Peripartum Cardiomyopathy
- An Autoimmune Disease

Prof. Karen Sliwa is co-chair of the new Peripartum Cardiomyopathy Working Group of the Heart Failure Association of the European Cardiac Society. This group had its first meeting in Nice, France.

Aims of the PPCM study group:

To establish a platform where the current knowledge of PPCM based on international experimental and clinical studies is summarised and regularly updated, for example in the form of consensus papers.

We will raise awareness of this rare but detrimental disease in specific awareness programmes, i.e. sessions of international and national congresses and publishing articles in local and international scientific publications. Furthermore we provide information and contact addresses on our webpage for physicians and patients.

In addition, we plan to coordinate international data collection and analysis for better understanding of the disease.
We will regularly meet to discuss and optimise current management strategies of PPCM in terms of diagnostic test, novel therapy strategies, and collecting data on long-term prognosis.

Study group organisation:

Co-chairs: Burkert Pieske (HFA member), Karen Sliwa (HeFSSA)
Members:
Uri Elkayam
Denise Hilfiker-Kleiner
John McMurray
Sabine Pankuweit
Zoltan Papp
Mark Petrie
Vera Regitz-Zagrosek
Petar Seferovic
Ajay Shah
Luigi Tavazzi
Dirk van Veldhuisen
Hugh Watkins

A collaborative project between University of the Witwatersrand, Republic of South Africa, Emory University, Department of Pathology and Laboratory Medicine, Atlanta, GA, USA, The University of Hannover, Molecular Cardiology, Germany and Max-Delbrűck Centrum Berlin, Germany.

Research Team

  • Dr Olaf ForsterDr. Olaf Forster (PhD candidate on "Peripartum cardiomyopathy – an autoimmune disease?")
  • Prof. Karen Sliwa
  • Prof. Aftab Ansari, Emory University, Atlanta, USA
  • Prof. Denise Hilfiker-Kleiner, Hannover University, Germany
  • Dr. Gerd Wallukat, Berlin, Germany
  • Winnie Tshane, research assistant
  • Marietta Nel, University of the Witwatersrand, Johannesburg, (Isolation of PBMC)
  • Dr. Geoff Candy, University of the Witwatersrand, Johannesburg
  • Dr Olaf Forster completed his PhD on this topic in November 2007. He is the recipient of the TH Bothwell prize for 2008.

Background

Peripartum cardiomyopathy (PPCM) has an incidence of 1:10,000 in the Western world, but at our referral centre we see two to three new cases every week. This unique situation prompted us to initiate a single centre prospective study of patients with PPCM, systematically assessing clinical status, the kinetics of cardiac function by echocardiography and collecting peripheral blood samples over a follow-up period of 36 months.

Research Areas

  1. Molecular and Genetic pathways in Peripartum Cardiomyopathy, a common condition affecting 1: 1000 black South Africans with a reported mortality of about 30% (PhD project Dr. Olaf Forster in collaboration with Prof. A. Ansari, Emory University, Atlanta, USA and Dr. D. Hilfiker-Kleinert, University of Hannover, Germany. (See scientific summary.)
  2. Measurement of the beta-adrenergic receptor up regulation in patients with Peripartum and idiopathic dilated cardiomyopathy in collaboration with Dr. Wallucat, Max Dellbrueck Centre for Molecular Medicine and Prof. A. Ansari, Emory University, USA. Identification of antibodies against cardiac myosin and the beta-1-adrenoreceptor protein may provide initial means to segregate patients into those that present from autoimmune components and those that do not in efforts to identify groups of patients that could benefit best from specific therapy aimed at auto-immune processes.    
  3. Heart Failure Management Program

Peripartum Cardiomyopathy Published Research

Sliwa K, Tibazarwa H, Hilfiker-Kleiner D. Management of Peripartum Cardiomyopathy. Curr Heart Fail Rep. 2008 ;5 (4):238-44.

Hilfiker-Kleinert D, Sliwa K, Drexler H. Peripartum Cardiomyopathy: Recent Insights in its Pathophysiology. Trends Cardiovascu Med 2008;18:173-179. [IF 5.1]

Forster O, Hilfiker-Kleinert D, Ansari A, Sundstrom B, Libhaber L; Tshani W; Becker A; Yip A ; Klein G, Sliwa K. Reversal of IFN-γ, oxLDL and prolactin serum levels correlate with clinical improvement in patients with Peripartum Cardiomyopathy. European J of Heart Failure, 2008, available online: 10.1016/j.e.jheart/2008.07.005 [IF 2.7]

Sliwa K, Fett J, Elkayam U. Peripartum Cardiomyopathy. The Lancet 2006; 368:687-93 [21.3].

Forster O, Ansari T, Becker A, Yip A, Tshane W, Sliwa K. Therapeutic management of Peripartum Cardiomyopathy. Women Health 2006; 2:587-5.

Sliwa K, Forster O, Libhaber E, Fett J, Sundstrom JB, Hilfiker-Kleiner D, Ansari. Peripartum Cardiomyopathy: Inflammatory markers as predictors of outcome in 100 prospective studied patients. Eur Heart J 2006; 27(4):441-6. [6.2]

Wairraich R, Sliwa K, Damasceno A, Carraway R, Sundstrom B, Arif G, Essop R, Ansari A, Fett J, Yacoub M. Impact of pregnancy related heart failure on humoral immunity immunity: Clinical relevance of G3-subclass immunoglobulins in peripartum cardiomyopcathy. Am Heart J 2005;150:263-9. [3.6]

Sliwa K, Forster O, Zhanje F, Candy G, Kachope J, Essop R. Subsequent pregnancy in patients with peripartum cardiomyopathy. Am J Cardiol 2004;93:1441-1443. [3.2]

Sliwa K, Skudicky D, Bergemann A, Candy G, Sareli P. Peripartum Cardiomyopathy: Analysis of Clinical Outcome, Left ventricular Function, Plasma Levels of Cytokines and Fas/APO-1. J Am Coll Cardiol 2000;35:701-5. [9.1]