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.

Leukocyte antigens and disease: III. Association of HLA-B8 and HLA-BW 15 with insulin-dependent diabetes in three different population groups.

The distribution of 20 HLA antigens in 382 diabetic and 184 control subjects of white, Mexican-American, and black ancestry was studied. In all three populations, the incidence of antigens BB and BW15 was higher in the insulin-dependent diabetics than in the controls. The differences fell short of statistical significance when corrections were made for the number of antigens studied. When the results of previous studies were combined with our own, there was a highly significant association of insulin-dependent diabetes and the antigens BB and BW15 in the white population. It seems highly likely that this association would also hold true for the Mexican-American and the black diabetics if a sufficient number of patients were studied.