Pregnancy-Associated Cardiomyopathy

Abstract

Background-Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results-Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31Ϯ6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29Ϯ11% and improved to 46Ϯ14% (PՅ0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patients with left ventricular ejection fraction Ͼ30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome.

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

“…9 Almost 50% of patients had either chronic hypertension or preeclampsia. This might be related to the fact that 64% of the patients in this series were of African American/black ethnicity compared with 31% in our overall obstetric population.…”

“…6 Previous studies and reviews have focused largely on the medical and obstetric management of these patients. [7][8][9] Literature on anesthetic management has been limited to individual case reports. [10][11][12] The purpose of this case series was to report on the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre.…”

Clinical and Echocardiographic Profile and Outcomes of Peripartum Cardiomyopathy: The Philippine General Hospital Experience

“…In our study, pre-eclampsia was very common (78%) and even higher in prevalence compared with published reports. 11 16 17 Twin pregnancy is reported to be considerably associated with the development of PPCM. An autoimmune process has been proposed by Ansari et al 18 who found high titres of autoantibodies against normal human cardiac tissue proteins in the sera of PPCM patients.…”

Recovery from peripartum cardiomyopathy after treatment with bromocriptine

“…It has an incidence of approximately 1 in 4000 deliveries [1] and occurs more often in twin births [2]. The origins of this disease were unknown until recently, and thus treatment was empirical and restricted to standard heart failure therapy with ACE-inhibitors, beta-blockers, diuretics, aldosterone antagonists and, in most severe cases, biventricular assist systems or heart transplantation.…”

“…The origins of this disease were unknown until recently, and thus treatment was empirical and restricted to standard heart failure therapy with ACE-inhibitors, beta-blockers, diuretics, aldosterone antagonists and, in most severe cases, biventricular assist systems or heart transplantation. The prognosis of PPCM is controversial, but a left ventricular ejection fraction (LVEF) below 27% is associated with a mortality of between 9 and 30% [2,3]. According to a new pathophysiological explanation reported recently by Hilfiker-Kleiner et al, a 16 kDa form of the post-partally upregulated hormone prolactin initiates cell apoptosis and disrupts capillaries, thus inducing myocardial damage and heart failure [4].…”