International Journal of Cardiology 187 (2015) 316
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Late recovery in peripartum cardiomyopathy Murat Biteker a, Gül Biteker b, Ibrahim Altun a,⁎, Özcan Başaran a, Mustafa Özcan Soylu a a b
Muğla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey Fethiye Lokman Hekim Esnaf Private Hospital, Department of Obstetrics and Gynecology, Turkey
a r t i c l e
i n f o
Article history: Received 24 March 2015 Accepted 26 March 2015 Available online 27 March 2015 Keywords: Heart failure Peripartum cardiomyopathy Recovery
We have read with great interest the article recently published by Tahir et al. entitled “Delayed myocardial recovery in peripartum cardiomyopathy” [1]. We would like to discuss the current knowledge about duration of therapy and delayed recovery in peripartum cardiomyopathy (PPCM). The probability of delayed recovery in PPCM is first reported by Moreyra et al. [2]. The authors reported that an unexpected recovery occurred 15 months after severe heart failure in a 26-year-old woman. Although this case report is published 35 years ago there is still no clear consensus on the appropriate duration of therapy in patients with PPCM. It is also unknown when to discontinue heart failure medications in recovered patients or whether there is any deterioration in left ventricular function after an initial recovery. Recently we have published results of 42 prospectively followed PPCM patients [3,4]. 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 (3–42 months). Four patients (2 patients with complete recovery and 2 patients with partial recovery) showed delayed deterioration (12, 24, 26, and 34 months after diagnosis) during the study period. Of the four patients with spontaneous deterioration of left ventricular function, two patients with partial recovery were receiving full-dosage heart failure treatment, but two patients with complete recovery stopped taking their medications after recovery, and had delayed deterioration at 24 and 34 months. The findings of late deterioration are very important
⁎ Corresponding author at: Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi, Orhaniye Mah. Haluk Özsoy Cad., 48000 Muğla, Turkey. E-mail address: [email protected] (I. Altun).
http://dx.doi.org/10.1016/j.ijcard.2015.03.382 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
and indicate the need for a close follow-up with periodic determination of cardiac function in women in whom medications are discontinued after complete recovery. Due to probability of either delayed recovery or deterioration of left ventricular function in PPCM, long-term follow-up may be needed not only in nonrecovered patients, but also in patients with complete recovery. A general agreement among experts suggests continued therapy with standard heart failure medications for a minimum of 12 months [5]. Standard heart failure therapy may be continued in patients with persistently reduced left ventricle ejection fraction for several years or even lifelong. We continue heart failure drug therapy for at least 24 months after full recovery and recommend drug tapering according to the weaning protocol [6].
Conflict of interest The authors report no relationships that could be construed as a conflict of interest.
References [1] U. Tahir, G. Doros, F. Sam, Delayed myocardial recovery in peripartum cardiomyopathy, Int. J. Cardiol. 184C (Feb 24 2015) 310–312. [2] A.E. Moreyra, J.B. Kostis, M. Amendo, J.B. Chapa, H.B. Heiberger, L. Weinert, J. DeCara, R. Lang, J.U. Hibbard, Late recovery in peripartum cardiomyopathy, Clin. Cardiol. 3 (4) (1980) 281–283. [3] M. Biteker, E. Ilhan, G. Biteker, D. Duman, B. Bozkurt, Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy, Eur. J. Heart Fail. 14 (8) (2012) 895–901. [4] M. Biteker, K. Kayatas, D. Duman, M. Turkmen, B. Bozkurt, Peripartum cardiomyopathy: current state of knowledge, new developments and future directions, Curr. Cardiol. Rev. 10 (4) (2014) 317–326. [5] K. Sliwa, D. Hilfiker-Kleiner, M.C. Petrie, A. Mebazaa, B. Pieske, E. Buchmann, V. Regitz-Zagrosek, M. Schaufelberger, L. Tavazzi, D.J. van Veldhuisen, H. Watkins, A.J. Shah, P.M. Seferovic, U. Elkayam, S. Pankuweit, Z. Papp, F. Mouquet, J.J. McMurray, Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of CardiologyWorking Group on peripartum cardiomyopathy, Eur. J. Heart Fail. 12 (2010) 767–778. [6] I. Altun, F. Akin, O. Basaran, M. Biteker, Management of peripartum cardiomyopathy, Int. J. Cardiol. 177 (2) (Dec 15 2014) 714.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Late recovery in peripartum cardiomyopathy Murat Biteker a, Gül Biteker b, Ibrahim Altun a,⁎, Özcan Başaran a, Mustafa Özcan Soylu a a b
Muğla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Turkey Fethiye Lokman Hekim Esnaf Private Hospital, Department of Obstetrics and Gynecology, Turkey
a r t i c l e
i n f o
Article history: Received 24 March 2015 Accepted 26 March 2015 Available online 27 March 2015 Keywords: Heart failure Peripartum cardiomyopathy Recovery
We have read with great interest the article recently published by Tahir et al. entitled “Delayed myocardial recovery in peripartum cardiomyopathy” [1]. We would like to discuss the current knowledge about duration of therapy and delayed recovery in peripartum cardiomyopathy (PPCM). The probability of delayed recovery in PPCM is first reported by Moreyra et al. [2]. The authors reported that an unexpected recovery occurred 15 months after severe heart failure in a 26-year-old woman. Although this case report is published 35 years ago there is still no clear consensus on the appropriate duration of therapy in patients with PPCM. It is also unknown when to discontinue heart failure medications in recovered patients or whether there is any deterioration in left ventricular function after an initial recovery. Recently we have published results of 42 prospectively followed PPCM patients [3,4]. 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 (3–42 months). Four patients (2 patients with complete recovery and 2 patients with partial recovery) showed delayed deterioration (12, 24, 26, and 34 months after diagnosis) during the study period. Of the four patients with spontaneous deterioration of left ventricular function, two patients with partial recovery were receiving full-dosage heart failure treatment, but two patients with complete recovery stopped taking their medications after recovery, and had delayed deterioration at 24 and 34 months. The findings of late deterioration are very important
⁎ Corresponding author at: Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi, Orhaniye Mah. Haluk Özsoy Cad., 48000 Muğla, Turkey. E-mail address: [email protected] (I. Altun).
http://dx.doi.org/10.1016/j.ijcard.2015.03.382 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
and indicate the need for a close follow-up with periodic determination of cardiac function in women in whom medications are discontinued after complete recovery. Due to probability of either delayed recovery or deterioration of left ventricular function in PPCM, long-term follow-up may be needed not only in nonrecovered patients, but also in patients with complete recovery. A general agreement among experts suggests continued therapy with standard heart failure medications for a minimum of 12 months [5]. Standard heart failure therapy may be continued in patients with persistently reduced left ventricle ejection fraction for several years or even lifelong. We continue heart failure drug therapy for at least 24 months after full recovery and recommend drug tapering according to the weaning protocol [6].
Conflict of interest The authors report no relationships that could be construed as a conflict of interest.
References [1] U. Tahir, G. Doros, F. Sam, Delayed myocardial recovery in peripartum cardiomyopathy, Int. J. Cardiol. 184C (Feb 24 2015) 310–312. [2] A.E. Moreyra, J.B. Kostis, M. Amendo, J.B. Chapa, H.B. Heiberger, L. Weinert, J. DeCara, R. Lang, J.U. Hibbard, Late recovery in peripartum cardiomyopathy, Clin. Cardiol. 3 (4) (1980) 281–283. [3] M. Biteker, E. Ilhan, G. Biteker, D. Duman, B. Bozkurt, Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy, Eur. J. Heart Fail. 14 (8) (2012) 895–901. [4] M. Biteker, K. Kayatas, D. Duman, M. Turkmen, B. Bozkurt, Peripartum cardiomyopathy: current state of knowledge, new developments and future directions, Curr. Cardiol. Rev. 10 (4) (2014) 317–326. [5] K. Sliwa, D. Hilfiker-Kleiner, M.C. Petrie, A. Mebazaa, B. Pieske, E. Buchmann, V. Regitz-Zagrosek, M. Schaufelberger, L. Tavazzi, D.J. van Veldhuisen, H. Watkins, A.J. Shah, P.M. Seferovic, U. Elkayam, S. Pankuweit, Z. Papp, F. Mouquet, J.J. McMurray, Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of CardiologyWorking Group on peripartum cardiomyopathy, Eur. J. Heart Fail. 12 (2010) 767–778. [6] I. Altun, F. Akin, O. Basaran, M. Biteker, Management of peripartum cardiomyopathy, Int. J. Cardiol. 177 (2) (Dec 15 2014) 714.
