Abstract
SummaryObjectiveTo identify potential electrocardiographic predictors of peripartum cardiomyopathy (PPCM).Methods:This was a case–control study carried out in three hospitals in Kano, Nigeria. Logistic regression models and a risk score were developed to determine electrocardiographic predictors of PPCM.Results:A total of 54 PPCM and 77 controls were consecutively recruited after satisfying the inclusion criteria. After controlling for confounding variables, a rise in heart rate of one beat/minute increased the risk of PPCM by 6.4% (p = 0.001), while the presence of ST–T-wave changes increased the odds of PPCM 12.06-fold (p < 0.001). In the patients, QRS duration modestly correlated (r = 0.4; p < 0.003) with left ventricular dimensions and end-systolic volume index, and was responsible for 19.9% of the variability of the latter (R2 = 0.199; p = 0.003). A risk score of ≥ 2, developed by scoring 1 for each of the three ECG disturbances (tachycardia, ST–T-wave abnormalities and QRS duration), had a sensitivity of 85.2%, specificity of 64.9%, negative predictive value of 86.2% and area under the curve of 83.8% (p < 0.0001) for potentially predicting PPCM.ConclusionIn postpartum women, using the risk score could help to streamline the diagnosis of PPCM with significant accuracy, prior to confirmatory investigations
Highlights
MethodsThis was a case–control study carried out in the Murtala Mohammed Specialist Hospital (MMSH), Aminu Kano Teaching Hospital (AKTH), and a private cardiology clinic in Kano, Nigeria
Our findings show that the presence of heart rate less than 100 beats/min reduced the risk of diagnosing peripartum cardiomyopathy (PPCM) to 89.7%, while the presence of ST–T-wave abnormalities, QRS duration more than 110 ms and QTc duration longer than 460 ms increased the odds of PPCM 12.0, 5.2- and 9.5-fold, respectively
This study shows, for the first time, that in women presenting within the first nine months after delivery with symptoms of heart failure, heart rate and ST–T-wave abnormalities were potential predictors of a diagnosis of PPCM
Summary
This was a case–control study carried out in the Murtala Mohammed Specialist Hospital (MMSH), Aminu Kano Teaching Hospital (AKTH), and a private cardiology clinic in Kano, Nigeria. The inclusion criteria for the patients were: (1) confirmed diagnosis of PPCM; (2) onset of symptoms towards the end of pregnancy or within the puerperium, and presentation to hospital within nine months postpartum; (3) age of at least 18 years; and (4) written informed consent. The controls had to satisfy the following criteria: (1) be apparently healthy; (2) no past history of any cardiac disease or systemic hypertension (except pregnancyinduced hypertension); (3) normal ECG (except for flat T waves in leads III or aVF, and inverted T waves in aVR, V1 or V2, which are considered non-specific);[5] (4) present to the study centres within nine months postpartum for routine immunisations for their children; and (5) give written informed consent. Subjects taking drugs known to affect ECG intervals were excluded from the study.[6]
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