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Multicenter Study
. 2021 Aug;8(4):3257-3267.
doi: 10.1002/ehf2.13463. Epub 2021 Jun 17.

Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria

Kamilu M Karaye  1   2   3   4 , Naser A Ishaq  1 , Hadiza Sai'du  2   5 , Sulaiman A Balarabe  6 , Bashir G Ahmed  6 , Umar G Adamu  7 , Idris Y Mohammed  8 , Isa Oboirien  9 , Ejiroghene M Umuerri  10 , Abaram C Mankwe  11 , Vincent Y Shidali  12 , Sotonye Dodiyi-Manuel  13 , Paschal Njoku  14 , Taiwo Olunuga  15 , Veronica Josephs  16 , Amam C Mbakwem  17 , Okechukwu S Ogah  18 , Jamilu Tukur  19 , Basil Okeahialam  20 , Simon Stewart  21 , Michael Henein  3 , Karen Sliwa  4 ; Peripartum Cardiomyopathy in Nigeria (PEACE) Registry Investigators
Affiliations
Multicenter Study

Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria

Kamilu M Karaye et al. ESC Heart Fail. 2021 Aug.

Abstract

Aims: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere.

Methods and results: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling.

Conclusions: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

Keywords: Outcomes; PEACE registry; Peripartum cardiomyopathy; Regional disparities; Selenium.

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Figures

Figure 1
Figure 1
Map of Nigeria displaying location of study sites. Map of Nigeria illustrating location of study sites and number of recruited patients.
Figure 2
Figure 2
Study flow. PPCM, peripartum cardiomyopathy; N, number of patients. PPCM patients recruited from 14 study centres in Nigeria between 12 June 2017 and 31 March 2018. All the patients were reviewed at three monthly intervals till 31 March 2019.
Figure 3
Figure 3
Myocardial remodelling among PPCM patients in Kano versus other zones. Mean sizes of cardiac chambers and indices of ventricular systolic function among PPCM patients in Kano versus other zones at baseline (BL) and final profiling (F). LA, left atrial dimension; LVEDDi, left ventricular end‐diastolic dimension indexed to body surface area; LVEF, left ventricular ejection fraction; RV, right ventricular; TAPSE, tricuspid annular plane systolic dimension; *P‐value is statistically significant. Values are expressed as means.
Figure 4
Figure 4
Kaplan–Meier survival curves. Number of patients at risk of mortality. Kaplan–Meier survival curves showing patients at risk of mortality at each month of follow‐up in Kano and other study sites.
Figure 5
Figure 5
Causes of deaths among PPCM patients by zones in Nigeria. Pie charts showing the specific causes of deaths in Kano and other study sites.
See this image and copyright information in PMC

References

    1. Karaye KM, Habib AG, Sliwa K. Epidemiology of peripartum cardiomyopathy in Africa. Intern Cardiovas Forum J 2018; 15: 6–11.
    1. Desai D, Moodley J, Naidoo D. Peripartum cardiomyopathy: experiences at King Edward VIII Hospital, Durban, South Africa and a review of the literature. Trop Doct 1995; 25: 118–123. - PubMed
    1. Mielniczuk LM, Williams K, Davis DR, Tang AS, Lemery R, Green MS, Gollob MH, Haddad H, Birnie DH. Frequency of peripartum cardiomyopathy. Am J Cardiol 2006; 97: 1765–1768. - PubMed
    1. Kamiya CA, Kitakaze M, Ishibashi‐Ueda H, Nakatani S, Murohara T, Tomoike H, Ikeda T. Different characteristics of peripartum cardiomyopathy between patients complicated with and without hypertensive disorders. Results from the Japanese Nationwide survey of peripartum cardiomyopathy. Circ J 2011; 75: 1975–1981. - PubMed
    1. Karaye KM, Ishaq NA, Sa'idu H, Balarabe SA, Talle MA, Isa MS, Adamu UG, Umar H, Okolie HI, Shehu MN, Mohammed IY, Sanni B, Ogah OS, Oboirien I, Umuerri EM, Mankwe AC, Shidali VY, Njoku P, Dodiyi‐Manuel S, Shogade TT, Olunuga T, Ojji D, Josephs V, Mbakwem AC, Tukur J, Isezuo SA. PEACE Registry Investigators. Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the peripartum cardiomyopathy in Nigeria registry. ESC Heart Fail 2020; 7: 235–243. - PMC - PubMed

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