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Pubblicazioni recenti - peripartum cardiomyopathy
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Different Manifestations in Familial Isolated Left Ventricular Non-compaction: Two Case Reports and Literature Review.
Front Pediatr2020 ;8():370. doi: 10.3389/fped.2020.00370.
Al Hussein Hamida, Al Hussein Hussam, Stroe Valentin, Harpa Marius, Ghiragosian Claudiu, Goia Cristina Maria, Opris Carmen Elena, Suciu Horatiu,
Abstract
Left ventricular non-compaction (LVNC) is a form of cardiomyopathy characterized by prominent trabeculae and deep intertrabecular recesses which form a distinct "non-compacted" layer in the myocardium. It results from intrauterine arrest of the compaction process of the left ventricular myocardium. Clinical manifestations vary from asymptomatic to heart failure (HF), arrhythmias, or thromboembolic events. We present a case of mother and son diagnosed with isolated LVNC (ILVNC). A 4-years-old male patient, diagnosed at 3 months with ILVNC, and NYHA functional class IV HF, was admitted to the Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Romania, for cardiologic reevaluation, and diagnosis confirmation. ILVNC was confirmed using echocardiography, revealing a non-compaction to compaction (NC/C) ratio of > 2.7. His evolution was stationary until the age of 8 years, when severe pneumonia caused hemodynamic decompensation, and he was listed for heart transplantation (HT). The patient underwent HT at the age of 11 years with favorable postoperative outcome. Meanwhile, a 22-years-old female patient, mother of the aforementioned patient, was also admitted to our institute due to severe fatigue, dyspnea, and recurrent palpitations with multiple implantable cardioverter defibrillator (ICD) shock delivery. Extensive medical history revealed that a presumptive ILVNC diagnosis was established when she was 11 years old. She was asymptomatic until 18 years old, when 3 months post-partum, she developed NYHA functional class III HF, and subsequently underwent ICD implantation. Her diagnosis was confirmed using multi-detector computed tomography angiography, which revealed a NC/C ratio of > 3.3. ICD adjustments were carried out with a favorable evolution under chronic drug therapy. The last evaluation, at 27 years old, revealed that she was in NYHA functional class II HF. In conclusion, ILVNC, even when familial, can present different clinical pictures and therefore requires different medical approaches.
Copyright © 2020 Al Hussein, Al Hussein, Stroe, Harpa, Ghiragosian, Goia, Opris and Suciu.
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Severe Cardiopulmonary Disease in a Parturient With Noonan Syndrome.
Semin Cardiothorac Vasc Anesth2020 Aug;():1089253220945918. doi: 10.1177/1089253220945918.
Siegrist Kara K, Deegan Robert J, Dumas Susan D, Eagle Susan S,
Abstract
Noonan syndrome is a relatively common genetic disorder and the second most common cause of congenital heart disease after trisomy 21. The spectrum of cardiac anomalies in Noonan syndrome typically involves pulmonary valve stenosis occasionally in conjunction with hypertrophic cardiomyopathy. Mitral valve involvement is a rare finding in Noonan syndrome and is most commonly associated with either mitral valve prolapse or abnormal valvular insertion causing left ventricular outflow tract obstruction. Patients with Noonan syndrome typically have preserved fertility and, given the success of cardiac surgery and medical management of heart failure in this population, are beginning to present more commonly as parturients in adulthood. Maternal physiologic changes during pregnancy introduce an added complexity to hemodynamic management and anesthetic considerations during labor and delivery. In this article, we present a case of a patient with Noonan syndrome with severe mitral stenosis, pulmonary valve insufficiency, and severe restrictive and obstructive pulmonary disease who presented preterm for delivery due to increased dyspnea at rest. Here we review the pathophysiology behind Noonan syndrome and peripartum management strategies in a patient with severe combined cardiac and pulmonary disease.
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Pregnancy outcomes in women with dilated cardiomyopathy: Peripartum cardiovascular events predict post delivery prognosis.
J Cardiol2020 Jul;():. doi: S0914-5087(20)30248-3.
Yokouchi-Konishi Tae, Kamiya Chizuko A, Shionoiri Tadasu, Nakanishi Atsushi, Iwanaga Naoko, Izumi Chisato, Yasuda Satoshi, Yoshimatsu Jun,
Abstract
BACKGROUND:
The number of pregnant women with dilated cardiomyopathy (DCM) is relatively small, and therefore their prognosis after pregnancy is unknown. This study aims to elucidate pregnancy outcomes among women with DCM, as well as the long-term prognosis after pregnancy.
METHODS:
Thirty-five pregnancies and deliveries in 30 women, diagnosed with DCM before pregnancy, were retrospectively analyzed.
RESULTS:
All women had a left ventricular ejection fraction (LVEF) over 30% and belonged to the New York Heart Association (NYHA) class I or II before pregnancy. The mean gestational age at delivery was 36 weeks with 15 (43%) preterm deliveries. Eight pregnancies (23%) were complicated by peripartum cardiac events including 1 ventricular arrhythmia, 6 heart failures, and 1 significant deterioration in LVEF requiring termination of pregnancy. NYHA class II, pre-pregnancy use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/diuretics, elevated brain natriuretic peptide (BNP), and advanced diastolic dysfunction assessed by Doppler echocardiography were defined as risk factors for cardiac events. Although the more severe cases took beta-blockers during pregnancy, the rates of cardiac events and decreasing LVEF did not differ significantly between those taking beta-blockers and those who were not. Values of LVEF decreased by almost 10% after the average 4-year post-delivery follow-up period. The long-term event-free survival was considerably worse among women with peripartum cardiac events than in those without (p<0.0001).
CONCLUSIONS:
DCM women with pre-pregnancy LVEF over 30% tolerated pregnancy, but the rate of preterm delivery was high. Peripartum cardiovascular events occurred more often in women with NYHA class II, as well as those who received medications before and during pregnancy and showed more elevated BNP and advanced diastolic dysfunction before pregnancy. Beta-blockers likely allowed similar outcomes for DCM patients with lower initial LVEFs. Close monitoring later in life is required, particularly among the women with peripartum cardiac events.
Copyright © 2020. Published by Elsevier Ltd.
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Neonatal lupus with left bundle branch block and cardiomyopathy: a case report.
BMC Cardiovasc Disord2020 Jul;20(1):352. doi: 10.1186/s12872-020-01637-4.
Rumancik Brad, Haggstrom Anita N, Ebenroth Eric S,
Abstract
BACKGROUND:
Cardiac manifestations of neonatal lupus include an array of structural and conduction abnormalities due to placental transference of maternal anti-SSA/Ro and anti-SSB/La autoantibodies. Late-onset neonatal lupus cardiomyopathies, occurring outside the neonatal period, is an infrequently reported manifestation with unknown pathophysiology and poorly defined treatment regimens. Due to the rarity of this condition, additional studies and case reports are required to better understand and manage late-onset neonatal lupus cardiomyopathies.
CASE PRESENTATION:
A 4-week-old female, born to a mother with known anti-SSA/Ro and anti-SSB/La autoantibodies, presents with classic cutaneous manifestations for neonatal lupus and is found to have left bundle branch block, severely dilated cardiomyopathy with an ejection fraction of 25%, and a thin echogenic dyskinetic ventricular septum. Weekly second trimester and 30-week fetal echocardiograms showed no signs of structural or conduction abnormalities. There were no histologic signs of inflammation on cardiac tissue biopsy. After a complicated hospital course, she was successfully treated with biventricular pacemaker, intravenous immunoglobulin, and plasmapheresis.
CONCLUSIONS:
We present a case of late-onset neonatal lupus with severe dilated cardiomyopathy, a dyskinetic ventricular septum, and left bundle branch block. To our knowledge, the dyskinetic ventricular septum has never been reported and left bundle branch block is rarely reported in NL. This case further validates the need for long term cardiac follow up for patients born with NL, even if lacking cardiac manifestations in the peripartum period. We characterize a unique presentation of a rare clinical entity, highlighting the diagnostic challenges, and describe a successful treatment course.
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[The Effect of Bromocriptine on Clinical and Laboratory Parameters in Patients With Peripartum Cardiomyopathy].
Kardiologiia2020 Jul;60(6):984. doi: 10.18087/cardio.2020.6.n984.
Kurbanov R D, Mirzarakhimova S T, Abdullaev T A, Tsoy I A,
Abstract
Aim To evaluate the effect of bromocriptine on clinical hemodynamic and functional indexes and to analyze life prognosis for patients with periportal cardiomyopathy divided into two groups: group 1, bromocriptine treatment (n=21) and group 2, standard treatment without bromocriptine (n=22). History was taken, examination and standard clinical evaluation were performed, the Clinical Condition Scale (CCS with V.Yu. Mareev, 2000, modification) was administered, and 6-min walk test (6MWT) was performed. Quality of life was determined with the Minnesota questionnaire. Standard 12-lead electrocardiography, echocardiography, and blood biochemistry with measuring C-reactive protein (CRP) and prolactin, were performed. Follow-up duration was one year.Results Heart rate was significantly decreased in group 1 (22.7%) compared to group 2 (18%); the 6-min distance was increased (61 and 50?%, respectively), the total CCS score was decreased (66 and 55?%, respectively, and the quality of life Minnesota questionnaire score was improved (from 68.4±12.4 to 26.4±12.4 and from 63.4±10.9 to 36.4±15.1, respectively). Also, left ventricular (LV) end-diastolic dimension was reduced from 66.82±7.07 to 60.67±3.79?mm (9.2?%) in group 1 and from 61.92±4.41 to 58.91±4.68?mm (5?%) in group 2, which was associated with increases in LV ejection fraction by 18.3 and 14.5?%, respectively. In both groups, CRP concentration was decreased from 8.3±4.1 to 4.3±1.2?mg/l and from 8.5±3.5 to 6.3±1.5?mg/l, respectively. The bromocriptine treatment was associated with a significant decrease in prolactin level (62?%). The LV function completely recovered in 66.6% of patients in group 1 and in 27% of patients in group 2.Conclusion The bromocriptine treatment of periportal cardiomyopathy in combination with an optimal drug therapy was associated with an additional beneficial effect on the clinical functional status, intracardiac hemodynamics, blood concentration of CRP, and a potentiality for complete recovery of the LV function.
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Earlier Diagnosis of Peripartum Cardiomyopathy (PPCM).
Circ J -
The High, the Low, and the Narrow QRS in Peripartum Cardiomyopathy.
Circulation2020 Jul;142(2):178-180. doi: 10.1161/CIRCULATIONAHA.120.046608.
Di Cosola Roberta, Vicenzi Marco, Di Odoardo Luca A F,
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Complement-Mediated Disorders in Pregnancy.
Adv Chronic Kidney Dis2020 Mar;27(2):155-164. doi: S1548-5595(20)30002-1.
Amari Chinchilla Kana, Vijayan Madhusudan, Taveras Garcia Bruna, Jim Belinda,
Abstract
Complement-mediated disorders in pregnancy span a large spectrum and have been implicated in all three complement pathways: classical, lectin, and alternative. Our understanding of these disorders in recent years has advanced due to a better understanding of complement regulatory proteins, such as complement factor H, complement factor I, membrane cofactor protein, and thrombomodulin that particularly affect the alternative complement pathway. Enthusiasm in genotyping for mutations that encode these proteins has allowed us to study the presence of genetic variants which may predispose women to develop conditions such as pregnancy-associated hemolytic uremic syndrome (P-aHUS), thrombotic thrombocytopenic purpura, preeclampsia/hemolysis, elevated liver enzymes, low platelets (HELLP), systemic lupus erythematosus/antiphospholipid syndrome, and peripartum cardiomyopathy. The advent of the anti-C5-antibody eculizumab to quench the complement cascade has already proven in small case series to improve maternal kidney outcomes in complement-mediated obstetric catastrophes such as P-aHUS and HELLP. In this review, we will detail the pathogenesis behind these complement-mediated pregnancy disorders, the role of complement variants in disease phenotype, and the most up-to-date experience with eculizumab in this population.
Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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Common genetic predisposition for heart failure and cancer.
Herz2020 Jun;():. doi: 10.1007/s00059-020-04953-9.
Pfeffer Tobias J, Pietzsch Stefan, Hilfiker-Kleiner Denise,
Abstract
Cardiovascular diseases and cancer are major causes of mortality in industrialized societies. They share common risk factors (e.g., genetics, lifestyle, age, infection, toxins, and pollution) and might also mutually promote the onset of the respective other disease. Cancer can affect cardiac function directly while antitumor therapies may have acute- and/or late-onset cardiotoxic effects. Recent studies suggest that heart failure might promote tumorigenesis and tumor progression. In both cancer and cardiovascular diseases, genetic predisposition is implicated in the disease onset and development. In this regard, genetic variants classically associated with cardiomyopathies increase the risk for toxic side effects on the cardiovascular system. Genetic variants associated with increased cancer risk are frequent in patients with peripartum cardiomyopathy complicated by cancer, pointing to a common genetic predisposition for both diseases. Common risk factors, cardiotoxic antitumor treatment, genetic variants (associated with cardiomyopathies and/or cancer), and increased cardiac stress lead us to propose the "multi-hit hypothesis" linking cancer and cardiovascular diseases. In the present review, we summarize the current knowledge on potential connecting factors between cancer and cardiovascular diseases with a major focus on the role of genetic predisposition and its implication for individual therapeutic strategies and risk assessment in the novel field of oncocardiology.
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Inhibition of the Notch1 pathway induces peripartum cardiomyopathy.
J Cell Mol Med2020 Jun;():. doi: 10.1111/jcmm.15423.
Zhu Rong-Rong, Chen Qian, Liu Zhi-Bo, Ruan Han-Guang, Wu Qi-Cai, Zhou Xue-Liang,
Abstract
Increased expression and activity of cardiac and circulating cathepsin D and soluble fms-like tyrosine kinase-1 (sFlt-1) have been demonstrated to induce and promote peripartum cardiomyopathy (PPCM) via promoting cleavage of 23-kD prolactin (PRL) to 16-kD PRL and neutralizing vascular endothelial growth factor (VEGF), respectively. We hypothesized that activation of Hes1 is proposed to suppress cathepsin D via activating Stat3, leading to alleviated development of PPCM. In the present study, we aimed to investigate the role of Notch1/Hes1 pathway in PPCM. Pregnant mice between prenatal 3 days and postpartum 3 weeks were fed with LY-411575 (a notch inhibitor, 10 mg/kg/d). Ventricular function and pathology were evaluated by echocardiography and histological analysis. Western blotting analysis was used to examine the expression at the protein level. The results found that inhibition of Notch1 significantly promoted postpartum ventricular dilatation, myocardial hypertrophy and myocardial interstitial fibrosis and suppressed myocardial angiogenesis. Western blotting analysis showed that inhibition of Notch1 markedly increased cathepsin D and sFlt-1, reduced Hes1, phosphorylated Stat3 (p-Stat3), VEGFA and PDGFB, and promoted cleavage of 23k-D PRL to 16-kD PRL. Collectively, inhibition of Notch1/Hes1 pathway induced and promoted PPCM via increasing the expressions of cathepsin D and sFlt-1. Notch1/Hes1 was a promising target for prevention and therapeutic regimen of PPCM.
© 2020 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.
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Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy.
Am J Perinatol2020 Jun;():. doi: 10.1055/s-0040-1712451.
Cho Seo-Ho, Leonard Stephanie A, Lyndon Audrey, Main Elliott K, Abrams Barbara, Hameed Afshan B, Carmichael Suzan L,
Abstract
OBJECTIVE:
?The aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy.
STUDY DESIGN:
?This population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (?=?2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m) was classified as normal weight (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (?40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities.
RESULTS:
?The overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (?=?320). Unadjusted ORs were 1.32 (95% CI: 1.01-1.74) for women with overweight BMI and 2.03 (95% CI: 1.57-2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95-1.66) for overweight women and 1.38 (95% CI: 1.04-1.84) for women with obesity. The ORs suggested a dose-response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00.
CONCLUSION:
?Pre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period.
KEY POINTS:
· Pre-pregnancy obesity affects maternal health.. · Effects may extend to peripartum cardiomyopathy.. · The risk includes peripartum cardiomyopathy that emerges postpartum..
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Racial disparities in peripartum cardiomyopathy: eighteen years of observations.
J Matern Fetal Neonatal Med2020 Jun;():1-8. doi: 10.1080/14767058.2020.1773784.
Sinkey Rachel G, Rajapreyar Indranee N, Szychowski Jeff M, Armour Emily K, Walker Zachary, Cribbs Marc G, Howard Tera F, Wetta Luisa A, Subramaniam Akila, Tita Alan T,
Abstract
Black women have greater than a three-fold risk of pregnancy-associated death compared to White women; cardiomyopathy is a leading cause of maternal mortality. This study examined racial disparities in health outcomes among women with peripartum cardiomyopathy. Retrospective cohort of women with peripartum cardiomyopathy per the National Heart, Lung, and Blood Institute definition from January 2000 to November 2017 from a single referral center. Selected health outcomes among Black and White women were compared; primary outcome was ejection fraction at diagnosis. Secondary outcomes included cardiovascular outcomes, markers of maternal morbidity, resource utilization, and subsequent pregnancy outcomes. Ninety-five women met inclusion criteria: 48% Black, 52% White. Nearly all peripartum cardiomyopathy diagnoses were postpartum (95.4% Black, 93% White, =.11). Ejection fraction at diagnosis was not different between Black and White women (26.8?±?12.5 vs. 28.7?±?9.9, =.41). Though non-significant, fewer Black women had myocardial recovery to EF ?55% (35 vs. 53%, =.07); however, 11 (24%) of Black women vs. 1 (2%) White woman had an ejection fraction ?35% at 6-12?months postpartum (<.01). More Black women underwent implantable cardioverter defibrillator placement: ?=?15 (33%) vs. ?=?7 (14%), =.03. Eight women (8.4%) died in the study period, not different by race (=.48). Black women had higher rates of healthcare utilization. In the subsequent pregnancy, Black women had a lower initial ejection fraction (40 vs. 55%, =.007) and were less likely to recover postpartum (37.5 vs. 55%, =.02). Black and White women have similar mean ejection fraction at diagnosis of peripartum cardiomyopathy, but Black women have more severe left ventricular systolic dysfunction leading to worse outcomes, increased resource use, and lower ejection fraction entering the subsequent pregnancy.
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?1 adrenoceptor antibodies induce myocardial apoptosis via inhibiting PGC-1?-related pathway.
BMC Cardiovasc Disord2020 Jun;20(1):269. doi: 10.1186/s12872-020-01492-3.
Shi Linying, Liu Jia, Zhang Yuan, Chen Mulei, Liu Jiamei,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is life-threatening heart disease. However, the causes and pathogenesis of PPCM remain unclear. Previous studies found that ?1 adrenoceptor antibodies (?1AA) had possible involvement in the development of PPCM. In the present study, we determined the potential relationship between PPCM and ?1AA, including the mechanism of ?1AA leading to PPCM.
METHODS:
We extracted the ?1AA from the postpartum Wistar rats that were injected by the antigen peptide segment of the ?1 adrenoceptor to produce PPCM. We tested the effects of ?1AA on H9C2 cell line by CCK-8, LDH, TUNEL, SA-ELISA, qRT-PCR, and western blot methods. Furthermore, PGC-1? was overexpressed to rescue the effect of ?1AA on H9C2 cells.
RESULTS:
We found that the extracted ?1AA induced apoptosis of cardiac myocytes of H9C2 cell line. Moreover, the expression of peroxisome proliferator-activated receptor ? coactivator-1? (PGC-1?), which is a master regulator of mitochondrial metabolism, and its downstream transcript vascular endothelial growth factor (VEGF) got decreased in H9C2 cells after ?1AA treatment. In addition, the effect of ?1AA could be inhibited by atenolol, the antagonist of ?1 adrenoceptors (?1AR) and imitated by isoprenaline, the agonist of ?1AR. Furthermore, overexpression of PGC-1? in the H9C2 cells rescued the apoptosis of cells and inhibitory expression of VEGF induced by ?1AA.
CONCLUSIONS:
Our results suggest that the symptoms of PPCM due to myocardial cell apoptosis induced by ?1AA inhibiting the PGC-1?-related pathway impairs mitochondrial energy metabolism. Therefore, our results uncover a previously unknown role of the ?1AA pathway in the etiology of PPCM and provide a novel potential target for the treatment of PPCM.
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Mode of delivery is an independent risk factor for maternal mortality: a case-control study.
J Matern Fetal Neonatal Med2020 Jun;():1-7. doi: 10.1080/14767058.2020.1774874.
Balayla Jacques, Lasry Ariane, Badeghiesh Ahmad, Volodarsky-Perel Alexander, Gil Yaron,
Abstract
In contrast to the global trend, the maternal mortality ratio (MMR) in the United States has increased in recent decades. During this time, the cesarean section rate has concurrently and steadily increased. Herein, we sought to determine whether the mode of delivery is an independent risk factor for maternal in-hospital mortality. We conducted a retrospective, population-based, 1:1 matched, case-control study on all births recorded in the Health - Care Cost and Utilization Project - Nationwide Inpatient Sample between 2005 and 2014. We compared cases of maternal mortality and survival on a number of clinical characteristics. We conducted two different multivariate logistic regression analysis models, obtaining the adjusted odds ratios to determine the independent effect of mode of delivery on maternal mortality relative to surviving controls. We found a total of 617 cases of maternal mortality, which corresponds to an in-hospital MMR of 6.9/100,000 in our cohort. We matched 617 controls to mortality cases by year and geographic location. Relative to surviving controls, cases of maternal mortality were older, more likely to be African American, of lesser income, more likely to use Medicaid as payment, to have prolonged admissions, and more likely to have severe obstetrical complications including preterm delivery, postpartum hemorrhage, eclampsia, peripartum cardiomyopathy, pulmonary emboli, and disseminated intravascular coagulation (DIC). Relative to unassisted vaginal delivery, adjusted logistic regression analysis reveals no excess mortality observed with assisted vaginal delivery: OR 1.35, 95% CI [0.59-3.51]. However, after adjusting for demographic and obstetrical confounders, a significant risk of maternal mortality was observed with cesarean delivery: OR 3.21, 95% CI [2.80-3.61], -value = .0001. This risk was more pronounced amongst primary cesarean deliveries: OR 5.72, 95% CI [4.92-6.51], -value = .0001. Cesarean delivery, and particularly primary cesarean delivery, is an independent risk factor for maternal in-hospital mortality. Measures taken to reduce the cesarean section rate may impact the rising maternal mortality ratio (MMR) in the United States.
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T-Peak to T-End Improvements After Beta-Blocker Administration in Peripartum Cardiomyopathy Patients.
Cardiol Res2020 Jun;11(3):185-191. doi: 10.14740/cr1053.
Achmad Chaerul, Iqbal Mohammad, Karwiky Giky, Prameswari Hawani Sasmaya, Febrianora Mega,
Abstract
Background:
Many studies have shown that T-peak to T-end (TPTE) interval was associated with sudden cardiac events. Peripartum cardiomyopathy (PPCM) causes reversible left ventricle systolic dysfunction which may deteriorate into sudden cardiac death. This study aimed to evaluate beta-blocker as an antiarrhythmic agent to improve TPTE interval as a prognostic value of sudden cardiac death.
Methods:
A cohort experimental prospective study was performed. The PPCM was diagnosed from the emergency ward. A total of 54 cases were identified from 2014 to 2016. Thirty-four patients were followed up for further analysis. Electrocardiograms were conducted in all the patients, and TPTE interval was measured. After a follow-up of 6 months of beta-blocker treatment, the echocardiography and TPTE interval were measured again to obtain the repolarization heterogeneity.
Results:
The mean age of subjects was 32 ± 6.4 years. The mean left ventricular ejection fraction (LVEF) was 32.24±6.3%. The mean TPTE interval was 123.7 ± 28.2 ms. After 6 months of beta-blocker administration, the mean LVEF was 58.26±4.4% and the mean TPTE was 98.7 ± 39.5 ms. The paired -test showed a significant difference between TPTE interval pre- and post-administration of beta-blocker (P value < 0.001).
Conclusions:
There is an improvement of TPTE in PPCM patients after 6 months of beta-blocker administration. Administration of beta-blocker in PPCM patients is expected to prevent sudden cardiac death in PPCM populations.
Copyright 2020, Achmad et al.
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Hypoproteinemia as a parameter of poor perinatal/neonatal outcomes in women with preeclampsia diagnosed as hypertension plus proteinuria.
Pregnancy Hypertens2020 May;21():111-117. doi: S2210-7789(20)30076-3.
Morikawa Mamoru, Mayama Michinori, Saito Yoshihiro, Akabane-Nakagawa Kinuko, Umazume Takeshi, Chiba Kentaro, Kawaguchi Satoshi, Cho Kazutoshi, Watari Hidemichi,
Abstract
OBJECTIVES:
To investigate the relationship between serum total protein (TP) levels and maternal/neonatal outcomes among pregnant women with preeclampsia.
STUDY DESIGN:
TP was measured at preeclampsia diagnosis and delivery in 94 women with singleton pregnancies and preeclampsia as hypertension with proteinuria who delivered at ? 22 gestational weeks (GWs). As a control group, measurements were also made in 188 women with singleton pregnancies without hypertension and/or proteinuria.
MAIN OUTCOME MEASURES:
The relationship between serum TP levels and maternal outcomes.
RESULTS:
Serum TP levels showed a significantly negative relationship with urine protein-to-creatinine (P/C) ratio at preeclampsia diagnosis and delivery. Serum TP levels at delivery in the preeclampsia group (53 ± 7 g/L) were lower than in the control group (61 ± 4 g/L, P < 0.0001). In each group, there was no relationship between the daily decrease in TP and the daily increase maternal body weight. However, there was a positive relationship between the daily increase in P/C ratio and the daily increase in maternal body weight in the preeclampsia group (P = 0.0021). Severe hypoproteinemia at preeclampsia diagnosis was a predictor of abruptio placentae (TP < 49 g/L; odds ratio, 21.3) and peripartum cardiomyopathy (TP < 45 g/L; odds ratio, 43.5). Furthermore, women with severe hypoproteinemia at delivery had higher morbidity due to pulmonary edema (TP < 55 g/L; odds ratio, 26.4) and central serous chorioretinopathy (TP < 42 g/L; odds ratio, 264).
CONCLUSIONS:
Serum TP levels and proteinuria severity at preeclampsia diagnosis and delivery showed a positive relationship and predicted poor maternal outcome.
Copyright © 2020 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
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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 J S,
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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, Al-Musawi Mohammed, 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 the puerperium was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases including PubMed MEDLINE, Embase, and Cochrane Library were queried. Manuscripts that 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 of 6222 references were included with a total of 14 patients. The median age of patients was 31.5 years. Embolism, present in eight (57%) patients, was slightly more common than thrombosis. All patients had a pregnancy complication or concomitant medical condition that might have predisposed to arterial occlusion either directly or indirectly by leading to iatrogenic arterial injury; peripartum cardiomyopathy, the most common, occurred in six (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 most patients present with embolism or thrombosis without underlying systemic arterial disease.
Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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Extracorporeal membrane oxygenation in pregnancy and the postpartum period: a systematic review of case reports.
Int J Obstet Anesth2020 Aug;43():106-113. 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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