An update on peripartum cardiomyopathy

Abstract

Peripartum cardiomyopathy is a rare but potentially devastating complication of pregnancy. Although the definition of this condition has recently been revised by the Heart Failure Association of the European Society of Cardiology, the pathogenesis of peripartum cardiomyopathy is not well understood and relatively little is known about its incidence and prevalence. Hence, peripartum cardiomyopathy is often under-recognized in the clinical setting. A heightened awareness of this condition and its current management options is therefore warranted throughout primary and secondary care. The identification of the putative role of prolactin in the development and progression of this condition has been recently discovered, with preclinical work suggesting beneficial effects of prolactin antagonism. In this article, we review the literature regarding this condition including these recent advances.

Prolactin actions

“…Recent studies have pointed to 16K PRL as being a causal factor in peripartum cardiomyopathy (HilfikerKleiner et al 2007, Yamac et al 2010, Dalzell et al 2011. Peripartum cardiomyopathy is an uncommon but challenging pathology, and there may be multiple etiologies involved.…”

“…As a consequence, the cardiac capillary network was impaired, leading to cardiomyopathy (Hilfiker-Kleiner et al 2007). A causal role of 16K PRL in human peripartum cardiomyopathy was established by treating women at high risk of peripartum cardiomyopathy with bromocryptine to inhibit PRL secretion after delivery (Hilfiker-Kleiner et al 2007, Dalzell et al 2011.…”

Successful reversal of advanced heart failure due to peripartum cardiomyopathy with aggressive pharmacotherapy and a continuous-flow left ventricular assist device (RCD code: III-1B.8c)

“…PPCM is a rare cardiomyopathy which is associated with systolic dysfunction, malignant arrhythmias, thromboembolism and death and has a wide spectrum of potential clinical presentations [4]. Current understanding of all aspects of this condition is limited and it is often under-recognised in the clinical setting.…”

A novel marker of persistent left ventricular systolic dysfunction in patients with peripartum cardiomyopathy: monocyte count- to- HDL cholesterol ratio

“…PPCM is endemic in parts of Africa, but the actual incidence is unknown [3]. The exact pathophysiological mechanism that leads to PPCM is an unknown but genetic basis, viral myocarditis, abnormal immune or hemodynamic response to pregnancy, nutrient deficiency, increased oxidative stress and inflammation have all been proposed [2, 4–7]. The clinical course is markedly heterogeneous.…”