Peripartum cardiomyopathy: pathogenesis, presentations, diagnosis, treatment, and prognosis

N.G. Veselovskaya^1,2, G.A. Chumakova^1,2, M.G. Nikolaeva^2,3, Gorbacheva², A.V. Ott²

¹Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo

²Altay State Medical University, Barnaul

³Altay Branch of the National Medical Research Center of Hematology, Barnaul

Peripartum cardiomyopathy (PPCM) is a myocardial disorder with left ventricular (LV) systolic dysfunction and clinical signs of heart failure that presents in late pregnancy through the first months after delivery in previously healthy women. An irreversible myocardial lesion with persistent LV failure and high-grade abnormal heart rhythm result in unfavorable outcomes in young women. Therefore, timely diagnosis and treatment for PPCM (that provides recovery in most cases) are essential.

In recent years, oxidative stress as a factor potentiating PPCM development has been studied. The pathogenic relevance of a 16-kDa N-terminal prolactin fragment that provides a toxic effect on myocardium and cardiomyocyte apoptosis is established. In addition, the placenta produces antiangiogenic factors during pregnancy, e.g., sol uble vascular endothelial growth factor receptor (sFlt-1). Its high concentrations provoke LV dysfunction during pregnancy. Some trials demonstrate the efficacy of pathogenic therapy with bromocriptine to improve myocardial contractility and disease outcome.

However, more studies on PPCM prevalence in various ethnic groups and regions, etiology, risk factors, optimal therapy (including bromocriptine), long-term outcomes, and treatment duration after LV functional recovery.

Keywords: peripartum cardiomyopathy, oxidative stress, heart failure, left ventricular dysfunction, cardiomyocytes, bromocriptine, pregnancy, prolactin, apoptosis.

For citation: Veselovskaya N.G., Chumakova G.A., Nikolaeva M.G. et al. Peripartum cardiomyopathy: pathogenesis, presentations, diagnosis, treatment, and prognosis. RMJ. 2021;10:44–48.