Incidence, Risk Factors, and Clinical Characteristics of Peripartum Cardiomyopathy in South Korea

Lee, Sunki; Cho, Geum Joon; Park, Geun U.; Kim, Log Young; Lee, Tae Seon; Kim, Do Young; Choi, Suk Won; Youn, Jong Chan; Han, Seong Woo; Ryu, Kyu Hyung; Na, Jin Oh; Choi, Cheol Ung; Seo, Hong Seog; Kim, Eung Ju

doi:10.1161/circheartfailure.117.004134

Cited by 30 publications

(31 citation statements)

References 27 publications

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“…This may be due to epidemiological factors such as the racial and genetic background of the Japanese population, lifestyle, a decrease in women giving birth multiple times, and influence of the health care system. However, the incidence is far lower than those found in administrative data in Korea (1 in 1,741 deliveries) 27) and Taiwan (1 in 4,725 deliveries) 28) that are also in East Asia, are mostly populated by Asians, and have health care systems similar to that in Japan. Thus, the study by Kamiya, et al may have underestimated the incidence of PPCM due to biases related to the study design and the calculation used to estimate the incidence.…”

Section: Isogai Et Almentioning

confidence: 62%

“…First, only 4 single-center studies were prospective, 18,34,36,38) while all others were performed retrospectively. Second, from the perspective of data sampling, studies using administrative databases from the United States, [9][10][11][12][13][14][15][16][17] Canada, 54) Denmark, 31) Sweden, 32) Korea, 27) and Taiwan 28) were based on population-based cohort data, but cases of PPCM were screened and identified using diagnoses recorded with the International Classification of Diseases codes for hospital payments. Generally, diagnoses based on the codes in administrative databases are not confirmed by medical chart reviews and thus are less accurate and less validated than diagnoses in prospective studies, which can lead to misdiagnosis and over-or underestimation of the incidence.…”

Section: Difficulties With Studies Of the Incidence Of Ppcmmentioning

confidence: 99%

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Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality

Isogai

Kamiya

2019

Int. Heart J.

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Peripartum cardiomyopathy (PPCM) is a specific cardiomyopathy in which heart failure develops due to reduced myocardial contraction during pregnancy or in the postpartum period in women without a previous history of heart disease. The epidemiology of PPCM has been reported in various countries and areas, and the incidence of PPCM differed among these reports. The incidence was highest (1 in 102 deliveries) in Nigeria and lowest (1 in 15,533 births) in Japan. The incidence was higher in African-Americans than in other races in several reports from the United States, and was also high in African countries and Haiti, indicating that the risk for PPCM is highest in the black race. However, the study design and definition of PPCM differ among studies, and these differences may influence the incidence. Moreover, the incidence of PPCM and the maternal mortality rate were well correlated. Since maternal mortality reflects the level of perinatal health care and hygiene, this finding suggests that the extent of perinatal care is partly related to the incidence of PPCM, which reflects heart failure and cardiomyopathy of unknown cause in women.

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Section: Isogai Et Almentioning

confidence: 62%

Section: Difficulties With Studies Of the Incidence Of Ppcmmentioning

confidence: 99%

Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality

Isogai

Kamiya

2019

Int. Heart J.

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“…In a Japanese cohort the incidence was as low as 1:20 000, however, these data should be interpreted with caution due to methodological aspects and possible underreporting. In contrast, an analysis that appears more representative of the Asian population was published recently from a nationwide database and estimated the incidence of PPCM in South Korea at 1:1741 …”

Section: Definition and Epidemiologymentioning

confidence: 99%

“…Predisposing factors for PPCM seem to be multiparity and multiple pregnancies, family history, ethnicity, smoking, diabetes, hypertension, pre‐eclampsia, malnutrition, age of mother (with older mothers being at greater risk), and prolonged use of tocolytic beta‐agonists …”

Section: Definition and Epidemiologymentioning

confidence: 99%

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Bauersachs

König

Meer

et al. 2019

European J of Heart Fail

254

311

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Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients

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“…In the United States, the incidence of PPCM is rising and is approximately 4‐fold higher in black women (1 in 1000‐1500 live births) than in Caucasian women (1 in 4000 live births) . Other risk factors include older maternal age, multiple gestation, and preeclampsia . The etiology of PPCM remains unclear; proposed mechanisms have included angiogenic factor imbalance, abnormal prolactin cleavage, inflammation, selenium deficiency, and genetic susceptibility …”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic findings in peripartum cardiomyopathy

Honigberg

Elkayam

Rajagopalan

et al. 2019

Clinical Cardiology

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Background There is limited data on electrocardiographic (ECG) abnormalities and their prognostic significance in women with peripartum cardiomyopathy (PPCM). We sought to characterize ECG findings in PPCM and explore the association of ECG findings with myocardial recovery and clinical outcomes. Hypothesis We hypothesized that ECG indicators of myocardial remodeling would portend worse systolic function and outcomes. Methods Standard 12‐lead ECGs were obtained at enrollment in the Investigations of Pregnancy‐Associated Cardiomyopathy study and analyzed for 88 women. Left ventricular ejection fraction (LVEF) was measured by echocardiography at baseline, 6 months, and 12 months. Women were followed for clinical events (death, mechanical circulatory support, and/or cardiac transplantation) until 1 year. Results Half of women had an “abnormal” ECG, defined as atrial abnormality, ventricular hypertrophy, ST‐segment deviation, and/or bundle branch block. Women with left atrial abnormality (LAA) had lower LVEF at 6 months (44% vs 52%, P = 0.02) and 12 months (46% vs 54%, P = 0.03). LAA also predicted decreased event‐free survival at 1 year (76% vs 97%, P = 0.008). Neither left ventricular hypertrophy by ECG nor T‐wave abnormalities predicted outcomes. A normal ECG was associated with recovery in LVEF to ≥50% (84% vs 49%, P = 0.001) and event‐free survival at 1 year (100% vs 85%, P = 0.01). Conclusions ECG abnormalities are common in women with PPCM, but a normal ECG does not rule out the presence of PPCM. LAA predicted lower likelihood of myocardial recovery and event‐free survival, and a normal ECG predicted favorable event‐free survival.

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Incidence, Risk Factors, and Clinical Characteristics of Peripartum Cardiomyopathy in South Korea

Cited by 30 publications

References 27 publications

Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality

Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality

Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy

Electrocardiographic findings in peripartum cardiomyopathy

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