Fundikira Lulu Said, Chillo Pilly, Alimohamed Mohamed Z, Mayala Henry, Kifai Engerasiya, Aloyce Geofrey M, Kamuhabwa Appolinary, Kwesigabo Gideon, van Laake Linda W, Asselbergs Folkert W
Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania, Tanzania.
Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania.
Glob Heart. 2024 Feb 29;19(1):26. doi: 10.5334/gh.1298. eCollection 2024.
Non-ischemic dilated cardiomyopathy (NIDCM) is a common cause of heart failure with progressive tendency. The disease occurs in one in every 2,500 individuals in the developed world, with high morbidity and mortality. However, detailed data on the role of NIDCM in heart failure in Tanzania is lacking.
To characterize NIDCM in a Tanzanian cohort with respect to demographics, clinical profile, imaging findings and management.
Characterization of non-ischemic dilated cardioMyOpathY in a native Tanzanian cOhort (MOYO) is a prospective cohort study of NIDCM patients seen at the Jakaya Kikwete Cardiac Institute. Patients aged ≥18 years with a clinical diagnosis of heart failure, an ejection fraction of ≤45% on echocardiography and no evidence of ischemia were enrolled. Clinical data, echocardiography, electrocardiography (ECG), coronary angiography and stress ECG information were collected from February 2020 to March 2022.
Of 402 patients, n = 220 (54.7%) were males with a median (IQR) age of 55.0 (41.0, 66.0) years. Causes of NIDCM were presumably hypertensive n = 218 (54.2%), idiopathic n = 116 (28.9%), PPCM n = 45 (11.2%), alcoholic n = 10 (2.5%) and other causes n = 13 (3.2%). The most common presenting symptoms were dyspnea n = 342 (85.1%), with the majority of patients presenting with New York Heart Association (NYHA) Class III n = 195 (48.5%). The mean (SD) left ventricular ejection fraction (LVEF) was 29.4% (±7.7), and severe systolic dysfunction (LVEF <30%) was common n = 208 (51.7%). Compared with other forms of DCM, idiopathic DCM patients were significantly younger, had more advanced NYHA class (p < 0.001) and presented more often with left bundle branch block on ECG (p = 0.0042). There was suboptimal use of novel guidelines recommended medications ARNI n = 10 (2.5%) and SGLT2 2-inhibitors n = 2 (0.5%).
In our Tanzanian cohort, the majority of patients with NIDCM have an identified underlying cause, and they present at late stages of the disease. Patients with idiopathic DCM are younger with more severe disease compared to other forms of NIDCM.
非缺血性扩张型心肌病（NIDCM）是心力衰竭的常见病因，具有进行性发展趋势。在发达国家，该病的发病率为每2500人中就有1人患病，其发病率和死亡率都很高。然而，关于NIDCM在坦桑尼亚心力衰竭中作用的详细数据尚缺乏。
在一个坦桑尼亚队列中，从人口统计学、临床特征、影像学表现和治疗方面对NIDCM进行特征描述。
在坦桑尼亚本土队列（MOYO）中对非缺血性扩张型心肌病进行特征描述，这是一项对在贾卡亚·基奎特心脏研究所就诊的NIDCM患者进行的前瞻性队列研究。纳入年龄≥18岁、临床诊断为心力衰竭、超声心动图显示射血分数≤45%且无缺血证据的患者。收集了2020年2月至2022年3月期间的临床数据、超声心动图、心电图（ECG）、冠状动脉造影和负荷心电图信息。
在402例患者中，n = 220例（54.7%）为男性，中位（四分位间距）年龄为55.0（41.0，66.0）岁。NIDCM的病因据推测为高血压n = 218例（54.2%）、特发性n = 116例（28.9%）、围产期心肌病n = 45例（11.2%）、酒精性n = 10例（2.5%）和其他病因n = 13例（3.2%）。最常见的首发症状为呼吸困难n = 342例（85.1%），大多数患者表现为纽约心脏协会（NYHA）Ⅲ级n = 195例（48.5%）。平均（标准差）左心室射血分数（LVEF）为29.4%（±7.7），严重收缩功能障碍（LVEF <30%）很常见n = 208例（51.7%）。与其他形式的扩张型心肌病相比，特发性扩张型心肌病患者明显更年轻，NYHA分级更高（p < 0.001），心电图上更常出现左束支传导阻滞（p = 0.0042）。新型指南推荐药物ARNI的使用率较低n = 10例（2.5%），钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂的使用率为n = 2例（0.5%）。
在我们的坦桑尼亚队列中，大多数NIDCM患者有明确的潜在病因，且疾病处于晚期。与其他形式的NIDCM相比，特发性扩张型心肌病患者更年轻，疾病更严重。
