SUMMARY One hundred and sixty nine patients (mean age 39 1 years) with documented dilated cardiomyopathy were studied for a mean of 5 5 years One hundred and four patients died during this period. The average (SD) interval from the onset of symptoms to death was 4 1 (3 7) years. One year and five year mortality rates were 27-8% and 57-4% respectively. Most of the deaths occurred within two years of diagnosis. The only difference between survivors and those who died was in the severity of left ventricular dysfunction at the time of referral. Significant differences between survivors and non-survivors were found for left ventricular end diastolic pressure (17-3 versus 23-4mmHg), left ventricular end systolic volume (87-4 versus 128 9 ml/m2), left ventricular end diastolic volume (130-7 versus 173-2 ml/m2), and ejection fraction (32-8 versus 25-4%). The duration of previous symptoms, preceding virus infection, positive family history, recent pregnancy, or heavy alcohol intake did not seem to influence prognosis. Nor did treatment, which was similar in both groups with a quarter of the patients receiving vasodilators.Patients with dilated cardiomyopathy have a high mortality irrespective of treatment. The only identifiable prognostic indicator was the severity of left ventricular impairment at referral.

BackgroundThe study aimed at determining the response of BNP and tissue Doppler (TD) E/e´ to standard heart failure (HF) therapy in an African black population as data on these are lacking in Africa. BNP assessment in relation to HF severity and its association with its predictors were also determined.MethodsIt was a longitudinal-analytical study with a one month follow-up among 100 HF patients seen at Ahmadu Bello University Teaching Hospital, Zaria-Nigeria. Two-way Repeated Measures ANOVA determined BNP levels before and after treatment according to the HF severity. Wilcoxon-Signed Ranks test determined the difference in BNP and TD E/e´ before and after treatment. Pearson’s correlation assessed log-transformed BNP’s association with its predictors.ResultsBNP significantly (p<0.001) rose with increasing severity of HF from 386.6 ± 186.5 pg/mL to 581.7 ± 299.0 pg/mL to 805.0 ± 484.0 pg/mL in the NYHA II-IV HF, respectively, with consequent fall in a similar fashion following treatment. The Median (IQR) BNP levels reduced significantly (p<0.001) from 450 (362.5, 712.5) to 275.0 (225, 375.2) pg/mL with a 38.9% reduction over 4 weeks associated with significant improvement in TD E/e´, structural and functional parameters. Ln10BNP was significantly (p<0.001) positively correlated to TD E/e´ before (r=0.51) and after treatment (r=0.43). Likewise, Ln10BNP was significantly (p<0.05) negatively correlated to ejection fraction & fractional shortening before and after treatment.ConclusionBNP and tissue Doppler can serve as useful tools in the assessment of the effectiveness of African HF treatment and functional capacity over 4 weeks. TD E/e´ may be a reliable non-invasive estimate of left ventricular filling pressures and diastolic dysfunction.

Background:Acute decompensated heart failure (ADHF) comprises the etiology of heart failure and the precipitant of acute decompensation. Early identification of the precipitant of ADHF is important in management, but an association between the precipitant and etiology of ADHF has not been established.Objective:The objective of this study is to determine whether the precipitant of acute decompensation is associated with the etiology of heart failure.Methods:This was a prospective observational study conducted over 2 years. Patients with ADHF secondary to common etiologies such as hypertension and rheumatic heart diseases (RHD) were enrolled in the study. The demographics, precipitants, and relevant variables on echocardiography and electrocardiography were documented. The frequencies of the etiology and precipitants of heart failure were derived. The Chi-square test was used to determine an association between categorical variables, and independent t-test was used to compare the means of continuous variables. A value of P < 0.05 was considered statistically significant.Results:There were a total of 190 participants. Hypertensive and RHD were 96 (50.5%) and 94 (49.5%), respectively. One hundred and three (54.2%) were females and males were 87 (45.8%). The precipitants were pneumonia 104 (54.7%), arrhythmias 47 (24.7%), urinary tract infection 36 (19.5%), and infective endocarditis 3 (1.6%). The association between these etiologies and precipitants of ADHF yielded a value of P = 0.597.Conclusion:There is no association between the precipitant and etiology of ADHF. Therefore, the precipitant of ADHF should be actively sought for in every case for optimal management and better outcomes.

Dic-Ijiewere et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.