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Right ventricular systolic dysfunction and remodelling in Nigerians with peripartum cardiomyopathy: a longitudinal study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, 3 New Hospital Road, Kano, Nigeria..
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, 27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The literature on right ventricular systolic dysfunction (RVSD) in peripartum cardiomyopathy (PPCM) patients is scanty, and it appears that RV reverse remodelling in PPCM has not been previously described. This study thus aimed to assess RVSD and remodelling in a cohort of PPCM patients in Kano, Nigeria.

METHODS: A longitudinal study carried out in 3 referral hospitals in Kano, Nigeria. Consecutive PPCM patients who had satisfied the inclusion criteria were recruited and followed up for 12 months. RVSD was defined as the presence of either tricuspid annular plane systolic excursion (TAPSE) <16 mm or peak systolic wave (S') tissue Doppler velocity of RV free wall <10 cm/s. For the purpose of this study, recovery of RV systolic function was defined as an improvement of reduced TAPSE to ≥16 mm or S' to ≥10 cm/s, without falling to reduced levels again, during follow-up.

RESULTS: A total of 45 patients were recruited over 6 months with a mean age of 26.6 ± 7.0 years. RV systolic function recovery occurred in a total of 8 patients (8/45; 17.8 %), of whom 6 (75.0 %) recovered in 6 months after diagnosis. The prevalence of RVSD fell from 71.1 % at baseline to 36.4 % at 6 months (p = 0.007) and 18.8 % at 1 year (p = 0.0008 vs baseline; p = 0.41 vs 6 month). Patients with RVSD had higher serum creatinine, and TAPSE accounted for 19.2 % (p = 0.008) of the variability of serum creatinine at 6 months. Although 83.3 % of the deceased had RVSD, it didn't predict mortality in the regression models (p > 0.05).

CONCLUSION: RVSD and reverse remodelling were common in Nigerians with PPCM, in whom the first 6 months after diagnosis seem to be critical for RV recovery and survival.

Place, publisher, year, edition, pages
2016. Vol. 16, 27
Keyword [en]
Peripartum cardiomyopathy, Right ventricular dysfunction, RV remodelling
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:umu:diva-119624DOI: 10.1186/s12872-016-0204-8ISI: 000368975500002PubMedID: 26821537OAI: oai:DiVA.org:umu-119624DiVA: diva2:922826
Available from: 2016-04-25 Created: 2016-04-25 Last updated: 2017-11-30Bibliographically approved
In thesis
1. Clinical characteristics and prognosis of peripartum cardiomyopathy
Open this publication in new window or tab >>Clinical characteristics and prognosis of peripartum cardiomyopathy
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background:

Peripartum cardiomyopathy (PPCM) is an incompletely understood disease that causes significant morbidity and mortality in many parts of the world, including Northern Nigeria. The aims of this Thesis were: [1] to determine if selenium deficiency, serum ceruloplasmin and traditional birth practices are risk factors for PPCM, in Kano, Nigeria; [2] to describe the one year survival and left ventricular reverse remodeling (LVRR) in a group of patients with PPCM from three referral hospitals in Kano, Nigeria; [3] to identify potential electrocardiographic (ECG) predictors of PPCM; and [4] to assess right ventricular systolic dysfunction (RVSD) and remodelling in a cohort of PPCM patients in Kano, Nigeria.

Materials and Methods:

The studies were carried out in 3 referral hospitals in Kano, Nigeria. Study 1: This was a case-control study. Critically low serum selenium concentration was defined as <70μg/L. Study 2: This was a longitudinal study. LVRR was defined as absolute increase in LV ejection fraction (LVEF) by ≥10.0% and decrease in LV end-diastolic dimension indexed to body surface area (LVEDDi) ≤33.0 mm/m2, while recovered LV systolic function as LVEF ≥55%, at 12 months follow-up. Study 3: This was a case-control study. Logistic regression models and a risk score were developed to determine ECG predictors of PPCM. Study 4: This was a longitudinal study and patients were followed up for 12 months. RVSD was defined as the presence of either tricuspid annular plane systolic excursion (TAPSE) <16mm or peak systolic wave (S’) tissue Doppler velocity of RV free wall <10cm/s. Recovery of RV systolic function was defined as an improvement of reduced TAPSE to ≥16mm or S’ to ≥10cm/s, without falling to reduced levels again, during follow-up.

Results:

Study 1: Total of 39 PPCM patients and 50 controls were consecutively recruited after satisfying the inclusion criteria. Mean serum selenium in patients (61.7±14.9μg/L) was significantly lower than in controls (118.4±45.6μg/L) (p<0.001). The prevalence of serum selenium <70μg/L was significantly higher among patients (76.9%) than controls (22.0%) (p<0.001). The mean ceruloplasmin and prevalence of socio-economic indices, multiparity, pregnancy-induced hypertension, obesity and twin pregnancy were not different between the groups (p>0.05). Logistic regression showed that rural residency significantly increased the odds for serum selenium <70μg/L by 2.773 fold (p=0.037). Study 2: A total of 33 patients were followed-up. Of the 17 survivors at 12 months, 8 patients (47.1%) satisfied the criteria for LVRR, of whom 5 (29.4%) had recovered LV systolic function, but LVRR was not predicted by any variable in the regression models. The prevalence of normal LV diastolic function increased from 11.1% at baseline to 35.3% at twelve months (p=0.02). At one year follow-up, 41.4% of patients had died (two thirds of them within the first 6 months), but mortality wasn’t predicted by any variable including LVRR. Study 3: A total of 54 PPCM and 77 controls were studied. A rise in heart rate by 1 beat/minute increased the odds of PPCM by 6.4% (p=0.001), while presence of ST-T-wave changes increased the odds of PPCM by 12.06 fold (p<0.001). In patients, QRS duration modestly correlated (r=0.4; p<0.003) with LV dimensions and end-systolic volume index (LVESVI), and was responsible for 19.9% of the variability of the latter (R2 = 0.199; p=0.003). A risk score of ≥2 had a sensitivity of 85.2%, specificity of 64.9%, negative predictive value of 86.2% and area under the curve of 83.8% (p<0.0001) for potentially predicting PPCM. Study 4: A total of 45 patients were studied. RV systolic function recovery occurred in a total of 8 patients (8/45; 17.8%), of whom 6 (75.0%) recovered in 6 months after diagnosis. The prevalence of RVSD fell from 71.1% at baseline to 36.4% at 6 months (p=0.007) and 18.8% at one year (p=0.0008 vs baseline; p=0.41 vs 6 month). Although 83.3% of the deceased had RVSD, it didn’t predict mortality in the regression models (p>0.05).

Conclusion:

These studies have shown that selenium deficiency seems to be a risk factor for PPCM in Kano, Nigeria, related to rural residency. However, serum ceruloplasmin, customary birth practices and some other characteristics were not associated with PPCM in the study area. They have also shown that PPCM patients had modest LVRR but high mortality at one year. In addition, using the ECG risk score could help to streamline the diagnosis of PPCM with significant accuracy, prior to confirmatory investigations in postpartum women. Finally, RVSD and reverse remodelling were common in Nigerians with PPCM, in whom the first 6 months after diagnosis seem to be critical for RV recovery and survival.

Place, publisher, year, edition, pages
Umea: Print and Media, Umea University, 2016. 83 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1791
Keyword
peripartum cardiomyopathy, characteristics, survival, selenium, RV dysfunction
National Category
Medical and Health Sciences
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-119771 (URN)978-91-7601-441-7 (ISBN)
Public defence
2016-05-19, 9 trappor, Hörsal D, Umeå, 09:00 (English)
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Summary
Available from: 2016-04-28 Created: 2016-04-26 Last updated: 2016-05-26Bibliographically approved

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Karaye, Kamilu MusaLindmark, KristerHenein, Michael

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