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. 2020 Nov 17;76(20):2352-2364.
doi: 10.1016/j.jacc.2020.09.540.

Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria

Kamilu M Karaye  1 , Hadiza Sa'idu  2 , Sulaiman A Balarabe  3 , Naser A Ishaq  4 , Umar G Adamu  5 , Idris Y Mohammed  6 , Isa Oboirien  7 , Ejiroghene M Umuerri  8 , Abaram C Mankwe  9 , Vincent Y Shidali  10 , Paschal Njoku  11 , Sotonye Dodiyi-Manuel  12 , Taiwo Olunuga  13 , Veronica Josephs  14 , Amam C Mbakwem  15 , Henry Okolie  16 , Mohammed A Talle  17 , Muhammad S Isa  18 , Okechukwu S Ogah  19 , Simon Stewart  20 ; PEACE Registry Investigators
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Free article

Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria

Kamilu M Karaye et al. J Am Coll Cardiol. .
Free article

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.

Keywords: left ventricular remodeling; mortality; recovery; rehospitalization.

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Conflict of interest statement

Author Relationship With Industry The authors have received funding from Dantata Group of Companies, Ammasco International Ltd., and Fortune Oil Mills Nigeria Ltd. Dr. Stewart is supported by the NHMRC of Australia (GNT1135894). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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