Iannaccone Giulia, Graziani Francesca, Kacar Polona, Tamborrino Pietro Paolo, Lillo Rosa, Montanaro Claudia, Burzotta Francesco, Gatzoulis Michael A
Adult Congenital Heart Diseases Unit, Royal Brompton Hospital, London, UK.
Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Int J Cardiol Congenit Heart Dis. 2024 Jul 19;17:100530. doi: 10.1016/j.ijcchd.2024.100530. eCollection 2024 Sep.
Peripartum cardiomyopathy (PPCM) is a rare, but serious condition, with a non-negligible risk of adverse events. Several risk factors for PPCM have been individuated over the years, including Afro-American ethnicity, preeclampsia, advanced maternal age, genetic predisposition, multiparity, twin pregnancy, obesity, smoking and diabetes. However, PPCM pathophysiology is still poorly understood, thus making it challenging to develop disease specific therapies. At present, Bromocriptine is the only targeted drug, but further evidence is needed to establish indication and timing of administration. Therefore, these patients are mainly treated following general heart failure guidelines. Even though in most patients left ventricular ejection fraction recovers during follow-up, cases of persistent left ventricular dysfunction are not uncommon. Moreover, all patients detain a certain risk of recurrence after subsequent pregnancies, which is difficult to estimate due to the dearth of long-term prospective data. In this manuscript, we aim to provide an updated review of current evidence about PPCM pathophysiology, diagnosis, treatment and recurrence risk. In addition, we discuss the gaps in knowledge that should be addressed by future research.
围产期心肌病（PPCM）是一种罕见但严重的疾病，不良事件风险不可忽视。多年来已确定了一些PPCM的风险因素，包括非裔美国人种族、先兆子痫、高龄产妇、遗传易感性、多胎妊娠、双胎妊娠、肥胖、吸烟和糖尿病。然而，PPCM的病理生理学仍知之甚少，因此开发针对该疾病的疗法具有挑战性。目前，溴隐亭是唯一的靶向药物，但需要更多证据来确定用药指征和时机。因此，这些患者主要遵循一般心力衰竭指南进行治疗。尽管大多数患者在随访期间左心室射血分数会恢复，但持续性左心室功能障碍的病例并不少见。此外，所有患者在后续妊娠后都有一定的复发风险，由于缺乏长期前瞻性数据，这种风险难以估计。在本手稿中，我们旨在提供关于PPCM病理生理学、诊断、治疗和复发风险的最新证据综述。此外，我们还讨论了未来研究应解决的知识空白。
