Advancing Our Understanding of Peripartum Cardiomyopathy: Current Evidence and Future Directions.

Abstract

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening condition characterised by symptoms of heart failure that occur in the last month of pregnancy or within five months after delivery, with no other identifiable cause. It is identified by a left ventricular ejection fraction (LVEF) below 45%. PPCM affects approximately one in 2000 births worldwide, with significantly higher rates in Nigeria (1 in 100 births) and among Black Americans, who often experience more severe disease and poorer recovery. Common risk factors include advanced maternal age, hypertension, preeclampsia, multiple pregnancies, and genetic predisposition. The underlying causes are not fully understood but likely involve hormonal imbalances (e.g., prolactin cleavage, elevated sFlt-1), genetic mutations (e.g., in the TTN gene), and inflammatory processes. Symptoms such as exertional shortness of breath, fatigue, and leg swelling can resemble normal pregnancy changes, making diagnosis challenging. Echocardiography is key for detection, and other conditions like pre-existing cardiac disease must be excluded. While new treatments like bromocriptine show promise but require further research, management involves standard heart failure medications (beta-blockers, angiotensin-converting enzyme inhibitors, sodium-glucose co-transporter 2 inhibitors, and diuretics), with considerations for pregnancy and lactation. Early diagnosis, supported by tools like echocardiography and BNP levels, along with a multidisciplinary approach, is essential to improve outcomes. This review highlights the importance of increased awareness and ongoing research to better care for women with PPCM