A Review on Peripartum Cardiomyopathy | Ten Points to Remember

Authors:
Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J.
Citation:
Peripartum Cardiomyopathy: Current Management and Future Perspectives. Eur Heart J 2015;Jan 30:[Epub ahead of print].

The following are 10 key points about this update of peripartum cardiomyopathy (PPCM):

  1. The incidence of peripartum cardiomyopathy (PPCM) is rising in the United States.
  2. PPCM is an idiopathic cardiomyopathy with heart failure due to left ventricular (LV) dysfunction that presents near the end of pregnancy or in the months after delivery when no other cause is found.
  3. Transthoracic echocardiography is the modality of choice to diagnose PPCM. The role of cardiac magnetic resonance imaging is still being investigated.
  4. Prior studies have demonstrated the importance of low selenium levels, viral infections, stress activated cytokines, inflammation, autoimmune reactions, and hemodynamic stress as factors associated with PPCM.
  5. Biomarkers can help distinguish PPCM from other related pregnancy symptoms. N-terminal pro–B-type natriuretic peptide (NT-proBNP) has been shown to be elevated in PPCM. Other biomarkers that have been associated with PPCM include: 16-kDa prolactin, interferon-y, asymmetric dimethylarginine (ADMA), cathepsin D, soluble fms-like tyrosine kinase-1 (sFlt-1), and microRNA-146a.
  6. MicroRNA-146a has been shown to be specifically increased in the serum of PPCM patients.
  7. PPCM is currently being treated according to heart failure guidelines, which include a medical regimen of: beta-blockers, diuretics, angiotensin-converting enzyme inhibitors/AT1-blockers, and mineralocorticoid receptors antagonists. Studies have reported the beneficial effect of bromocriptine (a prolactin-blocker) in patients who present with acute PPCM. Bromocriptine is currently being evaluated in larger studies to assess its possible effects on blood pressure and thrombosis.
  8. PPCM patients are at risk for sudden cardiac death and benefit from implantable cardioverter-defibrillator and cardiac resynchronization therapy. The option of a wearable defibrillator as a bridge to decision over 3-6 months can also be considered.
  9. Extracorporeal life support systems should be considered for stabilization in patients with PPCM and refractory heart failure.
  10. Standard heart failure therapy should be continued for a minimum of 12 months post-diagnosis. PPCM patients should be advised on contraceptive measures and understand that if cardiac function recovers, cardiac dysfunction can re-emerge if patients are to get pregnant again. Therefore, PPCM patients should be advised not to get pregnant again.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound

Keywords: Cardiomyopathies, Biological Markers, Heart Failure, Peripartum Period, Pregnancy, Death, Sudden, Cardiac, Ventricular Dysfunction, Left, Inflammation, Echocardiography, Defibrillators, Implantable, Cardiac Resynchronization Therapy, Diuretics, Angiotensin-Converting Enzyme Inhibitors, Bromocriptine, MicroRNAs, Natriuretic Peptide, Brain, Receptors, Mineralocorticoid, Selenium


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