Peripartum Cardiomyopathy: From Genetics to Management

Karen Sliwa; Johann Bauersachs; Zolt Arany; Timothy F. Spracklen; Denise Hilfiker-Kleiner

Disclosures

Eur Heart J. 2021;42(32):3094-310. 

In This Article

Abstract and Introduction

Abstract

Peripartum cardiomyopathy (PPCM) is a disease that occurs globally in all ethnic groups and should be suspected in any peripartum women presenting with symptoms and signs of heart failure, towards the end of pregnancy or in the months following delivery, with confirmed left ventricular dysfunction. After good history taking, all women should be thoroughly assessed, and alternative causes should be excluded. Urgent cardiac investigations with electrocardiogram and natriuretic peptide measurement (if available) should be performed. Echocardiography follows as the next step in investigation. Patients with abnormal cardiac investigations should be urgently referred to a cardiology team for expert management. Referral for genetic work-up should be considered if there is a family history of cardiomyopathy or sudden death. PPCM is a disease with substantial maternal and neonatal morbidity and mortality. Maternal mortality rates range widely, from 0% to 30%, depending on the ethnic background and geographic region. Just under half of women experience myocardial recovery. Remarkable advances in the comprehension of the pathogenesis and in patient management and therapy have been achieved, largely due to team efforts and close collaboration between basic scientists, cardiologists, intensive care specialists, and obstetricians. This review summarizes current knowledge of PPCM genetics, pathophysiology, diagnostic approach, management, and outcome.

Graphical Abstract

Introduction

Peripartum cardiomyopathy (PPCM) is increasingly recognized as an important medical condition that can complicate pregnancy. It is a life-threatening cardiomyopathy, characterized by acute or slowly progressing left ventricular (LV) dysfunction—late in pregnancy, during delivery, or in the first postpartum months—in women with no previously known cardiac disease.[1,2] Over the past two decades a substantial amount of new knowledge on this condition has been published, including better understanding of the pathophysiology, the genetic predisposition for a portion of patients, on diagnostic tools, management and outcome. The Heart Failure Association of the European Society of Cardiology (ESC) Working Group on PPCM initiated the largest prospective global cohort study, under the umbrella of the EURObservational Research Programme (EORP), with >700 PPCM patients, providing novel data on presentation in various ethnic groups, as well as maternal and Foetal outcome.[3]

This review provides an update on new findings from genetics to management (Graphical abstract).

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