Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non–African American Women

Irizarry, Olga Corazón; Levine, Lisa D.; Lewey, Jennifer; Boyer, Theresa; Riis, Valerie; Elovitz, Michal A.; Arany, Zolt

doi:10.1001/jamacardio.2017.3574

Cited by 133 publications

(98 citation statements)

References 19 publications

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“…Africans and African Americans are at a higher risk for developing PPCM, with an estimated incidence of 1:100 pregnancies in Nigeria and 1:299 in Haiti whereas incidences in Caucasian populations range from 1:1500 pregnancies in Germany to 1:10 000 in Denmark . In a large US cohort of well‐phenotyped patients, African American women were diagnosed with PPCM at a younger age and later in the postpartum period, and were more likely to present with a LVEF < 30% compared with non–African American women . In the USA, an increasing incidence was described over the past years .…”

Section: Definition and Epidemiologymentioning

confidence: 99%

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Bauersachs

König

Meer

et al. 2019

European J of Heart Fail

301

311

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Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients

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Section: Definition and Epidemiologymentioning

confidence: 99%

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Bauersachs

König

Meer

et al. 2019

European J of Heart Fail

301

311

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“…Comparison between PPCM collectives of different ethnic backgrounds suggests that African PPCM patients may have a different pathophysiology and a lower chance for full recovery, compared with non‐African patients, but a direct comparison of different ethnic cohorts has not been performed yet. Thus, we aimed to directly compare the outcome of two large PPCM registries, one with patients from South Africa (SA‐PPCM), including only patients of African ethnicity, and one from Germany (G‐PPCM), with only Caucasian patients included.…”

Section: Introductionmentioning

confidence: 99%

Outcome in German and South African peripartum cardiomyopathy cohorts associates with medical therapy and fibrosis markers

et al. 2020

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Aims This study aims to compare the clinical course of peripartum cardiomyopathy (PPCM) cohorts from Germany (G-PPCM) and South Africa (SA-PPCM) with fibrosis-related markers to get insights into novel pathomechanisms of PPCM. Methods and results G-PPCM (n = 79) and SA-PPCM (n = 72) patients and healthy pregnancy-matched women from Germany (n = 56) and South Africa (n = 40) were enrolled. Circulating levels of procollagen type-I (PINP) and type-III (PIIINP) N-terminal propeptides, soluble ST2, galectin-3, and full-length and cleaved osteopontin (OPN) were measured at diagnosis (baseline) and 6 months of follow-up. Both cohorts received standard heart failure therapy while anticoagulation therapy was applied in 100% of G-PPCM but only in 7% of SA-PPCM patients. In G-PPCM patients, baseline left ventricular ejection fraction (LVEF) was lower, and outcome was better (baseline LVEF, 24 ± 8%, full recovery: 52%, mortality: 0%) compared with SA-PPCM patients (baseline LVEF: 30 ± 9%, full recovery: 32%, mortality: 11%; P < 0.05). At baseline, PINP/PIIINP ratio was lower in SA-PPCM and higher in G-PPCM compared with respective controls, whereas total OPN was elevated in both collectives. Cleaved OPN, which increases PIIINP levels, is generated by thrombin and was reduced in patients receiving anticoagulation therapy. High baseline galectin-3, soluble ST2, and OPN levels were associated with poor outcome in all PPCM patients. Conclusions SA-PPCM patients displayed a more profibrotic biomarker profile, which was associated with a less favourable outcome despite better cardiac function at baseline, compared with G-PPCM patients. Use of bromocriptine and anticoagulation therapy in G-PPCM may counteract fibrosis and may in part be responsible for their better outcome.

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“…In the IPAC cohort, mean LVEF at 12 month follow-up was 47% for black women and 56% for non-black women (P=0.001), and 16 of 27 black women recovered LVEF ≥50% compared with 50 of 65 non-black women (P=0.13) 76. Similarly, in a recent series of 220 women, black women were more likely than non-black women to present with LVEF <30% at diagnosis (56.5% v 39.5%; P=0.03) and were more likely to worsen after diagnosis (35.3% v 18.4%; P=0.02) despite similar use of medication in both groups 77. Although rates of adverse clinical events (such as death and cardiac transplantation) in most contemporary studies are sufficiently low that significant differences between racial groups are not apparent, one recent study of 52 black women and 104 non-black women showed higher rates of death or transplantation in black women (P=0.03) 96.…”

Section: Natural Course and Prognosismentioning

confidence: 81%

“…Recent data suggest that 50-80% of women with PPCM recover to normal range left ventricular systolic function (LVEF ≥50%), with most of this recovery occurring within the first six months 3767788. These statistics reflect the great improvement in the prognosis of PPCM since the early 1970s, when reported mortality was 30-50% (table 3).…”

Section: Natural Course and Prognosismentioning

confidence: 96%

Peripartum cardiomyopathy

Honigberg

Givertz

2019

BMJ

145

154

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Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.

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Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non–African American Women

Cited by 133 publications

References 19 publications

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Outcome in German and South African peripartum cardiomyopathy cohorts associates with medical therapy and fibrosis markers

Peripartum cardiomyopathy

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