Addressing the silent threat of peripartum cardiomyopathy in Pakistan: a review
Peripartum cardiomyopathy in Pakistan
DOI:
https://doi.org/10.52442/jrmi.v12i2.977Keywords:
Cardiovascular Diseases, Echocardiography, Maternal Mortality, Pakistan, Peripartum CardiomyopathyAbstract
Peripartum Dilated Cardiomyopathy (PPCM) is a serious heart condition that may occur in the last month of pregnancy or within five months postpartum. It is characterized by left ventricular systolic dysfunction with an ejection fraction (EF) less than 45%, often occurring in women without known cardiac history. PPCM is poorly understood and managed in developing countries like Pakistan where there are significant gaps pertaining to maternal healthcare systems and diagnosis. This narrative review examines PPCM’s epidemiology, underlying causes, diagnostic limitations, management strategies, as well as its broader implications for public health in Pakistan. Original articles, systemic reviews, meta-analyses and case reports that were published in the last five years (December 2019-December 2024) and were relevant to the Pakistani context were selected using different search engines: PubMed, Google Scholar, ResearchGate, Academia, Semantic Scholar and Scopus. To provide a diagnostic and treatment pathway paradigm specifically suited for enhancing maternal healthcare outcomes in Pakistani settings, attention was drawn to the discourse-informed context that contrasts local realities with international developments. Future strategies must emphasize early detection, postpartum care, awareness, and equity-driven, multidisciplinary interventions tailored to Pakistan’s socioeconomic context to combat PPCM and improve maternal health.
References
Mukkaram S, Ali L, Jamil R, Husnain F, Anbreen T. Risk factors and fetomaternal outcome in pregnant women with peripartum cardiomyopathy. J Surg Pakistan. 2021;26 (4):131-5. DOI:10.21699/jsp.26.4.3.
Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the ESC. Eur J Heart Fail. 2019 Jul;21(7):827-43. DOI: 10.1002/ejhf.14932022;24(5):605-20.
Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jan 21;75(2):207–21. DOI: 10.1016/j.jacc.2019.11.014.
Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000 Mar 1;283(9):1183–8. DOI: 10.1001/jama.283.9.1183.
Biljic-Erski A, Rajovic N, Pavlovic V, Bukumiric Z, Rakic A, Rovcanin M, et al. Hypertensive Disorders of Pregnancy and Peripartum Cardiomyopathy: A Meta-Analysis of Prevalence and Impact on Left Ventricular Function and Mortality. J Clin Med. 2025 Mar 4;14(5):1721. DOI: 10.3390/jcm14051721.
Bhandary A, Rambhatla T, Coplan N, Kronzon I. Peripartum cardiomyopathy: A contemporary review. J Clin Prev Cardiol. 2018;7:54-9. DOI: 10.4103/JCPC.JCPC_8_18
Honigberg MC, Givertz MM. Peripartum cardiomyopathy. BMJ. 2019 Jan 30;364:k5287. DOI: 10.1136/bmj.k5287.
Safira A, Tjahjadi AK, Adytia GJ, Waitupu A, Sutanto H. Peripartum cardiomyopathy unveiled: Etiology, diagnosis, and therapeutic insights. Curr Probl Cardiol. 2024 May;49(5):102474. DOI: 10.1016/j.cpcardiol.2024.102474.
Azibani F, Sliwa K. Peripartum Cardiomyopathy: an Update. Curr Heart Fail Rep. 2018 Oct;15(5):297-306. DOI: 10.1007/s11897-018-0404-x.
Razzaq A, Memon SH, Arain ZI, Khushk SA, Ali A, Bhutto AQ. Outcomes of Newly Diagnosed Patients of Peripartum Cardiomyopathy at Liaquat University Hospital, Hyderabad, Sindh, Pakistan. J Pharm Res Int. 2021;33(31B):10-6. DOI: 10.9734/JPRI/2021/v33i31B31682.
Kumar V, Ali BS, Choudry E, Khan S, Rehman NU, et al. Quality of Neonatal Care: A Health Facility Assessment in Balochistan Province, Pakistan. Cureus. March 01, 2022; 14(3): e22744. DOI: 10.7759/cureus.22744.
Jackson AM, Macartney M, Brooksbank K, et al. A 20-year population study of peripartum cardiomyopathy. Eur Heart J. 2023 Dec 21;44(48):5128–41. DOI: 10.1093/eurheartj/ehad626.
Iannaccone G, Graziani F, Kacar P, Tamborrino PP, Lillo R, Montanaro C, et al. Diagnosis and management of peripartum cardiomyopathy and recurrence risk. Int J Cardiol Congenit Heart Dis. 2024 Jul 19;17:100530. DOI: 10.1016/j.ijcchd.2024.100530.
Khan BAA, Mahmood H, Ahmed JM, Anwar B, Muhammad A, Jabeen R. Exploring challenges in accessing primary healthcare for pregnant women in Pakistan: a qualitative descriptive study. BMC Health Serv Res. 2025 Apr 1;25(1):482. DOI: 10.1186/s12913-024-11637-1.
Kryczka KE, Demkow M, Dzielińska Z. Biomarkers in Peripartum Cardiomyopathy-What We Know and What Is Still to Be Found. Biomolecules. 2024 Jan 12;14(1):103. DOI: 10.3390/biom14010103.
Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007 Feb 9;128(3):589–600. DOI: 10.1016/j.cell.2006.12.036
Halkein J, Tabruyn SP, Ricke-Hoch M, Haghikia A, Nguyen NQ, Scherr M, et al. MicroRNA-146a is a Therapeutic Target and Biomarker for Peripartum Cardiomyopathy. J Clin Invest. 2013 May;123(5):2143–54. DOI: 10.1172/JCI64365.
Kulkarni A, Squire G, Hogrefe K, Waseem Osman M. Peripartum cardiomyopathy. Obstet Gynaecol. 2021;23;278-89. DOI: 10.1111/tog.12770.
Munir R, Hussain S, Kayani AM. Peripartum Cardiomyopathy in a Pakistani Cohort. J Coll Physicians Surg Pak. 2016 Sep;26(9):740-3. PMID: 27671176.
Ricci F, De Innocentiis C, Verrengia E, Ceriello L, Mantini C, Pietrangelo C, et al. The Role of Multimodality Cardiovascular Imaging in Peripartum Cardiomyopathy. Front Cardiovasc Med. 2020;7:4. DOI:10.3389/fcvm.2020.00004.
Baig A, Rahat T. Addressing the Challenges Faced by Pakistan’s Healthcare System. PJMR. 2024 Oct 8;63(3):115-6. Available from: https://pjmr.org.pk/index.php/pjmr/article/view/843
Ramos Nascimento B, Zawacki Beaton A. Improved standardisation of training needed to achieve the potential of handheld echocardiography. Heart. 2021 Nov;107(22):1772-3. DOI: 10.1136/heartjnl-2021-319945.
Madonov P.G., Khidirova L.D., Kazantseva V.D. Features of modern diagnostics and pharmacotherapy of peripartum cardiomyopathy. J Siberian Med Sci. 2021;4, 134–48. DOI: 10.31549/2542-1174-2021-4-134-148.
Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: Executive summary: A report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol. 2022;79:1757-80. DOI: 10.1161/CIR.0000000000001062.
Bello NA, Bairey Merz CN, Brown H, Davis MB, Dickert NW, El Hajj SC, et al. Diagnostic cardiovascular imaging and therapeutic strategies in pregnancy: JACC focus seminar 4/5. J Am Coll Cardiol. 2021;77(14):1813-22. DOI: 10.1016/j.jacc.2021.01.056.
Sethi D, Kumar N. Peripartum cardiomyopathy with preeclampsia in a parturient: A case report with literature review. Turk J Emerg Med. 2020 Oct 7;20(4):202-205. DOI: 10.4103/2452-2473.297467.
Irfan M. Bromocriptine not yet a therapeutic option in peripartum cardiomyopathy. Pak Heart J. 2020 Jan 23;52(4). DOI: 10.47144/phj.v52i4.1856.
Ullah I, Khan SW, Fayyaz A, Khan K, Ahmad F, Shah SM. Patterns of Cardiomyopathy in Patients Presenting to a Tertiary Care Hospital. Cureus. 2025 Mar 18;17(3):e80794. DOI: 10.7759/cureus.80794. PMID: 40255771
Sliwa K, Rakisheva A, Viljoen C, Pfeffer T, Simpson M, Jackson AM, et al. Living with peripartum cardiomyopathy: A statement from the Heart Failure Association and the Association of Cardiovascular Nursing and Allied Professions of the European Society of Cardiology. Eur J Heart Fail. 2024 Oct;26(10):2143-54. DOI: 10.1002/ejhf.3377.
Batchelor W, Anwarrudin S, Wang D, Perpetua E, Krishnaswami A, Velagapudi P, et al. The multidisciplinary heart team in cardiovascular medicine: Current role and future challenges. JACC Adv 2023;2:100160. Doi: 10.1016/j.jacadv .2022.100160.
Batchelor W, Anwarrudin S, Wang D, Perpetua E, Krishnaswami A, Velagapudi P, et al. The multidisciplinary heart team in cardiovascular medicine: Current role and future challenges. JACC Adv 2023;2:100160. DOI: 10.1016/j.jacadv .2022.100160.
Pfeffer TJ, Herrmann J, Berliner D, König T, Winter L, Ricke-Hoch M, et al. Assessment of major mental disorders in a German peripartum cardiomyopathy cohort. ESC Heart Fail 2020;7:4394–8. DOI: 10.1002/ehf2.12967.
Wijayanto MA, Myrtha R, Lukas GA, Rahma AA, Hanifa SN, Zahira HA, et al. Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta- analysis. Open Heart. 2024;11:e002626. DOI:10.1136/ openhrt-2024-002626.
Tromp J, Jackson AM, Abdelhamid M, Fouad D, Youssef G, Petrie MC, et al. Investigators of the ESC EORP PPCM Registry. Thromboembolic events in peripartum cardiomyopathy: Results from the ESC EORP PPCM registry. Eur J Heart Fail. 2023;25:1464–6. DOI: 10.1002/ejhf.2871.
Lidegaard O, Lokkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: National follow-up study. BMJ. 2009;339:b2890. DOI: 10.1136/bmj.b2890.
Bahamondes L, Bahamondes MV, Juliato CRT. Subdermal contraceptive implants. Best Pract Res Clin Obstet Gynaecol. 2025 Jun;100:102604. DOI: 10.1016/j.bpobgyn.2025.102604.
Bahamondes L, Fernandes A, Monteiro I, Bahamondes MV. Long-acting reversible contraceptive (LARCs) methods. Best Pract Res Clin Obstet Gynaecol. 2020 Jul;66:28-40. DOI: 10.1016/j.bpobgyn.2019.12.002.
Lokossou GAG, Kouakanou L, Schumacher A, Zenclussen AC. Human Breast Milk: From Food to Active Immune Response with Disease Protection in Infants and Mothers. Front Immunol. 2022 Apr 5;13:849012. DOI: 10.3389/fimmu.2022.849012.
Noll A, Kawamoto KR, Dassanayake MT, Leuenberger L, Spehar SM, Wu J, et al. Breastfeeding in patients with peripartum cardiomyopathy: clinical outcomes and physician counseling. Int Breastfeed J. 2024 Oct 29;19(1):73. DOI: 10.1186/s13006-024-00673-6.
Maulaadianovi DI, Almashur FZ. Breastfeeding in peripartum cardiomyopathy mothers: A systematic review. World J Adv Res Rev. 2023;18(3):591-603. DOI: 10.30574/wjarr.2023.18.3.1127.
Ecker JL, Frigoletto FD Jr. Cesarean delivery and the risk-benefit calculus. N Engl J Med. 2007 Mar 1;356(9):885-8. DOI: 10.1056/NEJMp068290.
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