{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T14:56:28Z","timestamp":1773932188528,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"internal institutional funding"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during the last month of pregnancy or within five months postpartum. While levosimendan is considered beneficial in heart failure and cardiogenic shock, evidence supporting its use in PPCM is limited. This study investigated the prevalence of PPCM in Germany and evaluated outcomes associated with levosimendan use. Methods: Using national data from the German Statistical Office, all pregnant women diagnosed with PPCM and hospitalized between 2009 and 2022 were included. Patients were categorized into groups based on levosimendan treatment. Demographics, treatment modalities, peripartum complications, and transfusion rates were analyzed. Results: The prevalence of PPCM in Germany is 0.01%; 3.60% of patients received levosimendan, mostly after childbirth (61.76%). Peripartum complications and the use of mechanical circulatory support devices were significantly higher in the levosimendan group (p &lt; 0.0001). Women in the levosimendan group suffered significantly more often from intrapartum bleeding and increased rates of blood transfusion compared to women in the non-levosimendan group. Conclusions: PPCM is a rare disease in Germany with a prevalence of 0.01%. Despite higher complication rates in women with levosimendan treatment, further studies are necessary to help determine the role and timing of levosimendan in the treatment of women with PPCM.<\/jats:p>","DOI":"10.3390\/jcdd13030126","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T15:49:42Z","timestamp":1773071382000},"page":"126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics and Outcomes of 1894 Women with Peripartum Cardiomyopathy Treated with and Without Levosimendan in Germany"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6890-3239","authenticated-orcid":false,"given":"Jan A.","family":"Kloka","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Popescu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Friedrichson","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5845-6015","authenticated-orcid":false,"given":"Thomas","family":"Jasny","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lea V.","family":"Blum","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Noone","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2886-8947","authenticated-orcid":false,"given":"Armin","family":"Flinspach","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5324-981X","authenticated-orcid":false,"given":"Peter","family":"Kranke","sequence":"additional","affiliation":[{"name":"Intensive Care, Emergency and Pain Medicine, Department of Anaesthesiology, University Hospital W\u00fcrzburg, 97080 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0212-9110","authenticated-orcid":false,"given":"Kai","family":"Zacharowski","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Neef","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital, Goethe University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","unstructured":"MBRRACE-UK (2025, November 15). Saving Lives, Improving Mothers\u2019 Care Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017\u201319. Available online: https:\/\/www.npeu.ox.ac.uk\/assets\/downloads\/mbrrace-uk\/reports\/maternal-report-2021\/MBRRACE-UK_Maternal_Report_2021_-_FINAL_-_WEB_VERSION.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.jacc.2019.11.014","article-title":"Peripartum Cardiomyopathy: JACC State-of-the-Art Review","volume":"75","author":"Davis","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1056\/NEJMra2306667","article-title":"Peripartum Cardiomyopathy","volume":"390","author":"Arany","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3787","DOI":"10.1093\/eurheartj\/ehaa455","article-title":"Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: An ESC EORP registry","volume":"41","author":"Sliwa","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5142","DOI":"10.1093\/eurheartj\/ehad724","article-title":"Peripartum cardiomyopathy in Europe: New insights from the UK","volume":"44","author":"Viljoen","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_6","first-page":"e895","article-title":"2022 AHA\/ACC\/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"145","author":"Heidenreich","year":"2022","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1161\/CIRCHEARTFAILURE.113.000721","article-title":"Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Data from the Interagency Registry for Mechanically Assisted Circulatory Support","volume":"7","author":"Pamboukian","year":"2014","journal-title":"Circ. Heart Fail."},{"key":"ref_8","first-page":"337","article-title":"The role of Ca++-sensitizers for the treatment of heart failure","volume":"9","author":"Lehmann","year":"2003","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e19","DOI":"10.15420\/cfr.2020.03","article-title":"Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use","volume":"6","author":"Papp","year":"2020","journal-title":"Card. Fail. Rev."},{"key":"ref_10","first-page":"107","article-title":"Levosimendan for post-partum cardiomyopathy","volume":"7","author":"Nguyen","year":"2005","journal-title":"Crit. Care Resusc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1213\/01.ANE.0000099717.40471.83","article-title":"Successful use of levosimendan in a patient with peripartum cardiomyopathy","volume":"98","author":"Benlolo","year":"2004","journal-title":"Anesth. Analg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/j.ijcard.2006.11.171","article-title":"Peripartum cardiomyopathy: A new successful setting for levosimendan","volume":"123","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1007\/s00392-010-0279-7","article-title":"Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial","volume":"100","author":"Biteker","year":"2011","journal-title":"Clin. Res. Cardiol."},{"key":"ref_14","first-page":"100530","article-title":"Diagnosis and management of peripartum cardiomyopathy and recurrence risk","volume":"17","author":"Iannaccone","year":"2024","journal-title":"Int. J. Cardiol. Congenit. Heart Dis."},{"key":"ref_15","unstructured":"S\u00c4dBud, L. (2025, November 15). Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) 2005\u20132021. Available online: https:\/\/www.forschungsdatenzentrum.de\/de\/10-21242-23141-2020-00-00-1-1-0."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1093\/eurjhf\/hfq120","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: A position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy","volume":"12","author":"Sliwa","year":"2010","journal-title":"Eur. J. Heart Fail."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1161\/01.CIR.0000162478.36652.7E","article-title":"Pregnancy-associated cardiomyopathy: Clinical characteristics and a comparison between early and late presentation","volume":"111","author":"Elkayam","year":"2005","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1161\/HYPERTENSIONAHA.119.13291","article-title":"Importance of Early Diagnosis in Peripartum Cardiomyopathy","volume":"75","author":"Lewey","year":"2020","journal-title":"Hypertension"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/HCO.0000000000001037","article-title":"Peripartum cardiomyopathy: Risk factors and predictors of outcome","volume":"38","author":"Viljoen","year":"2023","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Masarone, D., Kittleson, M.M., Pollesello, P., Marini, M., Iacoviello, M., Oliva, F., Caiazzo, A., Petraio, A., and Pacileo, G. (2022). Use of Levosimendan in Patients with Advanced Heart Failure: An Update. J. Clin. Med., 11.","DOI":"10.3390\/jcm11216408"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"94","DOI":"10.4103\/0974-2700.58651","article-title":"Levosimendan use in the emergency management of decompensated peripartum cardiomyopathy","volume":"3","year":"2010","journal-title":"J. Emergencies Trauma Shock"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"171","DOI":"10.14740\/jmc4228","article-title":"Peripartum Cardiomyopathy: A Case Report of Mortality From a Rare and Potentially Fatal Condition","volume":"15","year":"2024","journal-title":"J. Med. Cases"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1053\/j.jvca.2016.01.015","article-title":"Comparative Effect of Levosimendan and Milrinone in Cardiac Surgery Patients With Pulmonary Hypertension and Left Ventricular Dysfunction","volume":"30","author":"Mishra","year":"2016","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1080\/10641955.2016.1242606","article-title":"Cardiogenic shock in pregnancy: Analysis from the National Inpatient Sample","volume":"36","author":"Banayan","year":"2017","journal-title":"Hypertens. Pregnancy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.athoracsur.2009.12.064","article-title":"Treatment of peripartum cardiomyopathy with mechanical assist devices and cardiac transplantation","volume":"89","author":"Zimmerman","year":"2010","journal-title":"Ann. Thorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"R93","DOI":"10.1186\/cc10098","article-title":"Acute and critically ill peripartum cardiomyopathy and \u2018bridge to\u2019 therapeutic options: A single center experience with intra-aortic balloon pump, extra corporeal membrane oxygenation and continuous-flow left ventricular assist devices","volume":"15","author":"Gevaert","year":"2011","journal-title":"Crit. Care"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Schiefenh\u00f6vel, F., Berger, C., Penkova, L., Grubitzsch, H., Haller, B., Meyer, A., Heringlake, M., Sander, M., Erb, J.M., and Balzer, F. (2023). Influence of timing of Levosimendan administration on outcomes in cardiac surgery. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1213696"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40119-024-00351-y","article-title":"Contemporary Management of Cardiomyopathy and Heart Failure in Pregnancy","volume":"13","author":"Afari","year":"2024","journal-title":"Cardiol. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4462","DOI":"10.1093\/eurheartj\/ehaf193","article-title":"2025 ESC Guidelines for the management of cardiovascular disease and pregnancy","volume":"46","author":"Haugaa","year":"2025","journal-title":"Eur. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1080\/14779072.2021.1905520","article-title":"An update on levosimendan in acute cardiac care: Applications and recommendations for optimal efficacy and safety","volume":"19","author":"Heringlake","year":"2021","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133105","DOI":"10.1016\/j.ijcard.2025.133105","article-title":"Efficacy and safety of bromocriptine in peripartum cardiomyopathy: A systematic review and meta-analysis","volume":"427","author":"Attachaipanich","year":"2025","journal-title":"Int. J. Cardiol."},{"key":"ref_32","first-page":"37","article-title":"Anemia, red blood cell transfusion and administration of blood products in obstetrics: A nationwide analysis of more than 6 million cases from 2011\u20132020","volume":"22","author":"Kloka","year":"2024","journal-title":"Blood Transfus."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1007\/s00134-022-06723-z","article-title":"How to manage anticoagulation during extracorporeal membrane oxygenation","volume":"48","author":"Levy","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/S0140-6736(07)61197-0","article-title":"Red blood cell transfusion in clinical practice","volume":"370","author":"Klein","year":"2007","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.bja.2023.12.014","article-title":"Use of cell salvage in obstetrics in Germany: Analysis of national database of 305 610 cases with peripartum haemorrhage","volume":"133","author":"Neef","year":"2024","journal-title":"Br. J. Anaesth."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1177\/1062860606288774","article-title":"Challenges of using medical insurance claims data for utilization analysis","volume":"21","author":"Tyree","year":"2006","journal-title":"Am. J. Med. Qual."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/3\/126\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T12:24:35Z","timestamp":1773923075000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/3\/126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcdd13030126"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13030126","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]}}}