Peripartum cardiomyopathy: Experience at a tertiary center

Ezgi Başaran; Betül Akgün Aktaş; Aydan Sezgin; Atakan Tanacan; Çağrı Yayla; Dilek Sahin

doi:10.47482/acmr.1740761

TR EN

Peripartum kardiyomiyopati: Üçüncü basamak merkez deneyimi

Öz

Arka plan: Peripartum kardiyomiyopati (PPCM), gebelikle ilişkili nadir ve idiopatik bir kardiyomiyopatidir ve kalp yetmezliği ile mortaliteye yol açabilir. Bu çalışmanın amacı, PPCM gelişen hastaların klinik özelliklerini, tanı ve tedavi yöntemlerini, prognozlarını değerlendirmek ve obstetrisyenlerin PPCM konusundaki farkındalığını artırarak erken tanı ve tedaviyi kolaylaştırmak ve böylece hasta sonuçlarını iyileştirmektir. Yöntemler: Ekim 2019 - Ekim 2023 tarihleri arasında Bilkent Şehir Hastanesi'nde PPCM tanısı alan hastalar retrospektif olarak analiz edildi. Risk faktörleri, klinik özellikleri ve sonuçları değerlendirildi. Bulgular: Çalışma periyodunda on iki PPCM hastası belirlendi. Sekiz hasta primigravid idi. İki hastada çoğul gebelik mevcuttu. Dört hasta antepartum, sekiz hasta ise postpartum dönemde tanı almıştı. Beş hastada preeklampsi vardı. En belirgin semptom dispne idi. Dört hastada hafif (EF ≥ %30), sekiz hastada şiddetli (EF < %30) LV disfonksiyonu saptandı. İki hasta entübe edildi; bir hasta tanıdan iki gün sonra kaybedildi. Dokuz hastada standart kalp yetmezliği tedavisine bromokriptin eklendi. Altıncı ayda 5 hastada, 12. ayda 8 hastada LVEF %50’nin üzerinde saptandı. Üç hastanın takip verilerine ulaşılamadı. Sonuç: PPCM, nadir görülmesi ve gebelikteki normal semptomlarla ve obstetrik komplikasyonlarla örtüşmesi nedeniyle genellikle geç tanı almaktadır. Semptom başlangıcı ile tanı arasındaki süre prognozu doğrudan etkilemektedir. Bu nedenle, geç gebelik veya postpartum dönemde görülen bu patolojide erken tanı ve hızlı tedavi maternal sonuçların iyileştirilmesi açısından kritik öneme sahiptir.

Anahtar Kelimeler

Peripartum kardiyomiyopati , gebelik , kalp yetmezliği , gebelik ilişkili kardiyomiyopati , ekokardiyografi

Peripartum cardiomyopathy: Experience at a tertiary center

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare, idiopathic cardiomyopathy associated with pregnancy that can lead to heart failure and maternal mortality. This study aims to evaluate the clinical features, diagnostic and treatment approaches, and outcomes of patients diagnosed with PPCM, while also increasing awareness among obstetricians, cardiologists and emergency medicine physicians to support earlier diagnosis and intervention. Methods: Patients diagnosed with PPCM and managed within a multidisciplinary team including the perinatology clinic between October 2019 and October 2023 were retrospectively analyzed. Risk factors, clinical presentation, and outcomes were evaluated. Results: Twelve patients with PPCM were identified. Eight were primigravida, and two had multiple pregnancies. Four patients were diagnosed antepartum and eight postpartum. Preeclampsia was present in five cases. Dyspnea was the most common symptom. Left ventricular dysfunction was mild (EF ≥ 30%) in four patients and severe (EF <30%) in eight. Two patients required intubation, and one died on the second day following diagnosis. Bromocriptine was added to standard heart failure therapy in nine patients. At 6 months, five patients had recovered LVEF ≥ 50%, and at 12 months, eight patients achieved this level. Three patients were lost to follow-up. Conclusion: Due to its rarity and nonspecific symptoms, PPCM is often diagnosed late, potentially worsening prognosis. Since delayed diagnosis negatively impacts outcomes, early recognition and timely initiation of treatment in late pregnancy or postpartum are vital for improving maternal health.

Keywords

Peripartum cardiomyopathy , pregnancy , heart failure , pregnancy-associated cardiomyopathy , echocardiography

References

Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767-78.
Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol. 2011;58(7):659-70.
Harper MA, Meyer RE, Berg CJ. Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality. Obstet Gynecol. 2012;120(5):1013-9.
Goland S, Modi K, Hatamizadeh P, Elkayam U. Differences in clinical profile of African-American women with peripartum cardiomyopathy in the United States. J Card Fail. 2013;19(4):214-8.
van Spaendonck-Zwarts KY, Posafalvi A, van den Berg MP, Hilfiker-Kleiner D, Bollen IA, Sliwa K, et al. Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy. Eur Heart J. 2014;35(32):2165-73.
Ware JS, Li J, Mazaika E, Yasso CM, DeSouza T, Cappola TP, et al. Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies. N Engl J Med. 2016;374(3):233-41.
Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol. 2014;11(6):364-70.
Hilfiker-Kleiner D, Haghikia A, Berliner D, Vogel-Claussen J, Schwab J, Franke A, et al. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J. 2017;38(35):2671-79.
Forster O, Hilfiker-Kleiner D, Ansari AA, Sundstrom JB, Libhaber E, Tshani W, et al. Reversal of IFN-gamma, oxLDL and prolactin serum levels correlate with clinical improvement in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2008;10(9):861-8.
Haghikia A, Podewski E, Libhaber E, Labidi S, Fischer D, Roentgen P, et al. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol. 2013;108(4):366.

Sliwa K, Hilfiker-Kleiner D, Mebazaa A, Petrie MC, Maggioni AP, Regitz-Zagrosek V, et al. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Eur J Heart Fail. 2014;16(5):583-91.
Demakis JG, Rahimtoola SH, Sutton GC, Meadows WR, Szanto PB, Tobin JR, et al. Natural course of peripartum cardiomyopathy. Circulation. 1971;44(6):1053-61.
Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283(9):1183-8.
Hibbard JU, Lindheimer M, Lang RM. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet Gynecol. 1999;94(2):311-6.
Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail. 2012;14(8):895-901.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016;18(8):891-975.
Duncker D, Haghikia A, König T, Hohmann S, Gutleben KJ, Westenfeld R, et al. Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function-value of the wearable cardioverter/defibrillator. Eur J Heart Fail. 2014;16(12):1331-6.
Bauersachs J, Arrigo M, Hilfiker-Kleiner D, Veltmann C, Coats AJ, Crespo-Leiro MG, et al. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance. Eur J Heart Fail. 2016;18(9):1096-105. Mebazaa A, Tolppanen H, Mueller C, Lassus J, DiSomma S, Baksyte G, et al. Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance. Intensive Care Med. 2016;42(2):147-63.
Fett JD. Earlier detection can help avoid many serious complications of peripartum cardiomyopathy. Future Cardiol. 2013;9(6):809-16.
Chapa JB, Heiberger HB, Weinert L, Decara J, Lang RM, Hibbard JU. Prognostic value of echocardiography in peripartum cardiomyopathy. Obstet Gynecol. 2005;105(6):1303-8.
Kayıkçıoğlu M, Biteker M, Mutluer FO, Güzel T, Yılmaz E, Demir E, et al. Baseline Characteristics and Clinical Insights from the ARTEMIS Registry: A Comprehensive Study of Peripartum Cardiomyopathy in Türkiye. Turk Kardiyol Dern Ars. 2024;52(7):474-83.
Sliwa K, Petrie MC, van der Meer P, Mebazaa A, Hilfiker-Kleiner D, Jackson AM, et al. Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry. Eur Heart J. 2020;41(39):3787-97.
Cooper LT, Mather PJ, Alexis JD, Pauly DF, Torre-Amione G, Wittstein IS, et al. Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and nonperipartum women. J Card Fail. 2012;18(1):28-33.
McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, et al. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study. J Am Coll Cardiol. 2015;66(8):905-14.
Laghari AH, Khan AH, Kazmi KA. Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. BMC Res Notes. 2013;6:495.
Pillarisetti J, Kondur A, Alani A, Reddy M, Reddy M, Vacek J, et al. Peripartum cardiomyopathy: predictors of recovery and current state of implantable cardioverter-defibrillator use. J Am Coll Cardiol. 2014;63(25):2831-9.
Blauwet LA, Libhaber E, Forster O, Tibazarwa K, Mebazaa A, Hilfiker-Kleiner D, et al. Predictors of outcome in 176 South African patients with peripartum cardiomyopathy. Heart. 2013;99(5):308-13.
Lindley KJ, Conner SN, Cahill AG, Novak E, Mann DL. Impact of Preeclampsia on Clinical and Functional Outcomes in Women With Peripartum Cardiomyopathy. Circ Heart Fail. 2017;10(6):e003797.
Bello N, Rendon ISH, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013;62(18):1715-23.
Jackson AM, Petrie MC, Frogoudaki A, Laroche C, Gustafsson F, Ibrahim B, et al. Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry. Eur J Heart Fail. 2021;23(12):2058-69.
Sliwa K, Mebazaa A, Hilfiker-Kleiner D, Petrie MC, Maggioni AP, Laroche C, et al. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail. 2017;19(9):1131-41.
van der Meer P, van Essen BJ, Viljoen C, Böhm M, Jackson A, Hilfiker-Kleiner D, et al. Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry. Eur Heart J. 2025;46(11):1017-27.
Tremblay-Gravel M, Marquis-Gravel G, Avram R, Desplantie O, Ducharme A, Bibas L, et al. The effect of bromocriptine on left ventricular functional recovery in peripartum cardiomyopathy: insights from the BRO-HF retrospective cohort study. ESC Heart Fail. 2019;6(1):27-36.
Trongtorsak A, Kittipibul V, Mahabir S, Ibrahim M, Saint Croix GR, Hernandez GA, Chaparro S. Effects of bromocriptine in peripartum cardiomyopathy: a systematic review and meta-analysis. Heart Fail Rev. 2022;27(2):533-43.
Fett JD. Promoting awareness of peripartum cardiomyopathy (PPCM). Int J Cardiol. 2020;305:113-4.

Details

Primary Language

English

Subjects

Surgery (Other)

Journal Section

Research Article

Authors

Ezgi Başaran ^*
0000-0002-5062-3316
Türkiye

Betül Akgün Aktaş
0000-0003-4523-011X
Türkiye

Aydan Sezgin This is me
0000-0002-3711-5747
Türkiye

Atakan Tanacan
0000-0001-8209-8248
Türkiye

Çağrı Yayla
0000-0002-5302-4052
Türkiye

Dilek Sahin
0000-0001-8567-9048
Türkiye

Publication Date

September 28, 2025

Submission Date

July 12, 2025

Acceptance Date

September 21, 2025

Published in Issue

Year 2025 Volume: 6 Number: 3

DOI

https://doi.org/10.47482/acmr.1740761

IZ

https://izlik.org/JA87ZE49WG

APA

Başaran, E., Akgün Aktaş, B., Sezgin, A., Tanacan, A., Yayla, Ç., & Sahin, D. (2025). Peripartum cardiomyopathy: Experience at a tertiary center. Archives of Current Medical Research, 6(3), 326-333. https://doi.org/10.47482/acmr.1740761

Archives of Current Medical Research (ACMR) provides instant open access to all content, bearing in mind the fact that presenting research

free to the public supports a greater global exchange of knowledge.

http://www.acmronline.org/

Peripartum kardiyomiyopati: Üçüncü basamak merkez deneyimi

Öz

Anahtar Kelimeler

Peripartum cardiomyopathy: Experience at a tertiary center

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite