This is a case series of six women with (PPCM) who underwent heart ultrasound prior to their initial PPCM presentation. The initial heart ultrasound the women who later developed PPCM showed normal heart strength (left ventricular ejection fraction, LVEF) and size. However, there was a trend towards abnormal global longitudinal strain (GLS is a heart ultrasound measurement of longitudinal heart shortening) in women who developed PPCM.
Recent PPCM Articles for Patients
ESC Heart Failure
This study did genetic testing on 469 women with PPCM and tested for 62 genetic abnormalities associated with heart muscle weakness. It found that about 10% of women with PPCM had a genetic abnormality in protein that makes up heart muscle cells called Titin (compared with 1% of the general population). PPCM survivors with this genetic abnormality (truncating mutation of Titin) had lower left ventricular ejection fraction at the time of presentation than women without the genetic abnormality; however the women with a Titin abnormality did not differ significantly in timing of presentation after delivery, in prevalence of preeclampsia, or in rates of clinical recovery. This study supports the contribution of a genetic predisposition to the development of PPCM.
Excellent review article with information on the definition, diagnosis, prognosis and current management of PPCM. The article also reviews managementrecommendations for a subsequent pregnancy after PPCM and discusses cardiovascular medication management during pregnancy and breastfeeding. There are excellent educational figures. The article highlights the following: 1. Medications used to treat HF during pregnancy and lactation require special considerations. 2. Severe heart failure may require advanced therapies and mechanical circulatory support. 3. Subsequent pregnancies carry risk of relapse, and dedicated counseling and monitoring are essential. 4. Future research about long-term outcomes, continued drug therapy, use of bromocriptine, device therapy, and genetics are needed.
Journal of American College of Cardiology
A retrospective study was conducted to determine whether first trimester N-terminal pro-B type natriuretic peptide (NT-proBNP) or high sensitivity cardiac troponin I (hs-cTnI) differed among women who developed PPCM versus those who did not.
Four cases of women with available blood tests prior to PPCM onset were identified. The PPCM women were matched to samples from women by age, race, number of prior pregnancies, and gestational age at which the blood sample was taken (Control A). A second comparison group was matched for all of the initial characteristics in addition to systolic BP at first prenatal visit and pregnancy weight gain (Control B).
First trimester NT-proBNP were numerically higher among women who developed PPCM (116 pg/mL [83–177]) as compared with women in Control A (56.1 pg/mL [38.7–118.7], not statistically significant) and control B (37.6 [23.3 − 53.8], p <0.05). A higher proportion of women who subsequently developed PPCM (50%) had detectable levels of hs-cTnI as compared with control A (0%, p = 0.03) or control B (18.8%, p = 0.52). Among both cases and controls, hs-cTnI values were low and often below the limit of detection.
American Journal of Perinatology
This study followed women who had a diagnosis of PPCM and studied the outcome of their subsequent pregnancies after PPCM diagnosis. In the study, forty-five women had 75 pregnancies. Of these pregnancies there were 8 miscarriages, 8 terminations, and 59 live births. The authors note that only one of the women who had recovered had a severe relapse. Of the women who did not have a recovered LVEF (LVEF <55%) prior to their post-PPCM pregnancy, relapse was observed in 25% of the women. There were no women who died and no fetal complications.
ESC Heart Failure
This article is a review of what is known about the causes of and risks for developing PPCM. Risk factors for developing PPCM include genetic variants (small variations in a person’s genetic code), pre-eclampsia (a pregnancy related cause of high blood pressure), low socioeconomic status and a history of cancer. The onset of PPCM most typically occurs at the same time as pregnancy related hormonal shifts, near the end of pregnancy or the months after. Studies done in animals suggest that PPCM is due to abnormal blood vessel development related to the pregnancy.
Nature Reviews Cardiology