Targeting disease biology in peripartum cardiomyopathy: rethinking support in cardiogenic shock?

This editorial refers to ‘Cardiogenic shock complicating peripartum cardiomyopathy benefits from combination therapy with levosimendan and bromocriptine, by T. J. Pfeffer et al., https://doi.org/10.1093/ejhf/xuag002. Peripartum cardiomyopathy (PPCM) affects approximately 1 in 1000–3000 pregnancies worldwide, with substantial geographic variability.1,2 PPCM can present across a wide clinical spectrum, ranging from mild, subacute heart failure to severe, fulminant disease complicated by cardiogenic shock (CS). In its most severe form, PPCM can lead to haemodynamic instability, respiratory failure, and end-organ hypoperfusion, requiring intensive care and advanced circulatory support. CS develops in a substantial subset of patients with PPCM, often early after diagnosis, and is associated with high short-term mortality. Importantly, CS complicating PPCM differs fundamentally from the shock associated with ischemic heart disease or other forms of dilated cardiomyopathy. It is frequently characterized by rapidly progressive systolic dysfunction and profound vasodilatation, while, at the same time, PPCM-related CS retains a unique potential for myocardial recovery, provided patients survive the acute phase.