Review of Randomized Controlled Trials in Patients with Peripartum Cardiomyopathy

Article ID: e230822207933 Pages: 10

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Abstract

Introduction: Peripartum cardiomyopathy (PPCM) is a rare but potentially lifethreatening disease, defined as idiopathic cardiomyopathy occurring towards the end of pregnancy or in the months following delivery, abortion or miscarriage. We aim to raise awareness of this condition and give an overview of current knowledge as well as an insight and comparison of clinical trials focusing on randomized controlled trials.

Material and Methods: Systematic literature searches were conducted using PubMed up to December 2021. Studies published involving clinical trials and interventions in women with PPCM after 1970 were selected.

Results: Randomized controlled trials have shown that the addition of Bromocriptine to standardized heart failure therapy improves outcome in terms of recovery of Left Ventricular Ejection Fraction (LVEF), symptoms and death. Bromocriptine 2.5 mg twice daily for two weeks followed by 2.5 mg once daily for six weeks had the best trend and outcome. The addition of Levosimendan to standardized heart failure therapy had no effect, whereas the addition of Selenium improved heart failure symptoms but did not reduce risk in terms of unrecovered LVEF or death. One prospective study showed potential usage of TNF-alfa inhibitors, but was never tried in a randomized clinical trial.

Conclusion: PPCM is a rare and potentially fatal disease. New insights on pathophysiology, genetics and clinical studies, particularly randomized controlled trials, have shown that the addition of Bromocriptine has a beneficial effect in terms of improved LVEF and death. However, some clinical studies have shown promising results using anti-inflammatory pharmacological agents with an improvement in LVEF. We suggest that targeting an anti-inflammatory route may prove beneficial in patients with PPCM. However, further research is highly warranted.

Keywords: Heart failure, Peripartum Cardiomyopathy, Pregnancy, Treatment of Peripartum Cardiomyopathy

Graphical Abstract

[1]
Sliwa K, Hilfiker D, Petrie MC, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: A position statement from the heart failure association of the european society of cardiology working group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12(8): 767-78.
[http://dx.doi.org/10.1093/eurjhf/hfq120] [PMID: 20675664]
[2]
Bauersachs J, König T, van der Meer P, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: A position statement from the heart failure association of the European society of cardiology study group on peripartum cardiomyopathy. Eur J Heart Fail 2019; 21(7): 827-43.
[http://dx.doi.org/10.1002/ejhf.1493] [PMID: 31243866]
[3]
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(9): 1183-8.
[http://dx.doi.org/10.1001/jama.283.9.1183] [PMID: 10703781]
[4]
Elkayam U, Akhter MW, Singh H, et al. Pregnancy associated cardiomyopathy: Clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111(16): 2050-5.
[http://dx.doi.org/10.1161/01.CIR.0000162478.36652.7E] [PMID: 15851613]
[5]
Pillarisetti J, Kondur A, Alani A, et al. Peripartum cardiomyopathy: Predictors of recovery and current state of implantable cardioverter defibrillator use. J Am Coll Cardiol 2014; 63 (25 Pt A): 2831-9.
[http://dx.doi.org/10.1016/j.jacc.2014.04.014] [PMID: 24814494]
[6]
Isezuo SA, Abubakar SA. Epidemiologic profile of peripartum cardiomyopathy in a tertiary care hospital. Ethn Dis 2007; 17(2): 228-33.
[PMID: 17682350]
[7]
Fett JD, Christie LG, Carraway RD, Murphy JG. Five year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution. Mayo Clin Proc 2005; 80(12): 1602-6.
[http://dx.doi.org/10.4065/80.12.1602] [PMID: 16342653]
[8]
Mielniczuk LM, Williams K, Davis DR, et al. Frequency of peripartum cardiomyopathy. Am J Cardiol 2006; 97(12): 1765-8.
[http://dx.doi.org/10.1016/j.amjcard.2006.01.039] [PMID: 16765131]
[9]
Ersbøll AS, Johansen M, Damm P, Rasmussen S, Vejlstrup NG, Gustafsson F. Peripartum cardiomyopathy in Denmark: A retrospective, population based study of incidence, management and outcome. Eur J Heart Fail 2017; 19(12): 1712-20.
[http://dx.doi.org/10.1002/ejhf.882] [PMID: 28597481]
[10]
Kamiya CA, Kitakaze M, Ishibashi H, et al. Different characteristics of peripartum cardiomyopathy between patients complicated with and without hypertensive disorders results from the Japanese nationwide survey of peripartum cardiomyopathy. Circ J 2011; 75(8): 1975-81.
[http://dx.doi.org/10.1253/circj.CJ-10-1214] [PMID: 21617320]
[11]
Hilfiker D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol 2014; 11(6): 364-70.
[http://dx.doi.org/10.1038/nrcardio.2014.37] [PMID: 24686946]
[12]
Kao DP, Hsich E, Lindenfeld J. Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy. JACC Heart Fail 2013; 1(5): 409-16.
[http://dx.doi.org/10.1016/j.jchf.2013.04.011] [PMID: 24163791]
[13]
Kolte D, Khera S, Aronow WS, et al. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: A nationwide population based study. J Am Heart Assoc 2014; 3(3)e001056
[http://dx.doi.org/10.1161/JAHA.114.001056] [PMID: 24901108]
[14]
Aggarwal A, Modi S, Kumar S, et al. Use of a single circuit CentriMag for biventricular support in postpartum cardiomyopathy. Perfusion 2013; 28(2): 156-9.
[http://dx.doi.org/10.1177/0267659112464713] [PMID: 23104581]
[15]
Ntusi NB, Mayosi BM. Aetiology and risk factors of peripartum cardiomyopathy: A systematic review. Int J Cardiol 2009; 131(2): 168-79.
[http://dx.doi.org/10.1016/j.ijcard.2008.06.054] [PMID: 18722678]
[16]
Hilfiker D, Kaminski K, Podewski E, et al. A cathepsin D cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007; 128(3): 589-600.
[http://dx.doi.org/10.1016/j.cell.2006.12.036] [PMID: 17289576]
[17]
Bajou K, Herkenne S, Thijssen VL, et al. Corrigendum: PAI-1 mediates the antiangiogenic and profibrinolytic effects of 16K prolactin. Nat Med 2015; 21(5): 537.
[http://dx.doi.org/10.1038/nm0515-537a] [PMID: 25951534]
[18]
Halkein J, Tabruyn SP, Ricke M, et al. MicroRNA-146a is a therapeutic target and biomarker for peripartum cardiomyopathy. J Clin Invest 2013; 123(5): 2143-54.
[http://dx.doi.org/10.1172/JCI64365] [PMID: 23619365]
[19]
Patten IS, Rana S, Shahul S, et al. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 2012; 485(7398): 333-8.
[http://dx.doi.org/10.1038/nature11040] [PMID: 22596155]
[20]
Arany Z, Foo SY, Ma Y, et al. HIF-independent regulation of VEGF and angiogenesis by the transcriptional coactivator PGC-1alpha. Nature 2008; 451(7181): 1008-12.
[http://dx.doi.org/10.1038/nature06613] [PMID: 18288196]
[21]
Venkatesha S, Toporsian M, Lam C, et al. Soluble endoglin contributes to the pathogenesis of preeclampsia. Nat Med 2006; 12(6): 642-9.
[http://dx.doi.org/10.1038/nm1429] [PMID: 16751767]
[22]
Powe CE, Levine RJ, Karumanchi SA. Preeclampsia, a disease of the maternal endothelium: The role of antiangiogenic factors and implications for later cardiovascular disease. Circulation 2011; 123(24): 2856-69.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.853127] [PMID: 21690502]
[23]
Bdolah Y, Lam C, Rajakumar A, et al. Twin pregnancy and the risk of preeclampsia: Bigger placenta or relative ischemia? Am J Obstet Gynecol 2008; 198(4): 428.e1-6.
[http://dx.doi.org/10.1016/j.ajog.2007.10.783] [PMID: 18191808]
[24]
Horne BD, Rasmusson KD, Alharethi R, et al. Genome-wide significance and replication of the chromosome 12p11.22 locus near the PTHLH gene for peripartum cardiomyopathy. Circ Cardiovasc Genet 2011; 4(4): 359-66.
[http://dx.doi.org/10.1161/CIRCGENETICS.110.959205] [PMID: 21665988]
[25]
Bakre MM, Zhu Y, Yin H, et al. Parathyroid hormone-related peptide is a naturally occurring, protein kinase A dependent angiogenesis inhibitor. Nat Med 2002; 8(9): 995-1003.
[http://dx.doi.org/10.1038/nm753] [PMID: 12185361]
[26]
Sheppard R, Hsich E, Damp J, et al. GNB3 C825T polymorphism and myocardial recovery in peripartum cardiomyopathy: Results of the multicenter investigations of pregnancy-associated cardiomyopathy study. Circ Heart Fail 2016; 9(3)e002683
[http://dx.doi.org/10.1161/CIRCHEARTFAILURE.115.002683] [PMID: 26915373]
[27]
Ware JS, Li J, Mazaika E, et al. Shared genetic predisposition in peripartum and dilated cardiomyopathies. N Engl J Med 2016; 374(3): 233-41.
[http://dx.doi.org/10.1056/NEJMoa1505517] [PMID: 26735901]
[28]
Lindquist S. The heat shock response. Annu Rev Biochem 1986; 55: 1151-91.
[http://dx.doi.org/10.1146/annurev.bi.55.070186.005443] [PMID: 2427013]
[29]
van Spaendonck KY, Posafalvi A, van den Berg MP, et al. Titin gene mutations are common in families with both peripartum cardiomyopathy and dilated cardiomyopathy. Eur Heart J 2014; 35(32): 2165-73.
[http://dx.doi.org/10.1093/eurheartj/ehu050] [PMID: 24558114]
[30]
Myers VD, McClung JM, Wang J, et al. The multifunctional protein BAG3: A novel therapeutic target in cardiovascular disease. JACC Basic Transl Sci 2018; 3(1): 122-31.
[http://dx.doi.org/10.1016/j.jacbts.2017.09.009] [PMID: 29938246]
[31]
Liu GS, Gardner G, Adly G, et al. A novel human S10F-Hsp20 mutation induces lethal peripartum cardiomyopathy. J Cell Mol Med 2018; 22(8): 3911-9.
[http://dx.doi.org/10.1111/jcmm.13665] [PMID: 29761889]
[32]
Haghikia A, Podewski E, Libhaber E, et al. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol 2013; 108(4): 366.
[http://dx.doi.org/10.1007/s00395-013-0366-9] [PMID: 23812247]
[33]
Goland S, Modi K, Bitar F, et al. Clinical profile and predictors of complications in peripartum cardiomyopathy. J Card Fail 2009; 15(8): 645-50.
[http://dx.doi.org/10.1016/j.cardfail.2009.03.008] [PMID: 19786252]
[34]
Fett JD. Earlier detection can help avoid many serious complications of peripartum cardiomyopathy. Future Cardiol 2013; 9(6): 809-16.
[http://dx.doi.org/10.2217/fca.13.63] [PMID: 24180539]
[35]
Arany ZP, Walker CM, Wang L. Case records of the Massachusetts general hospital. Case 22-2014. A 40 year old woman with postpartum dyspnea and hypoxemia. N Engl J Med 2014; 371(3): 261-9.
[http://dx.doi.org/10.1056/NEJMcpc1304163] [PMID: 25014691]
[36]
Honigberg MC, Elkayam U, Rajagopalan N, et al. Electrocardiographic findings in peripartum cardiomyopathy. Clin Cardiol 2019; 42(5): 524-9.
[http://dx.doi.org/10.1002/clc.23171] [PMID: 30843220]
[37]
Resnik JL, Hong C, Resnik R, et al. Evaluation of B-type natriuretic peptide (BNP) levels in normal and preeclamptic women. Am J Obstet Gynecol 2005; 193(2): 450-4.
[http://dx.doi.org/10.1016/j.ajog.2004.12.006] [PMID: 16098869]
[38]
Hameed AB, Chan K, Ghamsary M, Elkayam U. Longitudinal changes in the B-type natriuretic peptide levels in normal pregnancy and postpartum. Clin Cardiol 2009; 32(8): E60-2.
[http://dx.doi.org/10.1002/clc.20391] [PMID: 19455566]
[39]
Rafik Hamad R, Larsson A, Pernow J, Bremme K, Eriksson MJ. Assessment of left ventricular structure and function in preeclampsia by echocardiography and cardiovascular biomarkers. J Hypertens 2009; 27(11): 2257-64.
[http://dx.doi.org/10.1097/HJH.0b013e3283300541] [PMID: 19809366]
[40]
Tanous D, Siu SC, Mason J, et al. B-type natriuretic peptide in pregnant women with heart disease. J Am Coll Cardiol 2010; 56(15): 1247-53.
[http://dx.doi.org/10.1016/j.jacc.2010.02.076] [PMID: 20883932]
[41]
Ricke-Hoch M, Hoes MF, Pfeffer TJ, et al. In peripartum cardiomyopathy plasminogen activator inhibitor-1 is a potential new biomarker with controversial roles. Cardiovasc Res 2020; 116(11): 1875-86.
[http://dx.doi.org/10.1093/cvr/cvz300] [PMID: 31711127]
[42]
Sarojini A, Sai Ravi Shanker A, Anitha M. Inflammatory markers-serum level of C-reactive protein, tumor necrotic factor-α and interleukin-6 as predictors of outcome for peripartum cardiomyopathy. J Obstet Gynaecol India 2013; 63(4): 234-9.
[http://dx.doi.org/10.1007/s13224-013-0428-9] [PMID: 24431648]
[43]
Hu CL, Li YB, Zou YG, et al. Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy. Heart 2007; 93(4): 488-90.
[http://dx.doi.org/10.1136/hrt.2006.087387] [PMID: 17065185]
[44]
Tremblay M, Marquis G, Avram R, et al. The effect of bromocriptine on left ventricular functional recovery in peripartum cardiomyopathy: Insights from the BRO-HF retrospective cohort study. ESC Heart Fail 2019; 6(1): 27-36.
[http://dx.doi.org/10.1002/ehf2.12376] [PMID: 30565890]
[45]
Chapa JB, Heiberger HB, Weinert L, Decara J, Lang RM, Hibbard JU. Prognostic value of echocardiography in peripartum cardiomyopathy. Obstet Gynecol 2005; 105(6): 1303-8.
[http://dx.doi.org/10.1097/01.AOG.0000161382.30233.ba] [PMID: 15932821]
[46]
McNamara DM, Elkayam U, Alharethi R, et al. Clinical Outcomes for peripartum cardiomyopathy in North America: Results of the IPAC study (investigations of pregnancy-associated cardiomyopathy). J Am Coll Cardiol 2015; 66(8): 905-14.
[http://dx.doi.org/10.1016/j.jacc.2015.06.1309] [PMID: 26293760]
[47]
Goland S, Bitar F, Modi K, et al. Evaluation of the clinical relevance of baseline left ventricular ejection fraction as a predictor of recovery or persistence of severe dysfunction in women in the United States with peripartum cardiomyopathy. J Card Fail 2011; 17(5): 426-30.
[http://dx.doi.org/10.1016/j.cardfail.2011.01.007] [PMID: 21549301]
[48]
Liang YD, Xu YW, Li WH, et al. Left ventricular function recovery in peripartum cardiomyopathy: A cardiovascular magnetic resonance study by myocardial T1 and T2 mapping. J Cardiovasc Magn Reson 2020; 22(1): 2.
[http://dx.doi.org/10.1186/s12968-019-0590-z] [PMID: 31902370]
[49]
Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: Diagnosis, prognosis, and management. J Am Coll Cardiol 2011; 58(7): 659-70.
[http://dx.doi.org/10.1016/j.jacc.2011.03.047] [PMID: 21816300]
[50]
Greer IA. CLINICAL PRACTICE. Pregnancy complicated by venous thrombosis. N Engl J Med 2015; 373(6): 540-7.
[http://dx.doi.org/10.1056/NEJMcp1407434] [PMID: 26244307]
[51]
Kane A, Mbaye M, Ndiaye MB, et al. Evolution and thromboembolic complications of the idiopathic peripartal cardiomyopathy at Dakar University Hospital: Forward-looking study about 33 cases. J Gynecol Obstet Biol Reprod (Paris) 2010; 39(6): 484-9.
[http://dx.doi.org/10.1016/j.jgyn.2010.01.008] [PMID: 20472372]
[52]
Arany Z, Elkayam U. Peripartum cardiomyopathy. Circulation 2016; 133(14): 1397-409.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.115.020491] [PMID: 27045128]
[53]
Regitz V, Roos JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39(34): 3165-241.
[http://dx.doi.org/10.1093/eurheartj/ehy340] [PMID: 30165544]
[54]
Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum cardiomyopathy. J Am Coll Cardiol 2020; 75(2): 207-21.
[http://dx.doi.org/10.1016/j.jacc.2019.11.014] [PMID: 31948651]
[55]
Mallikethi S, Akintoye E, Trehan N, et al. Burden of arrhythmias in peripartum cardiomyopathy: Analysis of 9841 hospitalizations. Int J Cardiol 2017; 235: 114-7.
[http://dx.doi.org/10.1016/j.ijcard.2017.02.084] [PMID: 28268089]
[56]
Duncker D, Haghikia A, König T, et al. Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function value of the wearable cardioverter/defibrillator. Eur J Heart Fail 2014; 16(12): 1331-6.
[http://dx.doi.org/10.1002/ejhf.188] [PMID: 25371320]
[57]
Duncker D, Westenfeld R, Konrad T, et al. Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: A German multi centre analysis. Clin Res Cardiol 2017; 106(8): 582-9.
[http://dx.doi.org/10.1007/s00392-017-1090-5] [PMID: 28275862]
[58]
Sliwa 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; 121(13): 1465-73.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.109.901496] [PMID: 20308616]
[59]
Hilfiker D, Haghikia A, Berliner D, et al. Bromocriptine for the treatment of peripartum cardiomyopathy: A multicentre randomized study. Eur Heart J 2017; 38(35): 2671-9.
[http://dx.doi.org/10.1093/eurheartj/ehx355] [PMID: 28934837]
[60]
Haghikia A, Schwab J, Vogel J, et al. Bromocriptine treatment in patients with peripartum cardiomyopathy and right ventricular dysfunction. Clin Res Cardiol 2019; 108(3): 290-7.
[http://dx.doi.org/10.1007/s00392-018-1355-7] [PMID: 30121697]
[61]
Karaye KM, Sa’idu H, Balarabe SA, et al. Selenium supplementation in patients with peripartum cardiomyopathy: A proof of concept trial. BMC Cardiovasc Disord 2020; 20(1): 457.
[http://dx.doi.org/10.1186/s12872-020-01739-z] [PMID: 33087055]
[62]
Biteker M, Duran NE, Kaya H, et al. Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial. Clin Res Cardiol 2011; 100(7): 571-7.
[http://dx.doi.org/10.1007/s00392-010-0279-7] [PMID: 21197536]
[63]
Sliwa K, Skudicky D, Candy G, Bergemann A, Hopley M, Sareli P. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail 2002; 4(3): 305-9.
[http://dx.doi.org/10.1016/S1388-9842(02)00008-9] [PMID: 12034156]
[64]
Codsi E, Rose CH, Blauwet LA. Subsequent pregnancy outcomes in patients with peripartum cardiomyopathy. Obstet Gynecol 2018; 131(2): 322-7.
[http://dx.doi.org/10.1097/AOG.0000000000002439] [PMID: 29324614]
[65]
Yaméogo NV, Samadoulougou AK, Kagambèga LJ, et al. Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy. BMC Cardiovasc Disord 2018; 18(1): 119.
[http://dx.doi.org/10.1186/s12872-018-0856-7] [PMID: 29914408]
[66]
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(21): 1567-71.
[http://dx.doi.org/10.1056/NEJM200105243442101] [PMID: 11372007]
[67]
Hilfiker-Kleiner D, Haghikia A, Masuko D, et al. Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy. Eur J Heart Fail 2017; 19(12): 1723-8.
[http://dx.doi.org/10.1002/ejhf.808] [PMID: 28345302]
[68]
Irizarry OC, Levine LD, Lewey J, et al. Comparison of clinical characteristics and outcomes of peripartum cardiomyopathy between african american and non-african American women. JAMA Cardiol 2017; 2(11): 1256-60.
[http://dx.doi.org/10.1001/jamacardio.2017.3574] [PMID: 29049825]
[69]
Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006; 152(3): 509-13.
[http://dx.doi.org/10.1016/j.ahj.2006.02.008] [PMID: 16923422]
[70]
Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation 1971; 44(5): 964-8.
[http://dx.doi.org/10.1161/01.CIR.44.5.964] [PMID: 4255967]
[71]
Walsh JJ, Burch GE, Black WC, Ferrans VJ, Hibbs RG. Idiopathic myocardiopathy of the puerperium (postpartal heart disease). Circulation 1965; 32: 19-31.
[http://dx.doi.org/10.1161/01.CIR.32.1.19] [PMID: 14314486]
[72]
O’Connell JB, Costanzo MR, Subramanian R, et al. Peripartum cardiomyopathy: Clinical, hemodynamic, histologic and prognostic characteristics. J Am Coll Cardiol 1986; 8(1): 52-6.
[http://dx.doi.org/10.1016/S0735-1097(86)80091-2] [PMID: 3711532]
[73]
Goland S, Modi K, Hatamizadeh P, Elkayam U. Differences in clinical profile of African-American women with peripartum cardiomyopathy in the United States. J Card Fail 2013; 19(4): 214-8.
[http://dx.doi.org/10.1016/j.cardfail.2013.03.004] [PMID: 23582086]
[74]
Loyaga-Rendon RY, Pamboukian SV, Tallaj JA, et al. Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Circ Heart Fail 2014; 7(2): 300-9.
[http://dx.doi.org/10.1161/CIRCHEARTFAILURE.113.000721] [PMID: 24443515]
[75]
Rasmusson K, Brunisholz K, Budge D, et al. Peripartum cardiomyopathy: Post-transplant outcomes from the United Network for organ sharing database. J Heart Lung Transplant 2012; 31(2): 180-6.
[http://dx.doi.org/10.1016/j.healun.2011.11.018] [PMID: 22305380]
[76]
Habli M, O’Brien T, Nowack E, Khoury S, Barton JR, Sibai B. Peripartum cardiomyopathy: Prognostic factors for long-term maternal outcome. Am J Obstet Gynecol 2008; 199(4): 415.e1-5.
[http://dx.doi.org/10.1016/j.ajog.2008.06.087] [PMID: 18722572]
[77]
Moulig V, Pfeffer TJ, Ricke M, et al. Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: Low mortality, high cardiac recovery, but significant cardiovascular co-morbidities. Eur J Heart Fail 2019; 21(12): 1534-42.
[http://dx.doi.org/10.1002/ejhf.1624] [PMID: 31724271]