Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies

Pachariyanon, Pavida; Bogabathina, Hari; Jaisingh, Keerthish; Modi, Mala; Modi, Kalgi

doi:10.1016/j.jacc.2023.04.043

Cited by 19 publications

(2 citation statements)

References 33 publications

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“…Even in patients who recovered from PPCM, the subsequent pregnancies may again decrease LV contractility. Although the deterioration of LV function associated with subsequent pregnancy is greater in PPCM patients who do not show improved LV function, the mortality rate during eight years of observation is similar, reaching 20% irrespective of the value of the LVEF before subsequent pregnancies [8].…”

Section: Introductionmentioning

confidence: 87%

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

Kryczka,

Demkow,

Dzielińska

2024

Biomolecules

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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.

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Section: Introductionmentioning

confidence: 87%

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

Kryczka,

Demkow,

Dzielińska

2024

Biomolecules

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“…After 5 years of follow-up on 45 patients with SSP, the adverse outcome was significantly higher in a group with persistent LV dysfunction (53.3%), compared with the recovered LV function group (20%), with the mortality rate was 13.33%. 11 However, recovered LV function does not provide a guarantee of an uncomplicated SSP. 12 Some studies also found that SSP in patients with PPCM was well tolerated with no deterioration in cardiac function.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis

Wijayanto,

Myrtha,

Lukas

et al. 2024

Open Heart

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IntroductionThe primary concern for women who have experienced peripartum cardiomyopathy (PPCM) is the safety of a subsequent pregnancy (SSP). To maximie decision-making, facilitate effective patient counselling, and ultimately improve maternal and fetal outcomes as a whole, it is critical to comprehend the outcomes of SSP in women who have previously experienced PPCM. This study aimed to evaluate the outcomes of SSP in women with PPCM.MethodsThree databases (PubMed, Scopus, and ScienceDirect) were used to identify relevant studies prior to 17 October 2023. A total of 662 studies were reviewed. Following the abstract and full-text screenings, 18 observational studies were included, out of which 2 were deemed suitable for inclusion in this meta-analysis. The quality assessment was conducted using the Newcastle-Ottawa Scale.ResultsThis study has a total of 487 SSPs. Although recovered left ventricular (LV) function before entering SSP has the potential to be a beneficial prognostic factor, recovered LV function still has a substantial risk of relapse. The mortality rate of PPCM in an SSP ranged from 0% to 55.5%. Persistent LV dysfunction was significantly associated with an increased mortality rate (OR 13.17; 95% CI 1.54 to 112.28; p=0.02) and lower LV ejection fraction (MD −12.88; 95% CI −21.67 to −4.09; p=0.004). Diastolic and right ventricular functions remained unchanged before SSP and at follow-up. The majority of the SSP was observed alongside hypertension, while pre-eclampsia emerged as the predominant hypertensive complication in most studies.ConclusionSSP increases the risk of relapse and mortality in women with a previous history of PPCM. Persistent LV dysfunction prior to the SSP has a higher mortality risk compared with recovered LV function. SSP was also associated with the worsening of LV echocardiography parameters.

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Pharmacological interventions for peripartum cardiomyopathy

Papapanou,

Vaidakis,

Paraskevas

et al. 2024

Cochrane Database of Systematic Reviews

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Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies

Cited by 19 publications

References 33 publications

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

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

Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis

Pharmacological interventions for peripartum cardiomyopathy

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