Pubblicazioni recenti - peripartum cardiomyopathy
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Comment on "A new risk score for the assessment of outcomes for Chinese patients with peripartum cardiomyopathy".
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Transcriptomic Comparison of Human Peripartum and Dilated Cardiomyopathy Identifies Differences in Key Disease Pathways.
J Cardiovasc Dev Dis2023 Apr;10(5):. doi: 188.
Taylor Jude, Yeung Anna C Y, Ashton Anthony, Faiz Alen, Guryev Victor, Fang Bernard, Lal Sean, Grosser Mark, Dos Remedios Cristobal G, Braet Filip, McLachlan Craig S, Li Amy,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare form of acute onset heart failure that presents in otherwise healthy pregnant women around the time of delivery. While most of these women respond to early intervention, about 20% progress to end-stage heart failure that symptomatically resembles dilated cardiomyopathy (DCM). In this study, we examined two independent RNAseq datasets from the left ventricle of end-stage PPCM patients and compared gene expression profiles to female DCM and non-failing donors. Differential gene expression, enrichment analysis and cellular deconvolution were performed to identify key processes in disease pathology. PPCM and DCM display similar enrichment in metabolic pathways and extracellular matrix remodeling suggesting these are similar processes across end-stage systolic heart failure. Genes involved in golgi vesicles biogenesis and budding were enriched in PPCM left ventricles compared to healthy donors but were not found in DCM. Furthermore, changes in immune cell populations are evident in PPCM but to a lesser extent compared to DCM, where the latter is associated with pronounced pro-inflammatory and cytotoxic T cell activity. This study reveals several pathways that are common to end-stage heart failure but also identifies potential targets of disease that may be unique to PPCM and DCM.
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Early-onset peri-partum cardiomyopathy in a twin gestation: A rare presentation.
Med J Armed Forces India2023 ;79(3):348-351. doi: 10.1016/j.mjafi.2021.05.015.
Jose Tony, Maiti G D, Gupta Shilpa, Kundu Payel,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare pregnancy-associated dilated cardiomyopathy occurring in the last month of pregnancy and five months postdelivery, which presents with features of cardiac failure. Diagnosis is based on characteristic echocardiographic findings and elevated cardiac biomarkers and has significant mortality and morbidity when undiagnosed and untreated. Atypical presentations in earlier gestations are rare and associated with risk factors. Here we present a case of PPCM diagnosed in the second trimester in a post in vitro fertilization (IVF) twin pregnancy to emphasize the importance of considering the diagnosis of PPCM in all cases of unexplained cardiac failures during pregnancy in previously healthy patients, especially in the presence of risk factors.
© 2021 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.
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The role of temporary mechanical circulatory support in heart failure syndromes with cardiogenic shock: A contemporary review.
J Intensive Med2023 Apr;3(2):89-103. doi: 10.1016/j.jointm.2022.10.002.
Eftychiou Stavros, Kalakoutas Antonis, Proudfoot Alastair,
Abstract
Cardiogenic shock (CS) is a complex clinical syndrome with a high mortality rate. It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous. Acute myocardial infarction-related CS (AMI-CS) has historically been the most prevalent cause, and thus, research and guidance have focused primarily on this. Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission. There is, however, a paucity of data and guidelines to inform the management of these patients who fall into two broad groups: those with existing heart failure and CS and those with no known history of heart failure who present with "" CS. The use of temporary mechanical circulatory support (MCS) has expanded across all etiologies, despite its high cost, resource intensity, complication rates, and lack of high-quality outcome data. Herein, we discuss the currently available evidence on the role of MCS in the management of patients with CS to include fulminant myocarditis, right ventricular (RV) failure, Takotsubo syndrome, post-partum cardiomyopathy, and CS due to valve lesions and other cardiomyopathies.
© 2022 The Authors.
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Common obstetrics and gynecologic topics in critical care: A narrative review.
Int J Crit Illn Inj Sci2023 ;13(1):38-43. doi: 10.4103/ijciis.ijciis_20_22.
Ritchie Julia, Birsner Meredith L, Zighelboim Israel, Taylor Nicholas P,
Abstract
The fields of Obstetrics and Gynecology and Critical Care often share medically and surgically complex patients. Peripartum anatomic and physiologic changes can predispose or exacerbate certain conditions and rapid action is often needed. This review discusses some of the most common conditions responsible for the admission of obstetrical and gynecological patients to the critical care unit. We will consider both obstetrical and gynecologic concepts including postpartum hemorrhage, antepartum hemorrhage, abnormal uterine bleeding, preeclampsia and eclampsia, venous thromboembolism, amniotic fluid embolism, sepsis and septic shock, obstetrical trauma, acute abdomen, malignancies, peripartum cardiomyopathy, and substance abuse. This article aims to be a primer for the Critical Care provider.
Copyright: © 2023 International Journal of Critical Illness and Injury Science.
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Clinical Predictors of Referral for and Yield of Genetic Testing in Peripartum Cardiomyopathy.
JACC Heart Fail2023 May;():. doi: S2213-1779(23)00167-1.
Reza Nosheen, Packard Elizabeth, Goli Rahul, Chowns Jessica L, Owens Anjali Tiku, Arany Zoltan, Lewey Jennifer,
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Peripartum Cardiomyopathy: Risks Diagnosis and Management.
J Multidiscip Healthc2023 ;16():1249-1258. doi: 10.2147/JMDH.S372747.
Carlson Selma, Schultz Jessica, Ramu Bhavadharini, Davis Melinda B,
Abstract
Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.
© 2023 Carlson et al.
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Incidence, Risk Factors, Maternal and Neonatal Outcomes of Peripartum Cardiomyopathy (PPCM) in Oman.
Glob Heart2023 ;18(1):23. doi: 23.
Al Riyami Nihal, Al Khayari Safa, Al Zadjali Riham, Machado Lovina, Al Madhani Alya, Al Lawati Hatim,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is an idiopathic life-threatening condition occurring towards the end of pregnancy or in the first few months following delivery that might affect the maternal and neonatal outcomes.
OBJECTIVES:
To assess the incidence and to evaluate the antenatal risk factors and the maternal and neonatal outcomes in Omani women diagnosed with PPCM.
METHODS:
A retrospective cohort study was conducted at two tertiary institutions in Oman between the 1 of January 2010 to the 31 of December 2018. All cases fitting the standard definition of PPCM were included in the analysis. Patients with pre-existing dilated cardiomyopathy, chronic obstructive pulmonary disease and significant valvular heart disease have been excluded.
RESULTS:
A total of 113,104 deliveries were screened during the study period. PPCM was confirmed in 116 cases with an incidence of 1.02 per 1000 deliveries. Independent predictors for the development of PPCM were age; especially women at the mid reproductive age (26-35 years), singleton pregnancy and gestational hypertension. In general, maternal outcomes were favorable, with full recovery of left ventricular ejection fraction in 56.0%, recurrence of 9.2%, and an overall mortality rate of 3.4%. The most common maternal complication was pulmonary edema (16.3%). The neonatal mortality rate was 4.3% and the preterm birth rate was 35.7%. Neonatal outcomes included 94.3% live births, out of which 64.3% were term with Apgar scores of more than 7 at five minutes in 91.5% of the neonates.
CONCLUSION:
Our study resulted in an overall incidence of PCCM in Oman of 1.02 in 1000 deliveries. Given the significance of maternal and neonatal complications, establishing a national PPCM database and local practice guidelines, and emphasizing their implementations in all regional hospitals, are fundamental for early recognition of the disease, timely referral, and application of therapy. Future studies, with a clearly defined control group, are highly recommended to appraise the significance of antenatal comorbidities in PPCM compared to non-PPCM cases.
Copyright: © 2023 The Author(s).
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Clinical characteristics, predictors and pregnancy outcomes in Indian women with peripartum cardiomyopathy.
Obstet Med2023 Mar;16(1):23-28. doi: 10.1177/1753495X211051253.
Rajan Saroj, Jha Nivedita, Jha Ajay Kumar,
Abstract
BACKGROUND:
Predictors, pregnancy and subsequent pregnancy outcomes in women with peripartum cardiomyopathy (PPCM) are poorly understood in our geographical region.
METHODS:
We retrospectively analysed 58 women with PPCM diagnosed using criteria by the European Society of Cardiology during 2015 to 2019. The main outcome measures were predictors of left ventricular (LV) recovery. LV recovery was defined as return of LV ejection fraction to over 50%.
RESULTS:
Nearly 80% of women had LV recovery during 6 months follow up. Univariate logistic regression revealed LV end diastolic diameter (adjusted odds ratio (OR); 0.87; 95% CI, 0.78-0.98; ?=?0.02), LV end systolic diameter (OR; 0.89; 95% CI, 0.8-0.98; ?=?0.02) and inotrope use (OR; 0.2, 95% CI, 0.05-0.7; ?=?0.01) as predictors of LV recovery. Relapse was not seen in any of the nine women who had a subsequent pregnancy.
CONCLUSION:
LV recovery was higher than those reported in contemporary PPCM cohorts from other parts of the world.
© The Author(s) 2021.
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Severe Heart Failure After Fetal Loss and COVID-19: A Diagnostically Challenging Case With Complicated Timing.
Cureus2023 Mar;15(3):e36866. doi: e36866.
Lim Roy, Johnson Rachel R, Denney Brian, Zalikha Lina,
Abstract
Coronavirus disease 2019 (COVID-19), initially recognized to cause respiratory system complications, has been found to also affect the cardiovascular system leading to myocardial damage and subsequently causing heart failure. Peripartum cardiomyopathy, though an uncommon condition, may also manifest as heart failure toward the end of pregnancy. This atypical case highlights the potential diagnostic overlap between COVID-19 heart failure and peripartum cardiomyopathy. At this point, there is no recommended algorithm used to distinguish one disease from another.
Copyright © 2023, Lim et al.
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Reverse Takotsubo Cardiomyopathy During Immediate Post-partum: A Case Report.
Cureus2023 Mar;15(3):e36700. doi: e36700.
Sanchez-Amaya David Jacobo, Lopez-Lizarraga Miguel-Angel, Gutierrez Castañeda Mateo, Araiza-Garaygordobil Diego, Arias-Mendoza Alexandra,
Abstract
Takotsubo cardiomyopathy or stress-induced cardiomyopathy is a particular entity with a transient left ventricular dysfunction without significant coronary artery obstruction, preceded by a stressful circumstance. Clinical presentation may mimic myocardial infarction, acute heart failure among the most common conditions. If suspected, the integration of clinical aspects, imaging results, and laboratory tests allows its diagnosis and proper management. Once described as a post-menopausal women's disease, is now recognized as a more frequent condition of young women, especially after stressful conditions such as post-surgical status and peripartum period, rendering as a disease with a certain predisposition to female patients, with a not always benign evolution. This case remarks an atypical presentation experiencing a first nigh fatal evolution but a later satisfactory recuperation.
Copyright © 2023, Sanchez-Amaya et al.
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Anti-Diabetic Therapy and Heart Failure: Recent Advances in Clinical Evidence and Molecular Mechanism.
Life (Basel)2023 Apr;13(4):. doi: 1024.
Hsu Chih-Neng, Hsuan Chin-Feng, Liao Daniel, Chang Jack Keng-Jui, Chang Allen Jiun-Wei, Hee Siow-Wey, Lee Hsiao-Lin, Teng Sean I F,
Abstract
Diabetic patients have a two- to four-fold increase in the risk of heart failure (HF), and the co-existence of diabetes and HF is associated with poor prognosis. In randomized clinical trials (RCTs), compelling evidence has demonstrated the beneficial effects of sodium-glucose co-transporter-2 inhibitors on HF. The mechanism includes increased glucosuria, restored tubular glomerular feedback with attenuated renin-angiotensin II-aldosterone activation, improved energy utilization, decreased sympathetic tone, improved mitochondria calcium homeostasis, enhanced autophagy, and reduced cardiac inflammation, oxidative stress, and fibrosis. The RCTs demonstrated a neutral effect of the glucagon-like peptide receptor agonist on HF despite its weight-reducing effect, probably due to it possibly increasing the heart rate via increasing cyclic adenosine monophosphate (cAMP). Observational studies supported the markedly beneficial effects of bariatric and metabolic surgery on HF despite no current supporting evidence from RCTs. Bromocriptine can be used to treat peripartum cardiomyopathy by reducing the harmful cleaved prolactin fragments during late pregnancy. Preclinical studies suggest the possible beneficial effect of imeglimin on HF through improving mitochondrial function, but further clinical evidence is needed. Although abundant preclinical and observational studies support the beneficial effects of metformin on HF, there is limited evidence from RCTs. Thiazolidinediones increase the risk of hospitalized HF through increasing renal tubular sodium reabsorption mediated via both the genomic and non-genomic action of PPAR?. RCTs suggest that dipeptidyl peptidase-4 inhibitors, including saxagliptin and possibly alogliptin, may increase the risk of hospitalized HF, probably owing to increased circulating vasoactive peptides, which impair endothelial function, activate sympathetic tones, and cause cardiac remodeling. Observational studies and RCTs have demonstrated the neutral effects of insulin, sulfonylureas, an alpha-glucosidase inhibitor, and lifestyle interventions on HF in diabetic patients.
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Thromboembolic events in peripartum cardiomyopathy: results from the ESC EORP PPCM registry.
Eur J Heart Fail2023 Apr;():. doi: 10.1002/ejhf.2871.
Tromp Jasper, Jackson Alice M, Abdelhamid Magdy, Fouad Doaa, Youssef Ghada, Petrie Mark C, Bauersachs Johann, Sliwa Karen, van der Meer Peter, ,
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Peripartum Cardiomyopathy in a Multigravida Patient.
Cureus2023 Mar;15(3):e36492. doi: e36492.
Cross Mitchell, Schirding Joel H, Domanski Kristina,
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-associated disease that typically arises in the third trimester or up to six months postpartum. This case report focuses on a multigravida patient that has been pregnant a total of 12 times. The patient had no known past medical history apart from pre-eclampsia. Information related to this disease is scarce, and its pathophysiology remains poorly understood. This case report will further enhance scientific as well as medical literature by improving healthcare providers' knowledge and understanding of PPCM, which will ultimately improve patient outcomes through swift recognition and early treatment initiation.
Copyright © 2023, Cross et al.
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Association polymorphism of guanine nucleotide-binding protein ?3 subunit () C825T and insertion/deletion of the angiotensin-converting enzyme () gene with peripartum cardiomyopathy.
Front Cardiovasc Med2023 ;10():1096514. doi: 1096514.
Dewi Ivana Purnama, Wardhani Louisa Fadjri Kusuma, Maghfirah Irma, Dewi Kristin Purnama, Subagjo Agus, Alsagaff Mochamad Yusuf, Nugroho Johanes,
Abstract
INTRODUCTION:
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-related heart disease. Genetic roles such as gene polymorphisms may relate to the etiology of PPCM. This study analyzes the association between single nucleotide gene polymorphism (SNP) guanine nucleotide-binding protein beta-3 subunit () C825T and insertion/deletion (I/D) of the angiotensin-converting enzyme () gene with the incidence of PPCM.
METHODS:
An analytic observational study with a case-control design was conducted at the Integrated Cardiac Service Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. PPCM patients of the case and control groups were enrolled. Baseline characteristic data were collected and blood samples were analyzed for SNP in the C825T gene and for I/D in the gene by using the polymerase chain reaction, restriction fragment length polymorphism, and Sanger sequencing. We also assessed levels among different genotypes using a sandwich-ELISA test.
RESULTS:
A total of 100 patients were included in this study, with 34 PPCM cases and 66 controls. There were significant differences in TT and TC genotypes in the case group compared with that in the control group (TT: 35.3% vs. 10.6%, ?=?0.003; TC: 41.2% vs. 62.5%, ?=?0.022). The TT genotype increased the risk of PPCM by 4.6-fold. There was also a significant difference in the DD genotype in the case group compared with that in the control group (26.5% vs. 9.1%, ?=?0.021). DD genotypes increased the risk of PPCM by 3.6-fold. levels were significantly higher in the DD genotype group than in the ID and II genotype groups (4,356.88?±?232.44?pg/mL vs. 3,980.91?±?77.79?pg/mL vs. 3,679.94?±?325.77?pg/mL, ?0.001).
CONCLUSION:
The TT genotype of and the DD genotype of the are likely to increase the risk of PPCM. Therefore, these polymorphisms may be predisposing risk factors for PPCM incidence. levels were significantly higher in the DD genotype group, which certainly had clinical implications for the management of PPCM patients in the administration of inhibitors as one of the therapy options.
© 2023 Dewi, Wardhani, Maghfirah, Dewi, Subagjo, Alsagaff and Nugroho.
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Severe heart failure due to peripartum cardiomyopathy.
Respirol Case Rep2023 May;11(5):e01137. doi: e01137.
Michimata Haruhiko, Sumi Toshiyuki, Nagayama Daiki, Koshino Yuta, Watanabe Hiroki, Yamada Yuichi, Chiba Hirofumi,
Abstract
Perinatal cardiomyopathy presents similarly to dilated cardiomyopathy and should be suspected in perinatal women presenting with dyspnoea, even with no previous history of heart disease.
© 2023 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.
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Cardiovascular Complications of Pregnancy.
Emerg Med Clin North Am2023 May;41(2):247-258. doi: 10.1016/j.emc.2023.01.005.
Sawyer John Mark, Moridzadeh Naseem, Bavolek Rebecca A,
Abstract
The physiologic changes in pregnancy predispose the pregnant patient to a variety of potential cardiovascular complications. In this article, we discuss the major cardiovascular disorders of pregnancy and their management, highlight specific diagnostic challenges, and discuss new developments in the field. Topics covered in this article include venous thromboembolism, acute myocardial infarction, peripartum cardiomyopathy, and aortic dissection.
Copyright © 2023 Elsevier Inc. All rights reserved.
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Unexpected Course of Left Ventricular Thrombus after COVID-19 Infection in a Woman with Peripartum Cardiomyopathy Single Shield Against Double Shock.
J Saudi Heart Assoc2023 ;35(1):55-58. doi: 10.37616/2212-5043.1331.
Hazir Kutluhan E, ?ïm?ek Ersin Ç, Çabuk Gizem, Sari Cenk,
Abstract
Peripartum cardiomyopathy (PPCMP) is defined as heart failure that develops in the last trimester of pregnancy or in the first few months after delivery without an underlying cause. Altought it is seen rarely, it can lead to thromboembolic events and can be life-threatening. Similarly, COVID-19, which is a viral pneumonia agent, is known to cause thrombogenesis. In this case report, the unexpected course of left ventricular thrombus developing in a patient with peripartum cardiomyopathy accompanied by COVID-19 infection is presented.
© 2023 Saudi Heart Association.
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