Prevalence and predictors of right ventricular diastolic dysfunction in peripartum cardiomyopathy.

Abstract

This study aimed to assess the prevalence of right ventricular diastolic dysfunction (RVDD) and its potential predictors in peripartum cardiomyopathy (PPCM) patients. This was a cross-sectional study carried out in Nigeria. RVDD was defined and graded using Doppler filling and myocardial tissue Doppler velocities obtained at tricuspid annular level. Forty-three subjects with PPCM and mean age of 26.6±7.0years were recruited over 6months. RVDD was found in 30 (69.8%) subjects, of whom 16 (53.3%) had gradeI, 12 (40.0%) had gradeII and 2 (6.7%) had gradeIII severity. RV systolic dysfunction (RVSD), defined as RV fractional area change <35%, was found in 88.4%, while combined RVSD and RVDD was found in 58.1% of patients. Subjects with RVDD had significantly higher tricuspid E/e' ratio (5.1±2.8 versus 3.5±1.0, p=0.012) and prevalence of pulmonary hypertension (76.7 versus 46.2%; p<0.05), and lower serum selenium concentration (55.6±12.1 versus 72.5±12.0µg/L, p=0.001) than those with preserved RV diastolic function. Regression analyses showed serum selenium [odds ratio (OR)=1.14; 95% confidence interval (CI)=1.0-1.3; p=0.049] and combined RVSD and pulmonary hypertension (OR=79.2; CI=3.9-1593.7; p=0.004) as the only predictors of RVDD, and serum selenium <70µg/L increased the odds of RVDD by 6.67-fold (CI=1.18-37.78; p=0.032). Both RVDD and RVSD were common in PPCM patients. Selenium deficiency and combined RVSD and pulmonary hypertension seemed to be the only determinants of RVDD in this small cohort, a finding that needs verification in a larger sample of patients.