Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
Department of Medicine, Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Nat Rev Cardiol. 2022 Aug;19(8):555-565. doi: 10.1038/s41569-021-00664-8. Epub 2022 Jan 11.
Peripartum cardiomyopathy (PPCM) is a potentially fatal form of idiopathic heart failure with variable prevalence across different countries and ethnic groups. The cause of PPCM is unclear, but environmental and genetic factors and pregnancy-associated conditions such as pre-eclampsia can contribute to the development of PPCM. Furthermore, animal studies have shown that impaired vascular and metabolic function might be central to the development of PPCM. A better understanding of the pathogenic mechanisms involved in the development of PPCM is necessary to establish new therapies that can improve the outcomes of patients with PPCM. Pregnancy hormones tightly regulate a plethora of maternal adaptive responses, including haemodynamic, structural and metabolic changes in the cardiovascular system. In patients with PPCM, the peripartum period is associated with profound and rapid hormonal fluctuations that result in a brief period of disrupted cardiovascular (metabolic) homeostasis prone to secondary perturbations. In this Review, we discuss the latest studies on the potential pathophysiological mechanisms of and risk factors for PPCM, with a focus on maternal cardiovascular changes associated with pregnancy. We provide an updated framework to further our understanding of PPCM pathogenesis, which might lead to an improvement in disease definition.
围生期心肌病（PPCM）是一种潜在致命的特发性心力衰竭，在不同国家和种族中的发病率不同。PPCM 的病因尚不清楚，但环境和遗传因素以及与妊娠相关的疾病，如子痫前期，可能会导致 PPCM 的发生。此外，动物研究表明，血管和代谢功能受损可能是 PPCM 发生的核心机制。为了建立能够改善 PPCM 患者预后的新疗法，有必要深入了解 PPCM 发病机制中涉及的致病机制。妊娠激素可严密调控多种母体适应性反应，包括心血管系统的血液动力学、结构和代谢变化。在 PPCM 患者中，围生期与深刻而快速的激素波动有关，导致短暂的心血管（代谢）稳态破坏，容易发生继发性紊乱。在这篇综述中，我们讨论了 PPCM 的潜在病理生理机制和危险因素的最新研究进展，重点关注与妊娠相关的母体心血管变化。我们提供了一个更新的框架，以进一步了解 PPCM 的发病机制，这可能会改善疾病的定义。
