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Vol. 5 No. 2 (2020)
Salud y Sociedad Uptc volumen 5 número 2 2020

Artículos de Revisión

Peripartum cardiomyopathy

Published 2020-10-22

  • Laura Daniela Cárdenas Casallas
    • ,
  • Amanecer Rueda Monsalbe
    • ,
  • Diego Andrés Castañeda Martínez
    • ,
  • Erika Eliana Pinilla Romero

Laura Daniela Cárdenas Casallas
Universidad Pedagógica y Tecnológica de Colombia. Escuela de Medicina. Estudiante de IX semestre.

Amanecer Rueda Monsalbe
Universidad Pedagógica y Tecnológica de Colombia. Escuela de Medicina. Estudiante de IX semestre.

Diego Andrés Castañeda Martínez
Universidad Pedagógica y Tecnológica de Colombia. Escuela de Medicina. Estudiante de IX semestre.

Erika Eliana Pinilla Romero
Universidad Pedagógica y Tecnológica de Colombia. Escuela de Medicina. Estudiante de IX semestre.

Abstract

Peripartum cardiomyopathy (PPCM) is a rare, dilated heart disease of unknown origin and potentially fatal, for which various hypotheses have been postulated to explain its genesis, among which are viral myocarditis, immune response and own hemodynamic stress of pregnancy, among others. It usually begins with clinical manifestations of heart failure, which appear during the last month of pregnancy or the five months postpartum. As for the diagnosis, it is considered difficult to carry out, due to the number of diseases that have the same clinical characteristics and considering that other entities can overcome it, for this reason it is considered a diagnosis of exclusion, that is why , its diagnostic approach implies to achieve a complete history, whose findings are supported by paraclinical tests that allow to rule out other possible etiologies that may explain the affectation to the health of the pregnant woman. Another aspect of particular importance encompasses therapeutic considerations, for which it is necessary to keep in mind regimens that acomplish the best quality of life for both pregnant and postpartum women as well as for the product of pregnancy. The objective of this review article is to present updated information on this pathology, including aspects such as its epidemiology, risk factors, clinical manifestations, diagnostic approach, and pharmacological and life-support therapeutic measures.

 

Keywords

peripatetic myocardiopatia, pregnancy, heart failure

PDF (Español)

References

  1. C. P. De L’influence reciproque de la grossesse et del maladies du Coeur. Medical Faculty of Paris, France; 1880.
  2. By JOHN G. DEMAKIS, M.D., SHAHBUDIN H. RAHIMTOOLA, M.B., M.R.C.P.E., GEORGE C. SUTrON, M.D., W. ROBERT MEADOWS MD, PAUL B. SZANTO, M.D., JoHN R. TOBIN MD, AND RoLFM.GUNNAR, M.S. MD. Natural Course of Peripartum Cardiomyopathy. 1971;44:1053–1061.
  3. Hibbard JU, Lang RM. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. 1999;94(2):311–6.
  4. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail [Internet]. 2010 Aug;12(8):767–78. Available from: http://doi.wiley.com/10.1093/eurjhf/hfq120
  5. Ntusi NBA, Mayosi BM. Aetiology and risk factors of peripartum cardiomyopathy: A systematic review ☆. Int J Cardiol. 2009;131(2):168–79.
  6. Fett JD, Ansari AA, Sundstrom JB, Jr GFC. P eripartum cardiomyopathy: a selenium disconnection and an autoimmune connection. 2002;86:311–6.
  7. Klingel K, Na M, Bu BD, Wallwiener D, Kandolf R. High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. 2005;363–5.
  8. Sliwa K, Fett J, Elkayam U, Schweitzer HA. Peripartum cardiomyopathy. 2006;687–93.
  9. Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, et al. Temporal Trends in Incidence and Outcomes of Peripartum. 2011;1–13.
  10. Ul Z, Asad A. Peripartum cardiomyopathy : A systematic review of the literature.
  11. Gunderson EP, Croen LA. Epidemiology of Peripartum Cardiomyopathy. 2011;118(3):583–91.
  12. Brar SS, Khan SS, Sandhu GK, Jorgensen MB, Parikh N, Hsu JY, et al. Incidence, Mortality, and Racial Differences in Peripartum Cardiomyopathy. 2007;10–2.
  13. Sliwa K, Damasceno A, Mayosi BM. Epidemiology and Etiology of Cardiomyopathy in Africa. 2005;
  14. Desai D, Sa FCP, Moodley J. Peripartum cardiomyopathy: experiences at King Edward VIII Hospital, Durban, South Africa and a review of the literature. 1995;(July):118–23.
  15. Pandit V, Shetty S, Kumar A, Sagir A. Incidence and outcome of peripartum cardiomyopathy from a tertiary hospital in South India. 2009;(July):168–9.
  16. JAMES D. FETT, MD; LEN G. CHRISTIE, MD; ROBERT D. CARRAWAY, MD; AND JOSEPH G. MURPHY M, OBJECTIVE: Five-Year Prospective Study of the Incidence and Prognosis of Peripartum Cardiomyopathy at a Single Institution. 2005;80(December): 1602–6.
  17. Isezuo S, Abubakar SA. Epidemiologic profile of peripartum cardiomyopathy in a tertiary care hospital. 2007;17(2):228–33.
  18. Arany Z. Understanding Peripartum Cardiomyopathy. 2018;(August 2017):1–12.
  19. Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy. J Am Coll Cardiol [Internet]. 2020 Jan;75(2):207–21. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109719384578
  20. Arango G, Upegui A, Castillo JM, González JG, Rubio J, Mojica L. Paciente embarazada con enfermedad cardiaca * Manejo periparto basado en la estratificación del riesgo. Serie de casos Pregnant patient with cardiac diseases * Risk based peripartum management. Case series 2005-2009. 2010;38(3):348–60.
  21. Sliwa K, Libhaber E, Fett JD, Sundstrom JB, Fo O, Hilfiker-kleiner D, et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. 2013;(2006):441–6.
  22. Lkhider M, Castino R, Bouguyon E, Isidoro C, Ollivier-bousquet M. Cathepsin D released by lactating rat mammary epithelial cells is involved in prolactin cleavage under physiological conditions. 2004;148.
  23. Halkein J, Tabruyn SP, Ricke-Hoch M, Haghikia A, Nguyen N-Q-N, Scherr M, et al. MicroRNA-146a is a therapeutic target and biomarker for peripartum cardiomyopathy. J Clin Invest [Internet]. 2013 May 1;123(5):2143–54. Available from: http://www.jci.org/articles/view/64365
  24. Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, et al. A Cathepsin D-Cleaved 16 kDa Form of Prolactin Mediates Postpartum Cardiomyopathy. Cell [Internet]. 2007 Feb;128(3):589–600. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0092867407000608
  25. Patten IS, Rana S, Shahul S, Rowe GC, Jang C, Liu L, et al. Cardiac Angiogenic Imbalance Leads to Peri-partum Cardiomyopathy. 485(7398):333–8.
  26. Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: the role of anti-angiogenic factors and implications for later cardiovascular disease. 2011;123(24).
  27. Zagelbaum NK, Bhinder J, Gupta CA, Frishman WH, Aronow WS. Peripartum Cardiomyopathy Incidence, Risk Factors, Diagnostic Criteria, Pathophysiology, and Treatment Options. 2020;28(3).
  28. Baris L, Cornette J, Johnson MR, Sliwa K, Roos-Hesselink JW. Peripartum cardiomyopathy: disease or syndrome? Vol. 105, Heart. 2019. p. 357–62.
  29. Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation. 1971 Nov;44(5):964–8.
  30. Garg J, Palaniswamy C, Lanier GM. Peripartum cardiomyopathy: Definition, incidence, etiopathogenesis, diagnosis, and management. Cardiol Rev. 2015;23(2):69–78.
  31. Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000 Mar;283(9):1183–8.
  32. Stergiopoulos K, Lima F V. Peripartum cardiomyopathy-diagnosis, management, and long term implications. Vol. 29, Trends in Cardiovascular Medicine. Elsevier Inc.; 2019. p. 164–73.
  33. Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, et al. Pregnancyassociated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005 Apr;111(16):2050–5.
  34. Bello N, Rendon ISH, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013 Oct;62(18):1715–23.
  35. Azibani F, Sliwa K. Peripartum Cardiomyopathy: an Update. Vol. 15, Current Heart Failure Reports. Current Heart Failure Reports; 2018. p. 297–306.
  36. Jackson AM, Dalzell JR, Walker NL, Coats CJ, Jhund PS, Petrie MC. Peripartum cardiomyopathy: diagnosis and management. Heart. 2018 May;104(9):779–86.
  37. Koenig T, Hilfiker-Kleiner D, Bauersachs J. Peripartum cardiomyopathy. Herz. 2018;43(5):431–7.
  38. Bauersachs J, Arrigo M, Hilfiker-Kleiner D, Veltmann C, Coats AJS, Crespo-Leiro MG, et al. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail [Internet]. 2016 Sep;18(9):1096–105. Available from: http://doi.wiley.com/10.1002/ejhf.586
  39. Honigberg MC, Elkayam U, Rajagopalan N, Modi K, Briller JE, Drazner MH, et al. Electrocardiographic findings in peripartum cardiomyopathy. Clin Cardiol. 2019;42(5):524–9.
  40. Fett JD. Peripartum cardiomyopathy: challenges in diagnosis and management. Vol. 14, Expert Review of Cardiovascular Therapy. 2016. p. 1035–41.
  41. Ballard LC, Cois A, Kea B. Peripartum Cardiomyopathy: a Review. Curr Emerg Hosp Med Rep [Internet]. 2019 Sep 22;7(3):127–34. Available from: http://link.springer.com/10.1007/s40138-019-00192-3
  42. Davis MB, Walsh MN. Cardio-Obstetrics. Circ Cardiovasc Qual Outcomes [Internet]. 2019 Feb;12(2). Available from: https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.005417
  43. Lima F V., Yang J, Xu J, Stergiopoulos K. National Trends and In-Hospital Outcomes in Pregnant Women With Heart Disease in the United States. Am J Cardiol [Internet]. 2017 May;119(10):1694–700. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002914917301881
  44. Robbins KS, Krause M, Nguyen AP, Almehlisi A, Meier A, Schmidt U. Peripartum Cardiomyopathy: Current Options for Treatment and Cardiovascular Support. J Cardiothorac Vasc Anesth [Internet]. 2019 Oct;33(10):2814–25. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1053077019301417
  45. Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major Congenital Malformations after First-Trimester Exposure to ACE Inhibitors. N Engl J Med [Internet]. 2006 Jun 8;354(23):2443–51. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa055202
  46. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev [Internet]. 2018;4(2):112. Available from: https://www.cfrjournal.com/articles/postpartum-cardiomyopathy-and-considerations-breastfeeding
  47. Stergiopoulos K, Shiang E, Bench T. Pregnancy in Patients With Pre-Existing Cardiomyopathies. J Am Coll Cardiol [Internet]. 2011 Jul;58(4):337–50. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109711015816
  48. Laliberte B, Reed BN, Ather A, Devabhakthuni S, Watson K, Lardieri AB, et al. Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy. Pharmacother J Hum Pharmacol Drug Ther [Internet]. 2016 Sep;36(9):955–70. Available from: http://doi.wiley.com/10.1002/phar.1795
  49. Lewey J, Haythe J. Cardiomyopathy in pregnancy. Semin Perinatol [Internet]. 2014 Aug;38(5):309–17. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0146000514000391
  50. Vigil-De Gracia P, Dominguez L, Solis A. Management of chronic hypertension during pregnancy with furosemide, amlodipine or aspirin: a pilot clinical trial. J Matern Neonatal Med [Internet]. 2014 Sep;27(13):1291–4. Available from: http://www.tandfonline.com/doi/full/10.3109/14767058.2013.852180
  51. Freyer AM. Drugs in Pregnancy and Lactation 8th Edition: A Reference Guide to Fetal and Neonatal Risk. Obstet Med [Internet]. 2009 May 22;2(2):89–89. Available from: http://journals.sagepub.com/doi/10.1258/om.2009.090002
  52. Gammill HS, Chettier R, Brewer A, Roberts JM, Shree R, Tsigas E, et al. Cardiomyopathy and Preeclampsia. Circulation [Internet]. 2018 Nov 20;138(21):2359–66. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.031527
  53. Honigberg MC, Givertz MM. Peripartum cardiomyopathy. BMJ [Internet]. 2019 Jan 30;k5287. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.k5287
  54. Altenberger J, Gustafsson F, Harjola V-P, Karason K, Kindgen-Milles D, Kivikko M, et al. Levosimendan in Acute and Advanced Heart Failure. J Cardiovasc Pharmacol [Internet]. 2018 Mar;71(3):129–36. Available from: http://journals.lww.com/00005344-201803000-00002
  55. Koczo A, Marino A, Jeyabalan A, Elkayam U, Cooper LT, Fett J, et al. Breastfeeding, Cellular Immune Activation, and Myocardial Recovery in Peripartum Cardiomyopathy. JACC Basic to Transl Sci [Internet]. 2019 Jun;4(3):291–300. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2452302X19300531
  56. Bhakta P, Biswas BK, Banerjee B. Peripartum Cardiomyopathy: Review of the Literature. Yonsei Med J [Internet]. 2007;48(5):731. Available from: https://eymj.org/DOIx.php?id=10.3349/ymj.2007.48.5.731
  57. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J [Internet]. 2018 Sep 7;39(34):3165–241. Available from: https://academic.oup.com/eurheartj/article/39/34/3165/5078465
  58. Skudicky D, Bergemann A, Sliwa K, Candy G, Sareli P. Beneficial Effects of Pentoxifylline in Patients With Idiopathic Dilated Cardiomyopathy Treated With Angiotensin-Converting Enzyme Inhibitors and Carvedilol. Circulation [Internet]. 2001 Feb 27;103(8):1083–8. Available from: https://www.ahajournals.org/doi/10.1161/01.CIR.103.8.1083
  59. Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail [Internet]. 2002 Jun;4(3):305–9. Available from: http://doi.wiley.com/10.1016/S1388-9842%2802%2900008-9
  60. Ecker JL, Frigoletto FD. Cesarean Delivery and the Risk–Benefit Calculus. N Engl J Med [Internet]. 2007 Mar 1;356(9):885–8. Available from: http://www.nejm.org/doi/10.1056/NEJMp068290
  61. Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J [Internet]. 2015 May 2;36(18):1090–7. Available from: https://academic.oup.com/eurheartj/articlelookup/doi/10.1093/eurheartj/ehv009
  62. Honigberg MC, Givertz MM. Arrhythmias in Peripartum Cardiomyopathy. Card Electrophysiol Clin [Internet]. 2015 Jun;7(2):309–17. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1877918215000398
  63. Desai SR, Hwang NC. Advances in left ventricular assist devices and mechanical circulatory support. J Cardiothorac Vasc Anesth 2018;32: 1193–213.
  64. Samalavicius RS, Puodziukaite L, Radaviciute I, et al. Prophylactic use of an intra-aortic balloon pump in a high-risk patient with peripartum cardiomyopathy requiring cesarean delivery. Int J Obstet Anesth 2018;33:67–71.
  65. Marasco SF, Lukas G, McDonald M, et al. Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ 2008;17(Suppl4):S41–7.
  66. Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: Device strategies and patient selection: A scientific statement from the American Heart Association. Circulation 2012;126:2648–67.
  67. Birks EJ, George RS, Hedger M, et al. Reversal of severe heart failure with a continuous flow left ventricular assist device and pharmacological therapy: A prospective study. Circulation 2011;123:381–90.
  68. Moreno, M. P. Fust, S. Torregrosa. Cap. 57 Asistencia respiratoria (ECMO): técnica e indicaciones. C. Gomar, M. Mata, J.L. Pomar. Fisiopatología y técnicas de circulación extracorpórea. 2º edc. A.E.P. 2012 p. 651-662
  69. Moulopulos SD, Topaz S, Kolff WJ. Diastolic balloon pumping in the aorta: Mechanical assistance to the failing circulation. Am Heart J 1962; 62: 669.
  70. S. Windecker, P. Kolh, F. Alfonso, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

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