Biomarkers in Peripartum Cardiomyopathy—What We Know and What Is Still to Be Found

Abstract

Peripartum cardiomyopathy (PPCM) is a form of heart failure, often severe, that occurs in previously healthy women at the end of their pregnancy or in the first few months after delivery. In PPCM, the recovery of heart function reaches 45–50%. However, the all-cause mortality in long-term observation remains high, reaching 20% irrespective of recovery status. The incidence of PPCM is increasing globally; therefore, effort is required to clarify the pathophysiological background of the disease, as well as to discover specific diagnostic and prognostic biomarkers. The etiology of the disease remains unclear, including oxidative stress; inflammation; hormonal disturbances; endothelial, microcirculatory, cardiomyocyte and extracellular matrix dysfunction; fibrosis; and genetic mutations. Currently, antiangiogenic 16-kDa prolactin (PRL), cleaved from standard 23-kDa PRL in the case of unbalanced oxidative stress, is recognized as the main trigger of the disease. In addition, 16-kDa PRL causes damage to cardiomyocytes, acting via microRNA-146a secreted from endothelial cells as a cause of the NF-κβ pathway. Bromocriptine, which inhibits the secretion of PRL from the pituitary gland, is now the only specific treatment for PPCM. Many different phenotypes of the disease, as well as cases of non-responders to bromocriptine treatment, indicate other pathophysiological pathways that need further investigation. Biomarkers in PPCM are not well established. There is a deficiency in specific diagnostic biomarkers. Pro-brain-type natriuretic peptide (BNP) and N-terminal BNP are the best, however unspecific, diagnostic biomarkers of heart failure at the moment. Therefore, more efforts should be engaged in investigating more specific biomolecules of a diagnostic and prognostic manner such as 16-kDa PRL, galectin-3, myeloperoxidase, or soluble Fms-like tyrosine kinase-1/placental growth factor ratio. In this review, we present the current state of knowledge and future directions of exploring PPCM pathophysiology, including microRNA and heat shock proteins, which may improve diagnosis, treatment monitoring, and the development of specific treatment strategies, and consequently improve patients’ prognosis and outcome.

Peripartum Cardiomyopathy: A Case Report of Mortality From a Rare and Potentially Fatal Condition

“…PPCM is a serious condition marked by reduced left ventricular function during or after pregnancy, often leading to heart failure. It is distinct from other cardiomyopathies due to its timing and unique features [ 1 ] with a higher prevalence and significantly worse outcomes reported amongst African women; the variable incidence between and within countries could be attributed to the differences in prevalence of both genetic and non-genetic risk factors, as well as disparities in socioeconomic status and access to healthcare [ 3 ].…”

“…Other research suggests that one prominent pathophysiologic theory implicates prolactin, which can undergo enzymatic changes, leading to vasoconstriction, inflammation, and impaired heart muscle function. Additionally, disturbances in proangiogenic and antiangiogenic factors may play roles in PPCM development, affecting endothelial repair and function [ 1 ].…”

“…Peripartum cardiomyopathy (PPCM) represents a significant challenge in maternal health, manifesting as heart failure with reduced ejection fraction during late pregnancy or in the early postpartum period. Despite advances in understanding PPCM, it remains a life-threatening condition associated with substantial maternal morbidity and mortality due to its timing and individual characteristics [ 1 ]. It was first described in the late 1800s, but it is only in recent decades that it has gained recognition as a distinct cardiac condition.…”

“…Diagnostic challenges persist in PPCM, necessitating a comprehensive evaluation incorporating clinical suspicion, advanced imaging modalities such as echocardiography, and the exploration of potential biomarkers to aid in early detection and differentiation from physiological changes of pregnancy [ 1 ].…”

“…Management strategies for PPCM are currently based on general heart failure protocols [ 5 ], with bromocriptine emerging as a specific treatment by inhibiting PRL secretion from the pituitary gland [ 1 , 4 ]. However, the response to treatment varies among patients, highlighting the need for further research into alternative pathophysiological pathways and novel therapeutic targets [ 5 ].…”