Unexpected and rapid recovery of left ventricular function in patients with peripartum cardiomyopathy: impact of cardiac resynchronization therapy

Abstract

AimPeripartum cardiomyopathy (PPCM) is a rare cause of dilated cardiomyopathy responsible for heart failure toward the end of pregnancy, which can lead to chronic heart failure in 50% of cases. In this short report, we assessed the benefit of cardiac resynchronization in patients with PPCM and chronic systolic dysfunction despite optimal medical treatment. Methods and resultsFor the last 10 years, we managed eight patients diagnosed with PPCM. Two of them presented severe systolic dysfunction, and medical treatment resulted in limited improvement from 10% to 25% and from 25% to 28% despite optimal treatment for 9 and 6 years, respectively. These two patients were porposed to receive an implantatable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). Six months after ICD-CRT treatment, we observed a significant improvement in systolic function from 25% to 45% and 28% to 50%, respectively, and positive remodelling with reduction of left ventricular end-diastolic volume from 216 to 144 mL and from 354 to 105 mL, which represent a 34% and a 70% reduction, respectively. ConclusionsPhysicians in charge of patients with PPCM should offer the opportunity of CRT for patients whose cardiac function has not significantly improved under standard medical treatment.--

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

“…1,158,173,174,220,221 Wearable defibrillator life vests for high-risk patients with LVEF <35% can be considered while waiting for a response to medical therapy in the absence of a clear indication for an ICD. 176,222 Continuing Medical Therapy and Follow-up The duration of standard HF treatments should be indefinite, specifically when ventricular function fails to normalize.…”

Contemporary Views on Peripartum Cardiomyopathy — Clinical Picture, Diagnostics, Course, Treatment (Part Ii)

“…F. Mouquet et al описывают двух пациенток с тяже-лой систолической дисфункцией ЛЖ, которым была выполнена имплантация кардиовертера-дефибриллятора с последующей ресинхронизирую-щей терапией. Спустя 6 месяцев отмечено значи-тельное улучшение систолической функции (в одном случае увеличение ФВ с 25% до 45%, в другом -с 28% до 50%), а также положительная динамика ремоделирования ЛЖ со значительным уменьшением конечного диастолического объема [45]. По результатам только что опубликованной работы, выполненной J. Pillarisetti et al, роль имплантируемого кардиовертера-дефибриллятора, установленного 7 больным ПКМП с рефрактерной дисфункцией ЛЖ для первичной профилактики внезапной сердечной смерти, оценена как крайне низкая [46].…”

Cardiomyopathie du péripartum

“…En absence de récupération de la fonction cardiaque et selon l'évolution clinique, le traitement sera incrémenté de la même manière que pour tout patient insuffisant cardiaque. En particulier, la resynchronisation semble être efficace pour améliorer la récupération de la fonction systolique, même en cas de dysfonction systolique prolongée durant plusieurs années [26]. Si nécessaire, les patientes seront éventuellement inscrites sur liste de transplantation cardiaque.…”