Abstract
INTRODUCTION: Peripartum cardiomyopathy (PPCM) affects previously healthy women commonly of African ancestry resulting into elevated morbidity and mortality rates. The clinical characteristics of PPCM are diverse but there is yet limited data on outcomes for women with PPCM in Uganda. We sought to elucidate the clinical presentation, echocardiographic findings, and 6-month outcomes among women with PPCM in Uganda. METHODS: A prospective cohort study of 80 PPCM women matched for age were monitored over a 6-month period while on goal-directed medical therapy (GDMT) was conducted. All participants underwent a physical examination, 12-lead electrocardiography, echocardiography and biomarkers including NT-pro BNP and Prolactin at baseline and at 6-month follow-up visit. Additionally, 80 matched controls were recruited at baseline as comparison for the biomarkers. RESULTS: The mean age of cases and controls was 33.6 ± 6.6 and 30.2 ± 5.9 years respectively. Clinical data for cases were as follows: mean left ventricular ejection fraction (LVEF) was 35.7 ± 11.0%, mean LV global longitudinal strain (GLS) was -11.9 ± 4.7%, mean right ventricular GLS was -14.7 ± 10.9%. A total of 22 (27.5%) participants had a LVEF <35% while 6 (7.5%) participants had severe RV systolic dysfunction. 20 (25%) participants were in NYHA IV. 54 (68%) participants received bromocriptine therapy in addition to other GDMT. Clinical data for controls were as follows: mean LVEF was 67.2 ± 4.5%, mean LV GLS was -17.1 ± 4.9%, all controls had normal RV systolic function parameters. After 6-months of follow-up, 6 (7.5%) of the cases had died. Atrial fibrillation occurred in 2 (2.5%) participants and intracardiac thrombus was documented among 8 (10%) participants. 52 (65%) participants were in NYHA I. LV recovery (LVEF ≥ 50%) was observed in 37 (46.3%) cases. CONCLUSION: This study shows a high mortality rate of 7.5% aligning with global studies, the observed high thrombus burden and stroke occurred in 10% and 2.5%, respectively which may indicate severity of LV systolic dysfunction at presentation. Two-thirds of patients received Bromocriptine in addition to GDMT which may explain the high rate of LV recovery in this cohort.