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Ejim EC, Karaye KM, Antia S, Isiguzo GC, Njoku PO. Peripartum cardiomyopathy in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 93:102476. [PMID: 38395024 DOI: 10.1016/j.bpobgyn.2024.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women without known cardiovascular disease. PPCM is a global disease, but with a significant geographical variability within and between countries. Its true incidence in Africa is still unknown because of the lack of a PPCM population-based study. The variability in the epidemiology of PPCM between and within countries could be due to differences in the prevalence of both genetic and non-genetic risk factors. Several risk factors have been implicated in the aetiopathogenesis of PPCM over the years. Majority of patients with PPCM present with symptoms and signs of congestive cardiac failure. Diagnostic work up in PPCM is prompted by strong clinical suspicion, but Echocardiography is the main imaging technique for diagnosis. The management of PPCM involves multiple disciplines - cardiologists, anaesthetists, intensivists, obstetricians, neonatologists, and the prognosis varies widely.
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Affiliation(s)
- Emmanuel C Ejim
- Department of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria.
| | - Kamilu M Karaye
- Bayero University & Aminu Kano Teaching Hospital Kano, Nigeria.
| | - Samuel Antia
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Godsent C Isiguzo
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Paschal O Njoku
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
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2
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Radakrishnan A, Dokko J, Pastena P, Kalogeropoulos AP. Thromboembolism in peripartum cardiomyopathy: a systematic review. J Thorac Dis 2024; 16:645-660. [PMID: 38410599 PMCID: PMC10894371 DOI: 10.21037/jtd-23-945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/01/2023] [Indexed: 02/28/2024]
Abstract
Background Women with peripartum cardiomyopathy (PPCM) are at an increased risk of arterial and venous thromboembolic events. The review summarizes the evidence on the incidence of thromboembolic complications in women with PPCM, diagnostic approaches, related outcomes, and effects of therapies that have been used. Methods English articles were retrieved from Web of Science and PubMed using search terms to capture studies related to PPCM (or postpartum cardiomyopathy) and all combinations of thrombosis- and embolism-related keywords. A total of 347 articles from PubMed and 85 from Web of Science were obtained, and after removing duplicates, 327 articles were screened for original data and classified into four domains: epidemiology, risk factors, diagnosis, and therapy of thromboembolism in PPCM. Ultimately, 30 articles were included. Data were synthesized in summary tables for each domain. Results Studies in the United States and Europe reported varying incidence for thromboembolism in PPCM, up to 14% in 6 months. Risk factors include elevated levels of coagulation factors, decreased protein C and S activity, decreased fibrinolysis, and a low left ventricular ejection fraction (LVEF). Cesarean delivery and post-operative status were correlated with a higher incidence of thromboembolic complications. Diagnosis relied mostly on ultrasonography and magnetic resonance and depended on the suspected location of thrombus. Anticoagulation has been used mostly for PPCM patients with a reduced LVEF, with the duration varying across guidelines and healthcare systems. Unfractionated heparin and low molecular weight heparin (LMWH) were considered safe choices during pregnancy, while warfarin and novel oral anticoagulants (NOACs) were used postpartum. The association of bromocriptine with risk of thromboembolic complications remains debated. Conclusions There are important gaps in our understanding of the epidemiology, risk stratification, and optimal secondary prevention of thromboembolism in PPCM. Larger prospective studies with detailed phenotyping are required.
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Affiliation(s)
| | - Julia Dokko
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Paola Pastena
- Division of Cardiology, Stony Brook University, Stony Brook, NY, USA
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3
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Arany Z. Peripartum Cardiomyopathy. N Engl J Med 2024; 390:154-164. [PMID: 38197818 DOI: 10.1056/nejmra2306667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Zoltan Arany
- From the Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Dewi IP, Wardhani LFK, Maghfirah I, Dewi KP, Subagjo A, Alsagaff MY, Nugroho J. Association polymorphism of guanine nucleotide–binding protein β3 subunit (GNB3) C825T and insertion/deletion of the angiotensin-converting enzyme (ACE) gene with peripartum cardiomyopathy. Front Cardiovasc Med 2023; 10:1096514. [PMID: 37089887 PMCID: PMC10113497 DOI: 10.3389/fcvm.2023.1096514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
IntroductionPeripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-related heart disease. Genetic roles such as gene polymorphisms may relate to the etiology of PPCM. This study analyzes the association between single nucleotide gene polymorphism (SNP) guanine nucleotide–binding protein beta-3 subunit (GNB3) C825T and insertion/deletion (I/D) of the angiotensin-converting enzyme (ACE) gene with the incidence of PPCM.MethodsAn analytic observational study with a case–control design was conducted at the Integrated Cardiac Service Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. PPCM patients of the case and control groups were enrolled. Baseline characteristic data were collected and blood samples were analyzed for SNP in the GNB3 C825T gene and for I/D in the ACE gene by using the polymerase chain reaction, restriction fragment length polymorphism, and Sanger sequencing. We also assessed ACE levels among different ACE genotypes using a sandwich-ELISA test.ResultsA total of 100 patients were included in this study, with 34 PPCM cases and 66 controls. There were significant differences in GNB3 TT and TC genotypes in the case group compared with that in the control group (TT: 35.3% vs. 10.6%, p = 0.003; TC: 41.2% vs. 62.5%, p = 0.022). The TT genotype increased the risk of PPCM by 4.6-fold. There was also a significant difference in the ACE DD genotype in the case group compared with that in the control group (26.5% vs. 9.1%, p = 0.021). DD genotypes increased the risk of PPCM by 3.6-fold. ACE levels were significantly higher in the DD genotype group than in the ID and II genotype groups (4,356.88 ± 232.44 pg/mL vs. 3,980.91 ± 77.79 pg/mL vs. 3,679.94 ± 325.77 pg/mL, p < 0.001).ConclusionThe TT genotype of GNB3 and the DD genotype of the ACE are likely to increase the risk of PPCM. Therefore, these polymorphisms may be predisposing risk factors for PPCM incidence. ACE levels were significantly higher in the DD genotype group, which certainly had clinical implications for the management of PPCM patients in the administration of ACE inhibitors as one of the therapy options.
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Affiliation(s)
- Ivana Purnama Dewi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
- Correspondence: Ivana Purnama Dewi
| | - Louisa Fadjri Kusuma Wardhani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Irma Maghfirah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kristin Purnama Dewi
- Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Agus Subagjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Mochamad Yusuf Alsagaff
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Johanes Nugroho
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University—Dr. Soetomo General Hospital, Surabaya, Indonesia
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The genetic basis for adult-onset idiopathic dilated cardiomyopathy in people of African descent. Heart Fail Rev 2023:10.1007/s10741-023-10302-9. [PMID: 36917398 PMCID: PMC10011790 DOI: 10.1007/s10741-023-10302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
Cardiomyopathies are a heterogeneous group of cardiac muscle disorders that result in dilated, hypertrophic, or restrictive pathophysiological entities. Dilated cardiomyopathy (DCM) is the most common form in sub-Saharan Africa (SSA). However, population-specific research studies reporting the actual burden of DCM in this region are still lacking. Also, little is known about the genetic basis of DCM in this population, and genetic testing is still not readily accessible. This review describes the common pathogenic genes implicated in DCM globally and discusses the evidence-based management of patients with DCM. We also present a summary of studies describing genes implicated or associated with DCM in patients residing in SSA.
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Abstract
PURPOSE OF REVIEW Peripartum cardiomyopathy (PPCM) contributes significantly to maternal morbidity and mortality worldwide. In this review, we describe the present-day epidemiology and current understanding of the pathogenesis of PPCM. We provide an updated approach to diagnosis and management of PPCM, and discuss risk factors and predictors of outcome. RECENT FINDINGS The highest incidences of PPCM have been reported in African, Asian, and Caribbean populations. Contemporary literature supports a 'two-hit' hypothesis, whereby the 'first hit' implies a predisposition, and the 'second hit' refers to an imbalanced peripartal hormonal milieu that results in cardiomyopathy. Whereas a half of patients will have left ventricular (LV) recovery, a tenth do not survive. Clinical findings and special investigations (ECG, echocardiography, cardiac MRI, biomarkers) can be used for risk stratification. Frequent prescription of guideline-directed medical therapy is associated with improved outcomes. SUMMARY Despite advances in elucidating the pathogenesis of PPCM, it remains unclear why only certain women develop the disease. Moreover, even with better diagnostic work-up and management, it remains unknown why some patients with PPCM have persistent LV dysfunction or die. Future research should be aimed at better understanding of the mechanisms of disease and finding new therapies that could improve survival and LV recovery.
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Mujkanovic J, Qayyum AA. Review of Randomized Controlled Trials in Patients with Peripartum Cardiomyopathy. Curr Cardiol Rev 2023; 19:e230822207933. [PMID: 36017853 PMCID: PMC10201896 DOI: 10.2174/1573403x18666220823151854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Peripartum cardiomyopathy (PPCM) is a rare but potentially lifethreatening disease, defined as idiopathic cardiomyopathy occurring towards the end of pregnancy or in the months following delivery, abortion or miscarriage. We aim to raise awareness of this condition and give an overview of current knowledge as well as an insight and comparison of clinical trials focusing on randomized controlled trials. MATERIAL AND METHODS Systematic literature searches were conducted using PubMed up to December 2021. Studies published involving clinical trials and interventions in women with PPCM after 1970 were selected. RESULTS Randomized controlled trials have shown that the addition of Bromocriptine to standardized heart failure therapy improves outcome in terms of recovery of Left Ventricular Ejection Fraction (LVEF), symptoms and death. Bromocriptine 2.5 mg twice daily for two weeks followed by 2.5 mg once daily for six weeks had the best trend and outcome. The addition of Levosimendan to standardized heart failure therapy had no effect, whereas the addition of Selenium improved heart failure symptoms but did not reduce risk in terms of unrecovered LVEF or death. One prospective study showed potential usage of TNF-alfa inhibitors, but was never tried in a randomized clinical trial. CONCLUSION PPCM is a rare and potentially fatal disease. New insights on pathophysiology, genetics and clinical studies, particularly randomized controlled trials, have shown that the addition of Bromocriptine has a beneficial effect in terms of improved LVEF and death. However, some clinical studies have shown promising results using anti-inflammatory pharmacological agents with an improvement in LVEF. We suggest that targeting an anti-inflammatory route may prove beneficial in patients with PPCM. However, further research is highly warranted.
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Affiliation(s)
- Jasmin Mujkanovic
- Department of Cardiology, Rigshospitalet Glostrup, Nordre Ringvej 57,2600 Glostrup, Denmark
| | - Abbas Ali Qayyum
- Department of Cardiology, Amager-Hvidovre Hospital, Kettegaard Alle 30, 2650 Hvidovre, Denmark
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Hoevelmann J, Engel ME, Muller E, Hohlfeld A, Böhm M, Sliwa K, Viljoen C. A global perspective on the management and outcomes of peripartum cardiomyopathy: a systematic review and meta-analysis. Eur J Heart Fail 2022; 24:1719-1736. [PMID: 35778990 DOI: 10.1002/ejhf.2603] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/03/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Peripartum cardiomyopathy (PPCM) remains a major contributor to maternal morbidity and mortality worldwide. The disease is associated with various complications occurring mainly early during its course. Reported adverse outcomes include decompensated heart failure, thromboembolic complications, arrhythmias and death. We sought to systematically and comprehensively review published literature on the management, and outcome of women with PPCM across different geographical regions and to identify possible predictors of adverse outcomes. METHODS AND RESULTS We performed a comprehensive search of relevant literature (2000 to June 2021) across a number of electronic databases. Cohort, case-control and cross-sectional studies, as well as control arms of randomised controlled trials reporting on six- and/or twelve-month outcomes of PPCM were considered eligible (PROSPERO registration: CRD42021255654). Forty-seven studies (4875 patients across 60 countries) met the inclusion criteria. Haemodynamic and echocardiographic parameters were similar across all continents. All-cause mortality was 8.0% [95% CI 5.5-10.8, I2 =79.1%) at six months and 9.8% [95% CI 6.2-14.0], I2 =80.5%) at twelve months, respectively. All-cause mortality was highest in Africa and Asia/Pacific. Overall, 44.1% ([95% CI 36.1-52.2], I2 =91.7%) of patients recovered their LV function within six months and 58.7% ([95% CI 48.1-68.9], I2 =75.8%) within twelve months, respectively. Europe and North America reported the highest prevalence of LV recovery. Frequent prescription of beta-blocker, ACE-I/ARB and bromocriptine/cabergoline were associated with significantly lower all-cause mortality and better LV recovery. CONCLUSION We identified significant global differences in six- and twelve-month outcomes in women with PPCM. Frequent prescription of guideline-directed heart failure therapy was associated with better LV recovery and lower all-cause mortality. Timely initiation and up-titration of heart failure therapy should therefore be strongly encouraged to improve outcome in PPCM. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg (Saar), Deutschland
| | - Mark E Engel
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elani Muller
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ameer Hohlfeld
- South African Medical Research Council, Cape Town, South Africa
| | - Michael Böhm
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg (Saar), Deutschland
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charle Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Peripartum cardiomyopathy: a global effort to find the cause and cure for the rare and little understood disease. Biophys Rev 2022; 14:369-379. [PMID: 35340597 PMCID: PMC8921403 DOI: 10.1007/s12551-022-00930-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
In this review, we present our current understanding of peripartum cardiomyopathy (PPCM) based on reports of the incidence, diagnosis and current treatment options. We summarise opinions on whether PPCM is triggered by vascular and/or hormonal causes and examine the influence of comorbidities such as preeclampsia. Two articles published in 2021 strongly support the hypothesis that PPCM may be a familial disease. Using large cohorts of PPCM patients, they summarised the available genomic DNA sequence data that are expressed in human cardiomyocytes. While PPCM is considered a disease predominately affecting the left ventricle, there are data to suggest that some cases also involve right ventricular failure. Finally, we conclude that there is sufficient evidence to warrant an RNAseq investigation and that this would be most informative if performed at the cardiomyocytes level rather than analysing genomic DNA from the peripheral circulation. Given the rarity of PPCM, the combined resources of international human heart tissue biobanks have assembled 30 ventricular tissue samples from PPCM patients, and we are actively seeking to enlarge this patient base by collaborating with human heart tissue banks and research laboratories who would like to join this endeavour.
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Abstract
Peripartum cardiomyopathy (PPCM) is a form of heart failure that occurs toward the end of pregnancy or in the months following pregnancy and is marked by left ventricular systolic dysfunction. The cause of PPCM remains unknown and there is no diagnostic test specific to PPCM. Outcomes vary and include complete left ventricular recovery, persistent cardiac dysfunction, transplant, and death. Numerous advances have been made in understanding this disease, but many knowledge gaps remain. This article reviews recent data and recommendations for clinical practice in addition to highlighting the multiple knowledge gaps related to PPCM that warrant further investigation.
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Affiliation(s)
- Erika J Douglass
- Department of Cardiovascular Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA; Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lori A Blauwet
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Sliwa K, Bauersachs J, Arany Z, Spracklen TF, Hilfiker-Kleiner D. Peripartum cardiomyopathy: from genetics to management. Eur Heart J 2021; 42:3094-3102. [PMID: 34322694 DOI: 10.1093/eurheartj/ehab458] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a disease that occurs globally in all ethnic groups and should be suspected in any peripartum women presenting with symptoms and signs of heart failure, towards the end of pregnancy or in the months following delivery, with confirmed left ventricular dysfunction. After good history taking, all women should be thoroughly assessed, and alternative causes should be excluded. Urgent cardiac investigations with electrocardiogram and natriuretic peptide measurement (if available) should be performed. Echocardiography follows as the next step in investigation. Patients with abnormal cardiac investigations should be urgently referred to a cardiology team for expert management. Referral for genetic work-up should be considered if there is a family history of cardiomyopathy or sudden death. PPCM is a disease with substantial maternal and neonatal morbidity and mortality. Maternal mortality rates range widely, from 0% to 30%, depending on the ethnic background and geographic region. Just under half of women experience myocardial recovery. Remarkable advances in the comprehension of the pathogenesis and in patient management and therapy have been achieved, largely due to team efforts and close collaboration between basic scientists, cardiologists, intensive care specialists, and obstetricians. This review summarizes current knowledge of PPCM genetics, pathophysiology, diagnostic approach, management, and outcome.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa.,Department of Medicine, Division of Cardiology, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Zolt Arany
- Cardiovascular Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy F Spracklen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Medical Faculty of the Philipps University Marburg, Marburg, Germany
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Karaye KM, Ishaq NA, Sai'du H, Balarabe SA, Ahmed BG, Adamu UG, Mohammed IY, Oboirien I, Umuerri EM, Mankwe AC, Shidali VY, Dodiyi-Manuel S, Njoku P, Olunuga T, Josephs V, Mbakwem AC, Ogah OS, Tukur J, Okeahialam B, Stewart S, Henein M, Sliwa K. Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria. ESC Heart Fail 2021; 8:3257-3267. [PMID: 34137499 PMCID: PMC8318483 DOI: 10.1002/ehf2.13463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/09/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022] Open
Abstract
Aims The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North‐West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. Methods and results Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow‐up, relative to baseline status, were assessed by echocardiography. During median 17 months follow‐up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all‐cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling. Conclusions This study has shown important non‐racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.
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Affiliation(s)
- Kamilu M Karaye
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.,Department of Medicine, Bayero University, Kano, Nigeria.,Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.,Hatter Institute for Cardiovascular Research in Africa & CHI, Cape Town, South Africa
| | - Naser A Ishaq
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Hadiza Sai'du
- Department of Medicine, Bayero University, Kano, Nigeria.,Department of Medicine, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Sulaiman A Balarabe
- Department of Medicine, Muhammad Abdullahi Wase Specialist Hospital, Kano, Nigeria
| | - Bashir G Ahmed
- Department of Medicine, Muhammad Abdullahi Wase Specialist Hospital, Kano, Nigeria
| | - Umar G Adamu
- Department of Medicine, Federal Medical Centre, Bidda, Nigeria & Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Idris Y Mohammed
- Department of Chemical Pathology, Aminu Kano Teaching Hospital, Medicine Bayero University, Kano, Nigeria
| | - Isa Oboirien
- Department of Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
| | - Ejiroghene M Umuerri
- Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
| | - Abaram C Mankwe
- Department of Medicine, Federal medical centre, Yenagoa, Yenagoa, Nigeria
| | | | - Sotonye Dodiyi-Manuel
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Paschal Njoku
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Taiwo Olunuga
- Department of Medicine, Federal Medical centre, Abeokuta, Nigeria
| | - Veronica Josephs
- Department of Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Amam C Mbakwem
- Department of Medicine, University of Lagos, Lagos, Nigeria
| | - Okechukwu S Ogah
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Jamilu Tukur
- Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria
| | - Basil Okeahialam
- Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Simon Stewart
- Torrens University Australia, Adelaide, South Australia, Australia
| | - Michael Henein
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & CHI, Cape Town, South Africa
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13
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Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria. J Am Coll Cardiol 2021; 76:2352-2364. [PMID: 33183509 DOI: 10.1016/j.jacc.2020.09.540] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited. OBJECTIVES The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria. METHODS This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension <33 mm/m2 and absolute increase in left ventricular ejection fraction (LVEF) ≥10%. LV full recovery was defined as LVEF ≥55%. RESULTS Overall, 45 (18.7%) patients died during follow-up. Maternal age <20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF <25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF <25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study. CONCLUSIONS This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery.
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Spracklen TF, Chakafana G, Schwartz PJ, Kotta MC, Shaboodien G, Ntusi NAB, Sliwa K. Genetics of Peripartum Cardiomyopathy: Current Knowledge, Future Directions and Clinical Implications. Genes (Basel) 2021; 12:genes12010103. [PMID: 33467574 PMCID: PMC7830587 DOI: 10.3390/genes12010103] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 02/07/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a condition in which heart failure and systolic dysfunction occur late in pregnancy or within months following delivery. Over the last decade, genetic advances in heritable cardiomyopathy have provided new insights into the role of genetics in PPCM. In this review, we summarise current knowledge of the genetics of PPCM and potential avenues for further research, including the role of molecular chaperone mutations in PPCM. Evidence supporting a genetic basis for PPCM has emanated from observations of familial disease, overlap with familial dilated cardiomyopathy, and sequencing studies of PPCM cohorts. Approximately 20% of PPCM patients screened for cardiomyopathy genes have an identified pathogenic mutation, with TTN truncations most commonly implicated. As a stress-associated condition, PPCM may be modulated by molecular chaperones such as heat shock proteins (Hsps). Recent studies have led to the identification of Hsp mutations in a PPCM model, suggesting that variation in these stress-response genes may contribute to PPCM pathogenesis. Although some Hsp genes have been implicated in dilated cardiomyopathy, their roles in PPCM remain to be determined. Additional areas of future investigation may include the delineation of genotype-phenotype correlations and the screening of newly-identified cardiomyopathy genes for their roles in PPCM. Nevertheless, these findings suggest that the construction of a family history may be advised in the management of PPCM and that genetic testing should be considered. A better understanding of the genetics of PPCM holds the potential to improve treatment, prognosis, and family management.
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Affiliation(s)
- Timothy F. Spracklen
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Graham Chakafana
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Peter J. Schwartz
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy;
| | - Maria-Christina Kotta
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy;
| | - Gasnat Shaboodien
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Ntobeko A. B. Ntusi
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Correspondence:
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Varagic J, Desvigne-Nickens P, Gamble-George J, Hollier L, Maric-Bilkan C, Mitchell M, Pemberton VL, Redmond N. Maternal Morbidity and Mortality: Are We Getting to the "Heart" of the Matter? J Womens Health (Larchmt) 2020; 30:178-186. [PMID: 33259740 PMCID: PMC8020498 DOI: 10.1089/jwh.2020.8852] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular disease (CVD), including hypertensive disorders of pregnancy (HDP) and peripartum cardiomyopathy, is a leading cause of pregnancy-related death in the United States. Women who are African American or American Indian/Alaskan Native, have HDP, are medically underserved, are older, or are obese have a major risk for the onset and/or progression of CVD during and after pregnancy. Paradoxically, women with no preexisting chronic conditions or risk factors also experience significant pregnancy-related cardiovascular (CV) complications. The question remains whether substantial physiologic stress on the CV system during pregnancy reflected in hemodynamic, hematological, and metabolic changes uncovers subclinical prepregnancy CVD in these otherwise healthy women. Equally important and similarly understudied is the concept that women's long-term CV health could be detrimentally affected by adverse pregnancy outcomes, such as preeclampsia, gestational hypertension, and diabetes, and preterm birth. Thus, a critical life span perspective in the assessment of women's CV risk factors is needed to help women and health care providers recognize and appreciate not only optimal CV health but also risk factors present before, during, and after pregnancy. In this review article, we highlight new advancements in understanding adverse, pregnancy-related CV conditions and will discuss promising strategies or interventions for their prevention, diagnosis, and treatment.
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Affiliation(s)
- Jasmina Varagic
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joyonna Gamble-George
- Center for Translational Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Hollier
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Christine Maric-Bilkan
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Megan Mitchell
- Division of Extramural Research Activities, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Victoria L Pemberton
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Redmond
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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16
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Fett JD. Promoting Full Recovery and Improved Relapse-Free Prognosis in the Diagnosis and Treatment of Peripartum Cardiomyopathy. J Am Coll Cardiol 2020; 76:2365-2367. [DOI: 10.1016/j.jacc.2020.09.599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 11/16/2022]
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17
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Karaye KM, Ishaq NA, Sa'idu H, Balarabe SA, Talle MA, Isa MS, Adamu UG, Umar H, Okolie HI, Shehu MN, Mohammed IY, Sanni B, Ogah OS, Oboirien I, Umuerri EM, Mankwe AC, Shidali VY, Njoku P, Dodiyi-Manuel S, Shogade TT, Olunuga T, Ojji D, Josephs V, Mbakwem AC, Tukur J, Isezuo SA. Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry. ESC Heart Fail 2020; 7:235-243. [PMID: 31990449 PMCID: PMC7083508 DOI: 10.1002/ehf2.12562] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022] Open
Abstract
Aims The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. Methods and Results The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North–West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa–Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre‐eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa–Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. Conclusions In Nigeria, the burden of PPCM was greatest in the North–West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre‐eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa–Fulani ethnicity were not associated with PPCM in Nigeria.
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Affiliation(s)
- K M Karaye
- Department of Medicine, Bayero University, Kano, Nigeria.,Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.,Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - N A Ishaq
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - H Sa'idu
- Department of Medicine, Bayero University, Kano, Nigeria
| | - S A Balarabe
- Department of Medicine, Muhammad Abdullahi Wase Specialist Hospital, Kano, Nigeria
| | - M A Talle
- Department of Medicine, University of Maiduguri Teaching Hospital/University of Maiduguri, Maiduguri, Nigeria
| | - M S Isa
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - U G Adamu
- Department of Medicine, Federal Medical Centre Bida, Bida, Nigeria
| | - H Umar
- Department of Medicine, Usman Dan-Fodio University Teaching Hospital, Sokoto, Nigeria
| | - H I Okolie
- Department of Medicine, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - M N Shehu
- Department of Medicine, General Ahmadi Kurfi Specialist Hospital, Katsina, Nigeria.,Department of Medicine, Federal Medical Centre, Katsina, Nigeria
| | - I Y Mohammed
- Department of Chemical Pathology, Bayero University, Kano, Nigeria.,Department of Chemical Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - B Sanni
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - O S Ogah
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - I Oboirien
- Department of Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
| | - E M Umuerri
- Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria
| | - A C Mankwe
- Department of Medicine, Federal Medical Centre Yenagoa, Yenagoa, Nigeria
| | - V Y Shidali
- Department of Medicine, Federal Medical Centre Makurdi, Makurdi, Nigeria
| | - P Njoku
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - S Dodiyi-Manuel
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - T T Shogade
- Department of Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - T Olunuga
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - D Ojji
- Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - V Josephs
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
| | - A C Mbakwem
- Department of Medicine, University of Lagos Teaching Hospital, Lagos, Nigeria
| | - J Tukur
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria.,Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - S A Isezuo
- Department of Medicine, Usman Dan-Fodio University Teaching Hospital, Sokoto, Nigeria
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Ricke-Hoch M, Pfeffer TJ, Hilfiker-Kleiner D. Peripartum cardiomyopathy: basic mechanisms and hope for new therapies. Cardiovasc Res 2019; 116:520-531. [DOI: 10.1093/cvr/cvz252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/17/2019] [Accepted: 10/04/2019] [Indexed: 12/28/2022] Open
Abstract
Abstract
Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy characterized by acute or slow progression of left ventricular (LV) systolic dysfunction (LV ejection fraction of <45%) late in pregnancy, during delivery, or in the first postpartum months, in women with no other identifiable causes of heart failure. PPCM patients display variable phenotypes and risk factor profiles, pointing to involvement of multiple mechanisms in the pathogenesis of the disease. The higher risk for PPCM in women with African ancestry, the prevalence of gene variants associated with cardiomyopathies, and the high variability in onset and disease progression in PPCM patients also indicate multiple mechanisms at work. Experimental data have shown that different factors can induce and drive PPCM, including inflammation and immunity, pregnancy hormone impairment, catecholamine stress, defective cAMP-PKA, and G-protein-coupled-receptor signalling, and genetic variants. However, several of these mechanisms may merge into a common major pathway, which includes unbalanced oxidative stress and the cleavage of the nursing hormone prolactin (PRL) into an angiostatic, pro-apoptotic, and pro-inflammatory 16 kDa-PRL fragment, resulting in subsequent vascular damage and heart failure. Based on this common pathway, potential disease-specific biomarkers and therapies have emerged. Despite commonalities, the variation in aetiology and mechanisms poses challenges for the diagnosis, treatment, and management of the disease. This review summarizes current knowledge on the clinical presentation of PPCM in the context of recent experimental research. It discusses the challenge to develop disease-specific biomarkers in the context of rapid changing physiology in the peripartum phase, and outlines possible future treatment and management strategies for PPCM patients.
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Affiliation(s)
- Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
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Irizarry OC, Levine LD, Lewey J, Boyer T, Riis V, Elovitz MA, Arany Z. Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non-African American Women. JAMA Cardiol 2019; 2:1256-1260. [PMID: 29049825 DOI: 10.1001/jamacardio.2017.3574] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry, but well-powered studies to explore differences in severity of disease and clinical outcomes are lacking. Objective To compare the clinical characteristics, presentation, and outcomes of PPCM between African American and non-African American women. Design, Setting, and Participants This retrospective cohort study using data from January 1, 1986, through December 31, 2016, performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of African American individuals, included 220 women with PPCM. Main Outcomes and Measures Demographic and clinical characteristics and echocardiographic findings at presentation, as well as clinical outcomes including cardiac recovery, time to recovery, cardiac transplant, persistent dysfunction, and death, were compared between African American and non-African American women with PPCM. Results A total of 220 women were studied (mean [SD] age at diagnosis, 29.5 [6.6] years). African American women were diagnosed with PPCM at a younger age (27.6 vs 31.7 years, P < .001), were diagnosed with PPCM later in the postpartum period, and were more likely to present with a left ventricular ejection fraction less than 30% compared with non-African American women (48 [56.5%] vs 30 [39.5%], P = .03). African American women were also more likely to worsen after initial diagnosis (30 [35.3%] vs 14 [18.4%], P = .02), were twice as likely to fail to recover (52 [43.0%] vs 24 [24.2%], P = .004), and, when they did recover, recovery took at least twice as long (median, 265 vs 125.5 days; P = .02) despite apparent adequate treatment. Conclusions and Relevance In a large cohort of women with well-phenotyped PPCM, this study demonstrates a different profile of disease in African American vs non-African American women. Further work is needed to understand to what extent these differences stem from genetic or socioeconomic differences and how treatment of African American patients might be tailored to improve health outcomes.
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Affiliation(s)
- Olga Corazón Irizarry
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jennifer Lewey
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Theresa Boyer
- Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Valerie Riis
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Michal A Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Zolt Arany
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Abstract
Purpose of Review Peripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5 months postpartum. In this review, we outline recent reports about the disease pathogenesis and management and highlight the use of diagnosis and prognosis biomarkers. Recent Findings Novel data strengthen the implication of endothelial function in PPCM pathogenesis. The first international registry showed that patient presentations were similar globally, with heterogeneity in patient management and outcome. Summary Despite large improvement in patient management and treatment, there is still a sub-group of women who die from PPCM or who will not recover their cardiac function. Remarkable advances in the comprehension of disease incidence, pathogenesis, and prognosis could be determined with multi-center and international registries. Clinical Trials ClinicalTrials.gov Identifier: NCT02590601
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22
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POLYMORPHISM OF C825T (RS5443) G-PROTEIN 3-SUBUNIT GENE AND THE LONG-TERM PROGNOSIS FOR PATIENTS WITH HEART FAILURE. WORLD OF MEDICINE AND BIOLOGY 2019. [DOI: 10.26724/2079-8334-2019-1-67-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Significant progress in understanding the pathophysiology of peripartum cardiomyopathy, especially hormonal and genetic mechanisms, has been made. Specific criteria should be used for diagnosis, but the disease remains a diagnosis of exclusion. Both long-term and recurrent pregnancy prognoses depend on recovery of cardiac function. Data from large registries and randomized controlled trials of evidence-based therapeutics hold promise for future improved clinical outcomes.
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Affiliation(s)
- Meredith O Cruz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226-3522, USA.
| | - Joan Briller
- Division of Cardiology, University of Illinois at Chicago, 840 South Wood Street, M/C 715, Chicago, IL 60612, USA; Department of Obstetrics and Gynecology, University of Illinois at Chicago, 1740 W. Taylor Street, Chicago, IL 60612, USA
| | - Judith U Hibbard
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226-3522, USA
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Raeisi-Giglou P, Volgman AS, Patel H, Campbell S, Villablanca A, Hsich E. Advances in Cardiovascular Health in Women over the Past Decade: Guideline Recommendations for Practice. J Womens Health (Larchmt) 2018; 27:128-139. [PMID: 28714810 PMCID: PMC5815443 DOI: 10.1089/jwh.2016.6316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the number one cause of death in women. It is estimated that 44 million women in the United States are either living with or at risk for heart disease. This article highlights the recent significant progress made in improving care, clinical decision-making, and policy implications for women with CVD. We provide our perspective supported by evidence-based advances in cardiovascular research and clinical care guidelines in seven areas: (1) primary CVD prevention and community heart care, (2) secondary prevention of CVD, (3) stroke, (4) heart failure and cardiomyopathies, (5) ischemia with nonobstructive coronary artery disease, (6) spontaneous coronary artery dissection, and (7) arrhythmias and device therapies. Advances in these fields have improved the lives of women living with and at risk for heart disease. With increase awareness, partnership with national organizations, sex-specific research, and changes in policy, the morbidity and mortality of CVD in women can be further reduced.
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Affiliation(s)
| | - Annabelle Santos Volgman
- Rush Heart Center for Women Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Hena Patel
- Rush Heart Center for Women Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Amparo Villablanca
- Women's Cardiovascular Medicine Program, Division of Cardiovascular Medicine, University of California, Davis, Davis, California
| | - Eileen Hsich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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25
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The Role of Genetics in Peripartum Cardiomyopathy. J Cardiovasc Transl Res 2017; 10:437-445. [DOI: 10.1007/s12265-017-9764-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
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Fett JD. Reducing the risks for relapse of heart failure in a subsequent pregnancy after peripartum cardiomyopathy? Future Cardiol 2017. [PMID: 28621169 DOI: 10.2217/fca-2017-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- James D Fett
- Peripartum Cardiomyopathy Network Co-Investigations of Pregnancy Associated Cardiomyopathy (IPAC), Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.,Dept Adult Medicine, Hospital Albert Schweitzer, Deschapelles, Haiti
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27
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Affiliation(s)
- James D. Fett
- Hospital Albert Schweitzer, Adult Medicine, Deschapelles, Haiti
- Peripartum Cardiomyopathy Network, Cardiovascular Institute, Coordinating Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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