Predictors of outcome in 176 South African patients with peripartum cardiomyopathy

Blauwet, Lori A.; Libhaber, Elena; Förster, Olaf; Tibazarwa, Kemi; Mebazaa, A.; Hilfiker‐Kleiner, Denise; Sliwa, Karen

doi:10.1136/heartjnl-2012-302760

Cited by 122 publications

(122 citation statements)

References 34 publications

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Section: Discussionmentioning

confidence: 96%

“…Mortality rates as high as 24.2% at 6 months and 47.4% at 1 year of follow-up have been reported in Kano, Nigeria, but much lower rates of 13.0% over 6 months in South Africa, 15.3% over 2 years in Haiti and 28.0% over 5 years in USA, have also been reported [35][36][37][38][39]. In addition, the majority of the deaths seem to occur within 6 months of a PPCM diagnosis [35][36][37][38][39]. Although some researchers didn't identify any predictors of mortality, others inconsistently reported younger age at diagnosis, lower body mass index (BMI) and some echocardiographic variables as independent predictors of mortality [35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the majority of the deaths seem to occur within 6 months of a PPCM diagnosis [35][36][37][38][39]. Although some researchers didn't identify any predictors of mortality, others inconsistently reported younger age at diagnosis, lower body mass index (BMI) and some echocardiographic variables as independent predictors of mortality [35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

“…In our cohort, 47.1% satisfied the criteria for LVRR while 29.4% recovered LV systolic function at 1 year follow-up [38]. Blauwet et al found older age and smaller LV end-systolic dimension (LVESD) to be significant predictors of LV recovery among PPCM patients in South Africa [35]. In addition, "electrical remodelling" in the form of shortening of previously broad QRS duration, which is suggestive of improved LV function, has also been reported among PPCM patients [41].…”

Section: Discussionmentioning

confidence: 99%

“…LV function recovery and mortality rates for PPCM vary widely across the globe due to several reasons; likely a reflection of the standard of medical care in various Countries [35][36][37][38][39]. Mortality rates as high as 24.2% at 6 months and 47.4% at 1 year of follow-up have been reported in Kano, Nigeria, but much lower rates of 13.0% over 6 months in South Africa, 15.3% over 2 years in Haiti and 28.0% over 5 years in USA, have also been reported [35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

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Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE) Registry

Karaye

Mohammed

Okeahialam

2018

ICFJ

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Background: Nigeria probably has the highest burden of Peripartum Cardiomyopathy (PPCM) in the world. The primary objective is to describe the burden, ventricular remodelling and outcomes (rehospitalisation rate, cardio-embolic events and survival) of PPCM in Nigeria. In the sub-studies, we aim to describe the relationship between selenium deficiency, oxidative stress and PPCM, the impact of sodium selenite supplementation on cardiac function in PPCM, and the prevalence of selenium deficiency and its relationship with cardiac function in apparently healthy pregnant women.Methods: The main Registry and the first sub-study are prospective longitudinal studies, while the second sub-study is an open-label randomised trial. 36 study centres across Nigeria have been registered and 10 of them are already recruiting subjects. Patients will be recruited from June to December 2017 and followed up till December 2018. Serum selenium and glutathione peroxidase will be assayed at recruitment for consecutive PPCM patients with LV ejection fraction (LVEF) <45% at 6 months postpartum. 200 subjects with selenium deficiency will be randomised into treatment (Selenium Selenite 200µg tablets daily for 3 months) and control arms. In the second sub-study, 120 apparently healthy pregnant women will be recruited at 28-38 weeks of gestation and reviewed at 6-8 weeks postpartum, and their serum selenium and GPO levels will be measured at recruitment.Conclusion: This will be the largest systematic evaluation of PPCM in Nigeria, and it is hoped that the information will assist in developing locally applicable treatment guidelines and policies for the disease.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE) Registry

Karaye

Mohammed

Okeahialam

2018

ICFJ

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Poor Outcomes in Poor Patients?

Bauersachs

2017

JAMA Cardiol

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Peripartum cardiomyopathy (PPCM) contributes to maternal death during or after pregnancy. Previously healthy women present with often severe heart failure during the last month of pregnancy or the first months postdelivery. 1 Peripartum cardiomyopathy is a global disease that occurs in about 1 in 1000 pregnancies, with a mortality rate ranging from 5% to 30%. Previous analyses have pointed to a worse outcome of patients with PPCM of African ancestry. In this issue of JAMA Cardiology, using a retrospective analysis of the University of Pennsylvania Health System, Irizarry et al 2 present the largest cohort of patients with PPCM to date, including 121 African American women. 2 The investigators used stringent definitions for PPCM and excluded all patients with a potential other explanation for heart failure, such as a history of congenital heart disease, valvular heart disease, or receiving radiation treatment or chemotherapy.African American patients with PPCM were younger, received their diagnoses later during the postpartum period, and presented with significantly lower left ventricular ejection fraction. These results are not completely matched by the baseline characteristics of the recently published first 400 patients in the worldwide PPCM registry of the EURObservational Research Programme. 3 Among these patients, despite the huge differences in sociodemographic factors among regions of the world, the baseline characteristics of patients with PPCM, such as an obstetric history and clinical presentation, were remarkably similar. The mode of presentation and mean age were also independent of ethnic and socioeconomic backgrounds. 3 However, a detailed analysis regarding racial/ethnic groups has yet to be performed in this registry.Even more troublesome in comparison with non-African American patients in the Pennsylvanian cohort with PPCM, African American patients also had a markedly delayed recovery and a much higher proportion did not recover to an ejection fraction of more than 50%, despite receiving similar treatment with drugs often prescribed for heart failure such as angiotensin-converting enzyme inhibitors and β-blockers (although it is unclear whether drug prescription resulted in similar drug intake among African American and non-African American patients, and there are no data reported on drug dosage). However, compared with the Sliwa cohort of African American patients from South Africa 4 that reported a 12% mortality rate, and a recovery of ejection fraction in only 21%, outcomes regarding mortality rates and recovery were clearly better in the current US cohort. In fact, mortality rates and cardiac transplantats, as well as arrhythmia, were not different between African American and non-African American patients.

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2016

The Heart of Africa

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Predictors of outcome in 176 South African patients with peripartum cardiomyopathy

Abstract: This study suggests that increased LVESD, lower BMI and lower serum cholesterol at baseline may be independent predictors of poor outcome in patients with PPCM, while older age and smaller LVESD at baseline appear to be independently associated with a higher chance of LV recovery.

Cited by 122 publications

References 34 publications

Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE) Registry

Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE) Registry

Poor Outcomes in Poor Patients?

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