Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients

Sliwa, Karen; Förster, Olaf; Libhaber, Elena; Fett, James D.; Sundstrom, J. Bruce; Hilfiker‐Kleiner, Denise; Ansari, Aftab A.

doi:10.1093/eurheartj/ehi481

Cited by 276 publications

(259 citation statements)

References 27 publications

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“…This is in keeping with previous reports in Kano and Sokoto [30] [31] [32]. Patients from Zaria, South Africa and Haiti were however older than our patients with the mean age of the South African and Haiti patients being 31.6 ± 6.6 years and 31.8 ± 8.1 years respectively [33] [34]. This therefore explains the relatively larger number of primipara in our study.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

Prevalence and Characteristics of Peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

Saidu¹,

Kabir²,

Ndiche³

et al. 2018

JBM

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Introduction: Peripartum cardiomyopathy (PPCM) is a common clinical condition in northern Nigeria. This study aimed to determine the prevalence and characteristics of PPCM among women with heart failure referred for echocardiography. Materials and Methods: This is a retrospective study of 401 women managed for heart failure referred for echocardiography between October 2016 and September 2017. Their reports were analyzed for demographic and echocardiographic parameters. Results: The mean age of the 401 individuals studied was 41.28 ± 16.25 years. The commonest cause of heart failure was PPCM, accounting for 256 (69.5%), followed by hypertension 79 (19.7%) and rheumatic heart disease (RHD) 24 (5.9%). Conclusion: PPCM is a common and important cause of heart failure among women in Northern Nigeria.

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Section: Discussionsupporting

confidence: 92%

“…The prevalence is however lower in other parts of the world. In South Africa, it was reported to be 1:1000 live births, while in Haiti it was found to be 1:300 live births [33] [34].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Characteristics of Peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

Saidu¹,

Kabir²,

Ndiche³

et al. 2018

JBM

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show abstract

“…4 Interestingly, the results of Xia et al showed that, despite the theory that PPCM is caused by an anomalous inflammatory response, the levels of high-sensitivity CRP, a biomarker characterizing inflammation status, did not present any significant difference between the 2 groups.…”

Section: To the Editormentioning

confidence: 94%

Response to Expression of Programmed Cell Death‐1 and Its Ligand B7 Homolog 1 in Peripheral Blood Lymphocytes From Patients With Peripartum Cardiomyopathy

Căpîlna

Opincariu

Lázár

2017

Clinical Cardiology

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We read with great interest the article written by Xia et al, which was recently published in Clinical Cardiology, reporting the involvement of programmed death (PD)-1 and its ligand B7 homologue (B7-H1) in the immunological response of patients with peripartum cardiomyopathy (PPCM). 1 The authors found that the expression of PD-1 and B7-H1 in peripheral blood lymphocytes was significantly lower in patients with PPCM compared to the control group. At the same time, they reported that the levels of interferon gamma (IFN-γ) were significantly elevated, and the levels of interleukin 4 (IL-4) were significantly reduced in PPCM patients compared to controls. 1 The authors found an inverse correlation between the PD-1 and B7-H1 expression and IFN-γ cytokine derived from type 1 T helper (Th1) lymphocytes, associated with cellular immune response, and at the same time a direct relationship between IL-4 levels, associated with humoral immune response generated by type 2 T helper (Th2) lymphocytes, and the enhanced expression of both PD-1 and B7-H1. Therefore, the study brings new and relevant insights into the pathogenesis of this disorder, which can be fatal in otherwise healthy young women, and the authors can be congratulated for their results.However, after carefully reading the article, we have several comments.Despite the relevant value of the observations reported, the findings of the study raise several questions that are not addressed in the article. The first derives from the fact that PPCM patients expressed decreased levels of IL-4, characterizing humoral immunity, and at the same time elevated levels of IFN-γ, characterizing cell immune response. This is exactly opposed to the normal immune response to pregnancy, which is to suppress the Th1 cells (cellular immunity) in favor of the Th2 immunity type (humoral immunity). 2,3 In our opinion, it would be interesting to discuss which of these 2 findings is responsible to a higher extent for the development of PPCM. Is it the augmented cellular immunity, the suppressed humoral immunity, or is it rather the imbalance between the 2? Can an enhanced cellular immunological response, expressed by an increased level of IFN-γ, trigger the onset of the disease, or is it the decrease of IL-4 (associated with humoral response) that leads to development and progression of PPCM? However, the exact dimension of the imbalance between the 2 types of immune responses in PPCM and their role in the pathogenesis of the disease is still unelucidated.The second issue, which is only partially addressed in the article, refers to the role of inflammatory cytokines in the pathogenesis of PPCM. PPCM is a disease characterized by progressive heart failure.Heart failure is associated with significant release of inflammatory cytokines in the peripheral blood, whereas PD-1 and B7-H1 depresses T helper cell-mediated immune reactivity through reducing secretion of multiple cytokines. In our opinion, it would be interesting to discuss whether the changes in cytokine pattern can trigger the onset...

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“…Nevertheless, in the study of the small number of Haitian PPCM patients, there was no statistically significant difference in CRP plasma levels in survivors versus deceased patients. 8 Therefore, the issue is further supported by a study on the level of serum CRP in patients with PPCM.…”

Section: To the Editormentioning

confidence: 98%

Response to Letter to the Editor regarding the manuscript “Expression of programmed cell death‐1 and its ligand B7 homolog 1 in peripheral blood lymphocytes from patients with peripartum cardiomyopathy”

Xia

Liu

Wang

2017

Clinical Cardiology

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Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients

Abstract: Plasma markers of inflammation were significantly elevated and correlated with increased LV dimensions and lower LVEF at presentation. Baseline Fas/Apo-1 and higher NYHA FC were the only predictors of mortality. Normalization of LVEF was only observed in 23% of this African cohort.

Cited by 276 publications

References 27 publications

Prevalence and Characteristics of Peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

Prevalence and Characteristics of Peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

Response to Expression of Programmed Cell Death‐1 and Its Ligand B7 Homolog 1 in Peripheral Blood Lymphocytes From Patients With Peripartum Cardiomyopathy

Response to Letter to the Editor regarding the manuscript “Expression of programmed cell death‐1 and its ligand B7 homolog 1 in peripheral blood lymphocytes from patients with peripartum cardiomyopathy”

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