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Pubblicazioni recenti - peripartum cardiomyopathy
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The European Society of Cardiology Heart Failure Association Study Group on Peripartum Cardiomyopathy - what has been achieved in 10 years.
Eur J Heart Fail2020 May;():. doi: 10.1002/ejhf.1912.
Sliwa Karen, Bauersachs Johann, Coats Andrew Js,
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A Systematic Review of Diagnosis and Treatment of Acute Limb Ischemia during Pregnancy and Postpartum Period.
J Vasc Surg2020 May;():. doi: S0741-5214(20)31249-0.
Govsyeyev Nicholas, Malgor Rafael D, Hoffman Clayton, Sturman Erin, Siada Sammy, Musawi Mohamed, Malgor Emily A, Jacobs Donald L, Nehler Mark,
Abstract
BACKGROUND:
Acute limb ischemia (ALI) carries significant overall morbidity and mortality. Pregnant and postpartum women are physiologically hypercoagulable, but little is known about the impact of ALI in this cohort of patients. The goal of this systematic review was to gather available data on diagnosis and treatment of ALI during pregnancy and the postpartum period.
METHODS:
A systematic review of studies on patients with ALI during pregnancy and puerperium was performed following the PRISMA guidelines. Three databases including Pubmed Medline, EMBASE, and Cochrane library were queried. Manuscripts, which provided data on diagnosis and treatment of ALI in pregnant and postpartum patients, were included regardless of language or study design. Outcomes of interest included type of treatment for ALI (open and endovascular), morbidity and mortality.
RESULTS:
Fourteen manuscripts out of 6,222 references were included with a total of 14 patients. The median age of patients was 31.5 years. Embolism was the slightly more common than thrombosis, present in 8 (57%) patients. All patients had a pregnancy complication or concomitant medical condition which might have predisposed to arterial occlusion either directly or indirectly by leading to iatrogenic arterial injury, with peripartum cardiomyopathy being the most common and occurring in 6 (43%) patients. Open surgery was the preferred treatment option in 11 (79%) patients followed by anticoagulation alone. No endovascular procedures were described. One patient underwent major amputation on presentation and an additional patient required major amputation for recurrent ALI. No deaths occurred. Twelve (86%) patients had complete recovery with no other ALI-associated sequelae.
CONCLUSIONS:
ALI is rare in pregnant and postpartum women despite their transient physiologic hypercoagulability and is almost uniformly associated with pregnancy complications. Open surgical revascularization or anticoagulation alone appears to have acceptable outcomes as the majority of patients present with embolism or thrombosis without underlying systemic arterial disease.
Copyright © 2020. Published by Elsevier Inc.
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Extracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports.
Int J Obstet Anesth2020 Apr;():. doi: S0959-289X(20)30053-4.
Ong J, Zhang J J Y, Lorusso R, MacLaren G, Ramanathan K,
Abstract
The use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe cardiopulmonary failure has increased significantly in the past decade. However, the use of ECMO in pregnant and peripartum patients has received scant attention. We performed a systematic review of case reports in the literature, documenting indications and outcomes of ECMO in pregnancy and postpartum patients. Case reports on ECMO use in pregnant and postpartum patients were retrieved from MEDLINE, EMBASE and SCOPUS databases up to December 2018. Ninety publications reporting on 97 patients met our inclusion criteria. The majority of publications reported peripartum or postpartum ECMO use for cardiovascular failure (60.8%), while the remainder had respiratory failure. Adult Respiratory Distress Syndrome (91.9%) was the most common respiratory indication while pulmonary embolism (23.7%) and peripartum cardiomyopathy (16.9%) accounted for the two most common cardiovascular indications. Hemorrhage was the most common complication of ECMO reported (31.9%). Of 96 documented neonatal outcomes, 80 neonates (83.3%) survived while 88 of 97 (90.7%) mothers survived. Extracorporeal membrane oxygenation appears to be a viable life support modality in pregnant and postpartum women with severe cardiopulmonary failure, but publication bias in our study cohort should be considered.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Detection and management of arrhythmias in peripartum cardiomyopathy.
Cardiovasc Diagn Ther2020 Apr;10(2):325-335. doi: 10.21037/cdt.2019.05.03.
Hoevelmann Julian, Hähnle Lina, Hähnle Julia, Sliwa Karen, Viljoen Charle,
Abstract
Peripartum cardiomyopathy (PPCM) is an idiopathic dilated cardiomyopathy, in which previously healthy women present with heart failure secondary to left ventricular (LV) systolic dysfunction during the last months of pregnancy or up to 5 months postpartum. PPCM occurs worldwide. The incidence seems to be increasing, possibly due to increasing awareness of the condition and diagnosis thereof. Women diagnosed with PPCM present with symptoms and signs of heart failure, thromboembolism or arrhythmia. Although the incidence of arrhythmias in this condition is not well documented, patients with PPCM often have rhythm disturbances. Indeed, life-threating arrhythmias contribute significantly to sudden cardiac death (SCD) in this population, especially when patients have poor systolic function. In this review, we summarize the evidence on atrial and ventricular arrhythmias in PPCM, as detected by various diagnostic modalities. Furthermore, we summarize the management of arrhythmias in PPCM, as recommended by contemporary guidelines.
2020 Cardiovascular Diagnosis and Therapy. All rights reserved.
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DNA Damage, an Innocent Bystander in Atrial Fibrillation and Other Cardiovascular Diseases?
Front Cardiovasc Med2020 ;7():67. doi: 10.3389/fcvm.2020.00067.
Ramos Kennedy S, Brundel Bianca J J M,
Abstract
Atrial Fibrillation (AF) is the most common clinical tachyarrhythmia with a strong tendency to progress in time. AF is difficult to treat and therefore there is a great need to dissect root causes of AF with the ultimate goal to develop mechanism-based (drug) therapies. New findings related to mechanisms driving AF progression indicate a prime role for DNA damage-induced metabolic remodeling. A recent study uncovered that AF results in oxidative DNA damage and consequently excessive poly-ADP-ribose polymerase 1 (PARP1) activation and nicotinamide adenine dinucleotide (NAD) depletion and finally atrial cardiomyocyte electrical and contractile dysfunction. This newly elucidated role of DNA damage in AF opens opportunities for novel therapeutic strategies. Recently developed PARP inhibitors, such as ABT-888 and olaparib, provide beneficial effects in limiting experimental AF, and are also found to limit atherosclerotic coronary artery disease and heart failure. Another therapeutic option to protect against AF is to replenish the NAD pool by supplementation with NAD or its precursors, such as nicotinamide and nicotinamide riboside. In this review, we describe the role of DNA damage-mediated metabolic remodeling in AF and other cardiovascular diseases, discuss novel druggable targets for AF and highlight future directions for clinical trials with drugs directed at PARP1-NAD pathway with the ultimate aim to preserve quality of life and to attenuate severe complications such as heart failure or stroke in patients with AF.
Copyright © 2020 Ramos and Brundel.
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Peripartum cardiomyopathy: can the link between prolactin and PAI-1 provide a clue?
Cardiovasc Res -
Matrix Metalloproteases and Cathepsin D in Human Serum do not Cleave Prolactin to Generate Vasoinhibin.
Clin Lab2020 May;66(5):. doi: 10.7754/Clin.Lab.2019.191017.
Triebel Jakob, Schauer Nicole, Zamora Magdalena, Moreno-Vega Aura Ileana, Escalera Gonzalo Martinez de la, Clapp Carmen, Bertsch Thomas,
Abstract
BACKGROUND:
Vasoinhibin is generated in the pituitary gland and in multiple target tissues by proteolytic cleavage of prolactin by matrix metalloproteinases and cathepsin D. A dysregulation of vasoinhibin generation appears to contribute to diabetic retinopathy and diabetic macular edema, retinopathy of prematurity, peripartum cardiomyopathy, and preeclampsia. Here, we investigate whether vasoinhibin is generated by matrix metalloproteinases and cathepsin D in human serum.
METHODS:
The abundance of matrix metalloproteinases 1, 2, 3, 8, 9, 10, 13, tissue inhibitors of metalloproteinases 1, 2, 4, and the activity of cathepsin D in serum samples were determined. Samples from healthy male (n = 3) and female (n = 2) subjects, pregnant subjects (n = 2), and patients with type 2 diabetes mellitus (n = 2) were investigated. The samples were incubated with recombinant prolactin at 37°C, under different pH, time, and buffer conditions. Prolactin and cleaved prolactin products were investigated by SDS-PAGE and western blotting.
RESULTS:
Matrix metalloproteases-1, -2, -3, -8, -9, -10, -13, TIMP-1, -2, and -4, and the activity of cathepsin D were detected in all sera. Full-length prolactin incubated with human sera, containing endogenous matrix metalloproteinases and cathepsin D, remained intact at neutral pH during a time frame from 1 to 24 hours. Partial enzymatic cleavage of prolactin resulting in the generation of a vasoinhibin-like 17 kDa peptide was observed in samples incubated at pH 3.4. Heat inactivation of the serum and the addition of an MMP inhibitor suppressed the generation of the 17 kDa peptide, indicating that its generation was MMP-mediated.
CONCLUSIONS:
Vasoinhibin generation by enzymatic cleavage of prolactin by matrix metalloproteases or cathepsin D does not occur in human serum at physiological pH. A limited proteolysis of prolactin, resulting in the generation of a vasoinhibin-like peptide with an apparent molecular weight of 17 kDa occurs in serum at acidic pH. The generation of vasoinhibin may require the cellular and tissue microenvironments.
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Human induced pluripotent stem cells for modelling metabolic perturbations and impaired bioenergetics underlying cardiomyopathies.
Cardiovasc Res2020 May;():. doi: cvaa125.
Ramachandra Chrishan J A, Chua Jasper, Cong Shuo, Kp Myu Mai Ja, Shim Winston, Wu Joseph C, Hausenloy Derek J,
Abstract
Normal cardiac contractile and relaxation function are critically dependent on a continuous energy supply. Accordingly, metabolic perturbations and impaired mitochondrial bioenergetics with subsequent disruption of ATP production underpin a wide variety of cardiac diseases, including diabetic cardiomyopathy, dilated cardiomyopathy, hypertrophic cardiomyopathy, anthracycline cardiomyopathy, peripartum cardiomyopathy, and mitochondrial cardiomyopathies. Crucially, there are no specific treatments for preventing the onset or progression of these cardiomyopathies to heart failure, one of the leading causes of death and disability worldwide. Therefore, new treatments are needed to target the metabolic disturbances and impaired mitochondrial bioenergetics underlying these cardiomyopathies in order to improve health outcomes in these patients. However, investigation of the underlying mechanisms and the identification of novel therapeutic targets have been hampered by the lack of appropriate animal disease models. Furthermore, interspecies variation precludes the use of animal models for studying certain disorders, whereas patient-derived primary cell lines have limited lifespan and availability. Fortunately, the discovery of human induced pluripotent stem cells (hiPSCs) has provided a promising tool for modelling cardiomyopathies via human heart tissue in a dish. In this review article, we highlight the use of patient-derived iPSCs for studying the pathogenesis underlying cardiomyopathies associated with metabolic perturbations and impaired mitochondrial bioenergetics, as the ability of iPSCs for self-renewal and differentiation makes them an ideal platform for investigating disease pathogenesis in a controlled in vitro environment. Continuing progress will help elucidate novel mechanistic pathways, and discover novel therapies for preventing the onset and progression of heart failure, thereby advancing a new era of personalised therapeutics for improving health outcomes in patients with cardiomyopathy.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions please email: journals.permissions@oup.com.
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Post-Traumatic Stress, Depression, and Quality of Life in Women with Peripartum Cardiomyopathy.
MCN Am J Matern Child Nurs;45(3):176-182. doi: 10.1097/NMC.0000000000000614.
Donnenwirth Jo Ann, Hess Rosanna, Ross Ratchneewan,
Abstract
PURPOSE:
Peripartum cardiomyopathy, a traumatic life-threatening type of heart failure, occurs in the last trimester of pregnancy or shortly after childbirth. Little is known about psychological or emotional conditions women experience with peripartum cardiomyopathy. The purpose of this study was to examine relationships among post-traumatic stress, depression, and quality of life in women with peripartum cardiomyopathy.
DESIGN AND METHODS:
This cross-sectional, correlational survey study included 28 participants recruited via public notice on Facebook. Participants completed the Horowitz Impact of Events Scale, the Center for Epidemiology Scale-Depression 20, and the Ferrans & Powers Quality of Life Index-Cardiac Version-IV.
RESULTS:
Post-traumatic stress correlated significantly and positively with depression (r = .809, p < .001). Post-traumatic stress and depression correlated significantly and inversely with quality of life (r = -.455, p = .015), (r = -.544, p = .003), respectively. All participants measured positive for depression. Participants with lower education scored higher on post-traumatic stress and depression, whereas those unemployed or disabled registered a lower quality of life.
CLINICAL IMPLICATIONS:
Nurses, midwives, and physicians caring for women with cardiomyopathies must be vigilant for evidence of post-traumatic stress, depression, and poor quality of life. Targeted antenatal and postnatal support could be vital to emotional and psychological recovery.
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Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory.
Curr Opin Anaesthesiol2020 Jun;33(3):277-283. doi: 10.1097/ACO.0000000000000846.
Van de Putte Peter, Vernieuwe Lynn, Bouchez Stefaan,
Abstract
PURPOSE OF REVIEW:
This review focuses on the use of point-of-care ultrasound (PoCUS) in the obstetric context for airway management and assessment of aspiration risk, the placement of neuraxial blocks and the diagnosis and follow-up of cardiorespiratory dysfunction.
RECENT FINDINGS:
Gastric ultrasound is a useful aspiration risk assessment tool in pregnant patients. Total gastric fluid assessment models and specific cut-offs between high-risk and low-risk stomachs are presented. Airway assessment is useful to detect specific changes in pregnancy and to guide airway management. Handheld ultrasound devices with automated neuraxial landmark detection capabilities could facilitate needle placement in the future. Lung and cardiac ultrasonography is useful in the management of preeclampsia, pulmonary arterial hypertension and peripartum cardiomyopathy.
SUMMARY:
Owing to its noninvasiveness, ease of accessibility and lack of exposure to radiation, PoCUS plays an increasing and essential role in aspiration risk assessment, airway management, neuraxial anaesthesia and cardiorespiratory diagnosis and decision-making during pregnancy.
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Extracorporeal membrane oxygenation in peripartum cardiomyopathy: A review of the ELSO Registry.
Int J Cardiol2020 Mar;():. doi: S0167-5273(19)35831-0.
Olson T L, O'Neil E R, Ramanathan K, Lorusso R, MacLaren G, Anders M M,
Abstract
AIMS:
Data on the use of extracorporeal membrane oxygenation (ECMO) for cardiogenic shock in peripartum cardiomyopathy (PPCM) is limited. We queried the Extracorporeal Life Support Organization (ELSO) Registry for PPCM patients treated with ECMO in order to characterize demographic and clinical features, complications, survival, and variables associated with mortality.
METHODS AND RESULTS:
This was a retrospective review of patients voluntarily entered into the ELSO Registry. De-identified data was collected on patients with a diagnosis of PPCM based on ICD-9/ICD-10 coding who received ECMO between 2007 and 2019. Collected data included demographics, ECMO mode, cannulation strategies, pre-ECMO ventilator, biochemical, and hemodynamic parameters, run duration, complications, and survival to wean off ECMO and hospital discharge. Our primary outcome measure was survival to discharge. In the final analysis, 88 veno-arterial (VA) ECMO patients were included. Overall, 72% of patients were weaned off ECMO, including 10% who were weaned to ventricular assist device or heart transplantation, and 64% survived to hospital discharge. Extracorporeal cardiopulmonary resuscitation (ECPR) was performed in 11% of patients with 60% survival. Factors associated with decreased survival included neurologic complications (p = 0.03), specifically central nervous system hemorrhage (p = 0.01).
CONCLUSION:
Our review is the largest to date of PPCM patients supported with VA ECMO for cardiogenic shock. ECMO and ECPR are valuable forms of short-term mechanical circulatory support with acceptable mortality profiles for PPCM patients who remain refractory to aggressive medical management. Complications should be meticulously avoided, especially neurologic complications.
Copyright © 2020 Elsevier B.V. All rights reserved.
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Pregnancy Outcomes in Patients With Heart Disease in China.
Am J Cardiol2020 Jun;125(11):1718-1724. doi: S0002-9149(20)30222-8.
Hu Jiaqi, Ye Yingxian, Lu Anyi, Chen Liwen, Mai Yongjian, Huang Guiting, Wang Sheng,
Abstract
To analyze pregnancy outcomes of patients with heart disease in a single center and to explore the risk factors of adverse outcomes. One thousand thirty-three pregnant women with heart disease were retrospectively included from 2010 to 2017. We collected data of maternal, obstetric, and fetal outcomes. Among 1,086 pregnancies, 295 (27.1%) with congenital heart disease, 244 (22.5%) with rheumatic heart disease, 387 (35.6%) with arrhythmia, and 55 (5.1%) with cardiomyopathy. There were 8 (0.7%) maternal deaths. Risk factors of mortality were New York Heart Association (NYHA) classification IV (p <0.001), cardiac surgery during pregnancy (p <0.001), and general anesthesia (p <0.001). Maternal cardiac complications occurred in 6.7% of women, with most in the cardiomyopathy (26.0%) and rheumatic heart disease (32.9%) groups. Multivariate logistic regression modeling was used to analyze the potential risk factors. NYHA classification III and IV independently predicted worse maternal outcomes. Peripartum intensive care unit admission rate was 10.2%. Admission to intensive care unit was associated with NYHA classification II/III/IV, modified World Health Organization (mWHO) classification II-III/III/IV, and cardiac surgery during pregnancy. In conclusion, pregnancy with heart disease is at higher risk of complications for both women and neonates. In our findings, maternal morbidity is associated with NYHA classification and mWHO classification.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Temporal Changes in Hypertensive Disorders of Pregnancy and Impact on Cardiovascular and Obstetric Outcomes.
Am J Cardiol2020 May;125(10):1508-1516. doi: S0002-9149(20)30199-5.
Wu Pensée, Chew-Graham Carolyn A, Maas Angela Hem, Chappell Lucy C, Potts Jessica E, Gulati Martha, Jordan Kelvin P, Mamas Mamas A,
Abstract
Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown. Using National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension, and gestational hypertension) were analyzed to examine the association between HDP and adverse in-hospital outcomes. We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia, and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (odds ratio [OR] 7.83, 95% confidence interval [CI] 6.25 to 9.80), myocardial infarction (OR 5.20, 95% CI 3.11 to 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64 to 5.26), preterm birth (OR 4.65, 95% CI 4.48 to 4.83), placental abruption (OR 2.22, 95% CI 2.09 to 2.36), and stillbirth (OR 1.78, 95% CI 1.66 to 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic systemic hypertension without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic systemic hypertension are at even higher risk of some adverse outcomes compared to women with preeclampsia. In conclusion, the chronic hypertension population, with and without superimposed preeclampsia, is a particularly high-risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care.
Copyright © 2020. Published by Elsevier Inc.
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Did a shared thioredoxin-reductase gene mutation lead to maternal peripartum cardiomyopathy and fatal dilated cardiomyopathy in her son? A case report.
Case Rep Womens Health2020 Apr;26():e00196. doi: 10.1016/j.crwh.2020.e00196.
Rajapreyar Indranee, Sinkey Rachel, Pamboukian Salpy V, Tita Alan,
Abstract
Peripartum cardiomyopathy (PPCM) is characterized by development of left ventricular systolic dysfunction and heart failure that occurs towards the end of pregnancy or in the postpartum period in the absence of structural heart disease. A complex interplay of pathophysiological mechanisms likely contributes to the PPCM phenotype. Mutations in the mitochondrial thioredoxin reductase gene (TXNRD2) have been identified as a cause of dilated cardiomyopathy. We report a case of a shared, inherited genetic mutation in the TXNRD2 gene in a mother with PPCM and her infant son who died of dilated cardiomyopathy.
© 2020 The Authors. Published by Elsevier B.V.
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Pregnancy-associated cardiac dysfunction and the regulatory role of microRNAs.
Biol Sex Differ2020 Apr;11(1):14. doi: 10.1186/s13293-020-00292-w.
Aryan Laila, Medzikovic Lejla, Umar Soban, Eghbali Mansoureh,
Abstract
Many crucial cardiovascular adaptations occur in the body during pregnancy to ensure successful gestation. Maladaptation of the cardiovascular system during pregnancy can lead to complications that promote cardiac dysfunction and may lead to heart failure (HF). About 12% of pregnancy-related deaths in the USA have been attributed to HF and the detrimental effects of cardiovascular complications on the heart can be long-lasting, pre-disposing the mother to HF later in life. Indeed, cardiovascular complications such as gestational diabetes mellitus, preeclampsia, gestational hypertension, and peripartum cardiomyopathy have been shown to induce cardiac metabolic dysfunction, oxidative stress, fibrosis, apoptosis, and diastolic and systolic dysfunction in the hearts of pregnant women, all of which are hallmarks of HF. The exact etiology and cardiac pathophysiology of pregnancy-related complications is not yet fully deciphered. Furthermore, diagnosis of cardiac dysfunction in pregnancy is often made only after clinical symptoms are already present, thus necessitating the need for novel diagnostic and prognostic biomarkers. Mounting data demonstrates an altered expression of maternal circulating miRNAs during pregnancy affected by cardiovascular complications. Throughout the past decade, miRNAs have become of growing interest as modulators and biomarkers of pathophysiology, diagnosis, and prognosis in cardiac dysfunction. While the association between pregnancy-related cardiovascular complications and cardiac dysfunction or HF is becoming increasingly evident, the roles of miRNA-mediated regulation herein remain poorly understood. Therefore, this review will summarize current reports on pregnancy-related cardiovascular complications that may lead to cardiac dysfunction and HF during and after pregnancy in previously healthy women, with a focus on the pathophysiological role of miRNAs.
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Peripartum cardiomyopathy prognostication using cardiac magnetic resonance imaging.
Br J Hosp Med (Lond)2020 Mar;81(3):1-2. doi: 10.12968/hmed.2019.0273.
Feghaly Julien, Ampadu James, Mooradian Ariana, Salem Elsayed Abo,
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Practice Patterns Surrounding Pregnancy After Heart Transplantation.
Circ Heart Fail2020 Apr;13(4):e006811. doi: 10.1161/CIRCHEARTFAILURE.119.006811.
DeFilippis Ersilia M, Haythe Jennifer, Farr Maryjane A, Kobashigawa Jon, Kittleson Michelle M,
Abstract
BACKGROUND:
Pregnancy after heart transplantation (HT) is a concern for many female recipients. The International Society for Heart and Lung Transplantation has guidelines regarding reproductive health, but limited data exist regarding providers' attitudes and practices surrounding pregnancy post-HT.
METHODS:
We conducted an independent, confidential, voluntary, web-based survey sent electronically to 1643 United States heart transplant providers between June and August 2019.
RESULTS:
There were 122 responses, the majority from cardiologists (n=85, 70%) and nurse or transplant coordinators (n=22, 18%). Thirty-one percent (n=37) of respondents indicated that pregnancy should be avoided in all HT recipients, and only 43% (n=52) reported that their center had a formal policy regarding pregnancy following HT. The most commonly reported contraindications included nonadherence (n=109, 89%), reduced left ventricular ejection fraction (n=104, 85%), coronary allograft vasculopathy (n=86, 70%), prior rejection (n=76, 62%), presence of donor-specific antibodies (n=69, 57%), and prior peripartum cardiomyopathy pretransplant (n=57, 47%). Respondent sex, specialty, transplant volume, or prior experience with pregnancy after HT were not associated with recommendations to avoid posttransplant pregnancy.
CONCLUSIONS:
Transplant providers' attitudes regarding posttransplant pregnancy vary widely. Despite International Society for Heart and Lung Transplantation guidelines, a significant proportion indicates that pregnancy is contraindicated in all recipients and the majority of programs have no center-specific policy to manage such pregnancies. While the low response rate limits the generalizability of the findings, they do suggest that education on the feasibility of pregnancy post-HT is indicated as many recipients are of, or survive to, childbearing age.
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Probenecid treatment improves outcomes in a novel mouse model of peripartum cardiomyopathy.
PLoS One2020 ;15(3):e0230386. doi: 10.1371/journal.pone.0230386.
Onusko Evan, McDermott Michael R, Robbins Nathan, Liu Guansheng, Kranias Evangelia G, Rubinstein Jack, Koch Sheryl E,
Abstract
Probenecid has been used for decades in the treatment of gout but recently has also been found to improve outcomes in patients with heart failure via stimulation of the transient receptor potential vanilloid 2 (TRPV2) channel in cardiomyocytes. This study tested the use of probenecid on a novel mouse model of peripartum cardiomyopathy (PPCM) as a potential treatment option. A human mutation of the human heat shock protein 20 (Hsp20-S10F) in mice has been recently shown to result in cardiomyopathy, when exposed to pregnancies. Treatment with either probenecid or control sucrose water was initiated after the first pregnancy in both wild type and Hsp20-S10F mice. Serial echocardiography was performed during subsequent pregnancies and hearts were collected after the third pregnancies for staining and molecular analysis. Hsp20-S10F mice treated with probenecid had decreased mortality, hypertrophy, TRPV2 expression and molecular parameters of heart failure. Probenecid treatment also decreased apoptosis as evidenced by an increase in the level of Bcl-2/Bax. Probenecid improved survival in a novel mouse model of PPCM and may be an appropriate therapy for humans with PPCM as it has a proven safety and tolerability in patients with heart failure.
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Irreversible Acquired Noncompaction Cardiomyopathy in a Parturient with Corrected Atrial Septal Defect: A Case Report and Clinical Implications.
Case Rep Anesthesiol2020 ;2020():1937589. doi: 10.1155/2020/1937589.
Al-Aamri Is'haq, Derzi Simone, Moore Albert, Bottega Natalie, Ordoñez Maria V, Villeneuve Valerie, Hatzakorzian Roupen,
Abstract
Left ventricular noncompaction (LVNC) is described as a cardiomyopathy with an increase in left ventricle trabeculations and recesses. We report a rare case of persistent pregnancy-acquired LVNC cardiomyopathy and review the anesthetic peripartum management strategies. A 33-year-old parturient was followed closely by the high-risk obstetric service for her second pregnancy. She had an unresolved LVNC cardiomyopathy that was diagnosed during her first pregnancy for which she had a caesarean section. Her symptoms included occasional palpitations and dyspnea. She was started on metoprolol and enoxaparin. A successful caesarean section was performed at 37 weeks gestation under regional anesthesia. Echocardiograms prior to and during the second pregnancy demonstrated persistence of the LV hypertrabeculations, LV systolic dysfunction, and a left ventricular ejection fraction (LVEF) of 35%. Pregnancy-induced LV hypertrabeculations occur in a significant proportion of women, but most cases spontaneously resolve completely. Favorable maternal and fetal outcomes require multidisciplinary care and careful selection of the anesthetic technique and drugs that maintain stable hemodynamics.
Copyright © 2020 Is'haq Al-Aamri et al.
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Pulmonary thromboembolism presenting with chest pain in a case of peripartum cardiomyopathy.
Future Cardiol2020 Mar;():. doi: 10.2217/fca-2019-0029.
Mahmoudi Elham, Tabary Mohammadreza, Khaheshi Isa,
Abstract
Peripartum cardiomyopathy (PPCM) is an idiopathic reduction in left ventricular function, presenting at the peripartum period. The diagnosis is based on echocardiographic features and excluding other causes of heart failure. Similar to any other cause of heart failure, the management of PPCM consists of diuretics, prevention of ventricular remodeling, preventing short and long-term complications. Ventricular clots, transient cerebral ischemic attacks, lower extremity thrombosis, kidney and liver infarcts and pulmonary thromboembolism have been previously reported in PPCM cases. Among them, pulmonary thromboembolism is one of the most important complications, as it is also a challenging differential diagnosis of PPCM. We discuss a case of PPCM followed by a diagnosis of pulmonary thromboembolism and briefly review the relevant PPCM literature.
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