Cardiogenic shock complicating peripartum cardiomyopathy: Importance of early left ventricular unloading and bromocriptine therapy

Sieweke, Jan‐Thorben; Pfeffer, Tobias Jonathan; Berliner, Dominik; König, Tobias; Hallbaum, Maximiliane; Napp, L. Christian; Tongers, Jörn; Kühn, Christian; Schmitto, Jan D.; Hilfiker‐Kleiner, Denise; Schäfer, Andreas; Bauersachs, Johann

doi:10.1177/2048872618777876

Cited by 52 publications

(53 citation statements)

References 39 publications

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“…The current study is a retrospective analysis of 15 patients with PPCM undergoing LV unloading with Impella devices between November 2008 and October 2015, identified in the global cVAD registry. Of the 15 patients, five patients were treated at Hannover medical school (a cVAD site) and have been previously described . The remaining patients were enrolled at eight cVAD sites within the United States.…”

Section: Methodsmentioning

confidence: 99%

“…CS was defined as hypotension (systolic blood pressure < 90 mm Hg or need for inotropes/vasopressors to maintain systolic blood pressure > 90 mm Hg) and/or end‐organ hypoperfusion indicated by altered mental status, clammy skin, or lactate >2 mmol/L after adequate correction of preload . All patients were admitted to the intensive care unit where hemodynamic support with an Impella device was initiated.…”

Section: Methodsmentioning

confidence: 99%

“…Patients were treated according to current guidelines and institutional standard of care for acute heart failure and CS. Five patients (from Hannover cohort) also received the prolactin inhibitor bromocriptine, according to the bromocriptine treatment scheme for women with PPCM and CS from Hannover Medical school . Bromocriptine dosage was adjusted based on sequential measurements of prolactin levels (up to 10 mg twice a day, if necessary).…”

Section: Methodsmentioning

confidence: 99%

“…The Impella devices (Abiomed, Danvers, Massachusetts) are transvalvular microaxial pumps that can be rapidly deployed in the catheterization lab and provide LV unloading with forward blood flow of up to 5 L/min. 6 Given the low prevalence, published reports on the use of Impella devices in PPCM is limited . We report on 15 women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry.…”

Section: Introductionmentioning

confidence: 99%

“…6 Given the low prevalence, published reports on the use of Impella devices in PPCM is limited. 9,10 We report on 15 women with PPCM supported with an Impella device from the global catheter-based ventricular assist device (cVAD) Registry. This study, to our knowledge, is the largest reported series to date on the use of Impella devices in women with severe heart failure and CS due to PPCM.…”

mentioning

confidence: 99%

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Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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Racial and Ethnic Disparities in the Trends and Outcomes of Cardiogenic Shock Complicating Peripartum Cardiomyopathy

et al. 2022

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Clinical characteristics and long‐term outcomes of peripartum takotsubo cardiomyopathy and peripartum cardiomyopathy

Kim

Park

et al. 2020

ESC Heart Failure

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Aims Although some peripartum-associated cardiomyopathy patients present with features that are clinically and echocardiographically similar to those of takotsubo cardiomyopathy (TCM), little is known about the diagnosis and clinical course of peripartum TCM. Methods and results In a tertiary hospital in Seoul, Korea, we searched the hospital database to find cardiomyopathy cases that were associated with pregnancy from January 1995 to May 2019. Applying the published diagnostic criteria, we sought peripartum cardiomyopathy (PPCM) and peripartum TCM patients for comparison. Of 31 pregnancy-associated cardiomyopathy patients, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-miss death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 57.1%, P = 0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricular dysfunction. One death and one heart transplantation occurred in the PPCM group, while neither occurred in the peripartum TCM group. There was no difference between the two groups in terms of the rate of major adverse clinical events at 3 years of follow-up [PPCM group: 26.3% (5/19) vs. TCM group: 33.3% (3/9), P = 0.750]. Conclusions One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.

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Cardiogenic shock complicating peripartum cardiomyopathy: Importance of early left ventricular unloading and bromocriptine therapy

Cited by 52 publications

References 39 publications

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Racial and Ethnic Disparities in the Trends and Outcomes of Cardiogenic Shock Complicating Peripartum Cardiomyopathy

Clinical characteristics and long‐term outcomes of peripartum takotsubo cardiomyopathy and peripartum cardiomyopathy

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