International Journal of Cardiology 177 (2014) 714
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Management of peripartum cardiomyopathy Ibrahim Altun ⁎, Fatih Akin, Ozcan Basaran, Murat Biteker Mugla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey
a r t i c l e
i n f o
Article history: Received 1 October 2014 Accepted 4 October 2014 Available online 13 October 2014 Keywords: Peripartum cardiomyopathy Management Premature ventricular contraction
We read with great interest the article recently published by Liang et al. [1]. The authors present a case of a 36-year-old woman with peripartum cardiomyopathy (PPCM) complicated with premature ventricular contraction-induced cardiomyopathy. We, however, would like to address two major aspects. The authors performed catheter ablation due to symptomatic, frequent premature ventricular contractions at nine months postdelivery. Previous studies suggested that PPCM patients faced a poor prognosis if their left ventricular systolic function did not return to normal within six months of diagnosis. However, recent studies showed that the length of time required for complete recovery in patients with PPCM may be so much longer [2]. Recently we have published results of 42 prospectively followed PPCM patients [2]. Twenty patients (47.6%) recovered completely, 10 died (23.8%), and 12 (28.6%) had persistent left ventricular dysfunction. Average time to complete recovery was 19.3 months after initial diagnosis. Due to the probability of delayed recovery in PPCM, long-term follow-up may be needed in nonrecovered patients. We suggest that angiotensin-converting enzyme inhibitors and beta blockers should be continued for at least 2 years after complete recovery [2,3]. These drugs should be initiated at a low dose and uptitrated gradually in two week intervals in patients with heart failure. The authors should provide the data whether or not they gradually increased the carvediolol and lisinopril dose. Our second concern is about the acute treatment of PPCM. The management of patients with PPCM is similar to that of other forms of non-ischaemic dilated
⁎ Corresponding author at: Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi, Orhaniye Mah. Haluk Özsoy Cad., 48000 Muğla, Turkey. Tel.: +90 252 214 51 74. E-mail address: [email protected] (I. Altun).
http://dx.doi.org/10.1016/j.ijcard.2014.10.013 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
cardiomyopathy but must be individualized based on the patient's clinical presentation [3,4]. In addition to the standard therapeutic options for heart failure, specific targeted agents have been advocated for the treatment of PPCM. In a prospective, single center, randomized study, Sliwa et al. [5] reported that the addition of bromocriptine to standard heart failure therapy in women with PPCM, resulted in significantly greater improvements in functional capacity and left ventricle function, than with standard therapy alone. Although this is not a large scale study, we added bromocriptine to standard heart failure therapy in our clinical practice since 2010 [6]. We want to learn the authors' thoughts about bromocriptine therapy in acute PPCM patients. It is not clear whether the authors have added bromocriptine to the patient's medication or not. We appreciate their work and we would like to learn their thoughts about bromocriptine therapy in acute PPCM patients. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] Liang JJ, Blauwet LA, Cha YM. Radiofrequency ablation for premature ventricular contraction-induced cardiomyopathy complicating peripartum cardiomyopathy. Int J Cardiol 2014;176(3):e77–80. [2] Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail 2012;14(8):895–901. [3] Biteker M, Kayatas K, Duman D, Turkmen M, Bozkurt B. Peripartum cardiomyopathy: current state of knowledge, new developments and future directions. Curr Cardiol Rev 2014;10(4):317–26. [4] Biteker M, Duran NE, Kaya H, Gunduz S, Tanboga HI, Gokdeniz T, et al. Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial. Clin Res Cardiol 2011;100(7):571–7. [5] Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proofof-concept pilot study. Circulation 2010;121(13):1465–73. [6] Biteker M. Peripartum cardiomyopathy in Turkey. Int J Cardiol 2012 Jul 26;158(3): e60–1.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Management of peripartum cardiomyopathy Ibrahim Altun ⁎, Fatih Akin, Ozcan Basaran, Murat Biteker Mugla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey
a r t i c l e
i n f o
Article history: Received 1 October 2014 Accepted 4 October 2014 Available online 13 October 2014 Keywords: Peripartum cardiomyopathy Management Premature ventricular contraction
We read with great interest the article recently published by Liang et al. [1]. The authors present a case of a 36-year-old woman with peripartum cardiomyopathy (PPCM) complicated with premature ventricular contraction-induced cardiomyopathy. We, however, would like to address two major aspects. The authors performed catheter ablation due to symptomatic, frequent premature ventricular contractions at nine months postdelivery. Previous studies suggested that PPCM patients faced a poor prognosis if their left ventricular systolic function did not return to normal within six months of diagnosis. However, recent studies showed that the length of time required for complete recovery in patients with PPCM may be so much longer [2]. Recently we have published results of 42 prospectively followed PPCM patients [2]. Twenty patients (47.6%) recovered completely, 10 died (23.8%), and 12 (28.6%) had persistent left ventricular dysfunction. Average time to complete recovery was 19.3 months after initial diagnosis. Due to the probability of delayed recovery in PPCM, long-term follow-up may be needed in nonrecovered patients. We suggest that angiotensin-converting enzyme inhibitors and beta blockers should be continued for at least 2 years after complete recovery [2,3]. These drugs should be initiated at a low dose and uptitrated gradually in two week intervals in patients with heart failure. The authors should provide the data whether or not they gradually increased the carvediolol and lisinopril dose. Our second concern is about the acute treatment of PPCM. The management of patients with PPCM is similar to that of other forms of non-ischaemic dilated
⁎ Corresponding author at: Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi, Orhaniye Mah. Haluk Özsoy Cad., 48000 Muğla, Turkey. Tel.: +90 252 214 51 74. E-mail address: [email protected] (I. Altun).
http://dx.doi.org/10.1016/j.ijcard.2014.10.013 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
cardiomyopathy but must be individualized based on the patient's clinical presentation [3,4]. In addition to the standard therapeutic options for heart failure, specific targeted agents have been advocated for the treatment of PPCM. In a prospective, single center, randomized study, Sliwa et al. [5] reported that the addition of bromocriptine to standard heart failure therapy in women with PPCM, resulted in significantly greater improvements in functional capacity and left ventricle function, than with standard therapy alone. Although this is not a large scale study, we added bromocriptine to standard heart failure therapy in our clinical practice since 2010 [6]. We want to learn the authors' thoughts about bromocriptine therapy in acute PPCM patients. It is not clear whether the authors have added bromocriptine to the patient's medication or not. We appreciate their work and we would like to learn their thoughts about bromocriptine therapy in acute PPCM patients. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] Liang JJ, Blauwet LA, Cha YM. Radiofrequency ablation for premature ventricular contraction-induced cardiomyopathy complicating peripartum cardiomyopathy. Int J Cardiol 2014;176(3):e77–80. [2] Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail 2012;14(8):895–901. [3] Biteker M, Kayatas K, Duman D, Turkmen M, Bozkurt B. Peripartum cardiomyopathy: current state of knowledge, new developments and future directions. Curr Cardiol Rev 2014;10(4):317–26. [4] Biteker M, Duran NE, Kaya H, Gunduz S, Tanboga HI, Gokdeniz T, et al. Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial. Clin Res Cardiol 2011;100(7):571–7. [5] Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proofof-concept pilot study. Circulation 2010;121(13):1465–73. [6] Biteker M. Peripartum cardiomyopathy in Turkey. Int J Cardiol 2012 Jul 26;158(3): e60–1.
