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  • 1.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria.
    Dokainish, Hisham
    ElSayed, Ahmed
    Mondo, Charles
    Damasceno, Albertino
    Sliwa, Karen
    Balasubramanian, Kumar
    Grinvalds, Alex
    Yusuf, Salim
    Clinical Profiles and Outcomes of Heart Failure in Five African Countries: Results from INTER-CHF Study2021Ingår i: GLOBAL HEALTH: the International Conference on Global Health Challenges, ISSN 2211-8160, E-ISSN 2308-4553, Vol. 16, nr 1, artikel-id 50Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A wide knowledge gap exists on the clinical profiles and outcomes of heart failure (HF) in sub-Saharan Africa.

    Objectives: To determine the clinical profiles and outcomes of HF patients from five African countries.

    Methods: The INTERnational Congestive Heart Failure Study (INTER-CHF) is a prospective, multicenter cohort study. A total of 1,294 HF patients were consecutively recruited from Nigeria (383 patients), South Africa (169 patients), Sudan (501 patients), Uganda (151patients), and Mozambique (90 patients). HF was defined according to the Boston criteria for diagnosis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) score.

    Results: Of the 1294 patients, 51.4% were recruited as out-patients, 53.7% had HF with reduced ejection fraction (EF), 30.1% had HF with mid-range EF and 16.2% had HF with preserved EF (16.2%). The commonest etiologies of HF were hypertensive heart disease (35%) and ischemic heart disease (20%). The mean MoCA score was highest in Uganda (24.3 +/- 1.1) and lowest in Sudan (13.6 +/- 0.3). Prescriptions for guideline-recommended HF therapies were poor; only 1.2% of South African patients received an Implantable Cardioverter Defibrillator, and none of the patients received Cardiac Resynchronised Therapy. The composite outcome of death or HF hospitalization at one year among the patients was highest in Sudan (59.7%) and lowest in Mozambique (21.1%). Six variables were associated with higher mortality risk, while digoxin use (adjusted hazard ratio [aHR]: 0.69; 95% confidence interval [CI]: 0.49-0.97; p = 0.034) and 10mmHg unit increase in systolic blood pressure (aHR 0.86; 95%CI 0.81-0.93; p < 0.001) were associated with lower risk for mortality.

    Conclusions: This is the largest HF study in Africa that included in- and out-patients from the West, East, North, Central and South African sub-regions. Clinically relevant differences, including cognitive functional impairment, were found between the involved countries.

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  • 2.
    Karaye, Kamilu M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Peripartum cardiomyopathy: a review article2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 164, nr 1, s. 33-38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Peripartum cardiomyopathy (PPCM) is a disease with significant morbidity and mortality. It has a global spread but with important geographic variation. The aetiology and pathogenesis of PPCM is unknown, but several hypotheses have been proposed over the years. These include myocarditis, oxidised prolactin, autoimmunity, malnutrition, genetic susceptibility and apoptosis. This review discusses the epidemiology, risk factors, aetiology, clinical features, diagnosis, treatment and prognosis of PPCM. The possible role of novel echocardiographic techniques in the study of PPCM was also discussed.

  • 3.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ishaq, N. A.
    Sa'idu, H.
    Balarabe, S. A.
    Talle, M. A.
    Isa, M. S.
    Adamu, U. G.
    Umar, H.
    Okolie, H. I.
    Shehu, M. N.
    Mohammed, I. Y.
    Sanni, B.
    Ogah, O. S.
    Oboirien, I.
    Umuerri, E. M.
    Mankwe, A. C.
    Shidali, V. Y.
    Njoku, P.
    Dodiyi-Manuel, S.
    Shogade, T. T.
    Olunuga, T.
    Ojji, D.
    Josephs, V.
    Mbakwem, A. C.
    Tukur, J.
    Isezuo, S. A.
    Mohammed, B. L.
    Abubakar, H. A.
    Kabir, A.
    Armayau, I.
    Awwal, M. A.
    Adebayo, S.
    Durodola, A.
    Adesina, J.
    Ajani, A.
    Oladeji, O.
    Essien, I. O.
    Umoh, I. O.
    Inyang-Etoh, E. C.
    Andy, J. J.
    Josephs, V. A.
    Obasohan, A. O.
    Ogbemudia, A.
    Aghimien, O. D.
    Iyawe, L.
    Aghimien, E. C.
    Zagga, U. M.
    Isezuo, S.
    Sadeeq, I.
    Patrick, A.
    Onwubere, B. J. C.
    Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry2020Ingår i: ESC Heart Failure, E-ISSN 2055-5822, Vol. 7, nr 1, s. 236-244Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria.

    Methods and Results: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors.

    Conclusions: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

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  • 4.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria; Department of Medicine, Bayero University, Kano, Nigeria; Hatter Institute for Cardiovascular Research in Africa & CHI, Cape Town, South Africa.
    Ishaq, Naser A.
    Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
    Sai'du, Hadiza
    Department of Medicine, Bayero University, Kano, Nigeria; Department of Medicine, Murtala Mohammed Specialist Hospital, Kano, Nigeria.
    Balarabe, Sulaiman A.
    Department of Medicine, Muhammad Abdullahi Wase Specialist Hospital, Kano, Nigeria.
    Ahmed, Bashir G.
    Department of Medicine, Muhammad Abdullahi Wase Specialist Hospital, Kano, Nigeria.
    Adamu, Umar G.
    Department of Medicine, Federal Medical Centre, Bidda, Nigeria & Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
    Mohammed, Idris Y.
    Department of Chemical Pathology, Aminu Kano Teaching Hospital, Medicine Bayero University, Kano, Nigeria.
    Oboirien, Isa
    Department of Medicine, Dalhatu Araf Specialist Hospital, Lafia, Nigeria.
    Umuerri, Ejiroghene M.
    Department of Medicine, Delta State University Teaching Hospital, Oghara, Nigeria.
    Mankwe, Abaram C.
    Department of Medicine, Federal medical centre, Yenagoa, Yenagoa, Nigeria.
    Shidali, Vincent Y.
    Department of Medicine, Federal Medical Center, Keffi, Nigeria.
    Dodiyi-Manuel, Sotonye
    Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
    Njoku, Paschal
    University of Nigeria Teaching Hospital, Enugu, Nigeria.
    Olunuga, Taiwo
    Department of Medicine, Federal Medical centre, Abeokuta, Nigeria.
    Josephs, Veronica
    Department of Medicine, University of Benin Teaching Hospital, Benin, Nigeria.
    Mbakwem, Amam C.
    Department of Medicine, University of Lagos, Lagos, Nigeria.
    Ogah, Okechukwu S.
    Department of Medicine, University College Hospital, Ibadan, Nigeria.
    Tukur, Jamilu
    Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria.
    Okeahialam, Basil
    Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.
    Stewart, Simon
    Torrens University Australia, SA, Adelaide, Australia.
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Sliwa, Karen
    Hatter Institute for Cardiovascular Research in Africa & CHI, Cape Town, South Africa.
    Disparities in clinical features and outcomes of peripartum cardiomyopathy in high versus low prevalent regions in Nigeria2021Ingår i: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, nr 4, s. 3257-3267Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: The prospective, multicentre Peripartum Cardiomyopathy in Nigeria (PEACE) registry originally demonstrated a high prevalence of peripartum cardiomyopathy (PPCM) among patients originating from Kano, North-West Nigeria. In a post hoc analysis, we sought to determine if this phenomenon was characterized by a differential case profile and outcome among PPCM cases originating elsewhere.

    Methods and results: Overall, 199 (81.6%) of a total 244 PPCM patients were recruited from three sites in Kano, compared with 45 patients (18.4%) from 11 widely dispersed centres across Nigeria. Presence and extent of ventricular myocardial remodelling during follow-up, relative to baseline status, were assessed by echocardiography. During median 17 months follow-up, Kano patients demonstrated significantly better myocardial reverse remodelling than patients from other sites. Overall, 50.6% of patients from Kano versus 28.6% from other regions were asymptomatic (P = 0.029) at study completion, with an accompanying difference in all-cause mortality (17.6% vs. 22.2% respectively, P = 0.523) not reaching statistical significance. Alternatively, 135/191 (84.9%) of Kano patients had selenium deficiency (<70 μg/L), and 46/135 (34.1%) of them received oral selenium supplementation. Critically, those that received selenium supplementation demonstrated better survival (6.5% vs. 21.2%; P = 0.025), but the supplement did not have significant impact on myocardial remodelling.

    Conclusions: This study has shown important non-racial regional disparities in the clinical features and outcomes of PPCM patients in Nigeria, that might partly be explained by selenium supplementation.

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  • 5.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria.
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Electrocardiographic predictors of peripartum cardiomyopathy2016Ingår i: Cardiovascular Journal of Africa, ISSN 1995-1892, Vol. 27, nr 2, s. 66-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To 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 (R-2 = 0.199; p = 0.003), A risk score of >= 2, developed by scoring I 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.

    Conclusion: In postpartum women, using the risk score could help to streamline the diagnosis of PPCM with significant accuracy, prior to confirmatory investigations.

  • 6.
    Karaye, Kamilu M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Dept of Medicine Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria.
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Left ventricular structure and function among sisters of peripartum cardiomyopathy patients2015Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 182, s. 34-35Artikel i tidskrift (Refereegranskat)
  • 7.
    Karaye, Kamilu M
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria.
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    One Year Survival in Nigerians with Peripartum Cardiomyopathy2016Ingår i: Heart Views, ISSN 1995-705X, Vol. 17, nr 2, s. 55-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Peripartum cardiomyopathy (PPCM) is common in North-Western Nigeria. This study aimed to describe the 1-year survival and left ventricular reverse remodeling (LVRR) in a group of patients with PPCM from three referral hospitals in Kano, Nigeria.

    METHODS: PPCM was defined according to recommendations of the Heart Failure (HF) Association of the European Society of Cardiology Working Group on PPCM. LVRR was defined as absolute increase in left ventricular ejection fraction (LVEF) by ≥10.0% and decrease in left ventricular (LV) end-diastolic dimension indexed to body surface area ≤33.0 mm/m(2), while recovered LV systolic function as LVEF ≥55%, at 12 months follow-up.

    RESULTS: A total of 54 newly diagnosed PPCM patients with mean age of 26.6 ± 6.7 years, presented with classical features of predominantly left-sided HF and 33 of them qualified for follow-up. Of the 17 survivors at 12 months, 8 patients (47.1%) satisfied the criteria for LVRR, of whom 5 (29.4%) had recovered LV systolic function (LVEF ≥55%), but LVRR was not predicted by any variable in the regression models. The prevalence of normal LV diastolic function increased from 11.1% at baseline to 35.3% at 12 months (P = 0.02). At 1-year follow-up, 41.4% of patients had died (two-thirds of them within the first 6 months), but mortality was not predicted by any variable including LVRR.

    CONCLUSIONS: In Kano, PPCM patients had modest LVRR but high mortality at 1-year. Further studies should be carried out to identify reasons for the high mortality and how to curb it.

  • 8.
    Karaye, Kamilu M
    et al.
    Department of Medicine, Bayero University, Kano, Nigeria.
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Prevalence and predictors of right ventricular diastolic dysfunction in peripartum cardiomyopathy2017Ingår i: Journal of Echocardiography, ISSN 1349-0222, E-ISSN 1880-344X, Vol. 15, nr 3, s. 135-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This study aimed to assess the prevalence of right ventricular diastolic dysfunction (RVDD) and its potential predictors in peripartum cardiomyopathy (PPCM) patients.

    METHODS: 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.

    RESULTS: Forty-three subjects with PPCM and mean age of 26.6 ± 7.0 years were recruited over 6 months. RVDD was found in 30 (69.8 %) subjects, of whom 16 (53.3 %) had grade I, 12 (40.0 %) had grade II and 2 (6.7 %) had grade III 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 ± 12.0 µg/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 <70 µg/L increased the odds of RVDD by 6.67-fold (CI = 1.18-37.78; p = 0.032).

    CONCLUSIONS: 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.

  • 9.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sa'idu, Hadiza
    Balarabe, Sulaiman A.
    Ishaq, Naser A.
    Adamu, Umar G.
    Mohammed, Idris Y.
    Oboirien, Isa
    Umuerri, Ejiroghene M.
    Mankwe, Abaram C.
    Shidali, Vincent Y.
    Njoku, Paschal
    Dodiyi-Manuel, Sotonye
    Olunuga, Taiwo
    Josephs, Veronica
    Mbakwem, Amam C.
    Okolie, Henry
    Talle, Mohammed A.
    Isa, Muhammad S.
    Ogah, Okechukwu S.
    Stewart, Simon
    Clinical Features and Outcomes of Peripartum Cardiomyopathy in Nigeria2020Ingår i: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 76, nr 20, s. 2352-2364Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND Nigeria has the highest incidence of peripartum cardiomyopathy (PPCM) in the world. However, data on PPCM-related outcomes are limited. OBJECTIVES The purpose of this study was to examine the clinical profile, myocardial remodeling, and survival of patients with PPCM in Nigeria. METHODS This study consecutively recruited 244 PPCM patients (median 7 months postpartum) at 14 sites in Nigeria and applied structured follow-up for a median of 17 months (interquartile range: 14 to 20 months). Left ventricular reverse remodeling (LVRR) was defined as the composite of left ventricular (LV) end-diastolic dimension <33 mm/m(2) and absolute increase in left ventricular ejection fraction (LVEF) >= 10%. LV full recovery was defined as LVEF >= 55%. RESULTS Overall, 45 (18.7%) patients died during follow-up. Maternal age <20 years (hazard ratio [HR]: 2.40; 95% confidence interval (CI): 1.27 to 4.54), hypotension (HR: 1.87; 95% CI: 1.02 to 3.43), tachycardia (HR: 2.38; 95% CI: 1.05 to 5.43), and LVEF <25% at baseline (HR: 2.11; 95% CI: 1.12 to 3.95) independently predicted mortality. Obesity (HR: 0.16; 95% CI: 0.04 to 0.55) and regular use of beta-blockers at 6-month follow-up (HR: 0.20; 95% CI: 0.09 to 0.41) were independently associated with reduced risk for mortality. In total, 48 patients (24.1%) achieved LVRR and 45 (22.6%) achieved LV full recovery. LVEF <25% at baseline (HR: 0.66; 95% CI: 0.47 to 0.92) and regular use of beta-blockers at 6-month follow-up (HR: 1.62; 95% CI: 1.17 to 2.25) independently determined the risk for LV full recovery. Progressive reverse remodeling of all cardiac chambers was observed. In total, 18 patients (7.4%) were hospitalized during the study. CONCLUSIONS This is the largest study of PPCM in Africa. Consistent with late presentations, the mortality rate was high, whereas frequencies of LVRR and LV full recovery were low. Several variables predicted poor outcomes, and regular use of beta-blockers correlated with late survival and LV functional recovery. (C) 2020 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

  • 10.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Department of Medicine, Bayero University, Kano, Nigeria; Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria.
    Sa'idu, Hadiza
    Balarabe, Suleiman A.
    Ishaq, Naser A.
    Sanni, Bushra
    Abubakar, Haruna
    Mohammed, Baba Lawan
    Abdulsalam, Tijjani
    Tukur, Jamilu
    Mohammed, Idris Y.
    Selenium supplementation in patients with peripartum cardiomyopathy: a proof-of-concept trial2020Ingår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 20, nr 1, artikel-id 457Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We studied the efficacy and safety of selenium supplementation in patients who had peripartum cardiomyopathy (PPCM) and selenium deficiency.

    Methods: We randomly assigned 100 PPCM patients with left ventricular ejection fraction (LVEF) < 45% and selenium deficiency (< 70 mu g/L) to receive either oral Selenium (L-selenomethionine) 200 mu g/day for 3 months or nothing, in addition to recommended therapy, in an open-label randomised trial. The primary outcome was a composite of persistence of heart failure (HF) symptoms, unrecovered LV systolic function (LVEF < 55%) or death from any cause.

    Results: Over a median of 19 months, the primary outcome occurred in 36 of 46 patients (78.3%) in the selenium group and in 43 of 54 patients (79.6%) in the control group (hazard ratio [HR] 0.69; 95% confidence interval [CI] 0.43-1.09; p = 0.113). Persistence of HF symptoms occurred in 18 patients (39.1%) in the selenium group and in 37 patients (68.5%) in the control group (HR 0.53; 95% CI 0.30-0.93; p = 0.006). LVEF < 55% occurred in 33 patients (71.7%) in the selenium group and in 38 patients (70.4%) in the control group (HR 0.91; 95% CI 0.57-1.45; p = 0.944). Death from any cause occurred in 3 patients (6.5%) in the selenium group and in 9 patients (16.7%) in the control group (HR 0.37; 95% CI 0.10-1.37; p = 0.137).

    Conclusions: In this study, selenium supplementation did not reduce the risk of the primary outcome, but it significantly reduced HF symptoms, and there was a trend towards a reduction of all-cause mortality.

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  • 11.
    Karaye, Kamilu M.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Yahaya, Isah A.
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Serum Selenium and Ceruloplasmin in Nigerians with Peripartum Cardiomyopathy2015Ingår i: International Journal of Molecular Sciences, ISSN 1661-6596, E-ISSN 1422-0067, Vol. 16, nr 4, s. 7644-7654Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study aimed to determine if selenium deficiency, serum ceruloplasmin and traditional birth practices are risk factors for peripartum cardiomyopathy (PPCM), in Kano, Nigeria. This is a case-control study carried out in three hospitals, and PPCM patients were followed up for six months. Critically low serum selenium concentration was defined as <70 mu g/L. A total of 39 PPCM patients and 50 controls were consecutively recruited after satisfying the inclusion criteria. Mean serum selenium in patients (61.7 +/- 14.9 mu g/L) was significantly lower than in controls (118.4 +/- 45.6 mu g/L) (p < 0.001). The prevalence of serum selenium <70 mu g/L was significantly higher among patients (76.9%) than controls (22.0%) (p < 0.001). The mean ceruloplasmin and prevalence of socio-economic indices, multiparity, pregnancy-induced hypertension, obesity and twin pregnancy were not different between the groups (p > 0.05). Logistic regression showed that rural residency significantly increased the odds for serum selenium <70 mu g/L by 2.773-fold (p = 0.037). Baseline serum levels of selenium and ceruloplasmin were not associated with six-month mortality. This study has shown that selenium deficiency is a risk factor for PPCM in Kano, Nigeria, and is related to rural residency. However, serum ceruloplasmin, customary birth practices and some other characteristics were not associated with PPCM in the study area.

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  • 12.
    Karaye, Kamilu Musa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Clinical characteristics and prognosis of peripartum cardiomyopathy2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background:

    Peripartum cardiomyopathy (PPCM) is an incompletely understood disease that causes significant morbidity and mortality in many parts of the world, including Northern Nigeria. The aims of this Thesis were: [1] to determine if selenium deficiency, serum ceruloplasmin and traditional birth practices are risk factors for PPCM, in Kano, Nigeria; [2] to describe the one year survival and left ventricular reverse remodeling (LVRR) in a group of patients with PPCM from three referral hospitals in Kano, Nigeria; [3] to identify potential electrocardiographic (ECG) predictors of PPCM; and [4] to assess right ventricular systolic dysfunction (RVSD) and remodelling in a cohort of PPCM patients in Kano, Nigeria.

    Materials and Methods:

    The studies were carried out in 3 referral hospitals in Kano, Nigeria. Study 1: This was a case-control study. Critically low serum selenium concentration was defined as <70μg/L. Study 2: This was a longitudinal study. LVRR was defined as absolute increase in LV ejection fraction (LVEF) by ≥10.0% and decrease in LV end-diastolic dimension indexed to body surface area (LVEDDi) ≤33.0 mm/m2, while recovered LV systolic function as LVEF ≥55%, at 12 months follow-up. Study 3: This was a case-control study. Logistic regression models and a risk score were developed to determine ECG predictors of PPCM. Study 4: This was a longitudinal study and patients were followed up for 12 months. RVSD was defined as the presence of either tricuspid annular plane systolic excursion (TAPSE) <16mm or peak systolic wave (S’) tissue Doppler velocity of RV free wall <10cm/s. Recovery of RV systolic function was defined as an improvement of reduced TAPSE to ≥16mm or S’ to ≥10cm/s, without falling to reduced levels again, during follow-up.

    Results:

    Study 1: Total of 39 PPCM patients and 50 controls were consecutively recruited after satisfying the inclusion criteria. Mean serum selenium in patients (61.7±14.9μg/L) was significantly lower than in controls (118.4±45.6μg/L) (p<0.001). The prevalence of serum selenium <70μg/L was significantly higher among patients (76.9%) than controls (22.0%) (p<0.001). The mean ceruloplasmin and prevalence of socio-economic indices, multiparity, pregnancy-induced hypertension, obesity and twin pregnancy were not different between the groups (p>0.05). Logistic regression showed that rural residency significantly increased the odds for serum selenium <70μg/L by 2.773 fold (p=0.037). Study 2: A total of 33 patients were followed-up. Of the 17 survivors at 12 months, 8 patients (47.1%) satisfied the criteria for LVRR, of whom 5 (29.4%) had recovered LV systolic function, but LVRR was not predicted by any variable in the regression models. The prevalence of normal LV diastolic function increased from 11.1% at baseline to 35.3% at twelve months (p=0.02). At one year follow-up, 41.4% of patients had died (two thirds of them within the first 6 months), but mortality wasn’t predicted by any variable including LVRR. Study 3: A total of 54 PPCM and 77 controls were studied. A rise in heart rate by 1 beat/minute increased the odds of PPCM by 6.4% (p=0.001), while presence of ST-T-wave changes increased the odds of PPCM by 12.06 fold (p<0.001). In patients, QRS duration modestly correlated (r=0.4; p<0.003) with LV dimensions and end-systolic volume index (LVESVI), and was responsible for 19.9% of the variability of the latter (R2 = 0.199; p=0.003). A risk score of ≥2 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. Study 4: A total of 45 patients were studied. RV systolic function recovery occurred in a total of 8 patients (8/45; 17.8%), of whom 6 (75.0%) recovered in 6 months after diagnosis. The prevalence of RVSD fell from 71.1% at baseline to 36.4% at 6 months (p=0.007) and 18.8% at one year (p=0.0008 vs baseline; p=0.41 vs 6 month). Although 83.3% of the deceased had RVSD, it didn’t predict mortality in the regression models (p>0.05).

    Conclusion:

    These studies have shown that selenium deficiency seems to be a risk factor for PPCM in Kano, Nigeria, related to rural residency. However, serum ceruloplasmin, customary birth practices and some other characteristics were not associated with PPCM in the study area. They have also shown that PPCM patients had modest LVRR but high mortality at one year. In addition, using the ECG risk score could help to streamline the diagnosis of PPCM with significant accuracy, prior to confirmatory investigations in postpartum women. Finally, RVSD and reverse remodelling were common in Nigerians with PPCM, in whom the first 6 months after diagnosis seem to be critical for RV recovery and survival.

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  • 13.
    Karaye, Kamilu Musa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, 3 New Hospital Road, Kano, Nigeria..
    Lindmark, Krister
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Right ventricular systolic dysfunction and remodelling in Nigerians with peripartum cardiomyopathy: a longitudinal study2016Ingår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, artikel-id 27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The literature on right ventricular systolic dysfunction (RVSD) in peripartum cardiomyopathy (PPCM) patients is scanty, and it appears that RV reverse remodelling in PPCM has not been previously described. This study thus aimed to assess RVSD and remodelling in a cohort of PPCM patients in Kano, Nigeria.

    METHODS: A longitudinal study carried out in 3 referral hospitals in Kano, Nigeria. Consecutive PPCM patients who had satisfied the inclusion criteria were recruited and followed up for 12 months. RVSD was defined as the presence of either tricuspid annular plane systolic excursion (TAPSE) <16 mm or peak systolic wave (S') tissue Doppler velocity of RV free wall <10 cm/s. For the purpose of this study, recovery of RV systolic function was defined as an improvement of reduced TAPSE to ≥16 mm or S' to ≥10 cm/s, without falling to reduced levels again, during follow-up.

    RESULTS: A total of 45 patients were recruited over 6 months with a mean age of 26.6 ± 7.0 years. RV systolic function recovery occurred in a total of 8 patients (8/45; 17.8 %), of whom 6 (75.0 %) recovered in 6 months after diagnosis. The prevalence of RVSD fell from 71.1 % at baseline to 36.4 % at 6 months (p = 0.007) and 18.8 % at 1 year (p = 0.0008 vs baseline; p = 0.41 vs 6 month). Patients with RVSD had higher serum creatinine, and TAPSE accounted for 19.2 % (p = 0.008) of the variability of serum creatinine at 6 months. Although 83.3 % of the deceased had RVSD, it didn't predict mortality in the regression models (p > 0.05).

    CONCLUSION: RVSD and reverse remodelling were common in Nigerians with PPCM, in whom the first 6 months after diagnosis seem to be critical for RV recovery and survival.

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