Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Bauersachs, Johann; Arrigo, Mattia; Hilfiker‐Kleiner, Denise; Veltmann, Christian; Coats, Andrew J.S.; Crespo-Leiro, María G.; Boer, Rudolf A. de; Meer, Peter van der; Maack, Christoph; Mouquet, Frédéric; Petrie, Mark C.; Piepoli, Massimo F; Regitz‐Zagrosek, Vera; Schaufelberger, Maria; Seferović, Petar; Tavazzi, Luigi; Ruschitzka, Frank; Mebazaa, Alexandre; Sliwa, Karen

doi:10.1002/ejhf.586

Cited by 200 publications

(270 citation statements)

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“…Guidelines advise that standard treatments for heart failure with reduced ejection fraction are indicated in PPCM, with special attention to avoiding adverse fetal effects in women who are still pregnant (table 4). 81114115 In our clinical practice, and in accordance with American81 and European116 guidelines, sodium restriction is the mainstay of volume management, and a loop diuretic may be added for symptomatic pulmonary or peripheral edema 117. Care should be taken to avoid over-diuresis during pregnancy, which could result in maternal hypotension and uterine hypoperfusion.…”

Section: Management Of Peripartum Cardiomyopathymentioning

confidence: 99%

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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Section: Management Of Peripartum Cardiomyopathymentioning

confidence: 99%

Peripartum cardiomyopathy

Honigberg

Givertz

2019

BMJ

145

154

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“…Пролактин 16-kDa усиливает экспрессию микроРНК-146а, ответственную за большинство не-благоприятных эффектов самого гормона, а также секретируется в циркуляцию в виде микрочастиц (эк-зосом), где непосредственно повреждает кардиомио-циты [31]. Аналогичными эффектами, характеризу-ющимися нарушением ангиогенного баланса в око-лородовом периоде, обладают и другие факторы, на-пример растворимая fms-подобная тирозинкиназа-1(sFlt-1), которые вместе с пролактином 16-kDa вы-зывают повреждение эндотелия, кардиомиоцитов и, в конце концов, приводят к СН [10,14].…”

Section: определение и патогенезunclassified

“…Резюмируя результаты многочисленных исследова-ний, посвященных оценке эффективности агонистов рецепторов дофамина, J.D. Fett полагает, что пре-ждевременно рекомендовать широкое использова-ние ингибиторов пролактина (бромокриптина и ка-берголина) для лечения ПКМП [23,24], хотя многие европейские ученые все же включают бромокриптин в программы терапии заболевания, подчеркивая не-обходимость поведения дальнейших контролируе-мых исследований [10,32]. В частности в руковод-стве исследовательской группы ESC по ПКМП бро-мокриптин рекомендуется больным острой ПКМП в качестве дополнительной терапии к лечению СН (по 2,5 мг 2 р/сут в течение 2 нед.…”

Section: патогенетическая терапия перипартальной кардиомиопатииunclassified

“…с последующим снижением до 2,5 мг/сут на 6 нед.) [10]. С учетом ри-ска тромбоэмболических осложнений при лечении бромокриптином, хотя отмеченных в основном при больших дозировках, необходимо одновременное профилактическое назначение гепарина [10].…”

Section: патогенетическая терапия перипартальной кардиомиопатииunclassified

“…[10]. С учетом ри-ска тромбоэмболических осложнений при лечении бромокриптином, хотя отмеченных в основном при больших дозировках, необходимо одновременное профилактическое назначение гепарина [10]. По ре-зультатам работы D. Hilfiker-Kleiner et al низкие дозы бромокриптина (2-5 мг/сут) не сопровождались ка-кими-либо побочными эффектами при лечении 57 больных Регистра ПКМП Германии [32].…”

Section: патогенетическая терапия перипартальной кардиомиопатииunclassified

See 2 more Smart Citations

Treatment of Peripartum Cardiomyopathy (Review)

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Poor Outcomes in Poor Patients?

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Peripartum cardiomyopathy (PPCM) contributes to maternal death during or after pregnancy. Previously healthy women present with often severe heart failure during the last month of pregnancy or the first months postdelivery. 1 Peripartum cardiomyopathy is a global disease that occurs in about 1 in 1000 pregnancies, with a mortality rate ranging from 5% to 30%. Previous analyses have pointed to a worse outcome of patients with PPCM of African ancestry. In this issue of JAMA Cardiology, using a retrospective analysis of the University of Pennsylvania Health System, Irizarry et al 2 present the largest cohort of patients with PPCM to date, including 121 African American women. 2 The investigators used stringent definitions for PPCM and excluded all patients with a potential other explanation for heart failure, such as a history of congenital heart disease, valvular heart disease, or receiving radiation treatment or chemotherapy.African American patients with PPCM were younger, received their diagnoses later during the postpartum period, and presented with significantly lower left ventricular ejection fraction. These results are not completely matched by the baseline characteristics of the recently published first 400 patients in the worldwide PPCM registry of the EURObservational Research Programme. 3 Among these patients, despite the huge differences in sociodemographic factors among regions of the world, the baseline characteristics of patients with PPCM, such as an obstetric history and clinical presentation, were remarkably similar. The mode of presentation and mean age were also independent of ethnic and socioeconomic backgrounds. 3 However, a detailed analysis regarding racial/ethnic groups has yet to be performed in this registry.Even more troublesome in comparison with non-African American patients in the Pennsylvanian cohort with PPCM, African American patients also had a markedly delayed recovery and a much higher proportion did not recover to an ejection fraction of more than 50%, despite receiving similar treatment with drugs often prescribed for heart failure such as angiotensin-converting enzyme inhibitors and β-blockers (although it is unclear whether drug prescription resulted in similar drug intake among African American and non-African American patients, and there are no data reported on drug dosage). However, compared with the Sliwa cohort of African American patients from South Africa 4 that reported a 12% mortality rate, and a recovery of ejection fraction in only 21%, outcomes regarding mortality rates and recovery were clearly better in the current US cohort. In fact, mortality rates and cardiac transplantats, as well as arrhythmia, were not different between African American and non-African American patients.

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Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Cited by 200 publications

References 50 publications

Peripartum cardiomyopathy

Peripartum cardiomyopathy

Treatment of Peripartum Cardiomyopathy (Review)

Poor Outcomes in Poor Patients?

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