@article{9ecdfcbfe96142a6b53f0d4f172fc1ea,
title = "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",
abstract = "Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients respecting contraindications during pregnancy/lactation. The oxidative stress-mediated cleavage of the hormone prolactin into a cardiotoxic fragment has been identified as a driver of PPCM pathophysiology. Pharmacological blockade of prolactin release using bromocriptine as a disease-specific therapy in addition to standard therapy for heart failure treatment has shown promising results in two clinical trials. Thresholds for devices (implantable cardioverter-defibrillators, cardiac resynchronization therapy and implanted long-term ventricular assist devices) are higher in PPCM than in other conditions because of the high rate of recovery. The important role of education and counselling around contraception and future pregnancies is emphasised.",
keywords = "Peripartum cardiomyopathy, Heart failure, Pregnancy, CLINICAL CHARACTERISTICS, WORKING GROUP, MYOCARDIAL RECOVERY, WORLDWIDE REGISTRY, TAKOTSUBO SYNDROME, AFRICAN-AMERICAN, OUTCOMES, PREGNANCY, BROMOCRIPTINE, PREDICTORS",
author = "Johann Bauersachs and Tobias Koenig and {van der Meer}, Peter and Petrie, {Mark C.} and Denise Hilfiker-Kleiner and Amam Mbakwem and Righab Hamdan and Jackson, {Alice M.} and Paul Forsyth and {de Boer}, {Rudolf A.} and Christian Mueller and Lyon, {Alexander R.} and Lund, {Lars H.} and Piepoli, {Massimo F.} and Stephane Heymans and Ovidiu Chioncel and Anker, {Stefan D.} and Piotr Ponikowski and Seferovic, {Petar M.} and Johnson, {Mark R.} and Alexandre Mebazaa and Karen Sliwa",
note = "Funding Information: Johann Bauersachs was supported by the Deutsche Forschungsgemeinschaft, Clinical Research Group 311 (KFO 311) {\textquoteleft}(Pre-)terminal heart and lung failure: unloading and repair{\textquoteright}. Conflict of interest: J.B. reports personal fees from Novartis, Servier, Orion, Abbott, AstraZeneca, BMS; grants and personal fees from Bayer, Abiomed, CVRx, Medtronic, Vifor; grants from Zoll, outside the submitted work. P.v.d.M. reports personal fees from Novartis, Biotronic, grants and personal fees from Vifor Pharma, AstraZeneca, Pfizer: grants from Ionis, outside the submitted work. M.C.P. reports personal fees from Napp, NovoNordisk, Vifor, SCPharmaceuticals, 3R Lifesciences; grants and personal fees from Boehringer Ingelheim, Novartis, Bayer, Stealth; grants from Pharmacosmos, outside the submitted work. A.M. reports personal fees from Novartis, Orion, Roche, Servier, Cardiorentis, Zs Pharma; grants and personal fees from Adrenomed; grants from MyCartis, Critical diagnostics, outside the submitted work. R.A.d.B. reports grants from AstraZeneca, Bristol-Myers Squibb, Abbott, Novo Nordisk, Roche, Trevena, Thermofisher GmbH, and personal fees from AstraZeneca, MandalMed, Inc., Novartis, Servier, other from scPharmaceuticals, Inc., outside the submitted work. C.M. reports grants, personal fees and non-financial support from several diagnostic companies, outside the submitted work. A.R.L. reports personal fees from Servier, Novartis, Roche, Takeda, Boehringer Ingelheim, Amgen, Clinigen Group, Ferring Pharmaceuticals, Eli Lily, Bristol-Myers Squibb, Eisai Ltd; and grants and personal fees from Pfizer, outside the submitted work. L.H.L. reports grants and other from Novartis, Vifor Pharma, Relypsa; other from Merck, Boehringer Ingelheim, Sanofi, AstraZeneca, Bayer; and grants from Boston Scientific, outside the submitted work. O.C. reports grants from Novartis, Servier, and Vifor, outside the submitted work. S.D.A. reports grants and personal fees from Vifor Int, Abbott Vascular/SJM; personal fees from Bayer, Boehringer Ingelheim, Novartis, Servier, outside the submitted work. P.M.S. reports grants/research supports from the Ministry of Education, Science and Technological Development of Republic of Serbia; honoraria or consultation fees from Servier, Boehringer Ingelheim, Hemofarm, Novartis, AstraZeneca, and participation in a company sponsored speaker's bureau: Fondazione Internazionale Menarini. The other authors have nothing to disclose. Funding Information: Johann Bauersachs was supported by the Deutsche Forschungs-gemeinschaft, Clinical Research Group 311 (KFO 311) {\textquoteleft}(Pre-)terminal heart and lung failure: unloading and repair{\textquoteright}. Conflict of interest: J.B. reports personal fees from Novartis, Servier, Orion, Abbott, AstraZeneca, BMS; grants and personal fees from Bayer, Abiomed, CVRx, Medtronic, Vifor; grants from Zoll, outside the submitted work. P.v.d.M. reports personal fees from Novartis, Biotronic, grants and personal fees from Vifor Pharma, AstraZeneca, Pfizer: grants from Ionis, outside the submitted work. M.C.P. reports personal fees from Napp, NovoNordisk, Vifor, SCPharmaceuticals, 3R Lifesciences; grants and personal fees from Boehringer Ingelheim, Novartis, Bayer, Stealth; grants from Pharmacosmos, outside the submitted work. A.M. reports personal fees from Novartis, Orion, Roche, Servier, Cardiorentis, Zs Pharma; grants and personal fees from Adrenomed; grants Publisher Copyright: {\textcopyright} 2019 The Authors. European Journal of Heart Failure {\textcopyright} 2019 European Society of Cardiology",
year = "2019",
month = jul,
doi = "10.1002/ejhf.1493",
language = "English",
volume = "21",
pages = "827--843",
journal = "European journal of heart failure",
issn = "1388-9842",
publisher = "John Wiley & Sons Inc.",
number = "7",
}