Evaluation of the Clinical Relevance of Baseline Left Ventricular Ejection Fraction as a Predictor of Recovery or Persistence of Severe Dysfunction in Women in the United States With Peripartum Cardiomyopathy

Goland, Sorel; Bitar, Fahed; Modi, Kalgi; Safirstein, Jordan; Ro, Angela S.; Mirocha, James; Khatri, Nudrat; Elkayam, Uri

doi:10.1016/j.cardfail.2011.01.007

Cited by 104 publications

(85 citation statements)

References 21 publications

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“…56 However, it is important to note that reduced EF is not a specific predictor of failure to recover and thus should not be an indication for premature device implantation or cardiac transplantation. 89 Interestingly, LVEF at presentation in the Soweto study did not predict outcome in this large cohort, 87 in contrast to US studies. Lower levels of plasma troponin or brain natriuretic peptide have also been associated with improved outcomes.…”

Section: Predictors Of Recoverymentioning

confidence: 60%

“…In a recent study of 187 patients (mostly from California), mean EF was 31% in women who recovered EF to >50% at 6 months versus 23% in women who did not (P<0.0001). 89 Similarly, in the German cohort, mean presenting EF was 28% in women who improved versus 17% in those who did not (P<0.0001). 56 However, it is important to note that reduced EF is not a specific predictor of failure to recover and thus should not be an indication for premature device implantation or cardiac transplantation.…”

Section: Predictors Of Recoverymentioning

confidence: 82%

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Peripartum Cardiomyopathy

2016

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Abstract-Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease.

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Section: Predictors Of Recoverymentioning

confidence: 60%

Section: Predictors Of Recoverymentioning

confidence: 82%

Peripartum Cardiomyopathy

2016

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“…11,12 There is a single report with significantly lower rates in 40 indigent women with a recovery rate of 35% in the United States similar to those reported in South Africa and Haiti. 13,14 Most of the studies suggest that improvement of LVEF occurs within 6 months of diagnosis, 1,11,12 but delayed recovery of LV function may also occur.…”

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confidence: 72%

Angiogenic Imbalance and Residual Myocardial Injury in Recovered Peripartum Cardiomyopathy Patients

Goland

Weinstein

Zalik

et al. 2016

Circ: Heart Failure

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Background-Recent studies suggest that angiogenic imbalance during pregnancy may lead to acute peripartum cardiomyopathy (PPCM). We propose that angiogenic imbalance and residual cardiac dysfunction may exist even after recovery from PPCM. Methods and Results-Twenty-nine women at least 12 months after presentation with PPCM, who exhibited recovery of left ventricular (LV) ejection fraction (≥50%), were included in the study (mean age 35±6 years, LV ejection fraction 61.0±3.9%). The number of circulating endothelial progenitor cells (EPCs) and plasma levels of proangiogenic vascular endothelial growth factor and of soluble vascular endothelial growth factor receptor Flt1 (sFlt1) Conclusions-Higher concentration of sFlt1 with concomitant decreased circulating endothelial progenitor cell levels along with inappropriate attenuated vascular endothelial growth factor levels may imply an angiogenic imbalance that exists even after recovery and may thus predispose to PPCM. In addition, tissue Doppler imaging and 2D strain were able to identify residual myocardial injury in post-PPCM women with apparent recovery of LV systolic function. Both angiogenic imbalance and residual myocardial injury may play an important role in the recurrence of LV dysfunction during subsequent pregnancies. (Circ Heart Fail. 2016;9:e003349.

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“…(17) Goland et al recently reported that recovery to LVEF > 50% at six months was significantly related to the degree of myocardial insult at the time of diagnosis. (18) However, this was not evident in our study group, perhaps owing to its limited sample size.…”

Section: Discussionmentioning

confidence: 60%

Peripartum cardiomyopathy: experience in an Asian tertiary centre

Lim¹,

Sim²

2013

SMedJ

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INTRODUCTION Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition. We report 11 patients admitted to the National Heart Centre Singapore with a diagnosis of PPCM over a period of 14 months. METHODSBaseline demographics, pregnancy history, haematology, serum biochemistry and echocardiographic findings of women admitted with a diagnosis of PPCM were analysed. RESULTSThe incidence of PPCM was 0.89 per 1,000 live births in our cohort. 63.6% of the patients were Malay and 27.3% were Chinese. 45.5% of the patients were smokers and 45.5% had a history of pregnancy-induced hypertension or preeclampsia. There was no maternal mortality. Mean left ventricular ejection fractions at diagnosis and at six months were 26.9% ± 9.1% and 51.9% ± 10.6%, respectively. Mean left ventricular internal diameters in end-diastole at diagnosis and at six months were 5.5 ± 0.5 cm and 5.1 ± 0.6 cm, respectively. All patients were treated successfully for the acute episode and all but one patient had returned to New York Heart Association functional class I status at six months.CONCLUSION PPCM remains a rare condition and appears to occur more commonly in Malay patients. Smoking and pregnancy-induced hypertension appear to be significant risk factors. While short-term outcome remains excellent, collaborative studies with other tertiary centres will help enhance our understanding of the long-term management of and clinical outcomes in these patients.

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Evaluation of the Clinical Relevance of Baseline Left Ventricular Ejection Fraction as a Predictor of Recovery or Persistence of Severe Dysfunction in Women in the United States With Peripartum Cardiomyopathy

Cited by 104 publications

References 21 publications

Peripartum Cardiomyopathy

Peripartum Cardiomyopathy

Angiogenic Imbalance and Residual Myocardial Injury in Recovered Peripartum Cardiomyopathy Patients

Peripartum cardiomyopathy: experience in an Asian tertiary centre

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