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The challenge of cardiomyopathies and heart failure in pregnancy

Limongelli, Giuseppea,b,c,d; Rubino, Martaa,b; Esposito, Augustoa,b; Russo, Mariagiovannaa; Pacileo, Giuseppeb

Current Opinion in Obstetrics and Gynecology: December 2018 - Volume 30 - Issue 6 - p 378–384
doi: 10.1097/GCO.0000000000000496
WOMEN'S HEALTH: Edited by Joseph Aquilina
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Purpose of review To discuss the risk preexisting or new onset cardiomyopathy/heart failure (CMP/heart failure) in pregnant woman, and recent insights regarding their management and therapy.

Recent findings Recent data from the European Registry on Pregnancy and Heart disease of the European Society of Cardiology (ROPAC) suggest that, after an adequate prepregnancy evaluation in specialized centres, the vast majority of pregnancies are safe for both mother and foetus. A tailored approach is required according to cardiac phenotype (i.e. type of cardiomyopathy), clinical and functional status, and new potential treatments (i.e. bromocriptine in patients with peripartum cardiomyopathy).

Summary In clinical practice, prepregnancy cardiac evaluation is mandatory, including evaluation of the clinical status, standard ECG (and 24–48 h monitoring, whenever required), and imaging, to define the individual risk profile. In presence of severe symptoms (advanced New York Heart Association class), cardiac dysfunction (moderate–severe reduced ejection fraction), haemodynamic load (left ventricular outflow tract obstruction, pulmonary hypertension), pregnancy is contraindicated. A tailored monitoring is warranted in other cases (mild–moderate risk pregnancies). Likewise, in women who develop PPCM, a risk stratification and tailored monitoring and therapy should be achieved by an expert, multidisciplinary team, including cardiologists, gynaecologists, obstetricians, genetic counsellor, and psychologists.

aPediatric Cardiology, Department of Translational Medical Sciences, Luigi Vanvitelli University

bHeart Failure Unit, AORN Colli, Naples, Italy

cInstitute of Cardiovascular Sciences, University College of London-London, UK

dMember of the GUARD Heart ERN (European Reference Network)

Correspondence to Giuseppe Limongelli, Monaldi Hospital, AORN Colli, Department of Translational Medical Sciences, Luigi Vanvitelli University, 80135 Naples, Italy. Tel: +390817062815; e-mail: limongelligiuseppe@libero.it

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