Peripartum Cardiomyopathy: Do Exosomes Play a Role?
Peripartum cardiomyopathy (PPCM) refers to irreversible cardiomyocyte damage that occurs during the last month of pregnancy, or within 5 months after giving birth. It is characterized by systolic heart failure. This life-threatening condition is relativel
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Peripartum Cardiomyopathy: Do Exosomes Play a Role? Huanyu Gu, Qiying Dai, Zhuyuan Liu, Hongbao Wang, Jianhua Yao, and Lei Zhou
9.1 Introduction of PPCM In the 18th, PPCM has been widely accepted as one of the most dreadful complications during and after pregnancy. It was finally recorded in the medical literature until early in the 19th [1, 2]. It was correlated to heart failure induced by dilated cardiomyopathy initially at that time [3]. The term PPCM was used to name this dangerous disease. Classical definition are: (1) the symptoms of heart failure occur in the last month of pregnancy or within the 5 month after delivery; (2) the absence of preexisting cardiac disease leading to heat failure before the last month of pregnancy; (3) no other determinable cause of heart failure is found [1]. PPCM is mainly a diagnosis of exclusion. The 6 months’ time limit is very important, and all other causes of heart failure must be ruled out. Echocardiogram diagnostic criteria of PPCM includes left ventricular ejection fraction (EF) less than 45%, or fractional shortening less than 30%, or both [2]. Unfortunately, echocardiography is not accessible in some developing countries, left ventricular systolic dysfunction is hard to confirm.
Huanyu Gu, Qiying Dai and Zhuyuan Liu contributed equally to this work. H. Gu • Z. Liu • L. Zhou (*) Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China e-mail: [email protected] Q. Dai Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China Metrowest Medical Center, Framingham, MA 01702, USA H. Wang • J. Yao (*) Department of Cardiology, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2017 J. Xiao, S. Cretoiu (eds.), Exosomes in Cardiovascular Diseases, Advances in Experimental Medicine and Biology 998, DOI 10.1007/978-981-10-4397-0_9
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9.2 Epidemiology of PPCM It is not uncommon that PPCM can occur in healthy young women. This means that all women at reproductive age share the same risk of developing PPCM. However, epidemiologic data on PPCM remains insufficient. Separated diagnostic criteria, different population and individual studies have been blamed for. In addition, lack of systematic reporting, misdiagnosis and under-diagnosis, the true morbidity of PPCM is hard to ascertain. Incidence as high as 1 in 100 to 1 in 300 pregnant women were reported in Haiti and Nigeria, where are two global hotpots in the world map [3, 4]. The reasons for variation in the incidence among countries remains unclear. PPCM seem to be more common in African women. The incidence rate of South Africa is 1 in 1000 live births. What’s more, the prognosis is poorest in African women [5]. Even in the same country, the prevalence of PPCM is different based on geographical regions, races and social classes. For example, the incidences range from 1 in 1149 to 1 in 4350 in the United St
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