Isezuo A Simeon1. 1. Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.
Abstract
BACKGROUND: The diagnosis of peripartum cardiomyopathy in Nigeria has mostly been based on clinical criteria. Echocardiographic data are rare, even though echocardiography is useful in distinguishing this condition from others which mimic it. This is an effort to fulfill the need for such data. METHODS AND RESULTS: A cross-sectional analysis of the echocardiographic data of 65 patients with peripartum cardiomyopathy was carried out. The patients were recruited prospectively for the study. The incidence rate was 1 per 102 deliveries, and the patients were predominantly (84.6%) of the Hausa and Fulani ethnic groups. There were 20 (30.8%) primiparous and 45 (69.2%) multiparous women aged 28.2 +/- 8.1 years (range: 15-45 years). Transient hypertension occurred in 18 (27.7%) patients. Customary puerperal practice was observed in 53 (81.5%). The complications included pericardial effusion (13.5%), intracardiac thrombosis (12.3%) and atrial fibrillation (3.1%). The occurrence rate was 1.5% each for stroke, pulmonary embolism and acute lower extremity arterial occlusion. The mean cardiothoracic index, left ventricular end diastolic dimension and ejection fraction were 61.4 +/- 12.0%, 6.3 +/- 1 cm and 27.4 +/- 8.2%, respectively. Twenty-seven (41.5%) patients had severe left ventricular dysfunction characterized by a left ventricular end diastolic dimension greater than 6 cm and fractional shortening less than 20%. The cardiothoracic index correlated with the left ventricular ejection fraction (r = 0.4;p = 0.03) and fractional shortening )r = 0.3; p = 0.01). The duration of salt consumption correlated with the left ventricular end diastolic dimension (r = 0.3, p = 0.01) and cardiothoracic index (r = 0.2; p = 0.04). Parity also correlated with the left ventricular end diastolic dimension (r = 0.3, p = 0.04). The mortality rate was 12.3%. Compared to the survivors, the deceased had a significantly lower ejection fraction (25.7 +/- 7.4% vs 31.4 +/- 7.7%, p = 0.03), lower diastolic pressure (67.5 +/- 10.4 vs 83.4 +/- 19.4; p = 0.04) and higher cardiothoracic index (70.2 +/- 14.4% vs 60.9 +/- 5.5%; p = 0.07) at baseline. CONCLUSION: In addition to its diagnostic and prognostic usefulness, echocardiography may serve as an effective indicator in the study of the role of customary puerperal practice in the pathogenesis of peripartum cardiomyopathy in certain populations.
BACKGROUND: The diagnosis of peripartum cardiomyopathy in Nigeria has mostly been based on clinical criteria. Echocardiographic data are rare, even though echocardiography is useful in distinguishing this condition from others which mimic it. This is an effort to fulfill the need for such data. METHODS AND RESULTS: A cross-sectional analysis of the echocardiographic data of 65 patients with peripartum cardiomyopathy was carried out. The patients were recruited prospectively for the study. The incidence rate was 1 per 102 deliveries, and the patients were predominantly (84.6%) of the Hausa and Fulani ethnic groups. There were 20 (30.8%) primiparous and 45 (69.2%) multiparous women aged 28.2 +/- 8.1 years (range: 15-45 years). Transient hypertension occurred in 18 (27.7%) patients. Customary puerperal practice was observed in 53 (81.5%). The complications included pericardial effusion (13.5%), intracardiac thrombosis (12.3%) and atrial fibrillation (3.1%). The occurrence rate was 1.5% each for stroke, pulmonary embolism and acute lower extremity arterial occlusion. The mean cardiothoracic index, left ventricular end diastolic dimension and ejection fraction were 61.4 +/- 12.0%, 6.3 +/- 1 cm and 27.4 +/- 8.2%, respectively. Twenty-seven (41.5%) patients had severe left ventricular dysfunction characterized by a left ventricular end diastolic dimension greater than 6 cm and fractional shortening less than 20%. The cardiothoracic index correlated with the left ventricular ejection fraction (r = 0.4;p = 0.03) and fractional shortening )r = 0.3; p = 0.01). The duration of salt consumption correlated with the left ventricular end diastolic dimension (r = 0.3, p = 0.01) and cardiothoracic index (r = 0.2; p = 0.04). Parity also correlated with the left ventricular end diastolic dimension (r = 0.3, p = 0.04). The mortality rate was 12.3%. Compared to the survivors, the deceased had a significantly lower ejection fraction (25.7 +/- 7.4% vs 31.4 +/- 7.7%, p = 0.03), lower diastolic pressure (67.5 +/- 10.4 vs 83.4 +/- 19.4; p = 0.04) and higher cardiothoracic index (70.2 +/- 14.4% vs 60.9 +/- 5.5%; p = 0.07) at baseline. CONCLUSION: In addition to its diagnostic and prognostic usefulness, echocardiography may serve as an effective indicator in the study of the role of customary puerperal practice in the pathogenesis of peripartum cardiomyopathy in certain populations.
Authors: Juliet Nabbaale; Emmy Okello; Davis Kibirige; Isaac Ssekitoleko; Joseph Isanga; Patience Karungi; Elias Sebatta; Zhang Wan Zhu; Annettee Nakimuli; John Omagino; James Kayima Journal: PLoS One Date: 2020-10-21 Impact factor: 3.240