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Background: Peripartum cardiomyopathy (PPCM) disproportionately affects women of African descent, however knowledge about this disease in African countries is limited. Objectives: To describe the phenotype of women with PPCM seen at a referral hospital in Zambia and examine outcomes at 6 months. Methods: A prospective observational study describing characteristics and 6-month outcomes was performed at the University Teaching Hospital Echocardiography Lab in Lusaka, Zambia. Results: We enrolled 45 participants with PPCM and 38 were seen at 6-month follow up; 3 (7 %) died and 4 (9 %) were lost to follow up. Mean age was 32.9 years (SD:7.0); mean BMI was 25.3 kg/m2 (SD:4.1), mean parity was 3.4 (SD:2.2) children and twin pregnancies occurred in 4 (9 %). Median time from symptom onset to diagnosis was 60 days (IQR: 1-280). 20 (44 %) reported gestational hypertension and 10 (22 %) reported preeclampsia. Baseline median left ventricular ejection fraction (LVEF) was 36 % (IQR: 11-45), median left ventricular end-diastolic volume (LVEDV) was 150 mL (IQR: 58-229) and 79 % described New York Heart Association (NYHA) functional class IV symptoms. Median LVEF after 6 months was 49 % (IQR: 23-68; p < 0.001) and median LVEDV was 121 mL (IQR: 66-200; p < 0.001). At 6-month follow up 45 % had LVEF ≥ 50 %, 42 % had LVEDV ≤ 106 mL and 1 (3 %) had NYHA functional class IV symptoms. Conclusions: Hypertension was prevalent in this cohort. Overall mortality rate was low and clinically significant improvements in cardiac parameters were seen in over 40%. Further research is needed to identify and mitigate gaps in diagnosis and management.
RESUMO
OBJECTIVES: This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room. BACKGROUND: The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved. METHODS: Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n = 112) or without (n = 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings. RESULTS: Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n = 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n = 48, 6%) or with traditional surgical revision (n = 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients. CONCLUSIONS: Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.
