Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria.

AIMS: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere. METHODS AND RESULTS: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 µg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling. CONCLUSIONS: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

Right ventricular dysfunction in a hypertensive population stratified by patterns of left ventricular geometry.

INTRODUCTION: The aim of this study was to assess the prevalence, determinants and correlates of right ventricular (RV) systolic and diastolic dysfunction (RVSD and RVDD, respectively) in hypertensives, stratified by left ventricular (LV) geometric patterns. METHODS: The study was carried out in Aminu Kano Teaching Hospital in Kano, Nigeria, and was cross-sectional in design. Hypertensive subjects referred for echocardiography were consecutively recruited after satisfying the inclusion criteria. RVSD was defined as either tricuspid annular plane systolic excursion (TAPSE) of < 16 mm, or peak velocity of the systolic wave (S(m)) in tissue Doppler imaging (TDI) of the RV lateral tricuspid annulus of < 10 cm/s, or both. RVDD was defined as the ratio of < 1.0 of the peak velocities of the early (E(m)) to late (A(m)) diastolic waves in the TDI of the RV lateral tricuspid annulus. Subjects with normal LV geometry (NG) served as controls, and were compared with those who had eccentric (EH) or concentric (CH) LV hypertrophy or concentric LV remodelling. RESULTS: A total of 128 subjects were recruited. Overall, the prevalence of RVDD almost doubled that of RVSD in the studied subjects (61.72 vs 32.03%, respectively). Subjects with EH had the highest prevalence of RVSD (52.63%), while those with CH had the lowest prevalence (20.69%) (p < 0.01). By contrast, the prevalence of RVDD was high across the four groups without significant statistical difference; as high as 68.52% in subjects with NG and as low as 42.86% in those with CR. LVEF was the only independent determinant of RVSD after controlling for confounding variables, while age was the only determinant of RVDD. Likewise, age was the only correlate for E(m):A(m) ratio, while the best correlate for both TAPSE and S(m) was LVEF. CONCLUSION: The study has revealed that about two-thirds of the hypertensives had RVDD while about one-third had RVSD. Subjects with EH had the highest prevalence of RVSD, while RVDD was common across all the groups. LVEF and age were the only independent determinants of RVSD and RVDD, respectively.