Peripartum Cardiomyopathy Linked To Pregnancy Hypertension

 Peripartum Cardiomyopathy

Researchers at Beth Israel Deaconess Medical Center (BIDMC) have made new discoveries regarding peripartum cardiomyopathy. The researchers found that there is a critical connection between this disease and preeclampsia or pregnancy hypertension. Peripartum cardiomyopathy is a form of left ventricular systolic dysfunction that occurs in the last month of pregnancy or during the first 5 months postpartum. The incidence of this disease varies from 1/3000 to 1/10000, but this disease can go unnoticed due to the volume overload in the last period of pregnancy. Peripartum cardiomyopathy etiology  is incomplete  elucidated. It seems that some inflammatory factors, nutritional factors, and or infectious factors are involved. The role of  immune response during pregnancy has been also questioned, which is also implied in the occurence of  preeclampsia (gestational hypertension).

Pregnancy Hypertension

Symptoms of peripartum cardiomyopathy are due the decreased heart pump function (dyspnea, tachycardia, leg edema, cough, palpitations, thromboembolic events). Most women recover spontaneously, but in some cases it progresses to heart failure requiring transplantation. Complications in later stages may lead to death by congestive heart failure, systemic embolism, ventricular tachyarrhythmias. It should be noted that recurrence of cardiomyopathy is possible in later pregnacies. Also, the prognosis is worse if the recovery of ventricular function was not complete.

Senior author Zoltan Arany, MD, PhD, investigator year the Cardiovascular Institute at BIDMC and Assistant Professor of Medicine at Harvard Medical School, noted that before this condition could not be fully understood considering that it occurs in healthy women . ” The majority of women who develop this condition are otherwise healthy, even active,” said Dr.Arany. In addition, stressors that can affect the health of pregnant women are predominant in the first trimester, and not in the last when it occurs this  form of  cardiomyopathy .

Researchers found that peripartum dilated cardiomyopathy is actually a vascular disease. The discovery was made in collaboration with Several members of BIDMC’s Department of Obstetrics and Gynecology, led by co-first author Sarosh Rana, MD. Researchers found that peripartum dilated cardiomyopathy is caused by excess anti-angiogenic signaling. They also have found that an important role is played by high expression of SFLT1, a factor involved in the development of preeclampsia, during late pregnancy. In addition, it was also found that women diagnosed with peripartum cardiomyopathy had increased levels of anti-angiogenic factors in their blood.

Now researchers are trying to determine why some pregnant women manage well with increasing levels of anti-angiogenic factors, characteristic of the last period of pregnancy, and others do not. They also hope to find a cure for this disease.