15 Pentoxifylline, an anti-inflammatory
agent, was shown to improve clinical outcomes when added to conventional therapy in a small nonrandomized study of 59 patients.16 Viral Infection The definitive role of viral infection in PPCM has not been well established. A study by Bultmann et al. identified viral genomes in cardiac tissue of PPCM patients by polymerase chain reaction (PCR) Inhibitors,research,lifescience,medical testing.17 PPCM patients who were viral-positive had histological evidence of a cardiac interstitial inflammatory process, while control patients who were viral positive did not. Viruses identified in 8 out of 26 PPCM patients (30.8%) included Epstein-Barr virus, human cytomegalovirus, human herpes virus 6, and parvovirus.17, 18 However, a study by Lamparter et al. reported no evidence of viral infection in snap-frozen tissue from 7 PPCM patients undergoing left ventricular PD98059 price endomyocardial biopsy Inhibitors,research,lifescience,medical within 48 hours of diagnosis, questioning the role of viral infections in PPCM.18, 19 Genetic Susceptibility Familial clustering of PPCM has been systematically evaluated in the two studies.20, 21 A study by van Spaendonck-Zwarts et al. suggested that a subset of PPCM may be a part of the spectrum of familial DCM, presenting in the peripartum period.20 In this study, the authors identified a substantial Inhibitors,research,lifescience,medical number of DCM families with PPCM (5 of 90, 6%). Also, undiagnosed DCM was identified in all three families of PPCM patients
who did not show full recovery. Finally, the authors identified a mutation in a DCM family with one PPCM patient Inhibitors,research,lifescience,medical and another family member who had died suddenly soon after delivery. Hence the authors believe that it is justifiable to offer cardiological screening to first-degree relatives of recovered and unrecovered PPCM patients. A study of 520 pedigrees in the Familial Dilated Cardiomyopathy Research Project database found 45 cases of PPCM or pregnancy-associated cardiomyopathy (PACM) among 4,110 women.21 Inhibitors,research,lifescience,medical Evidence of familial clustering of dilated cardiomyopathy was noted in 23 of 42 unrelated cases. However, based on current levels of evidence, genetic testing is not recommended
as routine but is currently being done as part of research projects.22 Clinical Presentation Phosphatidylinositol diacylglycerol-lyase and Diagnosis Clinical presentation of patients with PPCM may be highly variable, but patients usually present with symptoms similar to those in patients presenting with systolic heart failure due to other causes. The signs and symptoms may be similar to normal physiological findings of pregnancy like edema of the legs, dyspnea on exertion, cough, paroxysmal nocturnal dyspnea, and orthopnea. Other symptoms may include abdominal discomfort, palpitations, dizziness, and chest pain.22 Most frequent initial presentation is NYHA class III or IV symptoms.23 The majority of patients present with symptoms in the first 4 months after delivery (78%), and only 9% present in the last month of pregnancy.