Background Image
Table of Contents Table of Contents
Previous Page  10 / 76 Next Page
Information
Show Menu
Previous Page 10 / 76 Next Page
Page Background

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017

8

AFRICA

Peripartum cardiomyopathy among cardiovascular

patients referred for echocardiography at Parirenyatwa

Teaching Hospital, Harare, Zimbabwe

Ellise Tapiwa Gambahaya, James Hakim, David Kao, Noleen Munyandu, Jonathan Matenga

Abstract

Objectives:

The 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.

Methods:

This was a prospective cohort study in which

patients recruited into a detailed PPCM registry were followed

up for six months. Echocardiograms were performed at enrol-

ment, and three and six months after diagnosis, to determine

left ventricular function.

Results:

From 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.

Conclusions:

Left ventricular function improved in a substan-

tial number of patients (42.9%) in this Zimbabwean cohort

compared to other African cohorts. However the mortality

rate remained high.

Keywords:

peripartum cardiomyopathy, Zimbabwe, outcomes

Submitted 17/3/15, accepted 3/4/16

Cardiovasc J Afr

2017;

28

: 8–13

www.cvja.co.za

DOI: 10.5830/CVJA-2016-043

Cardiovascular disease has reached epidemic proportions in

sub-Saharan Africa and is a major contributor to morbidity

and mortality.

1

These conditions often affect young women

disproportionately, particularly during pregnancy, and they

may have a worse prognosis compared to other groups of

patients.

2

Peripartum cardiomyopathy (PPCM) is one such

condition that affects previously healthy young women during

the most productive years of their lives. This has far-reaching

consequences for the patient, children and family unit as a whole.

Virchow recognised heart failure in associationwith pregnancy

as early as the 18th century.

3

However, it was not until the 1930s

when Hull and Hafkesbring formally described the syndrome of

heart failure following pregnancy, which they called ‘postpartum

cardiomyopathy’.

4

Demakis and Rahmitoola in 1971 formally

defined PPCM and gave criteria for its diagnosis, the basis of

which remains today.

5

Since the original description by Demakis, several studies

have assessed the clinical profile of patients with PPCM as well

as the natural history of the condition. These studies have been

done in a variety of settings with the majority emanating from

the United States and South Africa. Data from these studies

suggest that PPCM has a variable clinical course. Unlike many

other forms of cardiomyopathy, patients with PPCM are known

to recover fully from the condition. When it occurs, recovery is

rapid, usually within the first six months after diagnosis.

5

Series from the United States and South Africa show that

21 to 78% of patients with PPCM recover left ventricular

function (LVEF

50%) within six months of diagnosis.

6-9

However a proportion of patients never recovers and requires

long-term management of chronic heart failure. These women

often have relapses of decompensated cardiac failure that may

be severe enough to require cardiac transplantation. Factors

shown to be associated with recovery of left ventricular function

include Caucasian race, higher New York Heart Association

(NYHA) functional class, higher ejection fraction and smaller

left ventricular dimensions at presentation.

6,10

Typical causes

of death in PPCM patients include progressive cardiac failure

and sudden cardiac death, presumably due to arrhythmias and

thromboembolic events.

11

PPCM is known to occur more commonly in African

women or those of African descent, but despite the potentially

devastating consequences of PPCM, there is very little published

data about its outcome in African women outside South Africa,

and a few isolated historical reports from Nigeria.

12

A study

conducted in Haiti showed an incidence of PPCM of one in 350

live births, which is at least 10 times that of Western nations.

13

In South Africa the estimated incidence is one in approximately

1 000 live births.

14

Given these data, it is expected that Zimbabwe would be a

setting with a relatively high prevalence of PPCM, the impact

of which may be magnified by poorly resourced public hospitals

that make the diagnosis and management of these patients

suboptimal. Therefore, it was necessary to conduct the current

study to look at the outcome of PPCM in Zimbabwe. Clinical

characteristics of Zimbabwean PPCM patients were described,

and change in left ventricular function, functional status, and

overall survival within six months of diagnosis were evaluated.

College of Health Sciences, University of Zimbabwe,

Harare, Zimbabwe

Ellise Tapiwa Gambahaya, MB ChB, MMed,

egambahaya@gmail.com

James Hakim, MB ChB, MMed, MMedSc, FRCP

Noleen Munyandu, MB ChB, MMed

Jonathan Matenga, MB ChB, MSc, FRCP

Division of Cardiology, Department of Medicine, University

of Colorado Denver School of Medicine, Colorado, USA

David Kao MD