Clinical Outcomes in Peripartum Cardiomyopathy Complicated by Cardiogenic Shock: A Retrospective Multicenter Cohort Study.

Clinical presentation and echocardiographic characteristics of women with peripartum cardiomyopathy: Insights from the Italian Multicentre Registry.

The Relationship between Neutrophil Lymphocyte Ratio and Maternal Outcomes in Peripartum Cardiomyopathy Patients

Peripartum Cardiomyopathy (PPCM) is a rare but potentially fatal idiopathic cardiomyopathy that predominantly occurs in the late stages of pregnancy or within several months postpartum.

Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening cause of heart failure occurring in late pregnancy or the early postpartum period. Physiological cardiovascular adaptation and pregnancy-related complications may mimic PPCM, leading to diagnostic overestimation. This prospective cohort study included 60 pregnant women with clinically and echocardiographically suspected PPCM, stratified by gestational trimester, and 15 healthy pregnant controls. All participants underwent transthoracic echocardiography with assessment of left ventricular ejection fraction (LVEF), chamber dimensions, and diastolic function. True PPCM was confirmed in 4 women (6.7%), predominantly in the third trimester. Compared with earlier gestational groups, women evaluated in the third trimester more frequently demonstrated symptoms of heart failure, significantly reduced LVEF, progressive ventricular dilatation, and marked diastolic dysfunction. In most cases, echocardiographic abnormalities were attributable to physiological cardiac adaptation, anaemia, or hypertensive pregnancy disorders rather than true PPCM. In healthy controls, changes in LVEF remained within physiological limits. These findings indicate that the majority of suspected PPCM cases represent reversible pregnancy-related conditions. Strict diagnostic criteria and dynamic echocardiographic monitoring are essential to prevent overdiagnosis and unnecessary treatment.

Natriuretic peptides, such as active brain-type natriuretic peptide (BNP) and inert N-terminal pro-B-type natriuretic peptide (NT-proBNP), are hormones secreted by the heart in response to increased intraventricular pressure and circulating blood volume. Physiological cardiovascular adaptations during pregnancy result in an increase in BNP secretion. In non-pregnant populations, these peptides are well-established markers for diagnosing heart failure and assessing cardiac risk; however, their clinical usefulness in pregnancy and cardiovascular risk assessment is limited. This paper aims to summarise the possible uses of BNP in pregnancy based on the available literature and research. We searched Medline, PUBMED, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for English-language studies published regarding BNP and pregnancy. BNP and NT-proBNP are valuable markers for diagnosing and predicting cardiac complications in pregnancy, including heart failure, pre-eclampsia, and peripartum cardiomyopathy, and for risk stratification in women with adverse pregnancy outcomes. Recommended upper limits are 50 pg/ml for BNP across all trimesters and 200 pg/ml (first and second trimester) and 150 pg/ml (third trimester) for NT-proBNP. A BNP >100 pg/ml demonstrates high diagnostic accuracy (sensitivity 98%, specificity 92%, PPV 92%, NPV 97%) for cardiac complications. In addition, BNP used in conjunction with sFlt-1/PlGF ratio tests, has improved the predictive capability of delivery in pre-eclampsia (p = 0.011). BNP and NT-proBNP are widely used in emergency settings to differentiate cardiac from non-cardiac causes of dyspnoea and heart failure, but their use in pregnancy-specific conditions remains. The fluctuation of BNP levels with pre-existing cardiac, renal disease and obesity needs further evaluation to identify a useful cut-off for the use of BNP in pregnancy.

Background: Cardiovascular diseases are among the leading causes of maternal morbidity and mortality in the United States. During 2010–2020, 1 in 10 severe maternal morbidities (SMMs) during delivery hospitalization was heart disease (HD)-related. This report synthesizes science, including methodologies, challenges, and opportunities, and summarizes national estimates on HD during pregnancy, focusing on congenital heart disease (CHD), cardiomyopathies (CM), valvular heart disease (VHD), arrhythmias (ARR), and heart failure (HF). Methods and Results: We analyzed large nationwide databases, including the National Inpatient Sample and the Nationwide Readmissions Database. The prevalence of HD complicating deliveries ranges from approximately 20–40 cases per 10,000 deliveries. Increasing trends were observed in CHD, ARR, and HF. HF, particularly peripartum CM, is a leading cause of adverse maternal outcomes, including in-hospital mortality and SMM. VHD prevalence has declined, whereas ARR has become the most prevalent HD during pregnancy hospitalizations. Significant gaps exist due to inconsistent definitions and methodologies, limiting comparability and clinical utility. Proposed solutions include adopting standardized definitions, developing a core outcome set, improving data quality through structured documentation and standardized data models, and using validated algorithms and indices. Collaboration among multidisciplinary teams is essential to enhance research quality. Conclusion: The efforts aligning definitions of HD, outcomes, and indices with public health measures and initiatives present an opportunity to create a unifying framework that connects patient-level data to system-wide improvements. This integration helps ensure that advances in methodology translate into better care delivery, billing accuracy, research quality, and public health surveillance, and ultimately enhance outcomes for pregnant women with HD.

Hyponatremia is the most common electrolyte imbalance, however the prognostic significance of hyponatremia in peripartum cardiomyopathy (PPCM) remains unclear. To assess the prognostic significance of hyponatremia in PPCM patients. We consecutively recruited patients with PPCM from 14 sites in Nigeria and followed them up for a median of 18 months. Serum sodium was measured at baseline, and patients with hyponatremia (< 135 mmol/L) were compared with those with normal sodium levels. Cox proportional hazards regression models were developed to identify factors associated with all-cause mortality. Of the 191 PPCM patients recruited, 90 (47.1%) had hyponatremia at presentation. All-cause mortality among the hyponatremic patients (24/90; 26.7%) was significantly higher than among patients with normal serum sodium (7/101; 6.9%) (P-value < 0.001). In the Cox proportional hazards regression model, hyponatremia was independently associated with an increased risk of all-cause mortality [hazard ratio: 3.18 (95% confidence interval: 1.35-7.52; P = 0.008)], as were hypotension (systolic blood pressure < 100 mmHg) [2.22 (1.03-4.79); P = 0.043] and left ventricular ejection fraction (LVEF) < 25% [3.14 (1.47-6.73), P = 0.003]. Hyponatremia was common in our cohort of PPCM patients, and was independently associated with a threefold increased risk for all-cause mortality. Hypotension and a LVEF below 25% at presentation were also independent predictors of mortality.

The peptidyl-tRNA hydrolase 2 (PTRH2, Bit-1, BIT1) gene plays a pro-survival role during development with loss of function gene mutations causing congenital infantile multisystem disease (IMNEPD). In wild-type female mice hearts, Ptrh2 protein levels significantly increase during pregnancy and decrease postpartum, demonstrating a protective role in response to pregnancy-initiated cardiac stresses. Peripartum cardiomyopathy (PPCM) is due to dysregulated protective signaling in the pregnant heart. The genetic and molecular mechanisms underlying PPCM remain poorly defined with no specific therapies. Here, we engineered a cardiac-specific Ptrh2 knockout (Ptrh2-CKO) mouse and show these maternal mice develop left ventricular systolic dysfunction, exhibit high rates of postpartum heart failure, and model key features of human PPCM. Infusion of a caspase 3-specific inhibitor attenuated the PPCM phenotype. Collectively, our findings demonstrate Ptrh2 is a negative regulator of pregnancy-induced cardiac stresses by activating pro-survival signals and blocking apoptotic signals, suggesting Ptrh2 may be a therapeutic target for the treatment of PPCM.

Heart failure (HF) during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions. Pregnancy-induced increases in blood volume, cardiac output, and heart rate can exacerbate pre-existing heart diseases or trigger new-onset HF, such as peripartum cardiomyopathy and preeclampsia-related HF. With pregnancy-related physiological changes altering pharmacokinetics, dosage adjustment becomes crucial, making its application limited to carefully selected cases where benefits outweigh the risks. Medication management for these patients requires a meticulous approach. Beta-blockers like metoprolol and bisoprolol are preferred despite limited evidence, and carvedilol may be cautiously used per clinical experience; atenolol is contraindicated for low-birth-weight risk. Diuretics (furosemide, bumetanide) are safe for congestion relief but warrant judicious dosing. Digoxin is generally safe but requires dose adjustment and regular monitoring due to pregnancy-induced pharmacokinetic alterations. Among positive inotropes, dobutamine exhibits favorable safety in pregnancy, whereas milrinone should be used cautiously for hypotension risk. Renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors are all contraindicated owing to risks of fetal malformations, male fetal feminization, and insufficient safety evidence, respectively.

Background: Heart disease remains a leading cause of maternal mortality worldwide, exacerbated by pregnancy-related physiological changes affecting cardiovascular function, respiratory dynamics, hematological parameters, and pharmacokinetics—all of which influence maternal and fetal outcomes, as well as anesthetic management. Cardiac arrhythmias may be intensified by hemodynamic and hormonal changes during pregnancy. Furthermore, conditions such as peripartum cardiomyopathy, Takotsubo syndrome, myocardial infarction, and post–heart transplantation complications increase the risk of arrhythmias and adverse maternal and fetal outcomes, requiring specialized management to mitigate complications such as heart failure, thromboembolism, and cardiac arrest.Aim of the study: To review current evidence on anesthetic management in pregnant women with cardiac arrhythmias and other arrhythmia-inducing heart diseases.Material and methods: The review was conducted using articles and guidelines from PubMed, the National Institutes of Health (NIH), the Medycyna Praktyczna website, SpringerMedizin, Semantic Scholar, and book sources. Based on 420 articles, 4 books, and WHO/NIH sources, 43 key references (20 published after 2022) were analyzed.Results: Pregnancy induces significant cardiovascular and respiratory changes. Respiratory adaptations and hematologic alterations affect anesthesia and drug pharmacokinetics. Arrhythmias such as atrial fibrillation are treated with beta-blockers, verapamil, or cardioversion. The risk of arrhythmia is 47.91 times higher in patients with cardiomyopathy than in healthy individuals. Peripartum cardiomyopathy carries a high risk of arrhythmias. Takotsubo syndrome, often occurring in the peripartum period, is associated with catecholamine surges and is managed with beta-blockers and diuretics. Myocardial infarction is also associated with an increased risk of developing arrhythmias during pregnancy. Heart transplant recipients frequently experience concomitant cardiac arrhythmias and face significantly increased risks of maternal morbidity and preterm birth, necessitating specialized, multidisciplinary care.Conclusions: Pregnancy-induced physiological adaptations increase the risk of arrhythmias and require specialized management to mitigate maternal and fetal complications. Optimal outcomes depend on multidisciplinary care, individualized anesthesia, and rigorous monitoring.

Peripartum cardiomyopathy is characterized by left ventricular systolic dysfunction during the last month of pregnancy through five months after delivery. Our case involves a 22-year-old female who was diagnosed with peripartum cardiomyopathy a few days after giving birth. She received medication management and had an external defibrillator placed. She was advised to have close cardiology follow up as an outpatient.

Abstract Introduction Cardiomyopathy is a leading cause of maternal morbidity and mortality. A prolactin fragment has been implicated in the pathogenesis, and preliminary data suggest that bromocriptine—a dopamine receptor agonist that inhibits prolactin secretion—is a promising adjunctive therapy. However, bromocriptine pharmacokinetic (PK) data are largely derived from healthy males. Our objective was to conduct a postpartum oral bromocriptine PK study to inform a future trial to test the potential benefit of bromocriptine for add‐on peripartum cardiomyopathy (PPCM) therapy. Methods We conducted an oral bromocriptine PK study including healthy postpartum participants during the delivery‐associated hospitalization who delivered ≥1 fetus at ≥28 weeks’ gestation. Patients on CYP34A inhibitors or inducers, those with clinical contraindications according to the FDA package insert, and those who planned to express breastmilk (given the potential negative effects of bromocriptine on lactation) were excluded. Whole blood was collected pre‐dose and 1, 2, 3, 4, 6, 8, and 12 h after an observed dose of 5 mg bromocriptine. Plasma was analyzed using mass spectrometry. Parameters of interest included 12‐h area‐under‐the‐curve (AUC 12 ), elimination half‐life (t 1/2 ), maximum concentration (C max ), and time to C max ( T max ). Results Non‐compartmental PK analysis was conducted on nine participants, demonstrating mean ± SD AUC 12 , t 1/2 , C max , and T max were 180 ± 207 pg h/mL, 5.4 ± 4.8 h, 56 ± 64 pg/mL, and 1.6 ± 1.1 h, respectively. Conclusion In this modest sample, several PK parameters of oral bromocriptine in healthy postpartum participants differed from those reported in the literature, which may be due to physiological changes in pregnancy. The association between PK parameters and clinical outcomes in patients with PPCM warrants further evaluation.

Introduction Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that occurs in the last month of pregnancy or within the first five months postpartum. Preeclampsia, characterized by hypertension and organ dysfunction, increases the risk of long-term maternal cardiovascular complications. Antenatal Care (ANC) has a key role in the early detection and prevention of conditions like PPCM in women with preeclampsia. Case Illustration:A 22-year-old primiparous woman presented with severe difficulty breathing, fatigue, and leg swelling. She had given birth 35 days earlier who had prior episodes of preeclampsia and intrauterine growth restriction (IUGR). Examination revealed lung crackles, murmur, a gallop heart rhythm, and pitting edema. ECG showed sinus tachycardia and right ventricular enlargement, while chest X-ray indicated cardiomegaly with pulmonary edema. Treatment consisted of diuretics, beta-blockers, fluid restriction, and ICU care. During her last pregnancy, she had experienced leg swelling since 37 weeks gestation but had irregular ANC visits, no obstetric ultrasound, and only took vitamins from a primary healthcare center. Discussion:This case highlights the association between preeclampsia and PPCM, a severe Peripartum cardiovascular complication. The patient exhibited classic PPCM symptoms, including shortness of breath, fatigue, and leg edema, with clear signs of cardiac dysfunction. A key factor was poor pregnancy monitoring, as she did not attend ANC regularly, leading to undiagnosed preeclampsia and its complications. Conclusion:PPCM is a serious cardiovascular complication related to preeclampsia. Regular ANC, including ultrasound screening and blood pressure monitoring, is essential to early detection and prevention of adverse maternal and fetal outcomes.

Cardiovascular diseases during pregnancy remain one of the leading causes of maternal morbidity and mortality worldwide. Advances in digital technologies and artificial intelligence (AI) provide novel opportunities to improve risk stratification, early diagnosis, and monitoring of cardiovascular complications in pregnant women. Conventional diagnostic approaches, including electrocardiography, echocardiography, and biochemical markers, while effective, often face limitations in sensitivity, reproducibility, and timely application during pregnancy. AI-based methods, through the integration of multimodal data—such as clinical history, imaging, laboratory biomarkers, and wearable sensor outputs—demonstrate the potential to identify subclinical disease patterns that might otherwise remain undetected. Emerging evidence highlights AI applications in predicting maternal cardiovascular risk, detecting arrhythmias, diagnosing peripartum cardiomyopathy, evaluating valvular lesions, and forecasting hypertensive disorders of pregnancy, including preeclampsia. Neural network models have shown superior performance compared with conventional statistical tools in several clinical scenarios, with reported improvements in predictive accuracy and area under the curve (AUC) values exceeding 0.90 in selected studies. Moreover, AI-assisted interpretation of imaging and phonocardiographic data could reduce inter-observer variability and improve diagnostic workflows. Despite these promising findings, significant challenges remain, including data quality, bias, ethical concerns, regulatory frameworks, and limited validation in pregnant populations. The responsible integration of AI into maternal healthcare requires multidisciplinary collaboration, robust clinical validation, and transparent governance. In summary, AI holds transformative potential for optimizing cardiovascular care during pregnancy. Its application could reduce maternal morbidity and mortality with minimal economic burden, provided that ethical, regulatory, and clinical barriers are addressed through rigorous research and implementation studies.

Heart failure and pregnancy

We report three patients who developed Takotsubo cardiomyopathy (TTCM) or reverse TTCM following administration of ergometrine for postpartum bleeding. All three women were antenatally well with no personal or family history of any cardiovascular conditions. Shortly after birth, all three patients demonstrated cardiovascular compromise. Transthoracic echocardiogram (TTE) demonstrated markedly impaired left ventricular (LV) systolic function with either Takotsubo or reverse TTCM. All patients spent a period in the intensive care unit for inotropic support and commencement of heart failure therapy. Serial TTE demonstrated marked improvement with a normal LV ejection fraction within 13 days for all cases. By 6 months, all three women were off all heart failure medications. TTCM differs from peripartum cardiomyopathy, with LV ejection fraction typically recovering within 1 month of delivery. Judicious use of ergometrine in the management of an atonic uterus, even women with no cardiovascular history, is necessary.

Obstructive sleep apnea in pregnancy: Nationwide assessment of obstetric characteristics and maternal morbidity at delivery.

Assessment of Endomyocardial Fibrosis with Cardiac MRI: A peripartum cardiomyopathy case report.

Peripartum cardiomyopathy (PPCM) is an uncommon but serious form of heart failure affecting women during late pregnancy or early postpartum. This territory-wide multicentre retrospective study aimed to evaluate the local incidence, risk factors, and clinical outcomes, including subsequent pregnancies, in Hong Kong. Medical records were retrospectively reviewed for women who delivered at all public hospitals between 1 January 2013 and 31 December 2022 and met the 2010 European Society of Cardiology Working Group criteria for PPCM. Regression analysis was performed to investigate maternal risk factors. Thirty Asian women were diagnosed with PPCM, corresponding to an incidence of 1 in 11 179 live births. Eleven (36.7%) had antepartum onset of symptoms, and 25 (83.3%) were diagnosed after childbirth, most presenting with severe symptoms (90%). The median left ventricular ejection fraction was 30% (range, 10%-44%). Notable complications included cardiogenic shock (10%), respiratory failure (23.3%), acute renal failure (23.3%), and thromboembolism (23.3%). Most women received guideline-directed heart failure therapy. At 12 months, all-cause mortality was 6.7%, and cardiac recovery occurred in 60%. Eleven women had 13 subsequent pregnancies (three miscarriages, five terminations, and five live births). There were no maternal deaths or cases of recurrent PPCM. Genetic testing identified potentially pathogenic variants in at least 10% of women. Antenatal anaemia (adjusted odds ratio [OR]=13.04; 95% confidence interval [95% CI]=3.72-45.70) and hypertensive disorders of pregnancy (adjusted OR=38.00; 95% CI=9.66-149.52) were associated with higher odds of PPCM. This study highlights the substantial morbidity and mortality associated with PPCM. Genetic testing may aid in risk stratification and prognostication.