Aims Peripartum cardiomyopathy (PPCM) is a heart disease affecting women during the last month of pregnancy or in the first months after delivery. The impact of the disease on mental health is largely unknown. Methods and results Major mental disorders were assessed by a structured clinical interview in 40 patients with a confirmed PPCM diagnosis, and the data were compared with published prevalence in postpartum women. Circulating biomarkers associated with mental health, such as kynurenine, serotonin, and microRNA (miR)‐30e, were evaluated in PPCM and compared with matched healthy pregnancy‐matched postpartum controls (PP‐Ctrl). Major mental disorders were diagnosed in 65% (26/40) of the PPCM cohort. The prevalence for major depressive disorders was 4‐fold, for post‐traumatic stress disorder 14‐fold, and for panic disorder 6‐fold higher in PPCM patients compared with postpartum women without a PPCM diagnosis. Compared with PP‐Ctrl, PPCM patients displayed elevated levels of serum kynurenine (P < 0.01), reduced levels of serum serotonin (P < 0.05), and elevated levels of plasma miR‐30e (P < 0.05). Conclusions The majority of PPCM patients in the present cohort displayed mental disorders with a higher prevalence of major depressive disorders, post‐traumatic stress disorder (PTBS), and panic disorder, compared with postpartum women without a PPCM diagnosis. This higher prevalence was associated with an impaired tryptophan metabolism and elevated levels of the depression‐associated miR‐30e, suggesting a potential predisposition for mental disorders at the time of PPCM diagnosis. Consequently, physicians should be aware of the increased risk for mental disorders in PPCM patients, and psychiatric assessment should be included in the diagnosis and management of PPCM patients.

This study aimed to investigate the association of circulating biomarkers with echocardiographic parameters of atrial remodelling and their potential for predicting atrial fibrillation (AF). In patients with and without AF (n = 21 and n = 60) the following serum biomarkers were determined: soluble ST2 (sST2), Galectin−3 (Gal-3), N-terminal pro-brain natriuretic peptide (NT-proBNP), microRNA (miR)−21, −29a, −133a, −146b and −328. Comprehensive transthoracic echocardiography was performed in all participants. Biomarkers were significantly altered in patients with AF. The echocardiographic parameter septal PA-TDI, indicating left atrial (LA) remodelling, correlated with concentrations of sST2 (r = 0.249, p = 0.048), miR−21 (r = −0.277, p = 0.012), miR−29a (r = −0.269, p = 0.015), miR−146b (r = −0.319, p = 0.004) and miR−328 (r = −0.296, p = 0.008). In particular, NT-proBNP showed a strong correlation with echocardiographic markers of LA remodelling and dysfunction (septal PA-TDI: r = 0.444, p < 0.001, LAVI/a’: r = 0.457, p = 0.001, SRa: r = 0.581, p < 0.001). Multivariate Cox regressions analysis highlighted miR−21 and NT-proBNP as predictive markers for AF (miR−21: hazard ratio (HR) 0.16; 95% confidence interval (CI) 0.04–0.7, p = 0.009; NT-proBNP: HR 1.002 95%CI 1.001–1.004, p = 0.006). Combination of NT-proBNP and miR−21 had the best accuracy to discriminate patients with AF from those without AF (area under the curve (AUC)= 0.843). Our findings indicate that miR−21 and NT-proBNP correlate with echocardiographic parameters of atrial remodeling and predict AF, in particular if combined.

Background: Over the past decades the use of assisted reproduction technology (ART) increased worldwide. ARTs are associated with an elevated risk for cardiovascular complications. However, a potential relation between subfertility/ARTs and the heart disease peripartum cardiomyopathy (PPCM) has not been systematically analyzed yet. Methods: A retrospective cohort study was carried out, including n = 111 PPCM patients from the German PPCM registry. Data from PPCM patients were compared to those from postpartum women in the German general population. Results: The prevalence of reported subfertility was high among PPCM patients (30%; 33/111). Most of the subfertile PPCM patients (55%; 18/33) obtained vitro fertilizations (IVF) or intracytoplasmic sperm injections (ICSI). PPCM patients were older (p < 0.0001), the percentage of born infants conceived by IVF/ICSI was higher (p < 0.0001) with a higher multiple birth (p < 0.0001), C-section (p < 0.0001) and preeclampsia rate (p < 0.0001), compared to postpartum women. The cardiac outcome was comparable between subfertile and fertile PPCM patients. Whole exome sequencing in a subset of n = 15 subfertile PPCM patients revealed that 33% (5/15) carried pathogenic or likely pathogenic gene variants associated with cardiomyopathies and/or cancer predisposition syndrome. Conclusions: Subfertility occurred frequently among PPCM patients and was associated with increased age, hormonal disorders, higher twin pregnancy rate and high prevalence of pathogenic gene variants suggesting a causal relationship between subfertility and PPCM. Although this study found no evidence that the ART treatment per se increases the risk for PPCM or the risk for an adverse outcome, women with subfertility should be closely monitored for signs of peripartum heart failure. Graphical

Over the past two decades, advanced airway management, early coronary angiography, and therapeutic hypothermia have shaped post-out-of-hospital cardiac arrest (OHCA) care. However, recent large randomized trials have challenged these strategies and created substantial uncertainty leading to relevant guideline changes. This review focuses on the trials that ultimately influenced current guideline recommendations by downgrading previous recommendations. We determine how structural limitations may have affected the validity and interpretation of their results. The review critically evaluates the methodological design and execution of those trials. Despite neutral findings from recent randomized trials, use of advanced airway management during resuscitation, coronary angiography in patients with a high likelihood of acute coronary occlusion, and therapeutic hypothermia for comatose OHCA survivors still play a relevant role in post-resuscitation management.

Aims: Peripartum cardiomyopathy (PPCM) is characterized by left-ventricular systolic dysfunction. Plasminogen-activator-inhibitor 1 (PAI-1) and 16K-prolactin (PRL) are known drivers of PPCM. Treatment of cardiogenic shock (CS) complicating PPCM is challenging. The calcium sensitizer levosimendan (LS) is considered as a beneficial therapy in CS. There are only sparse data regarding the safety and efficacy of LS-treatment in PPCM. We aimed to investigate the molecular effects and safety of LS-treatment in the PPCM mouse model (cardiomyocyte-specific-knockout of signal-transducer-and-activator-of-transcription 3 (STAT3), CKO) and in patients from the German PPCM registry. Methods and results: In the PPCM mouse model, LS-treatment aggravated postpartum heart failure associated with fibrosis, reduced capillary density, and enhanced mortality, whereas LS-treatment together with the PRL-inhibitor bromocriptine (BR) preserved cardiac function. In CKO hearts, LS induced PAI-1 expression via the upregulation of thrombospondin-1/-4, transforming-growth-factor-β, and activation of SMAD2 that could be prevented by combination with BR. In the German PPCM registry, 17 PPCM patients with CS were treated with LS and BR. Despite the severity of CS, all these patients survived the acute phase, and most patients showed cardiac recovery in the ensuing course of the disease (left ventricular ejection fraction at 3-month follow-up: 40 ± 19%). Conclusion: Thus, the combination therapy with LS and BR seems to be a safe and potentially beneficial therapeutic concept for the treatment of PPCM patients with CS. As experimental PPCM mouse data suggest that treatment of PPCM patients in CS with LS alone may worsen cardiac function by enhancing the PRL/PAI-1-dependent pathomechanism, treatment of LS in PPCM patients should always be accompanied by BR treatment.

The percutaneous microaxial flow pump (mAFP) is an established mechanical circulatory support (MCS) device for cardiogenic shock (CS) and can also stabilize hemodynamics during cardiac and noncardiac procedures. This case series describes the safety and feasibility of repeated mAFP use for three indications in a single patient. We retrospectively reviewed three consecutive mAFP deployments in one patient enrolled in the Hannover-Cardiac-Unloading-REgistry between October 2021 and August 2023. Indications included acute myocardial infarction–related CS (AMI-CS), ventricular tachycardia (VT) ablation one year later, and elective thyroidectomy for amiodarone-induced hyperthyroidism another year later. A 62-year-old patient with ischemic cardiomyopathy (initial LVEF 34%) achieved hemodynamic stabilisation during AMI-CS, successful protected VT ablation without compromise, and stable perioperative support during thyroidectomy. No major adverse events occurred. Repeated mAFP use for AMI-CS, VT ablation, and high-risk surgery was feasible and safe, supporting its versatility in complex clinical care.