1. Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria
- Author
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Henry Okolie, Sulaiman A. Balarabe, Vincent Shidali, Naser A. Ishaq, Veronica Josephs, Idris Y. Mohammed, Paschal Njoku, Taiwo Olunuga, Umar G. Adamu, Muhammad Sani S Isa, E M Umuerri, Abaram C. Mankwe, Amam C. Mbakwem, Hadiza Saidu, Kamilu M. Karaye, Sotonye Dodiyi-Manuel, Simon Stewart, Okechukwu S Ogah, Mohammed Abdullahi Talle, and Isa Oboirien
- Subjects
Adult ,medicine.medical_specialty ,Peripartum cardiomyopathy ,Nigeria ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Full recovery ,Pregnancy ,Interquartile range ,Internal medicine ,Peripartum Period ,Humans ,Medicine ,Prospective Studies ,Registries ,030212 general & internal medicine ,Reverse remodeling ,Ventricular Remodeling ,business.industry ,Incidence (epidemiology) ,Mortality rate ,Atrial Remodeling ,Puerperal Disorders ,Functional recovery ,medicine.disease ,Cardiology ,Female ,Cardiomyopathies ,Cardiology and Cardiovascular Medicine ,business - Abstract
Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited.The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria.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/mOverall, 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.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.
- Published
- 2020
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