Improving outcomes in peripartum cardiomyopathy

Abstract

Peripartum cardiomyopathy (PPCM) is a rare condition with a diverse spectrum of potential outcomes, ranging from frequent complete recovery to fulminant heart failure and death. The pathogenesis of PPCM is not well understood, and relatively little is known about its incidence and prevalence. PPCM is often under-recognised in the clinical setting. Early investigation and diagnosis with subsequent expert management may improve outcomes. The development of registries will allow this condition to be better characterised and may help answer crucial questions regarding its optimal medical and surgical management. This paper reviews the potential approaches to improve outcomes in patients with PPCM.

Keywords:

• heart failure
• peripartum cardiomyopathy
• pregnancy
• prolactin
• transplantation
• ventricular assist device

Financial & competing interests disclosure

M Petrie is a member of the Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. The authors have no other relevant affiliations or financial involvement with any organisation or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilised in the production of this manuscript.

Key issues

• Peripartum cardiomyopathy (PPCM) is a distinct cardiomyopathy associated with systolic dysfunction, malignant arrhythmias, thromboembolism and death.

• Prognosis is better than for other forms of dilated cardiomyopathy, given the relatively high rate of recovery of left ventricular function.

• Current understanding of all aspects of this condition is limited.

• Non-specific symptoms and signs mean that a low threshold for cardiac investigation (ECG, B-type natriuretic peptide and echocardiography) is necessary.

• Patients should be managed according to the established heart failure guidelines and a multidisciplinary approach (including cardiac intensivists, obstetricians, neonatologists, heart failure cardiologists and cardiothoracic surgeons) to management is crucial.

• Pilot data have suggested a putative role for bromocriptine therapy as a disease modifying therapy for PPCM.

• If you have a patient diagnosed with PPCM, please contact the ESC Heart Failure Association Working Group on PPCM to register the patient in their registry (website: http://www.formstack.com/forms/escardio-eorp_contact or email [email protected]).