Katrin Bachelier-Walenta1, Denise Hilfiker-Kleiner, Karen Sliwa. 1. aKlinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar bDepartment of Cardiology und Angiology, Medizinische Hochschule Hannover, Hannover, Germany cFaculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa & IIDMM, University of Cape Town, Cape Town, South Africa.
Abstract
PURPOSE OF REVIEW: Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. Incidences vary geographically; it is common in some countries and rare in others. The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, and increase in the pulmonary capillary wedge pressure. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The syndrome carries a high morbidity and mortality and diagnosis is often delayed. This review focuses on new data and aspects in terms of diagnosis, causes of disease, pharmacological therapy, and management of delivery in patients with PPCM. RECENT FINDINGS: New investigations reveal that PPCM is likely due to multiple factors. It develops based on oxidative stress leading to cleavage of deleterious 16-kDa prolactin, which can be blocked with bromocriptine. New data show furthermore that it is partly a two-hit vascular disease due to imbalances in angiogenic signaling worsening the severity of the disease. SUMMARY: Different mechanisms have been investigated and give rise to promising therapeutic approach, which will be developed based on the new findings.
PURPOSE OF REVIEW: Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. Incidences vary geographically; it is common in some countries and rare in others. The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, and increase in the pulmonary capillary wedge pressure. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The syndrome carries a high morbidity and mortality and diagnosis is often delayed. This review focuses on new data and aspects in terms of diagnosis, causes of disease, pharmacological therapy, and management of delivery in patients with PPCM. RECENT FINDINGS: New investigations reveal that PPCM is likely due to multiple factors. It develops based on oxidative stress leading to cleavage of deleterious 16-kDa prolactin, which can be blocked with bromocriptine. New data show furthermore that it is partly a two-hit vascular disease due to imbalances in angiogenic signaling worsening the severity of the disease. SUMMARY: Different mechanisms have been investigated and give rise to promising therapeutic approach, which will be developed based on the new findings.
Authors: M F Hoes; I van Hagen; F Russo; D J Van Veldhuisen; M P Van den Berg; J Roos-Hesselink; K Y van Spaendonck-Zwarts; P van der Meer Journal: Neth Heart J Date: 2014-09 Impact factor: 2.380