Clinical characteristics, echocardiographic findings, six-month outcomes in Ugandan women with peripartum cardiomyopathy

Overview

Prospective cohort study of 80 Ugandan women with peripartum cardiomyopathy (PPCM) monitored over six months while receiving goal-directed medical therapy (GDMT). Age-matched controls (n=80) were enrolled for baseline biomarker comparison. Objectives were to characterize clinical presentation, echocardiographic parameters, biomarker profiles, and six-month clinical and echocardiographic outcomes in a sub-Saharan African cohort.

Methods and approach

Consecutive PPCM cases were recruited and matched by age to community controls. Baseline assessment comprised physical examination, 12-lead electrocardiography, transthoracic echocardiography including LV and RV global longitudinal strain (GLS), and biomarkers (NT-proBNP and prolactin). All cases received GDMT; bromocriptine was prescribed for a subset. Participants were re-evaluated at six months for mortality, NYHA functional class, arrhythmia, intracardiac thrombus, stroke, and left ventricular recovery defined as LVEF ≥50%. Comparative biomarker analyses used the matched control cohort.

Results

Baseline echocardiography in cases: mean LVEF 35.7% ± 11.0; mean LV GLS -11.9% ± 4.7; mean RV GLS -14.7% ± 10.9. Twenty-two (27.5%) had LVEF <35%; six (7.5%) had severe RV systolic dysfunction; 20 (25%) were NYHA IV. Controls had mean LVEF 67.2% ± 4.5 and LV GLS -17.1% ± 4.9 with normal RV function. Sixty-eight percent of cases received bromocriptine in addition to GDMT. At six months, six deaths (7.5%) occurred; atrial fibrillation in 2 (2.5%); intracardiac thrombus in 8 (10%); stroke in 2 (2.5%). Functional improvement to NYHA I was documented in 52 (65%), and LV recovery (LVEF ≥50%) in 37 (46.3%).

Implications

The observed 7.5% six-month mortality is consistent with prior global reports and underscores substantial short-term risk in this population. A notable intracardiac thrombus prevalence (10%) and occurrence of ischemic stroke reflect a high thromboembolic burden likely related to marked LV systolic impairment at presentation, indicating a need for systematic thrombus surveillance and consideration of anticoagulation strategies in selected patients.
The high proportion of LV recovery (46.3%) in a cohort where two thirds received bromocriptine suggests a potential therapeutic contribution but causality cannot be inferred from this observational design. Findings support the imperative for controlled studies to evaluate bromocriptine efficacy, optimize anticoagulation protocols, and identify predictors of reversibility in sub-Saharan PPCM populations.