Current Therapeutic Perspectives in Peripartum Cardiomyopathy

Abstract

I applaud the efforts of Zimmerman and colleagues [1Zimmerman H. Bose R. Smith R. Copeland J.G. Treatment of peripartum cardiomyopathy with mechanical assist devices and cardiac transplantation.Ann Thorac Surg. 2010; 89: 1211-1217Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar] on peripartum cardiomyopathy (PPCM). The course and outcome of PPCM is usually unpredictable. Although recent studies [2Amos A.M. Jaber W.A. Russell S.D. Improved outcomes in peripartum cardiomyopathy with contemporary.Am Heart. J 2006; 152: 509-513Abstract Full Text Full Text PDF PubMed Scopus (216) Google Scholar] reported lower morbidity or mortality rates of PPCM, we have recently reported 30% mortality in a Turkish cohort of women with PPCM [3Duran N. Günes H. Duran I. Biteker M. Ozkan M. Predictors of prognosis in patients with peripartum cardiomyopathy.Int J Gynaecol Obstet. 2008; 101: 137-140Abstract Full Text Full Text PDF PubMed Scopus (92) Google Scholar]. Previous studies [4Demakis J.G. Rahimtoola S.H. Peripartum cardiomyopathy.Circulation. 1971; 44: 964-968Crossref PubMed Scopus (291) Google Scholar] suggested that PPCM patients faced a poor prognosis if their left ventricular systolic function did not return to normal within 6 months of diagnosis. However, Fett and colleagues [5Fett J.D. Sannon H. Thélisma E. Sprunger T. Suresh V. Recovery from severe heart failure following peripartum cardiomyopathy.Int J Gynaecol Obstet. 2009; 104: 125-127Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar] showed that the length of time required for complete recovery in patients with PPCM may be so much longer. Although no specific treatment strategies exist for PPCM, current therapeutic options consist of conventional supportive therapy for congestive heart failure, and it is similar to that of other forms of congestive heart failure in pregnancy [4Demakis J.G. Rahimtoola S.H. Peripartum cardiomyopathy.Circulation. 1971; 44: 964-968Crossref PubMed Scopus (291) Google Scholar, 5Fett J.D. Sannon H. Thélisma E. Sprunger T. Suresh V. Recovery from severe heart failure following peripartum cardiomyopathy.Int J Gynaecol Obstet. 2009; 104: 125-127Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar]. Although the authors have evaluated the long-term efficacy of surgical interventions, such as mechanical circulatory support devices or cardiac transplantation (or both) in the present study, they have omitted to address nonconventional treatment modalities in the management of PPCM. In a retrospective study of women with PPCM, patients treated with high-dose immune globulin had a greater improvement in ejection fraction than patients who were treated conventionally [6Bozkurt B. Villaneuva F.S. Holubkov R. et al.Intravenous immune globulin in the therapy of peripartum cardiomyopathy.J Am Coll Cardiol. 1999; 34: 177-180Abstract Full Text Full Text PDF PubMed Scopus (189) Google Scholar]. Furthermore, in a prospective, single-center, randomized study, Sliwa and colleagues [7Sliwa K. Blauwet L. Tibazarwa K. et al.Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy A proof-of-concept pilot study.Circulation. 2010; (epub ahead of print)PubMed Google Scholar] showed that the addition of bromocriptine to standard congestive heart failure therapy in women with PPCM seemed to result in significantly greater improvements in functional capacity, left ventricular function than was seen with standard therapy alone. Recent studies show that when PPCM patients were treated with conventional therapy, most patients survived, and more than 50% completely recovered left ventricular systolic function. In summary, the addition of nonconventional treatment modalities may improve complete recovery rates of PPCM in patients, and cardiac transplantation or mechanical circulatory support, or both, should be the last resort for patients with PPCM, when all other treatments have failed. ReplyThe Annals of Thoracic SurgeryVol. 91Issue 1PreviewThe letter from Biteker [1] in regard to our article [2] addresses nonconventional treatments of postpartum cardiomyopathy using either intravenous immune globulin or bromocriptine. Both of these are modulators of the immune system. We share the interest and excitement regarding these therapies that may prevent patients from deteriorating to the point that they are referred for our services. We also support the use of these therapies in addition to conventional medical therapy for advanced congestive heart failure in postpartum cardiomyopathy. Full-Text PDF