Heart failure with reduced ejection fraction in young women: Management and outcomes in Reunion island

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a public health problem in France and around the world, with an increasing prevalence and a high mortality-rate. There is no data about HFrEF in young women in Reunion Island. We sought to describe characteristics, management, and evolution of HFrEF in young women in Reunion Island. We retrospectively enrolled all 18- to 44-year-old women, hospitalized between 01/01/2014 and 12/31/2019 with a new diagnosis of cardiac failure with left ventricular ejection fraction (LVEF) ≤ 45%. One hundred and thirty patients were included. Thirty-six patients (28%) had an ischemic cardiopathy, 88 (68%) a non-ischemic dilated cardiomyopathy. Among them, 40 (45%) had a peripartum cardiomyopathy, 27 (30%) an idiopathic cardiomyopathy, 5 (6%) an anthracycline-induced cardiomyopathy. Mean age was 36 ± 6 years, mean LVEF 29 ± 10%. Most frequent cardiovascular risk factors were: tobacco use (44%), hypertension (32%), and diabetes (25%). Obesity (39%) was particularly represented regardless of the type of cardiopathy. At discharge, 83% of patients were treated with beta-blockers and 86% with angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. Fifty-three patients (49%) had a complete LVEF recovery (≥ 50%) after one year, with a significantly higher rate in peripartum cardiomyopathy (71%) than in non-peripartum dilated cardiomyopathy (33%, P = 0.02). The overall one-year mortality-rate was 11%, significantly higher in non-peripartum dilated cardiomyopathy (19%) than peripartum cardiomyopathy (3%) and ischemic cardiopathy (8%). One patient underwent cardiac transplantation after a myocardial infarction. HFrEF has a high mortality-rate in young women in Reunion Island. In these young patients, dilated cardiomyopathy is frequent, but ischemic cardiopathy has a particularly high incidence due to the high prevalence of cardiovascular risk factors.