CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
326
AFRICA
correlated with persistently impaired systolic function at six
months. Specifically, the presence of major T-wave changes
at baseline was associated with a markedly lower LVEF at six
months (–12%, 95% CI: –4 to –21;
p
=
0.006) compared to those
without T-wave changes at baseline. In addition, ST-segment
elevation at baseline was associated with an even greater
reduction in LVEF at six months (–25%, 95% CI: –0.7 to –50;
p
=
0.044) compared to those without this ECG pattern at baseline.
Discussion
To the best of our knowledge, this is the first study to
systematically describe the 12-lead ECG in
de novo
cases of
PPCM. Our main aim was to examine the potential utility of
the 12-lead ECG (a relatively inexpensive and easy-to-apply
diagnostic tool) in detecting underlying LV dysfunction in
confirmed cases of
de novo
PPCM in African women. This
would require a high underlying level of ECG abnormalities in
such a cohort in order to discriminate against (presumably) more
normal 12-lead ECGs in African women experiencing healthier
pregnancies.
Of the 78 cases studied, 49% demonstrated major ECG
abnormalities, usually associated with significant underlying
cardiac pathology, while 62% demonstrated one or more forms
of minor variation/abnormality, potentially indicative of the
same. We also attempted to examine whether the 12-lead ECG
is a useful tool for discriminating between those cases who
respond to treatment (by the resolution of initially observed ECG
abnormalities) and those who had persistent LV dysfunction.
In this respect, we found that the presence of two major
abnormalities (T-wave inversion and ST-segment depression) and
a third Minnesota code criterion not listed as one of the major
or minor criteria (ST-segment elevation) found on the baseline
TABLE 3. 12-LEAD ECGAT BASELINE IN 78 PPCM PATIENTS
ECG characteristic
No. (%) (
n
=
78)
Rate and rhythm
Mean heart rate (beats/min)
±
SD
100
±
21
Proportion in sinus rhythm
70 (90%; 95% CI: 81–95)
Proportion with sinus tachycardia
35 (45%; 95% CI: 34–57)
Proportion with arrhythmias
• premature ventricular complex
• supraventricular tachycardia
• sinus arrhythmias
3 (4%; 95% CI: 0.8–11)
1 (1%; 95% CI: 0.03–7)
4 (5%; 95% CI: 1–13)
Axis
QRS axis
• abnormal
• left axis
• right axis
• indeterminate
20 (26%; 95% CI: 16–37)
9 (12%; 95% CI: 5–21)
8 (10%; 95% CI: 5–19)
3 (4%; 95% CI: 0.8–11)
Conduction
PR interval
>
220 ms
1 (1%; 95% CI: 0.04–7)
Proportion with bundle branch block (BBB)
• left BBB
• right BBB
9 (12%; 95% CI: 5–21)*
4 (5%; 95% CI: 1–13)
1 (1%; 95% CI: 0.03–7)
Proportion with prolonged QTc (
>
470 ms)
4 (5%; 95% CI 1–13)
Repolarisation
Proportion with T-wave abnormalities
• major
• minor
46 (59%; 95% CI: 47–70)**
30 (38%; 95% CI: 28–50)
24 (31%; 95% CI: 21–42)
Proportion with ST-segment changes
• major ST-segment changes
• minor ST-segment changes
• ST-segment elevation
1 (1%; 95% CI: 0.03–7)
3 (4%; 95% CI: 0.8–11)
1 (1%; 95% CI: 0.03–7)
Hypertrophy
Proportion with left ventricular hypertrophy
[Defined by Minnesota codes III
1
and (IV
1-3
or V
1-3
)]
7 (9%; 95% CI: 4–18)
Atria
Proportion with atrial abnormalities
• left atrium
• right atrium
• bi-atrial
23 (29%; 95% CI: 20–41)**
8 (10%; 95% CI: 5–19)
11 (14%; 95% CI: 7–24)
4 (5%; 95% CI: 1–13)
*This sum exceeds that of individual BBB as some patients manifested incomplete BBB (either left or right).
**This sum exceeds that of individual sub-categories as some patients manifested features of each sub-category.
Fig. 2. Prevalence of Minnesota major criteria at baseline
in 78 PPCM patients.
50
45
40
35
30
25
20
15
10
5
0
Proportion of PPCM patients, % (
n
= 78)
Major
T-wave
inversion
Bundle
branch
block
Premature
ventricular
complex
Major
Q-wave
changes
Major ST-
depression
