Peripartum Kardiyomiyopati

Peripartum kardiyomyopati PPKMP yüksek anne ve bebek mortalitesi ile seyredebilen bir dilate kardiyomiyopati formudur. Peripartum kardiyomyopati gebeliğin son 4 haftası ve postpartum 5. aylar arasında görülmektedir. Altta yatan kesin neden belli olmamakla beraber enfeksiyonlar, myokardit, immünolojik faktörler, prolaktinin neden olduğu oksidatif stres gibi birçok neden suçlanmaktadır. Bu derlemede hastalığın epidemiyolojisi, etyolojisi, tanısı, tedavisi ve prognozu hakkındaki güncel veriler tartışılmıştır.

Anahtar Kelimeler:

kardiyak, peripartum, kardiyomiyopati

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a form of dilated cardiomyopathy with a high rate of mother and fetus mortality. It is diagnosed in the last four months of the pregnancy and fifth month of the postpartum period. Although the exact underlying cause is uncertain; infections, myocarditis, immunologic factors, prolactin stimulated oxidative stress are accused for it. In this review the recent data about the epidemiology, diagnosis and prognosis of the disease is discussed.

Keywords:

cardiac, peripartum, cardiomyopathy,

PDF

___

Demakis JG, Rahimtoola SH. Peripartum cardiomyopa- thy. Circulation 1971; 44: 964–8.
Manolio TA, Baughman KL, Rodeheffer R, Pearson TA, Bristow JD, Michels VV, Abelmann WH, Harlan WR. Prev- alence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop). Am J Cardiol 1992; 69: 1458–66.
Witlin AG, Mabie WC, Sibai BM. Peripartum cardiomy- opathy: a longitudinal echocardiographic study. Am J Obstet Gynecol 1997;177:1129–32.
Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A,Baughman KL. Peripartum cardio- myopathy: National Heart, Lung and Blood Institute and Office of Rare Diseases Workshop recommendations and reviews. JAMA 2000; 283: 1183–8.
Fett JD, Christie LG, Carraway RD, Murphy JG. Five-year prospective study of the incidence and prognosis of peri- partum cardiomiopathy at a single insitution. Mayo Proc 2005; 80: 1602–6.
Modi KA, Illum S, Jariatul K, Caldito G, Reddy PC. Poor outcome of indigent patients with peripartum cardiomy- opathy in the United States, Am J Obstet Gynecol 2009;201: 171.e1–5
Hilfiker-Kleiner D, Sliwa K, Drexler H. Peripartum cardi- omyopathy: recent insights in its patophysiology. Trends Cardiovasc Med 2008; 18: 173–9.
Ntusi NBA, Mayosi BM. Aetiology and risk factors of peripartum cardiomyopathy: a systematic review. Int J Cardiol 2009;131:168–79.
Bultmann BD, Klingel K, Nabauer M, Wallwiener D, Kandolf R. High prevalence of viral genomes and inflam- mation in peripartum cardiomyopathy. Am J Obstet Gy- necol 2005; 193: 363-5.
Melvin KR, Richardson PJ, Olsen EG, Daly K, Jackson G. Peripartum cardiomyopathy due to myocarditis. N Engl J Med 1982; 307: 731–4.
Sanderson JE, Olsen EGJ, Gatei D. Peripartum heart disease: an endomyocardial biopsy study. Br Heart J 1986; 56: 285–91
Kühl U, Pauschinger M, Seeberg B, Lassner D, Noutsias M, Poller W, Schultheiss HP. Viral persistence in the myo- cardium is associated with progressive cardiac dysfunc- tion. Circulation 2005; 112:1965–70.
Sliwa K, Forster O, Tibazarwa K, Libhaber E, Becker A, Yip A, Hilfiker-Kleiner D.Long-term outcome of Peripar
tum cardiomyopathy in a population with high seroposi- tivity for human immunodeficiency virus. Int J Cardiol. 2011; 147: 202–8
Warraich RS, Sliwa K, Damasceno A, Carraway R, Sundrom B, Arif G, Essop R, Ansari A, Fett J, Yacoub M. Impact of pregnancy-related heart failure on humoral immunity: clinical relevance of G3-subclass immunglobu- lins in peripartum cardiomyopathy. Am Heart J 2005; 150: 263–69.
Ansari AA, Fett JD, Carraway RE, Mayne AE, Onlamoon N, Sundstrom JB. Autoimmune mechanisms as the basis for human peripartum cardiomyopathy. Clin Rev Allergy Immunol 2002;23: 301–24.
Nelson JL. Microchimerism: expanding new horizon in human health or incidental remnant of pregnancy? Lan- cet 2001;358: 2011–12.
Morales A, Painter T, Li R, Siegfried JD, Norton N, Hershberger RE. Rare variant mutations in pregnancy- associated or peripartum cardiomyopathy. Circulation 2010; 121: 2176–82.
Cenac A, Simonoff M, Moretto P, Djibo A. A low plasma selenium is a risk factor for peripartum cardiomy- opathy. A comparative study in Sahelian Africa. Int J Cardiol. 1992; 36: 57–9.
Fett JD, Ansari AA, Sundstrom JB, Combs Jr GF. Peri- partum cardiomyopathy: a selenium disconnection and an autoimmune connection. Int J Cardiol. 2002; 86: 311– 16
Ro A, Frishman WH. Peripartum cardiomyopathy. Cardiol Rev 2006;14: 35–42.
Bhakta P, Biswas BK, Banerjee B. Peripartum Cardio- myopathy: Review of the Literature. Yonsei Med J 2007;48(5):73 –747.
Hilfiker-Kleiner D, Meyer GP, Schieffer E, Goldmann B, Podewski E, Struman I, Fischer P, Drexler H. Recovery from postpartum cardiomyopathy in 2 patients by block- ing prolactin release with bromocriptine. J Am Coll Cardiol 2007; 50: 2354–55.
Jahns BG, Stein W, Hilfiker-Kleiner D, Pieske B, Emons G. Peripartum cardiomyopathy—a new treatment option by inhibition of prolactin secretion, Am J Obstet Gynecol 2008;199: no.e5–6
Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Beckerr A, McMurray J, Yamac H, Labidi S, Struman I, Hilkifer-Kleiner D. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 2010; 121: 1465–73
Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kühl U, Maisch B, McKenna WJ, Monserrat L, Pankuweit S, rapezzi C, seferovic P, Tavazzi L, Keren A. Classification of the cardiomyopathies: a position statement from the European Society of Cardiol- ogy Working Group on Myocardial and Pericardial Diseas- es. Eur Heart J 2008; 29: 270–6
Chapa JB, .Heiberger HB, Weinert L, DeCara J, Lang RM, Hibbard JU. Prognostic value of echocardiography i1n peripartum 2005;105:1303–8
Lampert MB, Lang RM. Peripartum cardiomyopathy. Am Heart J 1995; 130: 860–70.
Elkayam U, Akhter MW, Singh H, Khan S, Bitar F,Hameed A. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111: 2050–5.
Sliwa K, Förster O, Libhaber E, Fett JD, Sundstrom JB, Hilfiker-Kleiner D, Ansari AA. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J 2006; 27: 441– 6. Obst
Gynecol 31. Amos AM, Jaber A, Russell SD. Improved outcomes in peripartum cardiomypathy with contemporary. American Heart Journal 2007;50: 2354–5.
Ravikishore AG, Kaul UA, Sethi KK, Khalilullah M. Peripartum cardiomyopathy: prognostic variables at initial evaluation. Int J Cardiol. 1992 May;35: 283–4.
Goland S, Modi K, Bitar F, Janmohamed M, Mirocha JM, Czer LS, Illum S, Hatamizadeh P, Elkayam U. Clinical profile and predictors of complications in peripartum cardiomyopathy. J Card Fail 2009;15: 645–50.
Whitehead SJ, Berg CJ, Chang J. Pregnancy-related mortality due to cardiomyopathy: United States, 1991- 1997. Obstet Gynecol 2003;102:1326-31.
Kaaja R. Peripartum cardiomyopathy. Minerva Cardi- oangiol 2006; 543: 331–6.
Task force on the management of cardiovascular diseases during pregnancy of the European society of cardiology. Expert consensus document on the manage- ment of the cardiovascular disease during pregnancy. Eur Heart J 2003; 24: 761–81
Ardehali H, Kasper EK, Baughman KL. Peripartum cardiomyopathy. Minerva Cardioangiol 2003;51: 41–8.
Schaefer C, Peters P, Miller RK, editors. Drugs during pregnancy and lactation: Treatment options and risk assessment. 2nd ed. San Francisco, CA: Academic Press; 2007 pp. 202–207
Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, progno- sis, and management. J Am Coll Cardiol. 2011; 58: 659– 70.
Isezuo SA, Abubakar SA. Epidemiologic profile of peripartum cardiomyopathy in a tertiary care hospital. Ethn Dis 2007; 17: 228–33.
Ferrero S,Colombo BM, Ragni N. Maternal arrhytmias during pregnancy. Arch Gynecol Obstet 2004; 269: 244– 53.
Cleland JG, Daubert JC, Erdmann E, Fremantle N, Gras D, Kappenberger L, Tavazzi L. Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J 2006; 27: 1928–32
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM; Comparison of MedicalThera- py, Pacing, and Defibrillation in Heart Failure (COMPAN- ION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140–50.
Ford RF, Barton JR, O'brien JM, Hollingsworth PW. Demographics, management, and outcome of peripartum cardiomyopathy in a community hospital. Am J Obstet Gynecol 2000;182:1036–8.
Felker GM, Jaeger CJ, Klodas E, Thiemann DR, Hare JM, Hruban RH, Kasper EK, Baughman KL. Myocarditis and long-term survival in peripartum cardiomyopathy. Am Heart J. 2000 Nov;140(5): 785–91.
Geveart S, Van Belleghem Y, Bouchez S, Herck I, De Somer F, De Block YTromp F, Vandecasteele E, Martens F, De Pauw M. Acute and critically ill peripartum cardiomy- opathy and 'bridge to' therapeutic options: a single center experience with intra-aortic balloon pump, extra corpo- real membrane oxygenation and continuous-flow left ventricular assist devices. Crit Care 2011;15: R93.
Bozkurt B, Villaneuva FS, Holubkov R, Tokarczyk T, Alvarez RJ, MacGowan GA, Murali S, Rosenblum WD, Feldman AM, McNamara DM. Intravenous immuneglobu- lin in the therapy of peripartum cardiomyopathy. J Am Cardiol 1999; 34: 177–80.
Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2002; 4: 305–9.
Pyatt JR, Dubey G. Peripartum cardiomyopathy: cur- rent understanding, comprehensive management review and new developments. Postgrad Med J 2011; 87: 34–39. 50. Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR, Hameed A, Gvizada I, Shotan A. Maternal and fetal outcomes of subsewuent pregnancies in women with peripartum cardiomyopathy. N Eng J Med 2001; 344: 1567–71.
Fett JD, Fristoe KL, Welsh SN. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynaecol Obstet 2010 Apr;109: 34–6.