Burden, predictors and short-term outcomes of peripartum cardiomyopathy in a black African cohort.
Adult
Black People
Cardiomyopathies
/ physiopathology
Cohort Studies
Echocardiography
Female
Humans
Mortality
Outcome Assessment, Health Care
Peripartum Period
Pregnancy
Pregnancy Complications, Cardiovascular
/ physiopathology
Prevalence
Risk Factors
Uganda
Ventricular Dysfunction, Left
/ physiopathology
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
15
03
2020
accepted:
02
10
2020
entrez:
21
10
2020
pubmed:
22
10
2020
medline:
15
12
2020
Statut:
epublish
Résumé
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with acute heart failure during the peripartum period. It is common in patients of African ancestry. Currently, there is paucity of data on the burden, predictors and outcomes of PPCM in Uganda. This study aimed to investigate the prevalence, predictors and six-month outcomes of PPCM in an adult cohort attending a tertiary specialised cardiology centre in Kampala, Uganda. This study consecutively enrolled 236 women presenting with features of acute heart failure in the peripartum period. Clinical evaluation and echocardiography were performed on all the enrolled women. PCCM was defined according to recommendations of the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Poor outcome at six months of follow-up was defined as presence of any of the following: death of a mother or her baby, New York Heart Association (NYHA) functional class III-IV or failure to achieve complete recovery of left ventricular function (left ventricular ejection fraction ≤55%). The median age, BMI and parity of the study participants was 31.5 (25.5-38.0) years, 28.3 (26.4-29.7) and 3 (2-4) respectively. The prevalence of PPCM was 17.4% (n = 41/236). Multiple pregnancy was the only predictor of PPCM in this study population (OR 4.3 95% CI 1.16-16.05, p = 0.029). Poor outcome at six-months was observed in about 54% of the patients with PPCM (n = 4, 9.8% in NYHA functional class III-IV and n = 22, 53.7% with LVEF <55%). No maternal or foetal mortality was documented. PPCM is relatively common in Uganda and is associated with multiple pregnancy. Poor outcomes especially absence of complete recovery of left ventricular function are also common. Large studies to further investigate long-term maternal and foetal outcomes in Uganda are justified.
Sections du résumé
BACKGROUND
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with acute heart failure during the peripartum period. It is common in patients of African ancestry. Currently, there is paucity of data on the burden, predictors and outcomes of PPCM in Uganda. This study aimed to investigate the prevalence, predictors and six-month outcomes of PPCM in an adult cohort attending a tertiary specialised cardiology centre in Kampala, Uganda.
METHODS
This study consecutively enrolled 236 women presenting with features of acute heart failure in the peripartum period. Clinical evaluation and echocardiography were performed on all the enrolled women. PCCM was defined according to recommendations of the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Poor outcome at six months of follow-up was defined as presence of any of the following: death of a mother or her baby, New York Heart Association (NYHA) functional class III-IV or failure to achieve complete recovery of left ventricular function (left ventricular ejection fraction ≤55%).
RESULTS
The median age, BMI and parity of the study participants was 31.5 (25.5-38.0) years, 28.3 (26.4-29.7) and 3 (2-4) respectively. The prevalence of PPCM was 17.4% (n = 41/236). Multiple pregnancy was the only predictor of PPCM in this study population (OR 4.3 95% CI 1.16-16.05, p = 0.029). Poor outcome at six-months was observed in about 54% of the patients with PPCM (n = 4, 9.8% in NYHA functional class III-IV and n = 22, 53.7% with LVEF <55%). No maternal or foetal mortality was documented.
CONCLUSION
PPCM is relatively common in Uganda and is associated with multiple pregnancy. Poor outcomes especially absence of complete recovery of left ventricular function are also common. Large studies to further investigate long-term maternal and foetal outcomes in Uganda are justified.
Identifiants
pubmed: 33085703
doi: 10.1371/journal.pone.0240837
pii: PONE-D-20-07456
pmc: PMC7577461
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0240837Subventions
Organisme : FIC NIH HHS
ID : D43 TW010132
Pays : United States
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Bull World Health Organ. 1974;51(2):203-8
pubmed: 4549486
Heart. 2013 Mar;99(5):308-13
pubmed: 23118348
Int J Cardiol. 2012 May 17;157(1):e12-3
pubmed: 21962610
PLoS One. 2018 Dec 26;13(12):e0208931
pubmed: 30586432
Int J Cardiol. 2015;190:376-82
pubmed: 25966297
Int J Cardiol. 2011 Mar 3;147(2):342-3
pubmed: 21247640
Cardiovasc J Afr. 2016 Mar-Apr;27(2):66-70
pubmed: 27213852
Indian Heart J. 2006 May-Jun;58(3):234-8
pubmed: 19033622
Heart. 2014 Dec;100(24):1967-74
pubmed: 25227705
Nat Rev Cardiol. 2014 Jun;11(6):364-70
pubmed: 24686946
Ethn Dis. 2007 Spring;17(2):228-33
pubmed: 17682350
Nature. 2012 May 09;485(7398):333-8
pubmed: 22596155
Cardiovasc J Afr. 2017 Jan/Feb;28(1):8-13
pubmed: 28262909
J Am Coll Cardiol. 2011 Aug 9;58(7):659-70
pubmed: 21816300
ESC Heart Fail. 2020 Feb;7(1):235-243
pubmed: 31990449
N Engl J Med. 2015 Aug 6;373(6):540-7
pubmed: 26244307
Am J Cardiol. 2007 Jul 15;100(2):302-4
pubmed: 17631087
Cardiovasc J Afr. 2017 Mar/Apr 23;28(2):112-117
pubmed: 27701482
J Am Coll Cardiol. 2010 Feb 16;55(7):654-9
pubmed: 20170791
Eur J Heart Fail. 2019 Jul;21(7):827-843
pubmed: 31243866
Heart Views. 2016 Apr-Jun;17(2):55-61
pubmed: 27512533
BMC Cardiovasc Disord. 2016 Jan 29;16:27
pubmed: 26821537
BMC Cardiovasc Disord. 2018 Jun 18;18(1):119
pubmed: 29914408
BMC Cardiovasc Disord. 2008 Jul 22;8:16
pubmed: 18644161
Int J Mol Sci. 2015 Apr 07;16(4):7644-54
pubmed: 25853263
Trop Doct. 1995 Jul;25(3):118-23
pubmed: 7660481
J Am Coll Cardiol. 2013 Oct 29;62(18):1715-1723
pubmed: 24013055
PLoS One. 2015 Aug 07;10(8):e0133466
pubmed: 26252951
Int J Cardiol. 2011 Mar 3;147(2):202-8
pubmed: 19751951
Eur J Heart Fail. 2017 Dec;19(12):1723-1728
pubmed: 28345302
Eur J Heart Fail. 2017 Sep;19(9):1131-1141
pubmed: 28271625