Progress in Cardiovascular Diseases
Volume 52, Issue 4 , Pages 317-325 , January 2010

Peripartum Cardiomyopathy in Africa: Challenges in Diagnosis, Prognosis, and Therapy

  • Kemi Tibazarwa

      Affiliations

    • Soweto Cardiovascular Research Unit, Chris Hani Baragwannath Hospital, The University of the Witwatersrand, Johannesburg, South Africa
    • Department of Medicine, The University of Cape Town, Cape Town, South Africa
    • Corresponding Author InformationAddress reprint requests to Kemi Tibazarwa, MD, MPH, Department of Medicine, The University of Cape Town, Anzio Rd, Observatory 7925, Cape Town, South Africa.
    • Dr K Tibazarwa, postgraduate fellow, The University of Cape Town, Cape Town, South Africa, and postgraduate fellow, University of the Witwatersrand (also affiliated to University of Cape Town), Johannesburg, South Africa.
    • ,
  • Karen Sliwa

      Affiliations

    • Soweto Cardiovascular Research Unit, Chris Hani Baragwannath Hospital, The University of the Witwatersrand, Johannesburg, South Africa
    • Professor K Sliwa, director Soweto Cardiovascular Research Unit, Division of Cardiology, CH Baragwannath Hospital, University of the Witwatersrand, Johannesburg, South Africa.

References 

  1. Sliwa K, Tibazarwa K, Hilfiker-Kleiner D. Management of peripartum cardiomyopathy. Curr Heart Fail Rep. 2008;5:238–244
  2. Lampert MB, Lang RM. Peripartum cardiomyopathy. Am Heart J. 1995;130:860–870
  3. Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation. 1971;44:964–968
  4. Ladwig P, Fischer E. Peripartum cardiomyopathy. Aust N Z J Obstet Gynaecol. 1997;37:156
  5. Pearson GD, Veille JC, Rahimtoola S, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283:1183–1188
  6. Fett JD, Carrawa RD, Perry H, et al. Emerging insights into peripartum cardiomyopathy. J Health Popul Nutr. 2003;21:1–7
  7. Sliwa K, Förster O, Libhaber E, et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart. 2006;27:441–446
  8. Satpathy HK, Frey D, Satpathy R, et al. Peripartum cardiomyopathy. Postgrad Med. 2008;120:28–32
  9. Fett JD, Christie LG, Carraway RD. Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution. Mayo Clin Proc. 2005;80:1602–1606
  10. Stewart S, Wilkinson D, Hansen C, et al. Predominance of heart failure in the Heart of Soweto Cohort; emerging challenges for urban African communities. Circulation. 2008;118:2360–2367
  11. Ventura HO. Peripartum cardiomyopathy: clinical and therapeutic characteristics. J La State Med Soc. 1991;143:45–48
  12. Veille JC. Peripartum cardiomyopathies: a review. Am J Obstet Gynecol. 1984;148:805–818
  13. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006;368:687–693
  14. Watkins DA, Mayosi BM. The contribution of South Africans to the subject of dilated cardiomyopathy—with reference to cardiovascular collagenosis with parietal endocardial thrombosis: a clinicopathologic study of forty cases. Cardiovasc J S Afr. 2009;20:11–16
  15. Habli M, O'Brien T, Nowack E, et al. Peripartum cardiomyopathy: prognostic factors for long-term maternal outcome. Am J Obstet Gynecol. 2008;199:415.e1–415.e5
  16. Duran N, Günes H, Duran I, et al. Predictors of prognosis in patients with peripartum cardiomyopathy. Int J Gynaecol Obstet. 2008;101:137–140
  17. Sliwa K, Forster O, Tibazarwa K, et al. Long-term outcome of peripartum cardiomyopathy in a population with high seropositivity for human immunodeficiency virus. Int J Cardiol. 2009;12:[Epub ahead of print]
  18. Tibazarwa K, Lee G, Carrington M, et al. ECG characteristics in peripartum cardiomyopathy. In: European Society of Cardiology Congress, Barcelona. Abstract Number P4877. 2009;
  19. Kist WJ, Janssen NG, Kalk JJ, et al. Thrombophilias and adverse pregnancy outcome—a confounded problem!. Thromb Haemost. 2008;99:77–85
  20. Sliwa K, Wilkinson D, Hansen C, et al. A broad spectrum of heart disease and risk factors in a black urban population in South Africa: results from The Heart of Soweto Study Clinical Registry. Lancet. 2008;371:915–922
  21. Lee W. Clinical management of gravid women with peripartum cardiomyopathy. Obstet Gynaecol Clin North Am. 1991;18:257–271
  22. Talley NJ, O'Connor S. Clinical examination; A systematic guide to physical diagnosis. 5th ed.. Australia: Churchill Livingstone; 2006;
  23. Liakakos TM, Daskalaki M, Sfakianoudis K, et al. Permanent unilateral blindness associated with peripartum cardiomyopathy. Hippokratia. 2009;13:58–60
  24. Dresang LT, Fontaine P, Leeman L, et al. Venous thromboembolism during pregnancy. Am Fam Physician. 2008;77:1709–1716
  25. Lata I, Gupta R, Sahu S, et al. Emergency management of decompensated peripartum cardiomyopathy. J Emerg Trauma Shock. 2009;2:124–128
  26. Hirsh J, Fuster V, Ansell J, Halperin JL. American Heart Association/American College of Cardiology Foundation. American Heart Association/American College of Cardiology Foundation guide to warfarin therapy. J Am Coll Cardiol. 2003;41:1633–1652
  27. Elkayam U, Tummala PP, Rao K, et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med. 2001;344:1567–1571[Erratum in: N Engl J Med 2001 Aug 16;345:552]
  28. Lamparter S, Pankuweit S, Maisch B. Clinical and immunologic characteristics in Peripartum Cardiomyopathy. Int J Cardiol. 2007;118:14–20
  29. Diao M, Diop IB, Kane A, et al. Electrocardiographic recording of long duration (Holter) of 24 hours during idiopathic cardiomyopathy of the peripartum. Arch Mal Coeur Vaiss. 2004;97:25–30[Article in French]
  30. O'Connell JB, Constanzo-Nordin MR, Subramanian R, et al. Peripartum cardiomyopathy; clinical, haemodynamic, histologic, and prognostic characteristics. JACC. 1986;8:52–56
  31. Yamada T, McElderry HT, Muto M, et al. Ventricular arrhythmias originating from the epicardial ventricular outflow tract complicated with peripartum cardiomyopathy. J Interv Card Electrophysiol. 2009;25:53–57
  32. Marmursztejn J, Vignaux O, Goffinet F, et al. Delayed-enhanced cardiac magnetic resonance imaging features in peripartum cardiomyopathy. Int J Cardiol. 2009;11:
  33. Mouquet F, Lions C, de Groote P, et al. Characterisation of peripartum cardiomyopathy by cardiac magnetic resonance imaging. Eur Radiol. 2008;18:2765–2769
  34. Melvin KR, Richarson PJ, Olsen EG, et al. Peripartum cardiomyopathy due to myocarditis. N Engl J Med. 1982;307:731–734
  35. Midei MG, DeMent SH, Feldman AM, et al. Peripartum myocarditis and cardiomyopathy. Circulation. 1990;81:922–928
  36. Sanderson JE, Adesanya CO, Anjorin FI, et al. Postpartum cardiac failure—heart failure due to volume overload?. Am Heart J. 1979;97:613–621
  37. Kuhl U, Pauschinger M, Seeberg B, et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation. 2005;112:1965–1970
  38. Ramaraj R, Sorrell VL. Peripartum cardiomyopathy: causes, diagnosis, and treatment. Cleve Clin J Med. 2009;76:289–296
  39. Rizeq MN, Rickenbacher PR, Fowler MB, et al. Incidence of myocarditis in peripartum cardiomyopathy. Am J Cardiol. 1994;74:474–477
  40. Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342:1077–1084
  41. Wairraich R, Sliwa K, Damasceno A, et al. Impact of pregnancy-related heart failure on humoral immunity: clinical relevance of G3-subclass immunoglobulins in peripartum cardiomyopathy. Am Heart J. 2005;150:263–269[IF 3.6, C 5]
  42. Hilfiker-Kleiner D, Kaminski K, Podewski E, et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. 2007;128:589–600
  43. Pierce JA, Price BO, Joyce JW. Familial occurrence of postpartal heart disease. Arch Intern Med. 1963;111:651–655
  44. Constanzo-Nordin MR, O'Connell JB. Postpartum cardiomyopathy in the 1990s: etiologic and prognostic considerations and review of the literature. In:  Zipes DP,  Rowlands DJ editor. Progress in Cardiology. Philadelphia (Pa): Lea & Febiger; 1989;p. 225–239
  45. Fett JD. Diagnosis of viral cardiomyopathy by analysis of peripheral blood?. Expert Opin Ther Targets. 2008;12:1073–1075
  46. Ansari AA, Fett JD, Carraway RD, et al. Autoimmune mechanisms as the basis for human peripartum cardiomyopathy. Clin Rev Allergy Immunol. 2002;23:289–312
  47. Hilfiker-Kleiner D, Sliwa K, Drexler H. Peripartum cardiomyopathy: recent insights in its pathophysiology. Trends Cardiovasc Med. 2008;18:173–179
  48. Fett JD, Sannon H, Thélisma E, et al. Recovery from severe heart failure following peripartum cardiomyopathy. Int J Gynaecol Obstet. 2009;104:125–127
  49. Forster O, Hilfiker-Kleiner D, Ansari AA, et al. Reversal of IFN-gamma, oxLDL and prolactin serum levels correlate with clinical improvement in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2008;10:861–868
  50. Brar SS, Khan SS, Sandhu GK, et al. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol. 2007;100:302–304
  51. Mielniczuk LM, Williams K, Davis DR, et al. Frequency of peripartum cardiomyopathy. Am J Cardiol. 2006;97:1765–1768
  52. Sliwa K, Forster O, Zhanje F, et al: Outcome of subsequent pregnancy in patients with documented peripartum cardiomyopathy. Am J Cardiol 2004;93:1441-3, A10.
  53. Sliwa K, Skudicky D, Candy G, et al. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2002;4:305–309
  54. Hilfiker-Kleiner D, Meyer GP, Schieffer E, et al. Recovery from postpartum cardiomyopathy in 2 patients with blocking prolactin release with bromocriptine. J Am Coll Cardiol. 2007;50:2354–2355
  55. Sliwa K, Tibazarwa K, Blauwet L, et al. Bromocriptine promotes recovery of cardiac function and survival in patients with PPCM: first randomised study. In: European Society of Cardiology Congress, Barcelona. Abstract Number: 84026. 2009;
  56. Elliot P, Anderson B, Arbustini E, et al. Classification of the cardiomyopathies: a position statement from the European Society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2008;29:270–276
  57. Deneux-Tharaux C, Berg C, Bouvier-Colle MH, et al. Underreporting of pregnancy-related mortality in the United States or Europe. Obstet Gynecol. 2005;106:684–692[Published erratum appears in Obstet Gynecol 2006, 107:209]
  58. Tibazarwa K, Ntyintyane L, Sliwa K, et al. Time Bomb of Cardiovascular Risk Factors in South Africa: results from the Heart of Soweto Study “Heart Awareness Days.”. Int J Cardiol. 2008;
  59. Sliwa K, Damasceno A, Mayosi BM. Epidemiology and etiology of cardiomyopathy in Africa. Circulation. 2005;112:3577–3583
  60. Mayosi BM. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa. Heart. 2007;93:1176–1183
  61. Abboud J, Murad Y, Chen-Scarabelli C, et al. Peripartum cardiomyopathy: a comprehensive review. Int J Cardiol. 2007;118:295–303
  62. Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J. 2006;152:509–513
  63. Damasceno A, Cotter G, Dzudie A, et al. Heart failure in sub-Saharan Africa: time for action. J Am Coll Cardiol. 2007;50:1688–1693

 Statement of Conflict of Interest: see page 323.

PII: S0033-0620(09)00093-0

doi: 10.1016/j.pcad.2009.11.003

Progress in Cardiovascular Diseases
Volume 52, Issue 4 , Pages 317-325 , January 2010

Article Tools

* Image Usage & Resolution