Angiogenic Imbalance and Residual Myocardial Injury in Recovered Peripartum Cardiomyopathy Patients

Goland, Sorel; Weinstein, Jean Marc; Zalik, Adi; Kuperstein, Rafael; Zilberman, Liaz; Shimoni, Sara; Arad, Michael; Gal, Tuvia Ben; George, Jacob

doi:10.1161/circheartfailure.116.003349

Cited by 38 publications

(22 citation statements)

References 37 publications

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“…Despite full recovery of resting LVEF, the residual risk of recurrent HF has been documented and linked to the persistence of subclinical systolic dysfunction. This has been shown in a cohort of 29 women with previous PPCM presenting with lower tissue Doppler velocities and GLS of both the LV and right ventricle (RV) despite full LVEF recovery 12 months after the index event (48).…”

Section: Echocardiographymentioning

confidence: 82%

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

Ricci

Innocentiis

Verrengia

et al. 2020

Front. Cardiovasc. Med.

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Ricci et al. Multimodality Imaging in Peripartum Cardiomyopathy KEY POINTS-Peripartum cardiomyopathy is a rare but potentially fatal disease requiring prompt identification and treatment. -Cardiac imaging plays a pivotal role for the diagnosis, risk stratification, and follow-up of peripartum cardiomyopathy and related complications. -Cardiovascular magnetic resonance is a high-throughput imaging modality providing relevant information for clinical decision-making and understanding of the pathophysiology underlying peripartum cardiomyopathy.

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Section: Echocardiographymentioning

confidence: 82%

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

Ricci

Innocentiis

Verrengia

et al. 2020

Front. Cardiovasc. Med.

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“…4,5,21 The higher rates of hypertensive disorders and preeclampsia (22% vs 3-5%) found in PPCM patients than observed during pregnancy further support the hypothesis of a common vascular pathobiology. 22,23 Recent findings in human disease support this notion. Damp et al assessed the time course and relation with LV function of relaxin-2, prolactin, and sFlt1, an antiangiogenic factor released from the placenta peripartum, in 98 women presenting postdelivery with PPCM.…”

Section: Etiopathogenesismentioning

confidence: 91%

“…Angiogenic imbalance may persist even after recovery. In a cohort of 29 PPCM patients with LV function recovery, Goland et al 23 observed higher concentrations of soluble VEGF receptor sFlt1 and decreased levels of circulating endothelial progenitor cells and VEGF than in controls.…”

Section: Etiopathogenesismentioning

confidence: 96%

Peripartum cardiomyopathy: challenges and solutions

Scardovi¹,

Maria²

2017

RRCC

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Peripartum cardiomyopathy (PPCM) is a rare heart disease which affects previously healthy women toward the end of pregnancy or in the months following delivery. The incidence of the disease shows wide regional variations and has been rising, probably due to greater awareness or socioeconomic changes. The etiology and pathogenesis of PPCM are multifactorial and poorly understood. Several hypotheses have been proposed over the years including myocarditis, oxidized prolactin, autoimmunity, malnutrition, genetic susceptibility, and apoptosis. PPCM is still a diagnosis of exclusion. Biomarkers with a strictly pregnancy-related kinetics are unavailable in clinical practice, and their role has not yet been fully elucidated. Globally, prognosis has slightly improved over the past years. In some patients, the clinical status quickly improves and sometimes returns to normal. In others, clinical conditions rapidly worsen and are unresponsive to medical therapy, and chronic heart failure (HF) from persistent left ventricular dysfunction (LVD) develops. Acute care treatment may involve the use of intravenous vasodilators, inotropes, with a prominent role for levosimendan, intra-aortic balloon pump, ventricular assist devices, and heart transplant. Beta-1-adrenergic agonists may promote myocyte loss and HF in PPCM patients, induce permanent damage, and prevent recovery. Novel disease-specific therapeutic concepts, such as targeting 16 kDa prolactin and its downstream mediator miR-146a and/or the vascular endothelial growth factor (VEGF) system, may promote healing. Bromocriptine, a dopamine 2D agonist which blocks prolactin, may be a disease-specific treatment for PPCM in addition to standard therapy in patients with acute onset of the disease. Survivors of PPCM often recover from LVD; however, they may be at risk for HF recurrence and death in subsequent pregnancies. Women with chronic LVD should be managed according to international guidelines, and subsequent gestations should be avoided. Close follow-up and accurate risk stratification are mandatory for women who have recovered from PPCM and need counseling for future pregnancies.

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“…Data have shown that patients with a history of PPCM could have subclinical cardiac dysfunction and demonstrated reduced myocardial strain after recovery in women with PPCM at least 12 months after the diagnosis. There are no published data on the impact on SSP in this group of patients.…”

Section: How Can Patients Be Best Advised About the Risks For A Subsementioning

confidence: 99%

Long‐term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

Sliwa

Petrie

Hilfiker‐Kleiner

et al. 2018

European J of Heart Fail

113

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Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented.

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Angiogenic Imbalance and Residual Myocardial Injury in Recovered Peripartum Cardiomyopathy Patients

Cited by 38 publications

References 37 publications

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy

Peripartum cardiomyopathy: challenges and solutions

Long‐term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy

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