Shuangbo Liu1, Sobia A Zuberi2, Amrit A Malik1, Brett M Hiebert1, Allan Schaffer1, Shelley Zieroth1, Francisco J Cordova3. 1. Section of Cardiology, Rady Faculty of Health Sciences and Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 2. Department of Internal Medicine, Rady Faculty of Health Sciences and Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 3. Section of Cardiology, Rady Faculty of Health Sciences and Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: fcordova@sbgh.mb.ca.
Abstract
BACKGROUND: Peripartum cardiomyopathy (PPCM) is a heterogeneous condition characterized by heart failure and left ventricular dysfunction (left ventricular ejection fraction [LVEF] < 45%) in the absence of an alternative cause and a previous diagnosis of cardiomyopathy. The Aboriginal population (Inuit, First Nations, Metis) of Canada often has barriers to health care, which can lead to delays in diagnosis and treatment. Our objectives are to describe PPCM in a Canadian population, and to determine if Canadian Aboriginal women have worse clinical outcomes than non-Aboriginal women. METHODS: A retrospective study was performed at a single tertiary care centre, between 2008 and 2014. Demographic characteristics, symptoms at presentation, medical history, discharge medications, blood work, echocardiographic parameters, and follow-up information were collected. RESULTS: A total of 177 women were screened, and 23 were included in the study (52% were Aboriginal). Aboriginal women were found to have higher rates of gravidity and parity, and higher incidence of tobacco smoking than non-Aboriginal women, and were more likely to be discharged with diuretic medications. At diagnosis, Aboriginal women were more likely to have a lower LVEF (20% [interquartile range (IQR), 15%-23%] vs 40% [IQR, 30%-42%]; P = 0.02) and a more dilated left ventricle (left ventricular end-diastolic diameter, 64 mm [IQR, 57-74 mm] vs 54 mm [IQR, 50-57mm]; P < 0.01). Recovery rate, defined as LVEF > 50%, was similar (46% in Aboriginal patients and 60% in non-Aboriginal patients). CONCLUSIONS: Our findings support that Aboriginal women with PPCM are more likely to present with lower LVEF and a more dilated left ventricle, as well, require more symptomatic management. To our knowledge, this is the first description and contrast of PPCM between Aboriginal and non-Aboriginal Canadians.
BACKGROUND: Peripartum cardiomyopathy (PPCM) is a heterogeneous condition characterized by heart failure and left ventricular dysfunction (left ventricular ejection fraction [LVEF] < 45%) in the absence of an alternative cause and a previous diagnosis of cardiomyopathy. The Aboriginal population (Inuit, First Nations, Metis) of Canada often has barriers to health care, which can lead to delays in diagnosis and treatment. Our objectives are to describe PPCM in a Canadian population, and to determine if Canadian Aboriginal women have worse clinical outcomes than non-Aboriginalwomen. METHODS: A retrospective study was performed at a single tertiary care centre, between 2008 and 2014. Demographic characteristics, symptoms at presentation, medical history, discharge medications, blood work, echocardiographic parameters, and follow-up information were collected. RESULTS: A total of 177 women were screened, and 23 were included in the study (52% were Aboriginal). Aboriginal women were found to have higher rates of gravidity and parity, and higher incidence of tobacco smoking than non-Aboriginalwomen, and were more likely to be discharged with diuretic medications. At diagnosis, Aboriginal women were more likely to have a lower LVEF (20% [interquartile range (IQR), 15%-23%] vs 40% [IQR, 30%-42%]; P = 0.02) and a more dilated left ventricle (left ventricular end-diastolic diameter, 64 mm [IQR, 57-74 mm] vs 54 mm [IQR, 50-57mm]; P < 0.01). Recovery rate, defined as LVEF > 50%, was similar (46% in Aboriginal patients and 60% in non-Aboriginalpatients). CONCLUSIONS: Our findings support that Aboriginal women with PPCM are more likely to present with lower LVEF and a more dilated left ventricle, as well, require more symptomatic management. To our knowledge, this is the first description and contrast of PPCM between Aboriginal and non-Aboriginal Canadians.
Authors: Anudeep K Dodeja; Francesca Siegel; Katherine Dodd; Marwan Ma'ayeh; Laxmi S Mehta; Margaret M Fuchs; Kara M Rood; May Ling Mah; Elisa A Bradley Journal: Open Heart Date: 2021-08