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Published in: BMC Cardiovascular Disorders 1/2024

Open Access 01-12-2024 | Cardiomyopathy | Research

Recovery of left ventricular systolic function in peripartum cardiomyopathy: an observational study from rural Tanzania

Authors: Andrew Katende, Laurine Roos, Victor Z. Urio, Evance Mahundi, Victor Myovela, Dorcas Mnzava, Chipegwa Mlula, Christamonica Chitimbwa, Dominick M. Raphael, Winfrid Gingo, Fabian C. Franzeck, Daniel H. Paris, Luigia Elzi, Maja Weisser, Martin Rohacek

Published in: BMC Cardiovascular Disorders | Issue 1/2024

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Abstract

Background

The aim of this study was to evaluate the recovery rate of the left ventricular systolic function of women diagnosed with peripartum cardiomyopathy receiving specialized care in rural Tanzania.

Methods

In this observational study, women diagnosed with peripartum cardiomyopathy at a referral center in rural Tanzania between December 2015 and September 2021 were included. Women diagnosed between February and September 2021 were followed prospectively, those diagnosed between December 2015 and January 2021 were tracked back for a follow-up echocardiography. All participants received a clinical examination, a comprehensive echocardiogram, and a prescription of guideline-directed medical therapy. The primary outcome was recovery of the left ventricular systolic function (left ventricular ejection fraction > 50%).

Results

Median age of the 110 participants was 28.5 years (range 17–45). At enrolment, 49 (45%) participants were already on cardiac medication, 50 (45%) had severe eccentric hypertrophy of the left ventricle, and the median left ventricular ejection fraction was 30% (range 15–46). After a median follow-up of 8.98 months (IQR 5.72–29.37), 61 (55%) participants were still on cardiac medication. Full recovery of the left ventricular systolic function was diagnosed in 76 (69%, 95% CI 59.6–77.6%) participants. In the multivariate analysis, a higher left ventricular ejection fraction at baseline was positively associated with full recovery (each 5% increase; OR 1.7, 95% CI 1.10–2.62, p = 0.012), while higher age was inversely associated (each 10 years increase; OR 0.40, 95% CI 0.19–0.82, p = 0.012).

Conclusion

Left ventricular systolic function recovered completely in 69% of study participants with peripartum cardiomyopathy from rural Tanzania under specialized care.
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Literature
1.
go back to reference Bauersachs J, Konig T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, Hamdan R, Jackson AM, Forsyth P, de Boer RA, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019;21(7):827–43.CrossRefPubMed Bauersachs J, Konig T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, Hamdan R, Jackson AM, Forsyth P, de Boer RA, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019;21(7):827–43.CrossRefPubMed
2.
go back to reference Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767–78.CrossRefPubMed Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767–78.CrossRefPubMed
3.
go back to reference Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy: JACC State-of-the-art review. J Am Coll Cardiol. 2020;75(2):207–21.CrossRefPubMed Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy: JACC State-of-the-art review. J Am Coll Cardiol. 2020;75(2):207–21.CrossRefPubMed
4.
go back to reference Raphael DM, Roos L, Myovela V, McHomvu E, Namamba J, Kilindimo S, Gingo W, Hatz C, Paris DH, Weisser M, et al. Heart diseases and echocardiography in rural Tanzania: occurrence, characteristics, and etiologies of underappreciated cardiac pathologies. PLoS ONE. 2018;13(12):e0208931.CrossRefPubMedCentralPubMed Raphael DM, Roos L, Myovela V, McHomvu E, Namamba J, Kilindimo S, Gingo W, Hatz C, Paris DH, Weisser M, et al. Heart diseases and echocardiography in rural Tanzania: occurrence, characteristics, and etiologies of underappreciated cardiac pathologies. PLoS ONE. 2018;13(12):e0208931.CrossRefPubMedCentralPubMed
5.
go back to reference Sliwa K, Bauersachs J, Arany Z, Spracklen TF, Hilfiker-Kleiner D. Peripartum cardiomyopathy: from genetics to management. Eur Heart J. 2021;42(32):3094–102.CrossRefPubMed Sliwa K, Bauersachs J, Arany Z, Spracklen TF, Hilfiker-Kleiner D. Peripartum cardiomyopathy: from genetics to management. Eur Heart J. 2021;42(32):3094–102.CrossRefPubMed
6.
go back to reference Blauwet LA, Libhaber E, Forster O, Tibazarwa K, Mebazaa A, Hilfiker-Kleiner D, Sliwa K. Predictors of outcome in 176 South African patients with peripartum cardiomyopathy. Heart. 2013;99(5):308–13.CrossRefPubMed Blauwet LA, Libhaber E, Forster O, Tibazarwa K, Mebazaa A, Hilfiker-Kleiner D, Sliwa K. Predictors of outcome in 176 South African patients with peripartum cardiomyopathy. Heart. 2013;99(5):308–13.CrossRefPubMed
7.
go back to reference Karaye KM, Sa’idu H, Balarabe SA, Ishaq NA, Adamu UG, Mohammed IY, Oboirien I, Umuerri EM, Mankwe AC, Shidali VY, et al. Clinical features and outcomes of Peripartum Cardiomyopathy in Nigeria. J Am Coll Cardiol. 2020;76(20):2352–64.CrossRefPubMed Karaye KM, Sa’idu H, Balarabe SA, Ishaq NA, Adamu UG, Mohammed IY, Oboirien I, Umuerri EM, Mankwe AC, Shidali VY, et al. Clinical features and outcomes of Peripartum Cardiomyopathy in Nigeria. J Am Coll Cardiol. 2020;76(20):2352–64.CrossRefPubMed
8.
go back to reference Moulig V, Pfeffer TJ, Ricke-Hoch M, Schlothauer S, Koenig T, Schwab J, Berliner D, Pfister R, Michels G, Haghikia A, et al. Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co-morbidities. Eur J Heart Fail. 2019;21(12):1534–42.CrossRefPubMed Moulig V, Pfeffer TJ, Ricke-Hoch M, Schlothauer S, Koenig T, Schwab J, Berliner D, Pfister R, Michels G, Haghikia A, et al. Long-term follow-up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co-morbidities. Eur J Heart Fail. 2019;21(12):1534–42.CrossRefPubMed
9.
go back to reference McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, et al. Clinical outcomes for Peripartum Cardiomyopathy in North America: results of the IPAC Study (investigations of pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol. 2015;66(8):905–14.CrossRefPubMedCentralPubMed McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, et al. Clinical outcomes for Peripartum Cardiomyopathy in North America: results of the IPAC Study (investigations of pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol. 2015;66(8):905–14.CrossRefPubMedCentralPubMed
10.
go back to reference Hoevelmann J, Engel ME, Muller E, Hohlfeld A, Bohm M, Sliwa K, Viljoen C. A global perspective on the management and outcomes of peripartum cardiomyopathy: a systematic review and meta-analysis. Eur J Heart Fail. 2022;24(9):1719–36.CrossRefPubMed Hoevelmann J, Engel ME, Muller E, Hohlfeld A, Bohm M, Sliwa K, Viljoen C. A global perspective on the management and outcomes of peripartum cardiomyopathy: a systematic review and meta-analysis. Eur J Heart Fail. 2022;24(9):1719–36.CrossRefPubMed
11.
go back to reference Sliwa K, Petrie MC, van der Meer P, Mebazaa A, Hilfiker-Kleiner D, Jackson AM, Maggioni AP, Laroche C, Regitz-Zagrosek V, Schaufelberger M, et al. Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry. Eur Heart J. 2020;41(39):3787–97.CrossRefPubMedCentralPubMed Sliwa K, Petrie MC, van der Meer P, Mebazaa A, Hilfiker-Kleiner D, Jackson AM, Maggioni AP, Laroche C, Regitz-Zagrosek V, Schaufelberger M, et al. Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry. Eur Heart J. 2020;41(39):3787–97.CrossRefPubMedCentralPubMed
12.
go back to reference Strasser R, Kam SM, Regalado SM. Rural Health Care Access and Policy in developing countries. Annu Rev Public Health. 2016;37:395–412.CrossRefPubMed Strasser R, Kam SM, Regalado SM. Rural Health Care Access and Policy in developing countries. Annu Rev Public Health. 2016;37:395–412.CrossRefPubMed
13.
go back to reference McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726.CrossRefPubMed McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726.CrossRefPubMed
14.
go back to reference Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104.CrossRefPubMed Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104.CrossRefPubMed
15.
go back to reference Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.CrossRefPubMed Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.CrossRefPubMed
16.
go back to reference Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al. Recommendations for the evaluation of left ventricular diastolic function by Echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–60.CrossRefPubMed Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, et al. Recommendations for the evaluation of left ventricular diastolic function by Echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–60.CrossRefPubMed
17.
go back to reference Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713. quiz 786 – 688.CrossRefPubMed Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685–713. quiz 786 – 688.CrossRefPubMed
18.
go back to reference Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777–802.CrossRefPubMed Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777–802.CrossRefPubMed
19.
go back to reference Cuenza LR, Manapat N, Jalique JR. Clinical Profi Le and predictors of outcomes of patients with Peripartum Cardiomyopathy: the Philippine Heart Center Experience. ASEAN Heart J. 2016;24(1):9.CrossRefPubMedCentralPubMed Cuenza LR, Manapat N, Jalique JR. Clinical Profi Le and predictors of outcomes of patients with Peripartum Cardiomyopathy: the Philippine Heart Center Experience. ASEAN Heart J. 2016;24(1):9.CrossRefPubMedCentralPubMed
20.
go back to reference Kamiya CA, Kitakaze M, Ishibashi-Ueda H, Nakatani S, Murohara T, Tomoike H, Ikeda T. Different characteristics of peripartum cardiomyopathy between patients complicated with and without hypertensive disorders. -Results from the Japanese Nationwide survey of peripartum cardiomyopathy. Circ J. 2011;75(8):1975–81.CrossRefPubMed Kamiya CA, Kitakaze M, Ishibashi-Ueda H, Nakatani S, Murohara T, Tomoike H, Ikeda T. Different characteristics of peripartum cardiomyopathy between patients complicated with and without hypertensive disorders. -Results from the Japanese Nationwide survey of peripartum cardiomyopathy. Circ J. 2011;75(8):1975–81.CrossRefPubMed
21.
go back to reference Hu CL, Li YB, Zou YG, Zhang JM, Chen JB, Liu J, Tang YH, Tang QZ, Huang CX. Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy. Heart. 2007;93(4):488–90.CrossRefPubMed Hu CL, Li YB, Zou YG, Zhang JM, Chen JB, Liu J, Tang YH, Tang QZ, Huang CX. Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy. Heart. 2007;93(4):488–90.CrossRefPubMed
22.
go back to reference Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail. 2012;14(8):895–901.CrossRefPubMed Biteker M, Ilhan E, Biteker G, Duman D, Bozkurt B. Delayed recovery in peripartum cardiomyopathy: an indication for long-term follow-up and sustained therapy. Eur J Heart Fail. 2012;14(8):895–901.CrossRefPubMed
Metadata
Title
Recovery of left ventricular systolic function in peripartum cardiomyopathy: an observational study from rural Tanzania
Authors
Andrew Katende
Laurine Roos
Victor Z. Urio
Evance Mahundi
Victor Myovela
Dorcas Mnzava
Chipegwa Mlula
Christamonica Chitimbwa
Dominick M. Raphael
Winfrid Gingo
Fabian C. Franzeck
Daniel H. Paris
Luigia Elzi
Maja Weisser
Martin Rohacek
Publication date
01-12-2024
Publisher
BioMed Central
Keyword
Cardiomyopathy
Published in
BMC Cardiovascular Disorders / Issue 1/2024
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-024-03906-y

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