare heart disease, occurring in previously heart-healthy women during the last month of pregnancy or the first months after delivery due to left ventricular (LV) systolic dysfunction. A common pathomechanistic pathway of PPCM includes increased oxidative stress and the subsequent generation of a cleaved prolactin fragment (16 kDa PRL), which promotes the onset of heart failure (HF) in a microRNA (miR)-146a-dependent manner. Inhibition of prolactin secretion with the dopamine D2 receptor (D2R) agonist bromocriptine combined with standard HF therapy supports cardiac recovery. This study examined whether treatment with the more selective D2R agonist cabergoline prevents HF development in an experimental PPCM mouse model and might be used as an alternative treatment regime for PPCM.
METHODS AND RESULTS:
Postpartum (PP) female PPCM-prone mice with a cardiomyocyte restricted STAT3-deficiency (?MHC-Cre ; Stat3 ; CKO) were treated over two consecutive nursing periods with cabergoline (CKO Cab, 0.5 mg/kg/day) and were compared with bromocriptine treated CKO (CKO Br) and postpartum-matched WT and CKO mice. Cabergoline treatment in CKO PP mice preserved cardiac function [fractional shortening (FS): CKO Cab: 34.5 ± 9.4% vs. CKO: 22.1 ± 9%, P
CONCLUSIONS:
In the experimental PPCM mouse model, the selective D2R agonist cabergoline prevents the onset of postpartum HF similar to bromocriptine. In PPCM patients, cabergoline treatment was safe and effective as all patients fully recovered. Cabergoline might serve as a promising alternative to bromocriptine. However, these findings are based on experimental data and a small case series and thus have to be interpreted with caution and should be validated in a larger clinical trial.
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004-2019).
J Am Heart Assoc2022 Nov;11(21):e026786. doi: e026786.
Zahid Salman, Hashem Anas, Minhas Anum S, Bennett Wendy L, Honigberg Michael C, Lewey Jennifer, Davis Melinda B, Michos Erin D,
Abstract
Background Gestational diabetes (GD) is associated with increased risk of long-term cardiovascular complications. However, data on acute peripartum cardiovascular complications are not well established. Hence, we aimed to investigate the association of GD with acute cardiovascular outcomes at the time of delivery admission. Methods and Results We used data from the National Inpatient Sample (2004-2019). () or () codes were used to identify delivery hospitalizations and GD diagnosis. A total of 63?115?002 weighted hospitalizations for deliveries were identified, of which 3.9% were among individuals with GD (n=2?435?301). The prevalence of both GD and obesity increased during the study period ( trends
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Cardiovascular Complications During Delivery Admissions Associated With Assisted Reproductive Technology (from a National Inpatient Sample Analysis 2008 to 2019).
Am J Cardiol2023 Jan;186():126-134. doi: 10.1016/j.amjcard.2022.08.037.
Zahid Salman, Hashem Anas, Minhas Anum S, Harrington Colleen M, Quesada Odayme, Aggarwal Niti R, Shufelt Chrisandra L, Baker Valerie L, Michos Erin D,
Abstract
Women who conceive through assisted reproductive technology (ART) have a known increased risk of obstetric complications. However, whether ART is also associated with higher risk of developing cardiovascular complications during delivery admissions has not been well established. We used data from the National Inpatient Sample (2008 to 2019) and used the International Classification of Diseases codes to identify delivery hospitalizations and ART procedures. A total of 45,867,086 weighted delivery cases were identified, of which 0.24% were among women who conceived through ART (n = 108,542). Women with an ART history were older at the time of delivery (median 35 vs 28 years, p
Copyright © 2022 Elsevier Inc. All rights reserved.
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Peripartum cardiomyopathy or acute myocardial infarction: how to face the challenge?
Pol Arch Intern Med2022 Oct;():. doi: 16359.
S?awek-Szmyt Sylwia, Grygier Joanna, ??czak Micha?, Ropacka-Lesiak Mariola, Grygier Marek, Lesiak Maciej,
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