The Importance of Early Intervention of Peripartum Cardiomyopathy

September 23, 2019

Dr. Uri Elkayam discusses Impella Support for PPCM

Dr. Uri Elkayam discusses the importance of recognizing and treating peripartum cardiomyopathy (PPCM). He explains that the majority of patients who require mechanical circulatory support or transplant develop deterioration of heart function to the point where they present with cardiogenic shock.” Yet he emphasizes, “The potential for recovery is much higher than cardiogenic shock due to other conditions. Patients present very, very sick. If we support them, they recover.”

Dr. Elkayam, an internationally recognized expert in peripartum cardiomyopathy, explains that peripartum cardiomyopathy is a condition in which young, otherwise healthy, pregnant women develop severe congestive heart failure secondary to decreasing cardiac function with an average ejection fraction of 30%, or sometimes much lower, in the range of 10% to 20%. Patients typically present with signs and symptoms of congestive heart failure, but they are often not diagnosed because shortness of breath and decreased exercise tolerance are common manifestations of pregnancy.

“As a community, we need to have a high level of awareness of this condition,” Dr. Elkayam explains. “Peripartum cardiomyopathy has to be included in the differential diagnosis. The unique characteristic of this syndrome is that the majority of patients recover.” Because peripartum cardiomyopathy is typically diagnosed by cardiologists, Dr. Elkayam recommends a lower threshold for requesting a cardiology consult for these patients.

Dr. Elkayam explains that patients with PPCM who have been supported with devices show remarkable recovery. “Sometimes the recovery is within days. The predictor of recovery is mainly the degree of myocardial insult at presentation reflected by ejection fraction and the size of the ventricle.”

Dr. Elkayam discusses clinical data from the Investigations of Pregnancy-Associated Cardiomyopathy (IPAC) study of 100 women diagnosed in US and followed for 1 year. He notes that this study revealed a mortality rate of 4%; however, mortality rates in other countries are as high as 20%. “So, it is not a benign syndrome,” he emphasizes.

Dr. Elkayam also discusses newer PPCM data related to the use of mechanical circulatory support to improve survival in these patients and enable the heart to recover. Because of the high potential for recovery in these patients, he advises using devices, such as Impella®, earlier rather than later.

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