Abstract
Peripartum cardiomyopathy (PPCM) is a rare but life-threatening cardiac disorder characterized by maternal systolic heart failure. Although PPCM is a major cause of maternal mortality, little is known about the acute-phase management of PPCM in real-world clinical settings. We retrospectively identified patients hospitalized with PPCM from 2007 to 2014 using the Diagnosis Procedure Combination database in Japan. We investigated patient characteristics, in-hospital examinations and treatment, and in-hospital outcomes. The study patients were 283 patients hospitalized with PPCM at 177 hospitals. The mean age was 32.7 ± 5.5 years. Of the eligible patients, 134 (47.3%) patients had a hypertensive disorder, including 48 (17.0%) patients with pre-eclampsia, and 111 (39.2%) patients were admitted to the intensive care unit or emergency center. Coronary angiography, cardiac magnetic resonance imaging, and endomyocardial biopsy were performed during hospitalization in 69 (24.4%), 42 (14.8%), and 43 (15.2%) patients, respectively. Invasive pulmonary artery pressure monitoring was used in 14 (4.9%) patients. Mechanical circulatory support was used in 13 (4.6%) patients (intra-aortic balloon pumping, n = 12; extracorporeal membrane oxygenation, n = 5; ventricular assist device, n = 0). Catecholamine therapy and phosphodiesterase-III inhibitor therapy were used in 79 (27.9%) and 13 (4.6%) patients, respectively. Prolactin blockade therapy was used in 78 (27.6%) patients. During hospitalization, four (1.4%) patients died and nine (3.2%) patients developed ventricular tachycardia or fibrillation. Two (0.7%) patients received an implantable cardioverter defibrillator, but no patient received other permanent cardiac devices. This retrospective cohort study suggests that attending physicians should be ready to provide intensive care for patients with PPCM during the acute phase.
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References
Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ; Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy (2010) 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 12:767–778
Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J (2015) Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J 36:1090–1097
Bauersachs J, Arrigo M, Hilfiker-Kleiner D, Veltmann C, Coats AJ, Crespo-Leiro MG, De Boer RA, van der Meer P, Maack C, Mouquet F, Petrie MC, Piepoli MF, Regitz-Zagrosek V, Schaufelberger M, Seferovic P, Tavazzi L, Ruschitzka F, Mebazaa A, Sliwa K (2016) Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 18:1096–1105
Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, Forster O, Quint A, Landmesser U, Doerries C, Luchtefeld M, Poli V, Schneider MD, Balligand JL, Desjardins F, Ansari A, Struman I, Nguyen NQ, Zschemisch NH, Klein G, Heusch G, Schulz R, Hilfiker A, Drexler H (2007) A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 128:589–600
Sliwa K, Skudicky D, Bergemann A, Candy G, Puren A, Sareli P (2000) Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. J Am Coll Cardiol 35:701–705
Ware JS, Li J, Mazaika E, Yasso CM, DeSouza T, Cappola TP, Tsai EJ, Hilfiker-Kleiner D, Kamiya CA, Mazzarotto F, Cook SA, Halder I, Prasad SK, Pisarcik J, Hanley-Yanez K, Alharethi R, Damp J, Hsich E, Elkayam U, Sheppard R, Kealey A, Alexis J, Ramani G, Safirstein J, Boehmer J, Pauly DF, Wittstein IS, Thohan V, Zucker MJ, Liu P, Gorcsan J, 3rd, McNamara DM, Seidman CE, Seidman JG, Arany Z; IMAC-2 and IPAC Investigators (2016) Shared genetic predisposition in peripartum and dilated cardiomyopathies. N Engl J Med 374:233–241
Ntusi NB, Badri M, Gumedze F, Sliwa K, Mayosi BM (2015) Pregnancy-associated heart failure: a comparison of clinical presentation and outcome between hypertensive heart failure of pregnancy and idiopathic peripartum cardiomyopathy. PLoS One 10:e0133466
McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J 3rd, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD; IPAC Investigators (2015) Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC Study (investigations of pregnancy-associated cardiomyopathy). J Am Coll Cardiol 66:905–914
Libhaber E, Sliwa K, Bachelier K, Lamont K, Bohm M (2015) Low systolic blood pressure and high resting heart rate as predictors of outcome in patients with peripartum cardiomyopathy. Int J Cardiol 190:376–382
Loyaga-Rendon RY, Pamboukian SV, Tallaj JA, Acharya D, Cantor R, Starling RC, Naftel D, Kirklin J (2014) Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Data from the Interagency Registry for Mechanically Assisted Circulatory Support. Circ Heart Fail 7:300–309
Blauwet LA, Libhaber E, Forster O, Tibazarwa K, Mebazaa A, Hilfiker-Kleiner D, Sliwa K (2013) Predictors of outcome in 176 South African patients with peripartum cardiomyopathy. Heart 99:308–313
Krishnamoorthy P, Garg J, Palaniswamy C, Pandey A, Ahmad H, Frishman WH, Lanier G (2016) Epidemiology and outcomes of peripartum cardiomyopathy in the United States: findings from the Nationwide Inpatient Sample. J Cardiovasc Med (Hagerstown, Md) 17:756–761
Kamiya CA, Kitakaze M, Ishibashi-Ueda H, Nakatani S, Murohara T, Tomoike H, Ikeda T (2011) Different characteristics of peripartum cardiomyopathy between patients complicated with and without hypertensive disorders. -Results from the Japanese Nationwide Survey Of Peripartum Cardiomyopathy. Circ J 75:1975–1981
Prasad GS, Bhupali A, Prasad S, Patil AN, Deka Y (2014) Peripartum cardiomyopathy—case series. Indian Heart J 66:223–226
Lim CP, Sim DK (2013) Peripartum cardiomyopathy: experience in an Asian tertiary centre. Singapore Med J 54:24–27
Mandal D, Mandal S, Mukherjee D, Biswas SC, Maiti TK, Chattopadhaya N, Majumdar B, Panja M (2011) Pregnancy and subsequent pregnancy outcomes in peripartum cardiomyopathy. J Obstet Gynaecol Res 37:222–227
Hasegawa J, Sekizawa A, Tanaka H, Katsuragi S, Osato K, Murakoshi T, Nakata M, Nakamura M, Yoshimatsu J, Sadahiro T, Kanayama N, Ishiwata I, Kinoshita K, Ikeda T (2016) Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan. BMJ Open 6:e010304
Tanaka H, Katsuragi S, Osato K, Hasegawa J, Nakata M, Murakoshi T, Yoshimatsu J, Sekizawa A, Kanayama N, Ishiwata I, Ikeda T (2017) The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991 to 1992 to 2010–2012. J Cardiol 69:74–78
Naganuma M, Matsui H, Fushimi K, Yasunaga H (2016) Clinical features of isolated dissections of abdominal aortic branches. Heart Vessels 31:1006–1009
Isogai T, Yasunaga H, Matsui H, Tanaka H, Hisagi M, Fushimi K (2017) Factors affecting in-hospital mortality and likelihood of undergoing surgical resection in patients with primary cardiac tumors. J Cardiol 69:287–292
Gunderson EP, Croen LA, Chiang V, Yoshida CK, Walton D, Go AS (2011) Epidemiology of peripartum cardiomyopathy: Incidence, predictors, and outcomes. Obstet Gynecol 118:583–591
Afana M, Brinjikji W, Kao D, Jackson E, Maddox TM, Childers D, Eagle KA, Davis MB (2016) Characteristics and in-hospital outcomes of peripartum cardiomyopathy diagnosed during delivery in the United States from the Nationwide Inpatient Sample (NIS) Database. J Cardiac Fail 22:512–519
Kao DP, Hsich E, Lindenfeld J (2013) Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy. JACC Heart Fail 1:409–416
Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC (2014) Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: A nationwide population-based study. J Am Heart Assoc 3:e001056
Isogai T, Yasunaga H, Matsui H, Tanaka H, Ueda T, Horiguchi H, Fushimi K (2015) Effect of weekend admission for acute myocardial infarction on in-hospital mortality: a retrospective cohort study. Int J Cardiol 179:315–320
Isogai T, Matsui H, Tanaka H, Fushimi K, Yasunaga H (2016) Early β-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy. Heart 102:1029–1035
Yasuda S, Nakao K, Nishimura K, Miyamoto Y, Sumita Y, Shishido T, Anzai T, Tsutsui H, Ito H, Komuro I, Saito Y, Ogawa H (2016) The current status of cardiovascular medicine in Japan—analysis of a large number of health records from a nationwide claim-based database, JROAD-DPC. Circ J 80:2327–2335
Ikeda Y, Inomata T, Fujita T, Iida Y, Nabeta T, Ishii S, Maekawa E, Yanagisawa T, Mizutani T, Naruke T, Koitabashi T, Takeuchi I, Ako J (2016) Cardiac fibrosis detected by magnetic resonance imaging on predicting time course diversity of left ventricular reverse remodeling in patients with idiopathic dilated cardiomyopathy. Heart Vessels 31:1817–1825
Ishii S, Inomata T, Fujita T, Iida Y, Ikeda Y, Nabeta T, Yanagisawa T, Naruke T, Mizutani T, Koitabashi T, Takeuchi I, Ako J (2016) Clinical significance of endomyocardial biopsy in conjunction with cardiac magnetic resonance imaging to predict left ventricular reverse remodeling in idiopathic dilated cardiomyopathy. Heart Vessels 31:1960–1968
Nabeta T, Inomata T, Iida Y, Ikeda Y, Iwamoto M, Ishii S, Sato T, Watanabe I, Naruke T, Shinagawa H, Koitabashi T, Takeuchi I, Nishii M, Inoue Y, Izumi T (2014) Baseline cardiac magnetic resonance imaging versus baseline endomyocardial biopsy for the prediction of left ventricular reverse remodeling and prognosis in response to therapy in patients with idiopathic dilated cardiomyopathy. Heart Vessels 29:784–792
Desplantie O, Tremblay-Gravel M, Avram R, Marquis-Gravel G, Ducharme A, Jolicoeur EM (2015) The medical treatment of new-onset peripartum cardiomyopathy: a systematic review of prospective studies. Can J Cardiol 31:1421–1426
Saltzberg MT, Szymkiewicz S, Bianco NR (2012) Characteristics and outcomes of peripartum versus nonperipartum cardiomyopathy in women using a wearable cardiac defibrillator. J Card Fail 18:21–27
Duncker D, Haghikia A, Konig T, Hohmann S, Gutleben KJ, Westenfeld R, Oswald H, Klein H, Bauersachs J, Hilfiker-Kleiner D, Veltmann C (2014) Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function-value of the wearable cardioverter/defibrillator. Eur J Heart Fail 16:1331–1336
Sasaki S, Tomita H, Shibutani S, Izumiyama K, Higuma T, Itoh T, Sasaki K, Horiuchi D, Kimura M, Okumura K (2014) Usefulness of the wearable cardioverter-defibrillator in patients at high risk for sudden cardiac death. Circ J 78:2987–2989
Laliberte B, Reed BN, Ather A, Devabhakthuni S, Watson K, Lardieri AB, Baker-Smith CM (2016) Safe and effective use of pharmacologic and device therapy for peripartum cardiomyopathy. Pharmacotherapy 36:955–970
Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, McMurray J, Yamac H, Labidi S, Struman I, Hilfiker-Kleiner D (2010) Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 121:1465–1473
Haghikia A, Podewski E, Libhaber E, Labidi S, Fischer D, Roentgen P, Tsikas D, Jordan J, Lichtinghagen R, von Kaisenberg CS, Struman I, Bovy N, Sliwa K, Bauersachs J, Hilfiker-Kleiner D (2013) Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol 108:366
Bernard N, Jantzem H, Becker M, Pecriaux C, Benard-Laribiere A, Montastruc JL, Descotes J, Vial T; French Network of Regional Pharmacovigilance Centres (2015) Severe adverse effects of bromocriptine in lactation inhibition: a pharmacovigilance survey. BJOG 122:1244–1451
Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL (2000) Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 283:1183–1188
Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB (2006) Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation 113:1807–1816
Acknowledgements
This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (Grant Numbers: H27-Policy-Designated-009 and H28-Policy-Strategy-011). The funders had no role in the execution of this study or the interpretation of the results.
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Isogai, T., Matsui, H., Tanaka, H. et al. In-hospital management and outcomes in patients with peripartum cardiomyopathy: a descriptive study using a national inpatient database in Japan. Heart Vessels 32, 944–951 (2017). https://doi.org/10.1007/s00380-017-0958-7
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DOI: https://doi.org/10.1007/s00380-017-0958-7