Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging

Ntusi, Ntobeko; Chin, Ashley

doi:10.1007/s00330-008-1244-y

Cited by 15 publications

(8 citation statements)

References 15 publications

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“…The data from this study show that there are significant differences in the time of onset of heart failure, clinical characteristics, and outcomes of patients with HHFP compared to those with truly unexplained PPCM. Hence, these data support the proposal that a history or presence of hypertension in pregnancy should exclude the diagnosis of PPCM, as the two appear to be distinct clinical conditions [ 2 , 3 , 10 ]. However, this study has a number of limitations including small sample size, being from a single centre, differences in follow-up duration between HHFP and PPCM patients, lack of repeat echocardiography in the majority of HHFP patients at follow-up and the lack of information about repeat pregnancies and the potential for confusion between the symptoms of heart failure and the often similar symptoms of normal pregnancy.…”

Section: Discussionsupporting

confidence: 80%

“…Our group has proposed a clear case definition of PPCM, noting that PPCM should be a diagnosis of exclusion that precludes all other known causes of peripartum heart failure, including hypertension [ 3 , 10 ]. Since the seminal description of PPCM by Demakis in 1971, where preeclampsia was found in 22% of the 27 patients studied [ 5 ], it has been unclear what the role of PIH in PPCM is.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy

et al. 2015

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AimsThere is controversy regarding the inclusion of patients with hypertension among cases of peripartum cardiomyopathy (PPCM), as the practice has contributed significantly to the discrepancy in reported characteristics of PPCM. We sought to determine whether hypertensive heart failure of pregnancy (HHFP) (i.e., peripartum cardiac failure associated with any form of hypertension) and PPCM have similar or different clinical features and outcome.Methods and ResultsWe compared the time of onset of symptoms, clinical profile (including electrocardiographic [ECG] and echocardiographic features) and outcome of patients with HHFP (n = 53; age 29.6 ± 6.6 years) and PPCM (n = 30; age 31.5 ± 7.5 years). The onset of symptoms was postpartum in all PPCM patients, whereas it was antepartum in 85% of HHFP cases (p<0.001). PPCM was more significantly associated with the following features than HHFP (p<0.05): twin pregnancy, smoking, cardiomegaly with lower left ventricular ejection fraction on echocardiography, and longer QRS duration, QRS abnormalities, left atrial hypertrophy, left bundle branch block, T wave inversion and atrial fibrillation on ECG. By contrast, HHFP patients were significantly more likely (p<0.05) to have a family history of hypertension, hypertension and pre-eclampsia in a previous pregnancy, tachycardia at presentation on ECG, and left ventricular hypertrophy on echocardiography. Chronic heart failure, intra-cardiac thrombus and pulmonary hypertension were found significantly more commonly in PPCM than in HHFP (p<0.05). There were 5 deaths in the PPCM group compared to none among HHFP cases (p = 0.005) during follow-up.ConclusionThere are significant differences in the time of onset of heart failure, clinical, ECG and echocardiographic features, and outcome of HHFP compared to PPCM, indicating that the presence of hypertension in pregnancy-associated heart failure may not fit the case definition of idiopathic PPCM.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy

et al. 2015

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“…Echocardiography is the keystone in the diagnosis of PPCM and essential in detecting the reduced LV ejection fraction (LVEF) as well as evaluating the presence of LV dilatation or thrombus [16]. Cardiac magnetic resonance imaging (MRI) has been used in a limited number of patients for the assessment of cardiac function and detection of mural thrombi or myocardial fibrosis; however, the use of gadolinium should be avoided during pregnancy, as there are theoretical concerns for fetal nephrogenic toxicity as it crosses the placenta [24][25][26].…”

Section: Diagnostic Challengesmentioning

confidence: 99%

The pregnant heart: cardiac emergencies during pregnancy

McGregor¹,

Barron²,

Rosene‐Montella³

2015

The American Journal of Emergency Medicine

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“…As fibrosis can increase myocardial stiffness and does not contribute to active force development, increased fibrosis can influence both systolic and diastolic function. Increased fibrosis is common in DCM patients (Assomull et al, 2006 ; Herpel et al, 2006 ) and the cardiac STAT3 KO mouse model of PPCM (Ricke-Hoch et al, 2014 ), however, there are limited and contradictory reports about fibrosis in PPCM patients (Kawano et al, 2008 ; Mouquet et al, 2008 ; Leurent et al, 2009 ; Ntusi and Chin, 2009 ).…”

Section: Oxidative Stress and Prolactin: A Deadly Combinationmentioning

confidence: 99%

Peripartum cardiomyopathy and dilated cardiomyopathy: different at heart

et al. 2015

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Peripartum cardiomyopathy (PPCM) is a severe cardiac disease occurring in the last month of pregnancy or in the first 5 months after delivery and shows many similar clinical characteristics as dilated cardiomyopathy (DCM) such as ventricle dilation and systolic dysfunction. While PPCM was believed to be DCM triggered by pregnancy, more and more studies show important differences between these diseases. While it is likely they share part of their pathogenesis such as increased oxidative stress and an impaired microvasculature, discrepancies seen in disease progression and outcome indicate there must be differences in pathogenesis as well. In this review, we compared studies in DCM and PPCM to search for overlapping and deviating disease etiology, pathogenesis and outcome in order to understand why these cardiomyopathies share similar clinical features but have different underlying pathologies.

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Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging

Cited by 15 publications

References 15 publications

Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy

Pregnancy-Associated Heart Failure: A Comparison of Clinical Presentation and Outcome between Hypertensive Heart Failure of Pregnancy and Idiopathic Peripartum Cardiomyopathy

The pregnant heart: cardiac emergencies during pregnancy

Peripartum cardiomyopathy and dilated cardiomyopathy: different at heart

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