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@article{Bauersachs:2019:10.1002/ejhf.1493,
author = {Bauersachs, J and König, T and van, der Meer P and Petrie, MC and Hilfiker-Kleiner, D and Mbakwem, A and Hamdan, R and Jackson, AM and Forsyth, P and de, Boer RA and Mueller, C and Lyon, AR and Lund, LH and Piepoli, MF and Heymans, S and Chioncel, O and Anker, SD and Ponikowski, P and Seferovic, PM and Johnson, MR and Mebazaa, A and Sliwa, K},
doi = {10.1002/ejhf.1493},
journal = {European Journal of Heart Failure},
pages = {827--843},
title = {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},
url = {http://dx.doi.org/10.1002/ejhf.1493},
volume = {21},
year = {2019}
}

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TY  - JOUR
AB  - Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients respecting contraindications during pregnancy/lactation. The oxidative stress-mediated cleavage of the hormone prolactin into a cardiotoxic fragment has been identified as a driver of PPCM pathophysiology. Pharmacological blockade of prolactin release using bromocriptine as a disease-specific therapy in addition to standard therapy for heart failure treatment has shown promising results in two clinical trials. Thresholds for devices (implantable cardioverter-defibrillators, cardiac resynchronization therapy and implanted long-term ventricular assist devices) are higher in PPCM than in other conditions because of the high rate of recovery. The important role of education and counselling around contraception and future pregnancies is emphasised.
AU  - Bauersachs,J
AU  - König,T
AU  - van,der Meer P
AU  - Petrie,MC
AU  - Hilfiker-Kleiner,D
AU  - Mbakwem,A
AU  - Hamdan,R
AU  - Jackson,AM
AU  - Forsyth,P
AU  - de,Boer RA
AU  - Mueller,C
AU  - Lyon,AR
AU  - Lund,LH
AU  - Piepoli,MF
AU  - Heymans,S
AU  - Chioncel,O
AU  - Anker,SD
AU  - Ponikowski,P
AU  - Seferovic,PM
AU  - Johnson,MR
AU  - Mebazaa,A
AU  - Sliwa,K
DO  - 10.1002/ejhf.1493
EP  - 843
PY  - 2019///
SN  - 1388-9842
SP  - 827
TI  - 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
T2  - European Journal of Heart Failure
UR  - http://dx.doi.org/10.1002/ejhf.1493
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31243866
UR  - http://hdl.handle.net/10044/1/71400
VL  - 21
ER  -

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