Unrecognized peripartum cardiomyopathy in Haitian women.

OBJECTIVE: Haitian women have a high relative incidence of clinical presentation with peripartum cardiomyopathy (PPCM): an incidence estimated at one case per three hundred live births, a ten-fold occurrence compared to American women. Our objective has been to test the hypothesis that some Haitian women may have a forme fruste of PPCM while still without clinical symptoms. METHOD: A preliminary case-control study was conducted at the Hospital Albert Schweitzer (HAS), Deschapelles, Haiti, in which 25 apparently healthy postpartum women, without cardiovascular symptoms and with a normal cardiovascular clinical examination, were selected from a consecutive list of obstetrical deliveries and screened by echocardiography for left ventricular dysfunction. RESULT: Four out of 25 patients (16%) had asymptomatic left ventricular dysfunction that subsequently evolved towards either improvement or deterioration. Supporting evidence for the existence of asymptomatic left ventricular dysfunction or forme fruste PPCM is presented. A hypothetical schema of the pathophysiology of PPCM explains how a latent phase of variable duration may exist prior to onset of detectable clinical heart failure. CONCLUSION: Screening Haitian women during the last month of pregnancy or in the early postpartum period may help to detect asymptomatic left ventricular dysfunction. Early detection and treatment of PPCM in a known high risk population could lead to improvements in maternal and fetal mortality and morbidity.

Emerging insights into peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is relatively common in the Hospital Albert Schweitzer (HAS) district of Haiti. This investigation was carried out to expand epidemiologic data aiming at identifying risk factors for PPCM in this population. The HAS District PPCM Registry with 74 PPCM patients, enrolled from 1 February 2000 to 1 September 2002, served to identify the PPCM patients involved in this study. Thirty-seven non-PPCM Haitian mothers from the HAS district served as controls in the case-control study I and 32 non-PPCM Haitian mothers from the HAS district served as controls for the case-control study II. Following informed consent, patients and controls participated in clinical examination, echocardiography, epidemiologic questionnaire interviews, and immunohaematologic testing. Findings revealed: increased parity in PPCM vs control mothers (4.6 vs 3.3, p = 0.0252); 47% of the PPCM mothers had their initial diagnosis with the 5th or more pregnancy; increased number of patients with some hospital prenatal care in PPCM vs control mothers (42% vs 0%, p = 0.00001); and increased valley unit PPCM vs control mothers with no formal schooling (54% vs 24%, p = 0.0054). However, when hill-unit controls were included, there was no statistical difference in this category. Taking drinking-water from the river was found in 11% of the valley PPCM mothers vs 0% of the valley control mothers (p = 0.0509). Although the first 59 PPCM cases identified came from the valley units, recent identification of PPCM mothers in the hill unit indicates similar incidence of PPCM in mothers of remote hill area compared to the valley mothers--approximately 1 per 350 to 400 livebirths. Although the cause of PPCM and reasons for increased incidence in the HAS district of Haiti remain unknown, initial data present emerging insights and avenues to pursue in subsequent studies.