Peripartum Cardiomyopathy: From Pathophysiology to Management 0128176679, 9780128176672

Table of contents :
Front-Matter_2021_Peripartum-Cardiomyopathy
Front Matter
Copyright_2021_Peripartum-Cardiomyopathy
Copyright
Contributors_2021_Peripartum-Cardiomyopathy
Contributors
Preface_2021_Peripartum-Cardiomyopathy
Preface
Acknowledgments_2021_Peripartum-Cardiomyopathy
Acknowledgments
Foreword_2021_Peripartum-Cardiomyopathy
Foreword
Chapter-1---Etiology-and-pathophysiology_2021_Peripartum-Cardiomyopathy
Etiology and pathophysiology
Genetics of PPCM
References
Chapter-2---How-to-diagnose-the-condition_2021_Peripartum-Cardiomyopathy
How to diagnose the condition
Clinical presentation
Investigations
Electrocardiography
Blood tests and biomarkers
Chest radiography
Transthoracic echocardiography
Cardiac magnetic resonance imaging
Genetic testing
Summary
References
Chapter-3---Risk-stratification-in-patients-newly-diagn_2021_Peripartum-Card
Risk stratification in patients newly diagnosed with peripartum cardiomyopathy
Patient characteristics
Age
Medical history
Onset and time of diagnosis
Hemodynamic parameters
ECG
Concomitant hypertension
Predictors of mortality and morbidity
Predictors of LV function recovery
Concomitant right ventricular dysfunction at diagnosis
Magnetic resonance imaging (MRI)
Other factors associated with lack of LV function recovery (ethnicity, biomarkers)
Ethnicity
Biomarkers
Genetic predictors
Summary
References
Chapter-4---How-to-manage-a-woman-presenting-with-_2021_Peripartum-Cardiomyo
How to manage a woman presenting with acute PPCM?
Introduction
Clinical presentation and evaluation of acute PPCM
Management of acute PPCM presenting with systemic congestion without cardiopulmonary distress
Initial management of acute PPCM with cardiopulmonary distress or hemodynamic instability
Advanced management of severe acute PPCM
References
Chapter-5---What-needs-to-be-known-about-longer-term-m_2021_Peripartum-Cardi
What needs to be known about longer-term management and prognosis?
Management
Beta-blocker
Angiotensin-converting enzyme inhibitor
Angiotensin receptor blocker
Angiotensin receptor neprilysin inhibitor
Mineralocorticoid receptor antagonist
Ivabradine
Diuretics
Cardiac glycosides
Vasodilators
Nitrates
Anticoagulation
Heparin and synthetic pentasaccharides
Long-term therapy
General approach for follow-up
Devices
Wearable cardioverter-defibrillator
Implantable cardioverter-defibrillator and cardiac resynchronization therapy
Left ventricular assist device and heart transplantation
Other implantable electronic devices
Prognosis
Recovery of left ventricular function
Recovery at 6 months
Recovery beyond 6 months
Mortality
Predictors
Clinical parameters and genetics
Electrocardiogram
Laboratory parameters
Imaging
References
Chapter-6---Is-a-subsequent-pregnancy-safe-_2021_Peripartum-Cardiomyopathy
Is a subsequent pregnancy safe?
Maternal risk during a subsequent pregnancy
Fetal risk during a subsequent pregnancy
A practical approach to a subsequent pregnancy
Summary
References
Chapter-7---How-to-advise-on-safe-delivery-and-best-cont_2021_Peripartum-Car
How to advise on safe delivery and best contraception for patients with heart failure
Anticoagulation
Termination of pregnancy
Mode of delivery
Contraception
Summary
References
Chapter-8---What-can-be-learned-from-the-global-reg_2021_Peripartum-Cardiomy
What can be learned from the global registry on PPCM?
Background to the registry
Methodology
Challenges of setting up a biobank
Other overall challenges
Overall successes
Key findings from the registry
Lessons learned
References
Chapter-9---Setting-up-a-clinical-service-for-PPC_2021_Peripartum-Cardiomyop
Setting up a clinical service for PPCM in Iraq
Introduction
Peripartum cardiomyopathy in Iraq: What was known and how was dealing with?
Challenges and barriers during setting a new PPCM service in Iraq
Initiative for setting new PPCM service in Iraq
Plan for setting up a clinical service for PPCM in Iraq: Questions and answers
Impact of EORP-PPCM registry on the setting up a clinical service for PPCM in Iraq
Exceptional data from the real daily practice about subsequent pregnancies in patients with PPCM
Future plan for quality improvement of PPCM service in Iraq
Lessons to learn and keys of success
For the sake of history, messages to Prof. Karen Sliwa and ESC from Iraqi PPCM site
References
Chapter-10---Electrocardiographic-assessment-and-manageme_2021_Peripartum-Ca
Electrocardiographic assessment and management of arrhythmias in peripartum cardiomyopathy
Introduction
The 12‑lead electrocardiogram in PPCM
Ambulatory ECG monitoring in PPCM
Prevention and treatment of arrhythmias in PPCM
Implantable and wearable cardioverter defibrillators in PPCM
Conclusion
Acknowledgments
References
Chapter-11---Learning-from-the-peripartum-cardiomyopathy-in-_2021_Peripartum
Learning from the peripartum cardiomyopathy in Nigeria (PEACE) registry: A multisite, contemporary PPCM registry in Nigeria
Background
Summary of the study protocol
Clinical profile, incidence and risk factors of PPCM patients in Nigeria
Mortality of PPCM patients in Nigeria
Remodeling of cardiac chambers in PPCM patients in Nigeria
Selenium supplementation trial in PPCM
Relationship between serum selenium and ventricular dysfunction in apparently healthy pregnant women
Conclusion
References
Index_2021_Peripartum-Cardiomyopathy
Index
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Citation preview

PERIPARTUM CARDIOMYOPATHY

PERIPARTUM CARDIOMYOPATHY

From Pathophysiology to Management

Edited by

KAREN SLIWA Hatter Institute for Cardiovascular Research in Africa, Department of Medicine and Cardiology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa

Academic Press is an imprint of Elsevier 125 London Wall, London EC2Y 5AS, United Kingdom 525 B Street, Suite 1650, San Diego, CA 92101, United States 50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom © 2021 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN 978-0-12-817667-2 For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals

Publisher: Stacy Masucci Acquisitions Editor: Katie Chan Editorial Project Manager: Sara Pianavilla Production Project Manager: Sreejith Viswanathan Cover Designer: Vicky Pearson Typeset by SPi Global, India

Contributors Mattia Arrigo Department of Cardiology, University Hospital Zurich, Zurich, Switzerland Feriel Azibani Inserm UMR-S 942, Paris, France Johann Bauersachs Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Olivia Briton Department of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa Matthew Cauldwell Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom Ashley Chin Division of Cardiology, University of Cape Town, Cape Town, South Africa P. van der Meer Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands Hasan Ali Farhan Scientific Council of Cardiology, Iraqi Board for Medical Specializations; Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq Sorel Goland The Heart Institute, Kaplan Medical Center, Rehovot; Hebrew University, Jerusalem, Israel Julia Hähnle University of the Witwatersrand, Johannesburg, South Africa Lina Hähnle Department of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa Denise Hilfiker-Kleiner Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Julian Hoevelmann Department of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa A.M. Jackson Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom

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Contributors

Mark Johnson Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom Kamilu Musa Karaye Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria Tobias König MHH, Cardiology and Angiology; Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Alexandre Mebazaa Hopital Lariboisière, Anesthesia and Critical Care, APHP, Paris, France Rob Scott Millar Division of Cardiology, University of Cape Town, Cape Town, South Africa Valeska Abou Moulig Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Frederic Mouquet Soins Intensifs et Cardiologie, Hopital prive le Bois, Ramsay Generale de Santé, Lille, France M.C. Petrie Institute of Cardiovascular and Medical Sciences, University of Glasgow; Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom Mark Petrie Institute of Cardiovascular and Medical Sciences, University of Glasgow; Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom Tobias Pfeffer Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany Karen Sliwa Department of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa K. Tibazarwa LHC, Dar es Salaam, Tanzania Charle Viljoen Division of Cardiology; Department of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa Israa Fadhil Yaseen Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq

Preface Peripartum cardiomyopathy (PPCM) is a global disease that is often not diagnosed timeously, leading to significant morbidity and mortality. It is an important contributor to early (  70 bpm [6]. In HFrEF patients with African origin, the combination of hydralazine and isosorbide dinitrate reduces mortality and HF hospitalizations [7]. In contrast, diuretics relieve symptoms and enhance quality of life but do not improve prognosis [8,9]. Besides optimal therapy in terms of drug and device treatment, several other aspects have to be considered in the long-term care: Since there is controversy on stopping lactation and the use of bromocriptine in PPCM patients (class IIb recommendation according to the 2018 ESC guidelines for the management of cardiovascular disease during pregnancy) [10] the compatibility of HF drugs with lactation/­breastfeeding

Peripartum Cardiomyopathy https://doi.org/10.1016/B978-0-12-817667-2.00005-0

© 2021 Elsevier Inc. All rights reserved.

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Table 5.1  Chronic drug treatment in PPCM patients after delivery [1]. Drug

Persisting heart failure and absence of complete LV recovery

Betablocker

Essential for all patients in standard or maximally tolerated dosages

ACEI

Essential for all patients in standard or maximally tolerated dosages

ARB

Recommended in patients who do not tolerate ACEI

ARNI

Recommended in patients with LVEF  70 b.p.m. at rest despite maximal tolerated beta-blocker uptitration

Discontinue if heart rate   0.04  ng/mL there was a significant difference in LVEF and more patients with a persisting left ventricular systolic dysfunction at follow-up. Furthermore, there are prognostic values that have been identified for soluble fms-like tyrosine kinase 1 (sFlt-1), oxidized low-density lipoprotein (Ox-LDL), Relaxin-2, Fas/Apo1, and Interferon gamma (IFN-γ) [40,58,74,75]. However, these biomarkers have not been implemented into clinical routine yet and their benefits remain uncertain [76].

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Peripartum cardiomyopathy

Other biomarkers such as prolactin, 16  kDa-prolactin, microRNA-146a, cathepsin D, and asymmetric dimethylarginine (ADMA) may serve as biomarkers for the diagnosis but do not predict outcome in PPCM patients [52,77]. Imaging Transthoracic echocardiography is recommended to be routinely performed both at diagnosis and follow-up [1]. Cardiac magnetic resonance imaging (MRI) may add beneficial information, e.g., in case of suspected myocarditis, infiltrative myocardial diseases, or an ischemic cause of heart failure. A few imaging findings have been associated with a lower probability of full recovery. An LV end-diastolic diameter >  60 mm and an initial LVEF