Early ivabradine treatment in patients with acute peripartum cardiomyopathy: Subanalysis of the German PPCM registry

Abstract

Peripartum Cardiomyopathy (PPCM) is a pregnancy associated form of heart failure and with a considerable rate of morbidity and mortality [1,2]. Although the pathophysiology of PPCM is not fully understood, emerging evidence point to vascular endothelial damage with subsequent impairment of the microcirculation as an essential pathomechanism of PPCM [3,4]. Current treatment recommendations for PPCM are based on standard heart failure therapy [1,5], although evidence-based data on any treatment option for PPCMare still missing. Among determinants of poor outcome very low baseline LVEF (b25%), LV dilatation and right ventricular function were identified in studies from different regions [6–9]. Importantly, elevated resting heart rate (HR) is common among PPCM patients and considered a negative predictor of outcome, in particular when coupled with low blood pressure (BP) [10]. In some patients with acute PPCM and severely reduced ejection fraction associated with particular poor outcome, the application of beta-blockers at higher doses is often limited due to low BP and, thus, with insufficient HR slowing effects in these patients [10]. Thus, additional HR reduction may be achieved by the “funny” (f)-channel blocker ivabradine, an established medication for patients with chronic heart failure [11]. While recommended in stable chronic heart failure at HR N70 bpm [12] data on application of ivabradine in