Current knowledge and recent development on management of peripartum cardiomyopathy

Eur Heart J Acute Cardiovasc Care. 2017 Jun;6(4):359-366. doi: 10.1177/2048872615612465. Epub 2015 Oct 16.

Abstract

Heart failure with left ventricular dysfunction occurring during pregnancy or during the post-partum period in patients without history of cardiovascular disease defines peripartum cardiomyopathy (PPCM). PPCM carries a high morbidity and mortality rate as well as the possibility of recovery ad integrum. Its incidence shows ethnic variations, with a greater prevalence of the disease among women with African descent. Pathogenesis of PPCM remains poorly understood. Both "oxidative stress-prolactin axis" and "anti-angiogenic-signaling excess" hypotheses are currently being investigated. Novel diagnostic strategies and biomarkers are currently being evaluated. Besides conventional treatment of heart failure, targeted therapies such as pharmacological prolactin blockade are under evaluation. The aim of this short review is to highlight current management as targeted therapy has far been disappointing.

Keywords: Peripartum cardiomyopathy; bromocriptine; heart failure; heart transplantation; left ventricular assist device.

Publication types

  • Review

MeSH terms

  • Bromocriptine / adverse effects
  • Bromocriptine / therapeutic use
  • Cardiomyopathies / diagnostic imaging*
  • Cardiomyopathies / mortality
  • Cardiomyopathies / physiopathology
  • Cardiomyopathies / therapy
  • Echocardiography / methods
  • Electrocardiography
  • Female
  • Heart Failure / complications*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Heart Transplantation / methods
  • Heart-Assist Devices
  • Hormone Antagonists / adverse effects
  • Hormone Antagonists / therapeutic use
  • Humans
  • Incidence
  • Natriuretic Peptide, Brain / analysis
  • Oxidative Stress / physiology
  • Peripartum Period
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / epidemiology
  • Pregnancy Complications, Cardiovascular / physiopathology
  • Pregnancy Complications, Cardiovascular / therapy
  • Prolactin / metabolism
  • Radiography, Thoracic / methods
  • Ventricular Dysfunction, Left / complications*

Substances

  • Hormone Antagonists
  • Natriuretic Peptide, Brain
  • Bromocriptine
  • Prolactin