Peripartum Cardiomyopathy in Africa: Challenges in Diagnosis, Prognosis, and Therapy

Tibazarwa, Kemi; Sliwa, Karen

doi:10.1016/j.pcad.2009.11.003

« Previous Next »Progress in Cardiovascular Diseases
Volume 52, Issue 4 , Pages 317-325, January 2010

Peripartum Cardiomyopathy in Africa: Challenges in Diagnosis, Prognosis, and Therapy

Kemi Tibazarwa
- Soweto Cardiovascular Research Unit, Chris Hani Baragwannath Hospital, The University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, The University of Cape Town, Cape Town, South Africa
- Address reprint requests to Kemi Tibazarwa, MD, MPH, Department of Medicine, The University of Cape Town, Anzio Rd, Observatory 7925, Cape Town, South Africa.
- Dr K Tibazarwa, postgraduate fellow, The University of Cape Town, Cape Town, South Africa, and postgraduate fellow, University of the Witwatersrand (also affiliated to University of Cape Town), Johannesburg, South Africa.
Karen Sliwa
- Soweto Cardiovascular Research Unit, Chris Hani Baragwannath Hospital, The University of the Witwatersrand, Johannesburg, South Africa
- Professor K Sliwa, director Soweto Cardiovascular Research Unit, Division of Cardiology, CH Baragwannath Hospital, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Peripartum cardiomyopathy (PPCM) is a form of heart failure affecting women of childbearing age, which can be associated with considerable mortality and chronic debilitating disease. Most patients present with acute postpartal heart failure that resembles the clinical presentation of idiopathic dilated cardiomyopathy. Historically, patients with PPCM have shown high rates of rapid recovery, with 6-month recovery rates averaging at 50%. However, recent prospective long-term follow-up of patients with PPCM in developing societies suggest recovery occurring only well into the second year after diagnosis, and recovery is poorly predicted by baseline left ventricular function. Beyond any potentially inherent factors contributing to poorer outcomes of patients with PPCM in developing societies, prognosis in these settings will continue to lag behind as the challenges faced to optimizing diagnosis remain immense. New insights into the role of inflammatory, apoptotic, and other genetic pathways may improve prognosis through the early detection and more targeted treatment of PPCM.

Abbreviations and Acronyms: NYHA-FC, New York Heart Association functional class, PPCM, peripartum cardiomyopathy, TNF-α, tumornecrosis factor α

Keywords: Peripartum cardiomyopathy, Africa, Heart failure, Women, Challenges, Diagnosis, Prognosis, Review