sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университет10.47093/2218-7332.2020.11.1.71-77sechenov-160Research ArticleINTERNAL MEDICINEВНУТРЕННИЕ БОЛЕЗНИPeripartum cardiomyopathy (clinical case)Перипартальная кардиомиопатия: клиническое наблюдениеhttps://orcid.org/0000-0003-2455-2304ИльинаЮ. В.IlinaYu. V.

Ильина Юлия Валентиновна, канд. мед. наук, доцент кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991Тел.: +7 (495) 623-13-76 

Yulia V. Ilina, MD, PhD, Associate Professor, Therapy Department

8/2, Trubetskaya str., Moscow, 119991Tel.: +7 (495) 623-13-76 

ilinayuli@yandex.ruhttps://orcid.org/0000-0003-1762-6934ФедороваТ. А.FedorovaT. A.

Федорова Татьяна Алексеевна, д-р мед. наук, профессор кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Tatiana A. Fedorova, MD, PhD, DMSc, Professor, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0002-9481-2346ЛощицН. В.LoshchitsN. V.

Лощиц Наталья Вячеславовна, заведующая терапевтическим отделением № 2

2-й Боткинский проезд, д. 5, г. Москва, 125284

Natalia V. Loshchits, Head, Therapy Department № 2

5, 2nd Botkinskiy travel, Moscow, 125284

https://orcid.org/0000-0003-4792-8079ВанхинВ. В.VanhinV. V.

Ванхин Вера Владимировна, клинический ординатор кафедры терапии

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Vera V. Vankhin, clinical resident, Therapy Department

8/2, Trubetskaya str., Moscow, 119991

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationГБУЗ «Городская клиническая больница им. С.П. Боткина Департамента здравоохранения г. Москвы»РоссияMoscow city clinical hospital named after S. P. Botkin of the Department of health of the City of MoscowRussian Federation2020300320201117177Copyright © Ilina Y.V., Fedorova T.A., Loshchits N.V., Vanhin V.V., 20202020Ильина Ю.В., Федорова Т.А., Лощиц Н.В., Ванхин В.В.Ilina Y.V., Fedorova T.A., Loshchits N.V., Vanhin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/160Introduction

Introduction. Peripartum cardiomyopathy (PPKMP) is a rare cause of heart failure (CHF) in healthy women during pregnancy and within 5 months after delivery.

Case report

Case report. A 33-year-old female patient, a native of Tajikistan, first developed shortness of breath and edema of the lower extremities at the 35th week of her third pregnancy. Cesarean section was performed at 39 weeks. Symptoms progressed within 3 months of the postpartum period, hepatomegaly, ascites and hydrothorax appeared. Echocardiography revealed heart chambers dilation, reduced left ventricular ejection fraction (26%), diffuse hypokinesis. The diagnosis of PPCM was established. Perindopril, bisoprolol, spironolactone, furosemide, bromocriptine, heparin were prescribed. The severity of HF symptoms decreased significantly during 12 days of treatment.

Discussion

Discussion. PPCM is a diagnosis of exclusion. Myocarditis, dilated and ischemic cardiomyopathy were considered in the differential diagnosis. The factors associated with increased risk of PPCM were age over 30 years, multiparity, preeclampsia. The clinical effect of bromocriptine confirms the diagnosis.

Перипартальная кардиомиопатия (КМП) — редкая причина развития сердечной недостаточности (СН) у здоровых женщин во время беременности и в течение 5 месяцев после родов.

Описание случая

Описание случая. У пациентки 33 лет, уроженки Таджикистана, на 35-й нед. третьей беременности впервые появились одышка и отеки нижних конечностей. Родоразрешение на 39-й неделе кесаревым сечением. Симптомы прогрессировали в течение 3 мес. после родоразрешения: появились гепатомегалия, асцит и гидроторакс. По данным эхокардиографии выявлена дилатация камер сердца, фракция выброса левого желудочка — 26%, диффузный гипокинез. Установлен диагноз перипартальной КМП, осложнившейся хронической СН IIБ, IV функциональный класс. Назначены периндоприл, бисопролол, спиронолактон, фуросемид, бромокриптин, гепарин. В течение 12 дней лечения проявления СН значительно уменьшились.

Обсуждение

Обсуждение. Перипартальная КМП является диагнозом исключения. В клиническом наблюдении отсутствовали данные за миокардит, дилатационную и ишемическую КМП. Факторами риска развития перипартальной КМП служили: возраст старше 30 лет, повторные роды, преэклампсия. Правильность диагноза подтверждается и несомненным эффектом предпринятой терапии хронической СН с включением бромокриптина.

перипартальная кардиомиопатияидиопатическая кардиомиопатиясердечная недостаточностькардиомиопатия беременныхкардиомегалияperipartum cardiomyopathyidiopathic cardiomyopathyheart failurepregnancy-associated cardiomyopathycardiomegalyReferencesGouley B.A., McMillan T.M., Bellet S. Idiopathic myocardial degeneration associated with pregnancy and especially the peripartum. American Journal of the Medical Sciences. 1937; 19: 185–99.Gouley B.A., McMillan T.M., Bellet S. Idiopathic myocardial degeneration associated with pregnancy and especially the peripartum. American Journal of the Medical Sciences. 1937; 19: 185–99.Sliwa K., Hilfiker-Kleiner D., Mebazaa A., et al. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. European Journal of Heart Failure. 2014; 16(5): 583–91. https://doi.org/10.1002/ejhf.68 PMID: 24591060Sliwa K., Hilfiker-Kleiner D., Mebazaa A., et al. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. European Journal of Heart Failure. 2014; 16(5): 583–91. https://doi.org/10.1002/ejhf.68 PMID: 24591060ЕОК Рекомендации по диагностике и лечению сердечно-сосудистых заболеваний во время беременности. Российский кардиологический журнал. 2019; 6: 151–228. https://doi.org/10.15829/1560-4071-2019-6-151-2282018 EOK Rekomendatsii po diagnostike i lecheniyu serdechnososudistykh zabolevanii vo vremya beremennosti. [2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy] Russian Journal of Cardiology. 2019; 6: 151–228 (In Russian). https://doi.org/10.15829/1560-4071-2019-6-151-228Hilfiker-Kleiner D., Kaminski K., Podewski E., et al. Сathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. 2007; 128(3): 589–600. https://doi.org/10.1016/j.cell.2006.12.036 PMID: 17289576Hilfiker-Kleiner D., Kaminski K., Podewski E., et al. Сathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell. 2007; 128(3): 589–600. https://doi.org/10.1016/j.cell.2006.12.036 PMID: 17289576Sliwa K., Forster O., Libhaber E., et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J. 2006; 27(4): 441–6. https://doi.org/10.1093/eurheartj/ehi481 PMID: 16143707Sliwa K., Forster O., Libhaber E., et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J. 2006; 27(4): 441–6. https://doi.org/10.1093/eurheartj/ehi481 PMID: 16143707Forster O., Hilfiker-Kleiner D., Ansari A.A., et al. Reversal of IFN-gamma, oxLDL and prolactinserum levels correlate with clinical improvement in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2008; 10(9): 861–8. https://doi.org/10.1016/j.ejheart.2008.07.005 PMID: 18768352Forster O., Hilfiker-Kleiner D., Ansari A.A., et al. Reversal of IFN-gamma, oxLDL and prolactinserum levels correlate with clinical improvement in patients with peripartum cardiomyopathy. Eur J Heart Fail. 2008; 10(9): 861–8. https://doi.org/10.1016/j.ejheart.2008.07.005 PMID: 18768352Sliwa K., Skudicky D., Bergemann A., et al. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. Journal of the American College of Cardiology. 2000; 35(3): 701–5. https://doi.org/10.1016/s0735-1097(99)00624-5 PMID: 10716473Sliwa K., Skudicky D., Bergemann A., et al. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. Journal of the American College of Cardiology. 2000; 35(3): 701–5. https://doi.org/10.1016/s0735-1097(99)00624-5 PMID: 10716473Sliwa K., Forster O., Tibazarwa K., et al. Long-term outcome of peripartum cardiomyopathy in a population with high seropositivity for human immunodeficiency virus. Int J Cardiol. 2011; 47(2): 202–8. Published online aheadof print 12 September 2009. https://doi.org/10.1016/j.ijcard.2009.08.022 PMID: 19751951Sliwa K., Forster O., Tibazarwa K., et al. Long-term outcome of peripartum cardiomyopathy in a population with high seropositivity for human immunodeficiency virus. Int J Cardiol. 2011; 47(2): 202–8. Published online aheadof print 12 September 2009. https://doi.org/10.1016/j.ijcard.2009.08.022 PMID: 19751951Haghikia A., Kaya Z., Schwab J., et al. Evidence of autoantibodies against cardiac troponin I and sarcomeric myosin in peripartum cardiomyopathy. Basic Res Cardiol. 2015; 110(6): 60. https://doi.org/10.1007/s00395-015-0517-2 PMID: 26519371Haghikia A., Kaya Z., Schwab J., et al. Evidence of autoantibodies against cardiac troponin I and sarcomeric myosin in peripartum cardiomyopathy. Basic Res Cardiol. 2015; 110(6): 60. https://doi.org/10.1007/s00395-015-0517-2 PMID: 26519371Warraich R.S., Sliwa K., Damasceno A., et al. Impact of pregnancy-related heart failure on humoral immunity: clinical relevance of G3-subclass immunoglobulins in peripartum cardiomyopathy. Am Heart J. 2005; 150(2): 263–9. https://doi.org/10.1016/j.ahj.2004.09.008 PMID: 16086928Warraich R.S., Sliwa K., Damasceno A., et al. Impact of pregnancy-related heart failure on humoral immunity: clinical relevance of G3-subclass immunoglobulins in peripartum cardiomyopathy. Am Heart J. 2005; 150(2): 263–9. https://doi.org/10.1016/j.ahj.2004.09.008 PMID: 16086928Sliwa K., Hilfiker-Kleiner D., Petrie M.C., et al. 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 Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010; 12: 767–78. https://doi.org/10.1093/eurjhf/hfq120Sliwa K., Hilfiker-Kleiner D., Petrie M.C., et al. 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 Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010; 12: 767–78. https://doi.org/10.1093/eurjhf/hfq120Sliwa K., Blauwet L., Tibazarwa K., et al. Evaluation of b tine in the treatment of acute severe peripartum cardiomyopathy: A proof-of-concept pilot study. Circulation. 2010; 121(13): 146573. https://doi.org/10.1161/CIRCULATIONAHA.109.901496 PMID: 20308616Sliwa K., Blauwet L., Tibazarwa K., et al. Evaluation of b tine in the treatment of acute severe peripartum cardiomyopathy: A proof-of-concept pilot study. Circulation. 2010; 121(13): 146573. https://doi.org/10.1161/CIRCULATIONAHA.109.901496 PMID: 20308616Hilfiker-Kleiner D., Haghikia A., Berliner D., et al. Bromocriptine for the treatment of peripartum cardiomyopathy: A multicentre randomized study. Eur Heart J. 2017; 38(35): 2671–9. https://doi.org/10.1093/eurheartj/ehx355 PMID: 28934837Hilfiker-Kleiner D., Haghikia A., Berliner D., et al. Bromocriptine for the treatment of peripartum cardiomyopathy: A multicentre randomized study. Eur Heart J. 2017; 38(35): 2671–9. https://doi.org/10.1093/eurheartj/ehx355 PMID: 28934837Haghikia A., Podewski E., Berliner D., et al. Rationale and design of a randomized, controlled multicentre clinical trial to evaluate the effect of bromocriptine on left ventricular function in women with peripartum cardiomyopathy. Clin Res Cardiol. 2015; 104(11): 911–7. https://doi.org/10.1007/s00392-015-0869-5 PMID: 26026286Haghikia A., Podewski E., Berliner D., et al. Rationale and design of a randomized, controlled multicentre clinical trial to evaluate the effect of bromocriptine on left ventricular function in women with peripartum cardiomyopathy. Clin Res Cardiol. 2015; 104(11): 911–7. https://doi.org/10.1007/s00392-015-0869-5 PMID: 26026286Davis M.B., Arany Z., McNamara D.M., el al. JACC State-of-the-Art Review. Peripartum Cardiomyopathy. Am Coll Cardiol 2020; 75(2): 207–21. https://doi.org/10.1016/j.jacc.2019.11.014Davis M.B., Arany Z., McNamara D.M., el al. JACC State-of-the-Art Review. Peripartum Cardiomyopathy. Am Coll Cardiol 2020; 75(2): 207–21. https://doi.org/10.1016/j.jacc.2019.11.014

The authors declare that there are no conflicts of interest present.