Peripartum cardiomyopathy among cardiovascular patients referred for echocardiography at Parirenyatwa Teaching Hospital, Harare, Zimbabwe

Abstract

SummaryObjectivesThe main aim was to evaluate the outcome of patients with peripartum cardiomyopathy (PPCM) within six months of diagnosis. The secondary aim was to describe demographic and clinical characteristics of patients with PPCM in Harare, Zimbabwe.MethodsThis was a prospective cohort study in which patients recruited into a detailed PPCM registry were followed up for six months. Echocardiograms were performed at enrolment, and three and six months after diagnosis, to determine left ventricular function.ResultsFrom 1 August 2012 to 31 July 2013, 43 patients with a new diagnosis of PPCM were recruited at Parirenyatwa Hospital in Harare. At six months, mean ejection fraction improved from 29.7 ± 9.8 to 44.9 ± 14.9%, p < 0.001 and New York Heart Association (NYHA) functional class improved significantly (p < 0.0001). Five (11.6%) patients died.ConclusionsLeft ventricular function improved in a substantial number of patients (42.9%) in this Zimbabwean cohort compared to other African cohorts. However the mortality rate remained high.

Burden, predictors and short-term outcomes of peripartum cardiomyopathy in a black African cohort

“…This finding of mild disease severity in our study cohort starkly contrasts with what has been observed in other African studies. Studies conducted in Zimbabwe [ 26 ], Togo [ 27 ] and South Africa [ 17 , 18 , 21 ] reported about 46.5%, 77% and 66.7–89% of patients with PPCM presenting in NYHA functional class III/IV at baseline respectively. A high proportion of patients with PPCM presenting in NYHA functional class III or IV (68.8%) was also reported by a multi-country study investigating clinical characteristics of patients with PPCM in Africa, Middle East, Asia and Europe [ 28 ].…”

“…EURObservational Research Programme (EORP), an ongoing registry for patients with PPCM presented with thrombo-embolic events (6.8%) [ 28 ]. A higher prevalence of co-existing intra-cardiac thrombus of 9.3% and 16.7% was documented in a study in Zimbabwe [ 26 ] and South Africa respectively [ 21 ]. Thrombo-embolic events are also associated with a high risk of mortality.…”

“…Thrombo-embolic events are also associated with a high risk of mortality. In a study conducted in Zimbabwe, deep vein thrombosis and an intra-mural thrombosis were presumed to be one of the direct causes of death in three patients with PPCM within 3 months of follow-up [ 26 ].…”

“…This could probably be due to differences in disease severity at diagnosis (low NYHA functional class and LVEF) and disparities in clinical management of PPCM during follow-up. Comparable rates of mortality of patients with PPCM at six months of follow-up were documented in Zimbabwe (11.6%) [ 26 ] and South Africa (10%, 12.6% and 13%) [ 17 , 19 , 25 ]. Higher rates of mortality were noted at six months of follow-up in Nigeria (24.2%) [ 11 ] and at 1 week post hospital discharge in Burkina Faso (48.3%) [ 22 ].…”

“…The above studies have also demonstrated that PPCM is associated with poor maternal outcomes in African patients like high rates of maternal mortality, incomplete recovery of LV function and minimal improvement in New York Heart Association (NYHA) functional class after six to twelve months of follow-up [ 11 , 17 – 19 , 21 , 22 , 26 ].…”