More research needed into pregnancy-related cardiomyopathy

20th July 2015

Heart experts have called for more research into pregnancy-related cardiomyopathy.

They said that despite the condition, called peripartum cardiomyopathy (PPCM), being serious no significant research had been undertaken to explore how it can be prevented or treated.

The condition, which comes on in the later stages of pregnancy or soon after childbirth, can affect otherwise healthy pregnant women.

The report, published in the Canadian Journal of Cardiology, said that only three studies of possible treatments have ever been conducted, and only two of those have shown any promise.

"Evidence guiding clinicians in the treatment of this disease is scarce and of poor quality," explained lead investigator Dr Marc Jolicoeur, associate clinical professor and director of research, adult interventional cardiology programme, and first author Dr Olivier Desplantie, both from the Montreal Heart Institute.

The condition can cause heart failure but despite current advances in heart failure treatment, young, healthy women can die from sudden cardiac death or progressive heart failure. One in ten need a heart transplant.

After searching the medical literature, investigators identified two controlled trials looking at the effects of the hormone bromocriptine and the drug levosimendan on PPCM, and a study of another drug, pentoxifylline. In the bromocriptine study, 80% of the patients receiving the drug experienced a significant reduction in adverse outcomes compared to10% of the others. However, this study included only 20 patients.

In the study of levosimendan, there were no differences in outcomes for those treated with the drug and those not treated, but there were only 24 patients.

In a third study pentoxifylline was given to 30 patients, but more than half failed to improve Failure to improve was found in 52% of the standard care group, while only 27% of the pentoxifylline group failed to improve.

For a disorder with such severe consequences, what can explain the apparent lack of interest?

Reason included tht PPCM was not well understood, and it was difficult to select potential therapies for trials. While more common treatments for heart failure, such as beta-blockers and ACE inhibitors, might be expected to help, results for women with PPCM have not been favourable.

Experts concluded that the lack of data on pregnant women and women of childbearing age could make informed decision-making difficult for doctors and patients

"PPCM needs further high quality investigation to guide disease-specific therapy recommendations. The review should serve as a call to action for investigators to renew efforts to further define the benefits of existing therapies and develop novel therapies for PPCM," they said.

 

Journal References:

  1. Olivier Desplantie, Maxime Tremblay-Gravel, Robert Avram, Guillaume Marquis-Gravel, Anique Ducharme, E. Marc Jolicoeur. The Medical Treatment of New-Onset Peripartum Cardiomyopathy: A Systematic Review of Prospective Studies. Canadian Journal of Cardiology, 2015; DOI: 1016/j.cjca.2015.04.029