Kamilu M Karaye1, Hadiza Sa'idu2, Sulaiman A Balarabe3, Naser A Ishaq4, Umar G Adamu5, Idris Y Mohammed6, Isa Oboirien7, Ejiroghene M Umuerri8, Abaram C Mankwe9, Vincent Y Shidali10, Paschal Njoku11, Sotonye Dodiyi-Manuel12, Taiwo Olunuga13, Veronica Josephs14, Amam C Mbakwem15, Henry Okolie16, Mohammed A Talle17, Muhammad S Isa18, Okechukwu S Ogah19, Simon Stewart20. 1. Department of Medicine, Bayero University, Kano, Nigeria; Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria; Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden; Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa. Electronic address: kkaraye@yahoo.co.uk. 2. Department of Medicine, Bayero University, Kano, Nigeria; Department of Medicine, Murtala Mohammed Specialist Hospital, Kano, Nigeria. 3. Department of Medicine, Muhammad Abdullahi Wase Specialist Hospital, Kano, Nigeria. 4. Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria. 5. Department of Medicine, Federal Medical Center Bidda, Bidda, Nigeria. 6. Department of Chemical Pathology, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria. 7. Department of Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nigeria. 8. Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria. 9. Department of Medicine, Federal Medical Center Yenagoa, Yenagoa, Nigeria. 10. Department of Medicine, Federal Medical Center Keffi, Keffi, Nigeria. 11. Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria. 12. Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. 13. Department of Medicine, Federal Medical Center Abeokuta, Abeokuta, Nigeria. 14. Department of Medicine, University of Benin Teaching Hospital, Benin, Nigeria. 15. Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa; Department of Medicine, University of Lagos Teaching Hospital, Lagos, Nigeria. 16. Department of Medicine, Federal Teaching Hospital, Gombe, Nigeria. 17. Department of Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria. 18. Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. 19. Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa; Department of Medicine, University College Hospital, Ibadan, Nigeria; Institute of Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria. 20. Torrens University Australia, Adelaide, Australia.
Abstract
BACKGROUND: Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited. OBJECTIVES: The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria. METHODS: This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension <33 mm/m2 and absolute increase in left ventricular ejection fraction (LVEF) ≥10%. LV full recovery was defined as LVEF ≥55%. RESULTS: Overall, 45 (18.7%) patients died during follow-up. Maternal age <20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF <25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF <25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study. CONCLUSIONS: This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery.
BACKGROUND: Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited. OBJECTIVES: The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria. METHODS: This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension <33 mm/m2 and absolute increase in left ventricular ejection fraction (LVEF) ≥10%. LV full recovery was defined as LVEF ≥55%. RESULTS: Overall, 45 (18.7%) patientsdied during follow-up. Maternal age <20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF <25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF <25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study. CONCLUSIONS: This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery.
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Authors: Kamilu M Karaye; Naser A Ishaq; Hadiza Sai'du; Sulaiman A Balarabe; Bashir G Ahmed; Umar G Adamu; Idris Y Mohammed; Isa Oboirien; Ejiroghene M Umuerri; Abaram C Mankwe; Vincent Y Shidali; Sotonye Dodiyi-Manuel; Paschal Njoku; Taiwo Olunuga; Veronica Josephs; Amam C Mbakwem; Okechukwu S Ogah; Jamilu Tukur; Basil Okeahialam; Simon Stewart; Michael Henein; Karen Sliwa Journal: ESC Heart Fail Date: 2021-06-17