O.S. Ogah1,2, A. Adebiyi1,2 A. Aje2, A.M. Adeoye1,2 , O.O. Oladapo1,2, T.A. Adeyanju2, O.A. Orimolade2, C.D. Eze2, A.O. Babatunde3, M.F. Okeke3
- Department of Medicine, University of Ibadan, Nigeria..
- Department of Medicine, University College Hospital, Ibadan.
- Clinical Student, College of Medicine, University of Ibadan, Ibadan
Background: Cardiomyopathies contribute about 18.2-40.2% (average- 21.4%) to the global burden of heart failure of which dilated cardiomyopathy (DCM) is a major cause. DCM is the second commonest cause of heart failure in Ibadan. The gender differences in the clinical profile has not been described in our setting.
Objective: In this study, we set out to describe the gender differences in the pattern and presentation of DCM at the University College Hospital, Ibadan, Nigeria.
Methods: This was an analysis of a prospectively collected data over a period of 5 years (August 1, 2016 to July 31, 2021).
Results: A total of 117 subjects, 88 males (75.3%) and 29 females (24.8%) aged 50.30 ± 14.7 years (range, 17 to 86 years). Males had significantly achieved a higher educational level than females (p = 0.004). Males were more likely to be employed and had more monthly income compared to females. Males were significantly more likely to use alcohol and smoke cigarette (p = 0.0001 and 0.001 respectively). Females were more likely to be in NYHA class III/IV. There was no statistically significant difference in the relationship between any medication and gender of participants (p > 0.05).
Conclusions: DCM is a disease of young and middle-aged adults in our population. The commonest age group was 20-39 years and there was male preponderance. There were some gender differences in the clinical profile of the disease in our environment.
Keywords: Dilated cardiomyopathy, Heart failure, Left ventricular fail
Dr. O.S. Ogah
Department of Medicine,
University of Ibadan,
Date of Acceptance: 30th Dec., 2022
Dilated Cardiomyopathy (DCM) is ranked second in the causes of heart failure in Nigeria behind hypertensive heart failure.1-3 The clinical picture at the time of diagnosis can vary widely from patient to patient; some have no symptoms, whereas others have progressive refractory heart failure. Males have a 2.5- fold increase in risk, as compared with females, that is unexplained by socioeconomic factors, alcohol intake or other variables.4
Several gender differences have been reported in patients with DCM with respect to clinical presentation, risk factors, pathophysiology, and prognosis.5-9 Women generally fare much better than men. Although these important gender differences have been previously investigated in patients with DCM in high income countries5-9, little is known about the gender differences in DCM in Nigeria. The aim of this study is to determine the gender differences on the clinical and echocardiographic profile of patients with DCM in Ibadan, Nigeria.
MATERIALS AND METHODS
This was an observational study conducted at the Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria. Ethical approval for the study was obtained from the University of Ibadan/University College Hospital, Ethics Review Committee as part of the Ibadan Heart Failure Project. Consecutive cases of DCM who presented to the hospital during the study period were recruited. They were recruited over a period of 5 years from August 1st 2016 to July 31st 2021. Data were collected using pretested structured questionnaire.
Information collected included biodata, clinical features and echocardiographic findings. After written informed consent, a detailed history was taken and physical examination was carried out. Key points of the history included the sociodemographic characteristics, presenting symptoms, type of underlying heart disease, drug history including cancer chemotherapy. All the participants had baseline anthropometric measurements of weight and height for the calculation of body mass index (BMI). Blood investigations in the form of complete blood count, fasting blood glucose, renal function tests were done. Echocardiography was done for all the patients.
DCM was diagnosed by the presence of ventricular dilatation and systolic dysfunction (LV ejection fraction <45%) on echocardiography in the absence of coronary artery disease, hypertension or valvular disease. (10) All the patients were treated for cardiac failure by using diuretics, ACE inhibitors, mineralocorticoid antagonist, cardio-selective beta blockers, and occasionally cardiac glycosides. In some of the patients, anticoagulants and anti-arrhythmic drugs were also used when indicated.
Subjects who were unwilling to participate, those with coronary artery disease, cancer, rheumatic heart disease,
hypertrophic cardiomyopathy, hypertensive heart disease, and congenital heart disease, or evidence of restrictive cardiomyopathy or constrictive heart disease were excluded.