Rana Kiran F, Saeed Aisha, Shamim Sohaib A, Tariq Muhammad Ali, Malik Bilal Haider
Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2019 Oct 8;11(10):e5867. doi: 10.7759/cureus.5867.
Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion and a heterogeneous disorder that presents during the last month of pregnancy or the first five months postpartum. It is a rare but potentially life-threatening illness. A lot of work has been done trying to discover the causes of this condition, and several risk factors have been identified, including hypertension during pregnancy (HDP), ethnicity, advanced age, and multiple gestations. HDP affects 40% of cases of PPCM, and the strength of the association increases with increasing severity of hypertension. Among PPCM patients, there is a 1.5 times higher prevalence of HDP and a four-fold higher prevalence of preeclampsia (PE). Besides, the risk of PPCM markedly increases among women with HDP (5-21 times) compared with normotensive women. The experimental work done in animal models has provided support for the angiogenic-imbalance theory proposed regarding the association between these two conditions. The presence of the same risk factors also supports the prevalence of the coexistence of PE and PPCM. During the last part of gestation, the placenta secretes more anti-angiogenic factors, which leads to the development of both PE and PPCM. However, not all patients with HDP develop PPCM. In fact, most PPCM patients do not show any signs of HDP. Further work in these patients elucidated that there is an underlying susceptibility in some women that predisposes them to develop this condition and results in a worse prognosis as compared with those PPCM patients who have HDP. Better provision of care, genetic variations, and association with HDP have been cited as some of the factors affecting prognosis. HDP has also been found to increase the risk of other forms of cardiomyopathies in the future. A lot of work still needs to be done to uncover all the pathologic mechanisms and genetic variations involved in this disorder. More intensive and focussed research may help in developing new therapies to better manage this condition and address all of its complications.
围产期心肌病（PPCM）是一种排除性诊断，是一种异质性疾病，出现在妊娠最后一个月或产后前五个月。它是一种罕见但可能危及生命的疾病。人们已经做了大量工作试图找出这种疾病的病因，并且已经确定了几个风险因素，包括妊娠期高血压（HDP）、种族、高龄和多胎妊娠。HDP影响40%的PPCM病例，并且这种关联的强度随着高血压严重程度的增加而增加。在PPCM患者中，HDP的患病率高1.5倍，先兆子痫（PE）的患病率高四倍。此外，与血压正常的女性相比，患有HDP的女性发生PPCM的风险显著增加（5 - 21倍）。在动物模型中进行的实验工作为关于这两种疾病之间关联的血管生成失衡理论提供了支持。相同风险因素的存在也支持了PE和PPCM共存的普遍性。在妊娠后期，胎盘分泌更多的抗血管生成因子，这导致了PE和PPCM的发生。然而，并非所有患有HDP的患者都会发生PPCM。事实上，大多数PPCM患者没有任何HDP的迹象。对这些患者的进一步研究表明，一些女性存在潜在的易感性，使她们易患这种疾病，并且与患有HDP的PPCM患者相比，预后更差。更好的护理、基因变异以及与HDP的关联被认为是影响预后的一些因素。还发现HDP会增加未来发生其他形式心肌病的风险。仍需要做大量工作来揭示这种疾病所涉及的所有病理机制和基因变异。更深入和有针对性的研究可能有助于开发新的疗法，以更好地管理这种疾病并解决其所有并发症。
