Clinical characteristics and one-year all-cause mortality outcomes in Africans with dilated cardiomyopathy

Nqoba Tsabedze; Dineo Mpanya; Claude Bailly; Samantha Nel; Sacha Grinter; Michèle Ramsay; Amanda Krause; Quinn S. Wells; Pravin Manga

doi:10.1016/j.ijcard.2023.131142

June 24, 2023International Journal of CardiologyOpen Access

Clinical characteristics and one-year all-cause mortality outcomes in Africans with dilated cardiomyopathy

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Why the study?

Dilated cardiomyopathy is a common cause of heart failure in sub-Saharan Africa, presenting with new-onset HFrEF of unknown origin, but clinical characteristics need to be described.

What are the clinical characteristics and mortality outcomes of dilated cardiomyopathy in an African population?

Structured PICO

What are the clinical characteristics and mortality outcomes of dilated cardiomyopathy in an African population?

P

Population

93 African participants with dilated cardiomyopathy (new-onset heart failure with reduced ejection fraction and no identifiable primary or secondary aetiology), mean age 47.5 years.

O

Outcome

All-cause mortalityhard clinical

Dilated cardiomyopathy in this African cohort is associated with a high one-year all-cause mortality of 19%, with increased left atrial volume index serving as a potential prognostic marker.

Implication

DCM in young African males signals need for region-specific risk stratification; extends prognostic data but leaves optimal therapies open.

Abstract

Aims Dilated cardiomyopathy (DCM) is a common cause of heart failure in sub-Saharan Africa (SSA). The affected individuals present with new-onset heart failure with reduced ejection fraction and no identifiable primary or secondary aetiology. We aim to describe the clinical characteristics of participants with heart failure of unknown origin. Methods We screened 161 participants with heart failure of unknown origin and prospectively excluded primary and secondary causes of DCM. All study participants were subjected to laboratory biochemical testing, echocardiography, cardiovascular magnetic resonance (CMR) imaging and invasive coronary angiography. Results The study comprised 93 participants with a mean age of 47.5 SD 13.1 years. Forty-six (56.1%) participants had evidence of late gadolinium enhancement (LGE) on imaging, and LGE was visualised in the mid wall in 28 (61.0%) of these participants. After a median duration of 13.4 months [interquartile range (IQR): 8.8–28.9 months], 18 (19%) participants died. Non-survivors had a higher median left atrial volume index (44.9 mL/m 2 (IQR: 34.4–58.7) compared to survivors [32.9 mL/m 2 (IQR: 24.5–47.0), p = 0.017)]. The rate of all-cause rehospitalisation was 29.3%, of which 17 of the 22 re-hospitalisations were heart failure related. Conclusion Dilated cardiomyopathy in Africans primarily affects young males. In our cohort, this disease was associated with an all-cause mortality of 19% in one year. In SSA, large multicenter studies are required to investigate this disease's pathogenesis and outcomes.