Skip to main content

Advertisement

SpringerLink
Log in

Pathological features of biopsied myocardium in patients clinically diagnosed with peripartum cardiomyopathy

  • Original Paper
  • Published:
Medical Molecular Morphology Aims and scope Submit manuscript

Abstract

The etiology of peripartum cardiomyopathy (PPCM) is unknown. Therefore, we evaluated the etiology of patients clinically diagnosed with PPCM using endomyocardial biopsy. We studied five patients diagnosed with PPCM following endomyocardial biopsy (age, 28–42 years; mean age, 35 years). Biopsied samples were evaluated using microscopy, including immunostaining and electron microscopy. The pathological findings were as follows: myocardial hypertrophy, myocardial fibrosis, and cell infiltration. Two patients were diagnosed with lymphocytic myocarditis, one with eosinophilic myocarditis, one with hypertensive heart disease, and one with a combination of hypertension and myocarditis. Endomyocardial biopsy suggested that the causes of PPCM were varied and related to myocarditis and myocardial overload due to hypertension.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, Hamdan R, Jackson AM, Forsyth P, de Boer RA, Mueller C, Lyon AR, Lund LH, Piepoli MF, Heymans S, Chioncel O, Anker SD, Ponikowski P, Seferovic PM, Johnson MR, Mebazaa A, Sliwa K (2019) pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the heart failure association of the european society of cardiology study group on peripartum cardiomyopathy. Eur J Heart Fail 21:827–843

    Article  CAS  PubMed  Google Scholar 

  2. Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U (2020) Peripartum cardiomyopathy: JACC State-of-the-Art review. J Am Coll Cardiol 75:207–221

    Article  CAS  PubMed  Google Scholar 

  3. Goli R, Li J, Brandimarto J, Levine LD, Riis V, McAfee Q, DePalma S, Haghighi A, Seidman JG, Seidman CE, Jacoby D, Macones G, Judge DP, Rana S, Margulies KB, Cappola TP, Alharethi R, Damp J, Hsich E, Elkayam U, Sheppard R, Alexis JD, Boehmer J, Kamiya C, Gustafsson F, Damm P, Ersbøll AS, Goland S, Hilfiker-Kleiner D, McNamara DM, Arany Z (2021) Genetic and Phenotypic landscape of peripartum cardiomyopathy. Circulation 143:1852–1862

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sliwa K, Bauersachs J, Arany Z, Spracklen TF, Hilfiker-Kleiner D (2021) Peripartum cardiomyopathy: from genetics to management. Eur Heart J 42:3094–3102

    Article  CAS  PubMed  Google Scholar 

  5. 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 (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

    Article  PubMed  Google Scholar 

  6. Sanderson JE, Olsen EG, Gatei D (1986) Peripartum heart disease: an endomyocardial biopsy study. Br Heart J 56:285–291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. O’Connell JB, Costanzo-Nordin MR, Subramanian R, Robinson JA, Wallis DE, Scanlon PJ, Gunnar RM (1986) Peripartum cardiomyopathy: clinical, hemodynamic, histologic and prognostic characteristics. J Am Coll Cardiol 8:52–56

    Article  CAS  PubMed  Google Scholar 

  8. Felker GM, Jaeger CJ, Klodas E, Thiemann DR, Hare JM, Hruban RH, Kasper EK, Baughman KL (2000) Myocarditis and long-term survival in peripartum cardiomyopathy. Am Heart J 140:785–791

    Article  CAS  PubMed  Google Scholar 

  9. Midei MG, DeMent SH, Feldman AM, Hutchins GM, Baughman KL (1990) Peripartum myocarditis and cardiomyopathy. Circulation 81:922–928

    Article  CAS  PubMed  Google Scholar 

  10. Melvin KR, Richardson PJ, Olsen EG, Daly K, Jackson G (1982) Peripartum cardiomyopathy due to myocarditis. N Engl J Med 307:731–734

    Article  CAS  PubMed  Google Scholar 

  11. Rizeq MN, Rickenbacher PR, Fowler MB, Billingham ME (1994) Incidence of myocarditis in peripartum cardiomyopathy. Am J Cardiol 74:474–477

    Article  CAS  PubMed  Google Scholar 

  12. Bültmann BD, Klingel K, Näbauer M, Wallwiener D, Kandolf R (2005) High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. Am J Obstet Gynecol 193:363–365

    Article  PubMed  Google Scholar 

  13. Pearce CB, McMeekin JD, Moyana TN, Sibley J (1999) A case of peripartum eosinophilic myocarditis. Can J Cardiol 15:465–468

    CAS  PubMed  Google Scholar 

  14. Borczuk AC, van Hoeven KH, Factor SM (1997) Review and hypothesis: the eosinophil and peripartum heart disease (myocarditis and coronary artery dissection)–coincidence or pathogenetic significance? Cardiovasc Res 33:527–532

    Article  CAS  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. Fidziańska A, Walczak E, Glinka Z, Religa G, Sobieszczańska-Małek M, Bilińska ZT (2010) Ultrastructural evidence of myocardial capillary remodeling in peripartum cardiomyopathy. Med Sci Monit 16:62–66

    Google Scholar 

  17. Galan DT, Bito V, Claus P, Holemans P, Abi-Char J, Nagaraju CK, Dries E, Vermeulen K, Ventura-Clapier R, Sipido KR, Driesen RB (2016) Reduced mitochondrial respiration in the ischemic as well as in the remote nonischemic region in postmyocardial infarction remodeling. Am J Physiol Heart Circ Physiol 311:H1075-h1090

    Article  PubMed  Google Scholar 

  18. Ebina T, Hoshi N, Kobayashi M, Kawamura K, Nanjo H, Sugita A, Sugiyama T, Masuda H, Xu C (2002) Physiological angiogenesis in electrically stimulated skeletal muscle in rabbits: characterization of capillary sprouting by ultrastructural 3-D reconstruction study. Pathol Int 52:702–712

    Article  PubMed  Google Scholar 

  19. Miyagami M, Katayama Y (2005) Angiogenesis of glioma: evaluation of ultrastructural characteristics of microvessels and tubular bodies (Weibel-Palade) in endothelial cells and immunohistochemical findings with VEGF and p53 protein. Med Mol Morphol 38:36–42

    Article  PubMed  Google Scholar 

  20. Marone G, de Crescenzo G, Adt M, Patella V, Arbustini E, Genovese A (1995) Immunological characterization and functional importance of human heart mast cells. Immunopharmacology 31:1–18

    Article  CAS  PubMed  Google Scholar 

  21. Metcalfe DD, Baram D, Mekori YA (1997) Mast cells. Physiol Rev 77:1033–1079

    Article  CAS  PubMed  Google Scholar 

  22. Patella V, Marinò I, Arbustini E, Lamparter-Schummert B, Verga L, Adt M, Marone G (1998) Stem cell factor in mast cells and increased mast cell density in idiopathic and ischemic cardiomyopathy. Circulation 97:971–978

    Article  CAS  PubMed  Google Scholar 

  23. Ryan GB, Cliff WJ, Gabbiani G, Irlé C, Montandon D, Statkov PR, Majno G (1974) Myofibroblasts in human granulation tissue. Hum Pathol 5:55–67

    Article  CAS  PubMed  Google Scholar 

  24. Hebda PA, Collins MA, Tharp MD (1993) Mast cell and myofibroblast in wound healing. Dermatol Clin 11:685–696

    Article  CAS  PubMed  Google Scholar 

  25. Berglund ME, Hildebrand KA, Zhang M, Hart DA, Wiig ME (2010) Neuropeptide, mast cell, and myofibroblast expression after rabbit deep flexor tendon repair. J Hand Surg Am 35:1842–1849

    Article  PubMed  Google Scholar 

  26. Ferrans VJ, Jones M, Maron BJ, Roberts WC (1975) The nuclear membranes in hypertrophied human cardiac muscle cells. Am J Pathol 78:427–460

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Legato MJ, Mulieri LA, Alpert NR (1984) The ultrastructure of myocardial hypertrophy: why does the compensated heart fail? Eur Heart J 5:251–269

    Article  PubMed  Google Scholar 

  28. Treskatsch S, Shakibaei M, Feldheiser A, Shaqura M, Dehe L, Roepke TK, Spies C, Schäfer M, Mousa SA (2015) Ultrastructural changes associated with myocardial apoptosis, in failing rat hearts induced by volume overload. Int J Cardiol 197:327–332

    Article  CAS  PubMed  Google Scholar 

  29. Chaanine AH (2019) Morphological stages of mitochondrial vacuolar degeneration in phenylephrine-stressed cardiac myocytes and in animal models and human heart failure. Medicina (Kaunas) 55(2):239

    Article  PubMed  Google Scholar 

  30. Bello N, Rendon ISH, Arany Z (2013) The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol 62:1715–1723

    Article  PubMed  PubMed Central  Google Scholar 

  31. Suzuki H, Hirashima C, Nagayama S, Takahashi K, Yamamoto T, Matsubara S, Ohkuchi A (2018) Increased serum levels of sFlt-1/PlGF ratio in preeclamptic women with onset at <32 weeks compared with ≥32 weeks. Pregnancy Hypertens 12:96–103

    Article  PubMed  Google Scholar 

  32. Patten IS, Rana S, Shahul S, Rowe GC, Jang C, Liu L, Hacker MR, Rhee JS, Mitchell J, Mahmood F, Hess P, Farrell C, Koulisis N, Khankin EV, Burke SD, Tudorache I, Bauersachs J, del Monte F, Hilfiker-Kleiner D, Karumanchi SA, Arany Z (2012) Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 485:333–338

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Damp J, Givertz MM, Semigran M, Alharethi R, Ewald G, Felker GM, Bozkurt B, Boehmer J, Haythe J, Skopicki H, Hanley-Yanez K, Pisarcik J, Halder I, Gorcsan J 3rd, Rana S, Arany Z, Fett JD, McNamara DM (2016) Relaxin-2 and soluble Flt1 levels in peripartum cardiomyopathy: results of the multicenter IPAC study. JACC Heart Fail 4:380–388

    Article  PubMed  PubMed Central  Google Scholar 

  34. Isogai T, Kamiya CA (2019) Worldwide Incidence of peripartum cardiomyopathy and overall maternal mortality. Int Heart J 60:503–511

    Article  PubMed  Google Scholar 

  35. Arany Z, Elkayam U (2016) Peripartum cardiomyopathy. Circulation 133:1397–1409

    Article  CAS  PubMed  Google Scholar 

  36. Goland S, Modi K, Hatamizadeh P, Elkayam U (2013) Differences in clinical profile of African-American women with peripartum cardiomyopathy in the United States. J Card Fail 19:214–218

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Hiroaki Kawano, Mitsuaki Ishijima, Masamichi Eguchi & Koji Maemura

  2. Faculty of Science and Engineering, Waseda University, Tokyo, Japan

    Koichi Kawamura

  3. Department of Pathology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan

    Kuniko Abe

  4. Department of Pathology, Shimabara Prefectural Hospital, Shimabara, Japan

    Tomayoshi Hayashi

  5. Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Kiyonori Miura

Authors
  1. Hiroaki Kawano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koichi Kawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mitsuaki Ishijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kuniko Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomayoshi Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masamichi Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kiyonori Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Koji Maemura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroaki Kawano.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawano, H., Kawamura, K., Ishijima, M. et al. Pathological features of biopsied myocardium in patients clinically diagnosed with peripartum cardiomyopathy. Med Mol Morphol 56, 58–68 (2023). https://doi.org/10.1007/s00795-022-00340-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00795-022-00340-x

Keywords

Search

Navigation