A global perspective on the management and outcomes of peripartum cardiomyopathy: a systematic review and meta‐analysis

Hoevelmann, Julian; Engel, Mark E; Muller, Elani; Hohlfeld, Ameer; Böhm, Michael; Sliwa, Karen; Viljoen, Charle

doi:10.1002/ejhf.2603

Cited by 31 publications

(30 citation statements)

References 76 publications

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“…However, significant variances of bromocriptine administration exist worldwide. The highest prescription rate of 87.5% was found in Europe, whereas in North America, Africa, and the Middle East, the prescription rates of bromocriptine have been as low as 0–20% 24 . Different to medical centres in Europe, bromocriptine has not been widely prescribed for PPCM patients in China for lack of large‐scale clinical trials, which explained no use of bromocriptine in our study.…”

Section: Discussionmentioning

confidence: 55%

“…The highest prescription rate of 87.5% was found in Europe, whereas in North America, Africa, and the Middle East, the prescription rates of bromocriptine have been as low as 0–20%. 24 Different to medical centres in Europe, bromocriptine has not been widely prescribed for PPCM patients in China for lack of large‐scale clinical trials, which explained no use of bromocriptine in our study. Considering that the prescription rate of bromocriptine varies greatly between different countries and bromocriptine is widely prescribed in European countries based on the positive results of several clinical trials and ESC recommendation, for PPCM populations receiving bromocriptine treatment, the risk factors for intracardiac thrombus may should be adjusted, and further evaluation is indispensable.…”

Section: Discussionmentioning

confidence: 74%

“…Considering that the prescription rate of bromocriptine varies greatly between different countries and bromocriptine is widely prescribed in European countries based on the positive results of several clinical trials and ESC recommendation, for PPCM populations receiving bromocriptine treatment, the risk factors for intracardiac thrombus may should be adjusted, and further evaluation is indispensable. 24 For the limited sample size in our retrospective study, lack of population on bromocriptine treatment was an inescapable limitation. For further studies involved bromocriptine administration, essential comparation should be conducted, and the relationship between bromocriptine and intracardiac thrombus in PPCM should be explored.…”

Section: Discussionmentioning

confidence: 94%

“…Different to medical centres in Europe, bromocriptine has not been widely prescribed for PPCM patients in China for lack of large‐scale clinical trials, which explained no use of bromocriptine in our study. Considering that the prescription rate of bromocriptine varies greatly between different countries and bromocriptine is widely prescribed in European countries based on the positive results of several clinical trials and ESC recommendation, for PPCM populations receiving bromocriptine treatment, the risk factors for intracardiac thrombus may should be adjusted, and further evaluation is indispensable 24 . For the limited sample size in our retrospective study, lack of population on bromocriptine treatment was an inescapable limitation.…”

Section: Discussionmentioning

confidence: 97%

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Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Zhang

Chen

et al. 2022

ESC Heart Failure

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Aims Peripartum cardiomyopathy (PPCM) are more vulnerable to intracardiac thrombus than other types of cardiomyopathies, although explicit anticoagulant strategy is not sure. Too aggressive anticoagulation therapy can lead to severe bleeding events. Hence, we want to construct a risk stratification model for intracardiac thrombus in PPCM patients. Methods and results A total of 159 suspected PPCM cases were initially screened, whereas 123 confirmed cases were enrolled in the final analysis. The study population was randomly assigned as derivation group ( N = 83) and validation group ( N = 40). The derivation cohort was utilized to develop the model, and the validation cohort was used to internal validate the discriminatory ability of the model. Formation of intracardiac thrombus was detected in 22 patients. After adjusted by multivariable logistic regression analysis, left ventricle ejection fraction (LVEF, OR 0.772, 95% CI 0.665–0.897, P = 0.001), haemoglobin levels (OR 1.050, 95% CI 1.003–1.099, P = 0.038), and thrombocyte counts (OR 1.018, 95% CI 1.006–1.029, P = 0.003) were identified as risk factors independently associated with intracardiac thrombus and were finally included in the tentative risk stratification model with a C‐indexes of 0.916 (95% CI: 0.850–0.982, P < 0.001). A score of ≤7 was regarded as low risk, 8–10 defined intermediate risk, and ≥11 defined high risk in our model. Internal validation showed good discriminatory ability of the model with a C‐indexes of 0.790 (95% CI: 0.644–0.936, P = 0.017). Conclusions In our retrospective study, impaired LVEF, elevated haemoglobin levels, and high thrombocyte counts were regarded as independent risk factors for intracardiac thrombus in PPCM. A risk stratification model derived from these risk factors, which was economic and easily applicable in clinical practice, could rapidly and accurately identify PPCM patients with higher‐risk of intracardiac thrombus.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

See 2 more Smart Citations

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Zhang

Chen

et al. 2022

ESC Heart Failure

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“…Indeed, WCD can, therefore, be used as "bridging" therapy, allowing for medical therapy to be initiated and protecting against SCD from VAs. This strategy would prevent unnecessary implantation of ICDs in young women with a disease with potential for LV recovery [20]. However, due to the high cost of the device, patient selection and risk stratification is of great importance [21].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of implantable loop recorder and Holter electrocardiographic monitoring for the detection of arrhythmias in patients with peripartum cardiomyopathy

et al. 2022

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Background Patients with peripartum cardiomyopathy (PPCM) are at increased risk of sudden cardiac death (SCD). However, the exact underlying mechanisms of SCD in PPCM remain unknown. By means of extended electrocardiographic monitoring, we aimed to systematically characterize the burden of arrhythmias occurring in patients with newly diagnosed PPCM. Methods and results Twenty-five consecutive women with PPCM were included in this single-centre, prospective clinical trial and randomised to receiving either 24 h-Holter ECG monitoring followed by implantable loop recorder implantation (ILR; REVEAL XT, Medtronic®) or 24 h-Holter ECG monitoring alone. ILR + 24 h-Holter monitoring had a higher yield of arrhythmic events compared to 24 h-Holter monitoring alone (40% vs 6.7%, p = 0.041). Non-sustained ventricular tachycardia (NSVT) occurred in four patients (16%, in three patients detected by 24 h-Holter, and multiple episodes detected by ILR in one patient). One patient deceased from third-degree AV block with an escape rhythm that failed. All arrhythmic events occurred in patients with a severely impaired LV systolic function. Conclusions We found a high prevalence of potentially life-threatening arrhythmic events in patients with newly diagnosed PPCM. These included both brady- and tachyarrhythmias. Our results highlight the importance of extended electrocardiographic monitoring, especially in those with severely impaired LV systolic function. In this regard, ILR in addition to 24 h-Holter monitoring had a higher yield of VAs as compared to 24 h-Holter monitoring alone. In settings where WCDs are not readily available, ILR monitoring should be considered in patients with severely impaired LV systolic dysfunction, especially after uneventful 24 h-Holter monitoring. Trial registration Pan African Clinical Trials Registry: PACTR202104866174807. Graphical abstract Extended electrocardiographic monitoring for the detection of arrhythmias in PPCM. (CHB, complete heart block/third degree AV block; ECG, electrocardiogram; ILR, implantable loop recorder; NSVT, non-sustained ventricular tachycardia; PPCM, peripartum cardiomyopathy)

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Adherence to heart failure treatment in patients with peripartum cardiomyopathy

Hoevelmann,

Sliwa,

Schaar

et al. 2024

ESC Heart Failure

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AimsPeripartum cardiomyopathy (PPCM) is characterized by left ventricular (LV) dysfunction developing towards the end of pregnancy or in the first months postpartum. Although about 60% of women with PPCM (the majority of which are prescribed evidence based heart failure [HF] medications) show LV recovery within 6 to 12 months, others remain with persistently impaired LV function. Poor adherence to medical therapy represents a major cause of avoidable hospitalizations, disability, and death in other cardiovascular conditions. In this study, we aimed to determine drug adherence to HF therapy among women with PPCM and to identify possible associations between drug adherence and LV recovery, functional status and psychological well‐being.Methods and resultsIn this single‐centre, prospective, observational study, we included 36 consecutive women with PPCM. Adherence to HF treatment was assessed by (i) verifying the collection of pharmacy refills and (ii) using liquid chromatography high‐resolution mass spectrometry (LC‐HRMS). Participants were thereby classified as ‘adherent’ (i.e. all prescribed HF drugs were detectable by LC‐HRMS), ‘partially adherent’ (i.e. at least one prescribed drug detectable) or ‘non‐adherent’ (i.e. none of the prescribed drugs detectable). Health state index scores were assessed by EQ‐5D‐5L and HADS‐A/D (for anxiety/depression). Patients' median age was 32.4 years (IQR 27.6–36.1). At the adherence visit (which occurred at a median of 16 months [IQR 5–45] after PPCM diagnosis), prescription included beta‐blockers (77.8%), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (75%), mineralocorticoid receptor antagonists (47.2%) and loop diuretics (95.2%). Less than two thirds of patients (63.9%) collected all their pharmacy refills in the 6 months prior to adherence visit. According to LC‐HRMS, 23.5% participants were classified as adherent, 53.0% as partially adherent, and 23.5% as non‐adherent. Adherence was associated with significantly lower LVEDD at follow‐up (47 mm [IQR 46–52), vs. 56 mm [IQR 49–64] with partial adherence, and 62 mm [IQR 55–64] with non‐adherence, P = 0.022), and higher LVEF at follow‐up (60% [IQR 41–65]), vs. partially adherence (46% [IQR 34–50]) and non‐adherence (41.0% [IQR 29–47], P = 014). Adherent patients had a lower overall EQ‐ 5D score (5.5 [IQR 5–7.5], vs. 6 [IQR 5–7] in partially adherent, and 10 [IQR 8–15] in non‐adherent patients, P = 0.032) suggestive of a better self‐rated health status.ConclusionsAdherence to HF therapy was associated with favourable LV reverse remodelling in PPCM and better self‐rated health status. Our study highlights the importance of drug adherence for functional recovery. Drug adherence should be an important component of patient communication and specific interventions in PPCM.

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A global perspective on the management and outcomes of peripartum cardiomyopathy: a systematic review and meta‐analysis

Cited by 31 publications

References 76 publications

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China

Effectiveness of implantable loop recorder and Holter electrocardiographic monitoring for the detection of arrhythmias in patients with peripartum cardiomyopathy

Adherence to heart failure treatment in patients with peripartum cardiomyopathy

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