Review article on PPCM in The Lancet brings the medical community and midwives up to date.
Professor Dr Denise Hilfiker-Kleiner and Professor Dr Johann Bauersachs have summarised the current knowledge on pregnancy-related heart failure (PPCM). Copyright: Karin Kaiser/MHH
Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition that can affect women with previously healthy hearts a few weeks before or after giving birth. It causes a severe reduction in the pumping capacity of the left ventricle. PPCM affects fewer than 1,500 to 2,000 pregnant women. It strikes without warning and can lead to severe heart failure and even death within a short period of time. The symptoms are similar to those that commonly occur towards the end of pregnancy and shortly after delivery: fatigue, shortness of breath, coughing, weight gain, especially due to water retention in the lungs and lower legs, and palpitations. PPCM is therefore often undiagnosed and is thought to occur more frequently than assumed.
A review article on the current state of knowledge on genetics, disease development, diagnostic procedures and treatment of PPCM aims to change this and raise awareness of PPCM among doctors, especially those specialising in general medicine, gynaecology and cardiology, as well as midwives. In addition, the review contains a novel risk score for predicting cardiac recovery, as well as information on the risks and outcomes of subsequent pregnancies. The article is published in The Lancet, one of the world's most prestigious medical journals. The authors include Professor Johann Bauersachs, Director of the Department for Cardiology and Angiology at Hannover Medical School (MHH), and MHH President Professor Denise Hilfiker-Kleiner, who established the field of research at MHH more than 20 years ago.
Clear evidence via ultrasound
‘PPCM is a condition with significant health implications for mothers and newborns,’ emphasises Professor Bauersachs. ‘Only half of the women affected achieve complete recovery of the heart muscle within six months of the onset of symptoms.’ The disease can be detected with the help of a heart ultrasound and certain marker proteins in the blood. The reduced pumping capacity of the left ventricle, known in technical terms as left ventricular systolic dysfunction, is crucial for the diagnosis. ‘PPCM is present when the ejection fraction of the left ventricle is below 45 percent,’ the cardiologist notes. This allows other causes of heart failure, such as pre-existing cardiomyopathy, heart valve disease or congenital heart defects, to be ruled out at the same time. If treated in time, the heart often recovers completely, but heart failure may remain. ‘Treatment with the weaning drug bromocriptine in addition to the medication usually used for heart failure is a promising treatment option,’ says Professor Hilfiker-Kleiner.
Subsequent pregnancy possible
Subsequent pregnancy is also possible for PPCM patients with an acceptable risk – but only if the patients continue to be cared for by an experienced, interdisciplinary medical team and receive appropriate medication. ‘This is the case at our clinic, for example, which is the leading PPCM centre in Europe,’ notes Professor Bauersachs. In a special outpatient ambulance, patients are cared for by a multi-professional team from the fields of cardiology, obstetrics and neonatology. The clinic not only treats the disease, but also focuses on it in its research, with a very large PPCM registry containing long-term data and biomaterials from more than 200 patients.
The original paper, ‘Peripartum Cardiomyopathy,’ can be found here.
Text: Kirsten Pötzke