Peripartum Cardiomyopathy: How Can We Approach Such a Heterogeneous Disease?

Peripartum cardiomyopathy (PPCM) is a rare disease that occurs during pregnancy and up to 5 months postpartum, in previously healthy women. Recent studies have revealed that 40% of PPCM patients complicated with pregnancy-induced hypertension, and from 10 to 20% of the PPCM patients had genetic etiology of dilated cardiomyopathy (DCM). A Japanese nationwide survey revealed that PPCM patients with pregnancy-induced hypertension had better cardiac function in the chronic phase, although the rate of death and cardiac parameters at diagnosis were similar in PPCM patients with or without pregnancy-induced hypertension. These findings suggest the heterogeneity of the disease, since PPCM is a diagnosis of exclusion. Anti-prolactin therapy (APT) has recently been introduced as an additional therapy for PPCM. The Japanese prospective observational survey suggested that patients with APT tended to recover their left ventricular contraction earlier in the acute phase, but showed the same recovery rate in the chronic phase as those without APT. Therefore, personalized medicine is probably important. Our experience showed that women who were complicated with pregnancy-induced hypertension ahead of diagnosis as PPCM and fully recovered cardiac function, showed good subsequent pregnancy outcomes. On the other hand, women with reduced LVEF showed more deteriorated cardiac contraction during the subsequent pregnancy. We need further investigation to assess personalized subsequent pregnancy risk.