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Pubblicazioni recenti - peripartum cardiomyopathy
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Peripartum Cardiomyopathy: A Review.
Curr Emerg Hosp Med Rep2019 Sep;7(3):127-134. doi: 10.1007/s40138-019-00192-3.
Ballard Lindsay C, Cois Adrian, Kea Bory,
Abstract
Purpose of review:
Peripartum cardiomyopathy (PPCM) is an important condition with high morbidity and mortality worldwide. Patients with PPCM are at risk of developing life-long cardiac disease, requiring regular management and medical intervention. This article conducts a review of recent literature and gives insight into this disease.
Recent findings:
There is promising research in the fields of vascular, hormonal and genetics. A number of genetic markers are being analyzed; including TTNC1, TTN and STAT3. Mutations to these genes have been found to be prevalent in PPCM. These combined with the secretion of placental angiogenic factors potentially create imbalance in angiogenesis as the primary etiology.
Summary:
Current biomarkers do not differentiate between PPCM and other variants of heart failure. Women with PPCM are more likely to have a cesarean section, have hypertensive disease, at greater risk of major adverse cardiac events and to have lifelong morbidity.
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Prophylactic percutaneous left ventricular assist device in pregnancy.
Obstet Med2019 Sep;12(3):151-152. doi: 10.1177/1753495X18777346.
Westcott Jill M, Yaghoubian Yasaman, Williams Mathew R, Roman Ashley S, Hughes Francine, Rosner Mara,
Abstract
Pregnancy-associated cardiomyopathy can present earlier in gestation than traditionally defined peripartum cardiomyopathy. Management and optimal delivery timing for these patients are not well defined. We present the case of a 30-year-old primigravid at 26 weeks who presented with new onset ventricular tachycardia, biventricular cardiac failure, and severe mitral regurgitation. She was medically stabilized for two weeks prior to delivery with modest improvement in her condition. Due to concern for life-threatening cardiac failure and pulmonary edema at the time of delivery, a percutaneous left ventricular assist device was inserted immediately prior to cesarean delivery. She remained on mechanical circulatory support for 36 h. We discuss considerations regarding use of a percutaneous left ventricular assist device as a novel therapy to support the hemodynamic changes following delivery in parturients with decompensated heart failure.
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Peripartum cardiomyopathy with co-incident preeclampsia: A cohort study of clinical risk factors and outcomes among commercially insured women.
Pregnancy Hypertens2019 Jul;17():82-88. doi: S2210-7789(19)30017-0.
Malhamé Isabelle, Dayan Natalie, Moura Cristiano S, Samuel Michelle, Vinet Evelyne, Pilote Louise,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) and preeclampsia are strongly associated, yet a description of risk factors for PPCM among women with preeclampsia is currently lacking. Additionally, the effect of preeclampsia on PPCM-related outcomes is not well known.
METHODS:
We constructed a cohort of delivery admissions from 2011 to 2014 using a large US administrative database (Marketscan). We assessed risk factors for the development of PPCM among women with preeclampsia. We compared the risks of major adverse cardiovascular events (MACE) at 6?months between PPCM with co-incident preeclampsia (pePPCM) and PPCM without preeclampsia (npePPCM).
RESULTS:
We included 1,024,035 pregnancies, of which 64,503 (6.3%) had preeclampsia. A total of 874 had PPCM (283 with preeclampsia and 591 without preeclampsia). Among women with preeclampsia, clinical risk factors for PPCM consisted in chronic kidney disease (OR 3.18, 95% CI [1.51, 6.69]), multiple pregnancy (OR 2.11, 95% CI [1.49, 2.98]), chronic hypertension (OR 1.88, 95% CI [1.43, 2.47]), advanced maternal age (OR 1.82, 95% CI [1.42, 2.33]), and type 2 diabetes (OR 1.58, 95% CI [1.00, 2.48]). Women with pePPCM had a higher risk of MACE than women with npePPCM (adjusted RR 1.29, 95% CI [1.06, 1.57]) due to increased rates of clinical heart failure and pulmonary embolism in the pePPCM group. Mortality did not differ between groups.
CONCLUSION:
Preeclamptic women with risk factors for PPCM and women with pePPCM at increased risk of MACE should be followed closely. Further studies are required to determine whether preeclampsia affects the long-term prognosis of women with PPCM.
Copyright © 2019 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
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Long-Term Myocardial Damage in Peripartum Cardiomyopathy Associated With Myocarditis.
Circ J2019 Aug;():. doi: 10.1253/circj.CJ-19-0493.
Kawano Hiroaki, Hayashi Tomayoshi, Koide Yuji, Maemura Koji,
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Peripartum cardiomyopathy: what is the role of the magnetic resonance imaging?
Arch Cardiol Mex2019 ;89(1):68-69. doi: 10.24875/ACME.M19000010.
Raymundo-Martínez Grecia I, Gopar-Nieto Rodrigo, Scuri Sergio Raul, Rodríguez-Chavez Laura L, Espinola-Zavaleta Nilda,
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12?lead ECG as an emerging risk stratifier in peripartum cardiomyopathy.
Int J Cardiol2019 Oct;293():185. doi: S0167-5273(19)31982-5.
Tak Bahar Tekin, Cetin Elif Hande Ozcan, Ulvan Nedret, Cay Serkan, Aras Dursun,
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Peripartum cardiomyopathy: a single institution 5-yr experience.
Br J Anaesth2019 10;123(4):e491-e493. doi: S0007-0912(19)30567-7.
Elsamragy Shahenaz, Babazade Rovnat, Simon Michelle, Ibrahim Mohamed, Vadhera Rakesh B,
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Use of Impella heart pump for management of women with peripartum cardiogenic shock.
Clin Cardiol2019 Aug;():. doi: 10.1002/clc.23249.
Elkayam Uri, Schäfer Andreas, Chieffo Alaide, Lansky Alexandra, Hall Shelley, Arany Zoltan, Grines Cindy,
Abstract
BACKGROUND:
Percutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited.
OBJECTIVE:
To assess outcomes in women with PPCM supported with an Impella device from the global catheter-based ventricular assist device (cVAD) Registry.
METHODS AND RESULTS:
A total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ±?7.34?years, eight women were Caucasian, and seven were African-American. The occurrence of PPCM was post-delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ±?6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno-arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD).
CONCLUSION:
MCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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A case of peripartum cardiomyopathy presenting as bilateral acute limb ischaemia and gangrene.
J Pak Med Assoc2019 Aug;69(8):1216-1218.
Ashraf Amber, Zahid Salman, Ahmad Zeeshan, Zia Ur Rehman Asma, Faheem Muhammad,
Abstract
Peripartum cardiomyopathy (PPCM) is a condition of unknown etiology that presents as heart failure due to left ventricular systolic dysfunction in the last of month of pregnancy and up to six months after giving birth. PPCM predisposes towards thrombo-embolism and an acute limb ischaemia can be a manifestation of this disease. We present a case of a 23-year-old lady presenting an acute lower limb ischaemia four months post-partum. Doppler ultrasound showed bilateral femoral emboli and cardiac ECHO showed a 24% ejection fraction. Amputation was performed on both limbs, below her right knee and above her left knee. The patient was started on heart failure medication and her symptoms improved with diuretic therapy, confirming the diagnoses of PPCM. It is important to recognise acute limb ischaemia as a rare manifestation of PPCM, as a timely diagnosis and effective treatment of the disease can improve the prognosis. We believe this is the first case to be reported in medical literature from Pakistan of a patient presenting PPCM with bilateral acute limb ischaemia and gangrene.
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Reply to '12?lead ECG as an emerging risk stratifier in peripartum cardiomyopathy'.
Int J Cardiol2019 Aug;():. doi: S0167-5273(19)32395-2.
Hoevelmann J, Viljoen C A, Millar R S, Manning K, Ntsekhe M, Sliwa K,
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Heart disease in pregnancy-clinical pattern and prevalence: initial data from the first cardio-maternal unit in Iraq.
BMC Res Notes2019 Aug;12(1):491. doi: 10.1186/s13104-019-4523-6.
Farhan Hasan Ali, Yaseen Israa Fadhil,
Abstract
OBJECTIVES:
The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage.
RESULTS:
A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.
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Evaluation of drugs used in chronic heart failure at tertiary care centre: a hospital based study.
J Cardiovasc Thorac Res2019 ;11(2):79-84. doi: 10.15171/jcvtr.2019.15.
Ghimire Rinku, Dhungana Sahadeb Prasad,
Abstract
There is lack of data on pattern of use of drugs in patients with chronic heart failure (CHF) from Nepalese population. This study was conducted to explore the trends of evidence based medications used for CHF in our population. This is a cross-sectional study on 200 consecutive patients with New York Heart Association (NYHA) class II to IV symptoms of CHF who attended cardiology clinic or admitted from September 2017 to August 2018 at Nobel Medical College Teaching Hospital, Biratnagar, Nepal. Mean age of patients was 54 (range 15-90) years. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart disease, peripartum cardiomyopathy were common etiologies of CHF. Analysis of drugs used in CHF revealed that 85% patients were prescribed diuretics, 58.5% angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 53% mineralocorticoid receptor antagonists (MRAs), 38% beta-blockers (BBs) and 24% digoxin. Digoxin was mainly used as add on therapy for patients with atrial fibrillation (24% of all patients). Antithrombotics (warfarin or aspirin), inotropic agents (dopamine, dobutamine or noradrenaline), antiarrhythmic agent (amiodarone) and nitrates (intravenous glyceryl trinitrate or oral isosorbide dinitrate) were prescribed for 48%, 28%, 5% and 6% patients respectively. All CHF patients with preserved or mid-range ejection fraction (25% of all patients) were prescribed diuretics along with antihypertensive drugs for hypertensive patients. CHF is associated with significant morbidity and mortality due to associated co-morbidities and underuse of proven therapy like BBs, ACEIs or ARBs and MRAs. Careful attention to optimization of different drugs therapy in patients with CHF may help to improve patient outcomes.
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Anticoagulation for intra-cardiac thrombi in peripartum cardiomyopathy: A review of the literature.
Rev Cardiovasc Med2019 Jun;20(2):53-58. doi: 10.31083/j.rcm.2019.02.55.
Agrawal Akanksha, Jain Deepanshu, Ram Pradhum, Leon Jorge Luis Penalver, Rangaswami Janani,
Abstract
Peripartum cardiomyopathy is a type of non-ischemic cardiomyopathy with a high rate of thromboembolic events. Guiding strategies for anticoagulation in patients with peripartum cardiomyopathy and thromboembolic events are limited. Literature for all cases of peripartum cardiomyopathy with intracardiac thrombi were reviewed and summarized from twelve case reports. Based on the available literature, we conclude that patients with peripartum cardiomyopathy with ejection fraction of less than 30% should strongly consider anticoagulation therapy to avoid thromboembolic events. Future studies may be able to further elucidate the optimal indication and duration of anticoagulation.
©2019 Agrawal et al. Published by IMR press. All rights reserved.
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A Retrospective Evaluation of Risk of Peripartum Cardiac Dysfunction in Survivors of Childhood, Adolescent and Young Adult Malignancies.
Cancers (Basel)2019 Jul;11(8):. doi: E1046.
Chait-Rubinek Lori, Mariani Justin A, Goroncy Natalie, Herschtal Alan, Wheeler Greg C, Dwyer Mary K, Seymour John F, Campbell Belinda A,
Abstract
Long-term survivors of childhood, adolescent and young adult (AYA) malignancies with past exposure to potentially cardiotoxic treatments are at risk of peripartum cardiac dysfunction. Incidence and risk factors for peripartum cardiac dysfunction and maternal cardiac outcomes in this population were investigated. Eligible long-term survivors were aged <30 years at cancer diagnosis, with ?1 pregnancy occurring ?5 years after diagnosis. "Peripartum" cardiac events were defined as occurring within pregnancy or ?5months after delivery. Cardiac events were classified "symptomatic" or "subclinical". "Peripartum cardiomyopathy" (PPCM) was defined as symptomatic dysfunction without prior cardiac dysfunction. Of 64 eligible women, 5 (7.8%) had peripartum cardiac events: 3 symptomatic, 2 subclinical. Of 110 live births, 2 (1.8%, 95% CI 0.2-6.4) were defined as PPCM: Significantly greater than the published general population incidence of 1:3000 ( < 0.001), representing a 55-fold (95% CI 6.6-192.0) increased risk. Risk factor analyses were hypothesis-generating, revealing younger age at cancer diagnosis and higher anthracycline dose. Postpartum, cardiac function of 4 women (80%) failed to return to baseline. In conclusion, peripartum cardiac dysfunction is an uncommon but potentially serious complication in long-term survivors of paediatric and AYA malignancies previously treated with cardiotoxic therapies. Peripartum cardiac assessment is strongly recommended for at-risk patients.
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An Unusual Case of Shock Following an Elective Caesarean Delivery.
J Obstet Gynaecol Can2019 Jul;():. doi: S1701-2163(19)30302-0.
Brennan Anthony Paul, Eskander Alex, Zois John, Burns Andrew T,
Abstract
BACKGROUND:
The differential diagnosis of peripartum chest pain and cardiogenic shock is broad and includes pulmonary embolism, amniotic fluid embolism, peripartum and Takotsubo cardiomyopathy, myocardial infarction, and anaesthetic complications.
CASE:
A 31-year-old woman with Addison's disease underwent an elective Caesarean section that was complicated by chest pain and cardiogenic shock. After initial resuscitation, she was transferred to a tertiary hospital, and urgent transthoracic echocardiography revealed severe systolic dysfunction. She was treated with an increased dose of hydrocortisone and intravenous furosemide and improved. Follow-up imaging showed improvement of left ventricular systolic function.
CONCLUSION:
In patients with cardiogenic shock after delivery, early transthoracic echocardiography is a non-invasive tool that can rapidly narrow the differential diagnosis.
Copyright © 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
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To Breastfeed or Not to Breastfeed With Peripartum Cardiomyopathy.
JACC Basic Transl Sci2019 Jun;4(3):301-303. doi: 10.1016/j.jacbts.2019.03.005.
Arany Zoltan, Feldman Arthur M,
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Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy.
JACC Basic Transl Sci2019 Jun;4(3):291-300. doi: 10.1016/j.jacbts.2019.01.010.
Koczo Agnes, Marino Amy, Jeyabalan Arun, Elkayam Uri, Cooper Leslie T, Fett James, Briller Joan, Hsich Eileen, Blauwet Lori, McTiernan Charles, Morel Penelope A, Hanley-Yanez Karen, McNamara Dennis M, ,
Abstract
The etiology of peripartum cardiomyopathy remains unknown. One hypothesis is that an increase in the 16-kDa form of prolactin is pathogenic and suggests that breastfeeding may worsen peripartum cardiomyopathy by increasing prolactin, while bromocriptine, which blocks prolactin release, may be therapeutic. An autoimmune etiology has also been proposed. The authors investigated the impact of breastfeeding on cellular immunity and myocardial recovery for women with peripartum cardiomyopathy in the IPAC (Investigations in Pregnancy Associated Cardiomyopathy) study. Women who breastfed had elevated prolactin, and prolactin levels correlated with elevations in CD8 T cells. However, despite elevated prolactin and cytotoxic T cell subsets, myocardial recovery was not impaired in breastfeeding women.
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Cardiomyopathy and pregnancy.
Heart2019 Jul;():. doi: heartjnl-2018-313476.
Schaufelberger Maria,
Abstract
Cardiomyopathy is a group of disorders in which the heart muscle is structurally and functionally abnormal in the absence of other diseases that could cause observed myocardial abnormality. The most common cardiomyopathies are hypertrophic and dilated cardiomyopathy. Rare types are arrhythmogenic right ventricular, restrictive, Takotsubo and left ventricular non-compaction cardiomyopathies. This review of cardiomyopathies in pregnancy shows that peripartum cardiomyopathy is the most common cardiomyopathy in pregnancy. Peripartum cardiomyopathy develops most frequently in the month before or after partum, whereas dilated cardiomyopathy often is known already or develops in the second trimester. Mortality in peripartum cardiomyopathy varies from <2%?to 50%. Few reports on dilated cardiomyopathy and pregnancy exist, with only a limited number of patients. Ventricular arrhythmias, heart failure, stroke and death are found in 39%-60% of high-risk patients. However, patients with modest left ventricular dysfunction and good functional class tolerated pregnancy well. Previous studies on >700 pregnancies in 500 women with hypertrophic cardiomyopathy showed that prognosis was generally good, even though three deaths were reported in high-risk patients. Complications include different types of supraventricular and ventricular arrhythmias, heart failure and ischaemic stroke. Recent studies on 200 pregnancies in 100 women with arrhythmogenic right ventricular cardiomyopathy have reported symptoms, including heart failure in 18%-33% of pregnancies. Ventricular tachycardia was found in 0%-33% of patients and syncope in one patient. Information on rare cardiomyopathies is sparse and only presented in case reports. Close monitoring by multidisciplinary teams in referral centres that counsel patients before conception and follow them throughout gestation is recommended.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
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From labor and delivery to left ventricular assist device: A peripartum cardiomyopathy case report.
Heart Lung2019 Jul;():. doi: S0147-9563(19)30211-0.
Hayworth Rachel,
Abstract
OBJECTIVE:
To report a peripartum cardiomyopathy (PPCM) case resulting in the implantation of a permanent left ventricular assist device (LVAD) as destination therapy.
METHOD:
Electronic medical record and literature review surrounding PPCM.
RESULTS:
A 39-year-old African America female of 38 weeks gestation presented to labor and delivery triage complaining of lower extremity edema and shortness of breath. Evaluation yielded an ejection fraction of 20-25% with left ventricular dilation, cardiomegaly, and interstitial edema. Following delivery, the patient experienced respiratory distress and was transferred to the cardiac intensive care unit (CICU) where she was stabilized and discharged. Within four weeks, the patient experienced sudden cardiac arrest requiring intubation, induced hypothermic treatment, and intravenous vasopressor and inotrope support. The patient was transferred out of CICU and discharged home with close outpatient follow-up in the heart failure clinic before urgently receiving a LVAD.
CONCLUSION:
PPCM is a life-threatening and life-changing condition requiring highly specialized interdisciplinary care.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy.
Eur J Heart Fail2019 Jul;21(7):827-843. doi: 10.1002/ejhf.1493.
Bauersachs Johann, König Tobias, van der Meer Peter, Petrie Mark C, Hilfiker-Kleiner Denise, Mbakwem Amam, Hamdan Righab, Jackson Alice M, Forsyth Paul, de Boer Rudolf A, Mueller Christian, Lyon Alexander R, Lund Lars H, Piepoli Massimo F, Heymans Stephane, Chioncel Ovidiu, Anker Stefan D, Ponikowski Piotr, Seferovic Petar M, Johnson Mark R, Mebazaa Alexandre, Sliwa Karen,
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients respecting contraindications during pregnancy/lactation. The oxidative stress-mediated cleavage of the hormone prolactin into a cardiotoxic fragment has been identified as a driver of PPCM pathophysiology. Pharmacological blockade of prolactin release using bromocriptine as a disease-specific therapy in addition to standard therapy for heart failure treatment has shown promising results in two clinical trials. Thresholds for devices (implantable cardioverter-defibrillators, cardiac resynchronization therapy and implanted long-term ventricular assist devices) are higher in PPCM than in other conditions because of the high rate of recovery. The important role of education and counselling around contraception and future pregnancies is emphasised.
© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.
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