Biomedical Papers, 2014 (vol. 158), issue 1

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(1):092-097 | 10.5507/bp.2012.080

The variable clinical course of peripartum cardiomyopathy

Jan Krejcia, Petr Hudea, Lenka Spinarovaa, Vita Zampachovab, Alzbeta Sirotkovab, Tomas Freibergerc, Eva Nemcovac, Jiri Vitoveca
a International Clinical Research Center - 1st Internal Cardio-Angiological Clinic, St. Anne's University Hospital Brno, Czech Republic
b 1st Department of Pathologic Anatomy, St. Anne's University Hospital and Masaryk University, Brno
c Center of Cardiovascular and Transplant Surgery, Brno

Background: In Europe, peripartum cardiomyopathy (PPCM) is a rare disorder, often difficult to diagnose and it has a variable clinical course. The aim of this report was to describe and discuss the individual variability of this disorder and its management. Patients and Methods: Three cases of PPCM manifesting as severe heart failure are compared. Common was the presence of myocardial inflammation detected by endomyocardial biopsy. Different were treatment methods and clinical course. Modern therapeutic concepts such as immunosuppressive therapy and bromocriptin administration are discussed, as well as non-pharmacological approaches.

Conclusion: In the differential diagnostics of dyspnea associated with pregnancy and childbirth, PPCM should be considered. The potentially severe course of the disease requires hospitalization with the possibility of comprehensive heart failure treatment, including non-pharmacological approaches such as device therapy and heart transplantation.

Keywords: peripartum cardiomyopathy, myocarditis, echocardiography, endomyocardial biopsy, therapy

Received: February 14, 2012; Accepted: July 20, 2012; Published: October 31, 2012


References

  1. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Waktins H, Shah A, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JV. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010;12:767-78. Go to original source... Go to PubMed...
  2. Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National institutes of Health) workshop recommendations and review. JAMA 2000;283:1183-8. Go to original source... Go to PubMed...
  3. Ramaraj R, Sorrell VL. Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleve Clin J Med 2009;76(5):289-96. Go to original source...
  4. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006;368:687-93. Go to original source... Go to PubMed...
  5. Gentry MB, Dias JK, Luis A, Patel R, Thornton J, Reed GL. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol 2010;55:654-9. Go to original source... Go to PubMed...
  6. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kuehl U, Maisch B, McKenna WJ, Monserrat L, Pankuweit S, Rapezzi C, Seferovic P, Tavazzi L, Keren A. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2008;29:270-6. Go to original source... Go to PubMed...
  7. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young GB. Contemporary definitions and classification of the cardiomyopathies: An American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 2006;113:1807-16. Go to original source... Go to PubMed...
  8. Van Spaendonck-Zwarts KY, Van Tintelen JP, van Veldhuisen DJ, van der Werf R, Jongbloed JDH, Paulus WJ, Dooijes D, van den Berg M. Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. Circulation 2010;121:2169-75. Go to original source... Go to PubMed...
  9. Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States. Diagnosis, prognosis, and management. J Am Coll Cardiol 2011;58:659-70. Go to original source... Go to PubMed...
  10. Abboud J, Murad Y, Chen-Scarabelli C, Saravolatz L, Scarabelli TM. Peripartum cardiomyopathy: A comprehensive review. Int J Cardiol 2007;118:295-303. Go to original source... Go to PubMed...
  11. Nabhan A. Peripartum cardiomyopathy. ASJOG 2005;2:231-7.
  12. Schultheiss HP, Kuehl U, Cooper LT. The management of myocarditis. Eur Heart J 2011;32:2616-25. Go to original source... Go to PubMed...
  13. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuehl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 2007;116:2216-33. Go to original source... Go to PubMed...
  14. Narula N, McNamara DM. Endomyocardial biopsy and natural history of myocarditis. Heart Fail Clin 2005;1:391-406. Go to original source... Go to PubMed...
  15. Cooper LT, Mather PJ, Alexis JD, Pauly DF, Torre-Amione G, Wittstein IS, Dec GW, Zucker M, Narula J, Kip K, McNamara DM. Myocardial Recovery in Peripartum Cardiomyopathy: Prospective Comparison With Recent Onset Cardiomyopathy in Men and Nonperipartum Women. J Cardiac Fail 2012;18:28-33. Go to original source...
  16. Lamparter S, Pankuweit S, Maisch B. Clinical and immunologic characteristics in peripartum cardiomyopathy. Int J Cardiol 2007;118:14-20. Go to original source... Go to PubMed...
  17. Bueltmann BD, Klingel K, Naebauer M, Wallwiener D, Kandolf R. High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. Am J Obstet Gynecol 2005;193:363-5. Go to original source... Go to PubMed...
  18. Midei MG, DeMent SH, Feldman AM, Hutchins GM, Baughman KL. Peripartum myocarditis and cardiomyopathy. Circulation 1990;81:922-8. Go to PubMed...
  19. Melvin K, Richardson P, Olsen EG, Daly K, Jackson G. Peripartum cardiomyopathy due to myocarditis. N Engl J Med 1982;307:731-4. Go to PubMed...
  20. Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, Glanowska G, Wilczewski P, Niklewski T, Zembala M, Polonski L, Rozek MM,, Wodniecki J. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation 2001;104:39-45. Go to original source... Go to PubMed...
  21. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J 2009;30:1995-2002. Go to original source... Go to PubMed...
  22. Hilfiker-Kleiner D, Sliwa K, Drexler H. Peripartum cardiomyopathy: Recent insights in its pathophysiology. Trends Cardiovasc Med 2008;18:173-9. Go to original source... Go to PubMed...
  23. Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, McMurray J, Yamac H, labidi S, Struman I, Hilfiker-Kleiner D. Evaluation of bromocriptin in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 2010;121:1465-73. Go to original source... Go to PubMed...
  24. Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P. The addition of pentoxiphylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Hear Fail 2002;4:305-9. Go to original source...
  25. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006;368:687-93. Go to original source... Go to PubMed...
  26. Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR, Hameed A, Gviazda I, Shotan A. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med 2001;344:1567-71. Go to original source... Go to PubMed...