Prevalence of Left Ventricular Dysfunction and Relationship with Serum Selenium in Apparently Healthy Pregnant Women: Results from the PEACE Registry


  • Kamilu Musa Karaye Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kno, Nigeria
  • Idris Y Mohammed
  • Hadiza Sa'idu
  • Naser A Ishaq
  • Suleiman A Balarabe
  • Jamilu Tukur
  • Tewogbade Adedeji
  • Olufemiwa N Makinde
  • Rasaaq A Adebayo



left ventricular dysfunction, pregnancy, selenium, peripartum cardiomyopathy, PEACE Registry


Background: The study aimed to determine the prevalence of left ventricular (LV) systolic and diastolic dysfunction in apparently healthy pregnant women and if there is relationship with serum selenium, in a society with high prevalence of peripartum cardiomyopathy (PPCM).

Methods: This was a prospective longitudinal study carried out in 3 centres in Kano, Nigeria. 108 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation and re-evaluated at the 6th to 8th weeks postpartum. Serum selenium was measured at enrolment during pregnancy. LV systolic dysfunction was defined as LV ejection fraction (LVEF) below 50%. 

Results: LV systolic dysfunction and diastolic dysfunction were found in 6 subjects (5.6%) and 20 subjects (18.5%) during pregnancy, and in 9 subjects (10.2%) (p=0.340) and 14 (15.9%) (p=0.631)  after delivery, respectively. Mean LVEF was 62.2±6.9% and 60.6±8.2% (p=0.108) during pregnancy and after delivery respectively. Selenium deficiency (<70μg/L) was found in only 2.8% of subjects, and serum selenium did not significantly correlate with indices for LV systolic (LVEF) or diastolic (mitral E/e’ ratio) functions both during pregnancy and after delivery. 

Conclusion: LV systolic and diastolic dysfunction and selenium deficiency were uncommon during apparently healthy pregnancy and early puerperium, and serum selenium did not correlate with indices for LV function, in a population with high prevalence of PPCM.


Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation 2014; 130: 1003-1008. PMID: 25223771. DOI:10.1161/CIRCULATIONAHA.114.009029

Melchiorre K, Sharma R, Khalil A, et al. Maternal cardiovascular function in pregnancy. Evidence of maladaptation to chronic volume overload. Hypertension 2016; 67: 754-762. PMID: 26962206. DOI:10.1161/HYPERTENSIONAHA.115.06667

Sliwa K, Hilfiker-Kleiner D, Petrie MC, et al. Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12(8): 767-778. PMID: 20675664. doi: 10.1093/eurjhf/hfq120.

Arany Z, Elkayam U. Peripartum cardiomyopathy. Circulation 2016; 133: 1397-1409. PMID: 27045128. doi: 10.1161/CIRCULATIONAHA.115.020491.

Karaye KM, Yahaya IA, Lindmark K, et al. Serum Selenium and Ceruloplasmin in Nigerians with Peripartum Cardiomyopathy. Int J Mol Sci 2015; 16: 7644-7654. PMID: 25853263. DOI:10.3390/ijms16047644

Karaye KM, Ishaq NA, Sa'idu H, Balarabe SA, Talle MA, Isa MS, et al; PEACE Registry Investigators. Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the peripartum cardiomyopathy in Nigeria Registry. ESC Heart Fail 2020; 7(1): 235-243. DOI: 10.1002/ehf2.12562

Karaye KM, Mohammed IY, Ogah OS, Okeahialam BN. Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE) Registry. International Cardiovascular Forum Journal 2017; 12: 12-17. DOI: 10.17987/icfj.v12i0.462

Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28(1): 1-39. PMID: 25559473. doi: 10.1016/j.echo.2014.10.003.

Kadish AH, Buxton AE, Kennedy HL, et al. ACC/AHA clinical competence statement on electrocardiography and ambulatory electrocardiography: a report of the American College of Cardiology/American Heart Association/ American College of Physicians − American Society of Internal Medicine Task Force on Clinical Competence (ACC/AHA Committee to Develop a Clinical Competence Statement on Electrocardiography and Ambulatory Electrocardiography). J Am Coll Cardiol 2001; 38: 2091−2100. PMID: 11738321

World Medical Association Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. J Postgrad Med 2002; 48: 206-208. PMID: 12432198

Cenac A, Simonoff M, Moretto P, Djibo A. A low plasma selenium is a risk factor for peripartum cardiomyopathy. A comparative study in Sahelian Africa. Int J Cardiol 1992; 36: 57–59. PMID:1428253

Robson SC, Hunter S, Moore M, Dunlop W. Haemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Br J Obstet Gynaecol 1987; 94: 1028–1039. PMID: 3322367

Ducas RA, Elliott JE, Melnyk SF, et al. Cardiovascular magnetic resonance in pregnancy: insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study. J Cardiovasc Magn Reson 2014; 16: 1. PMID: 24387349. DOI: 10.1186/1532-429X-16-1

Umar S, Nadadur R, Iorga A, Amjedi M, Matori H, Eghbali M. Cardiac structural and hemodynamic changes associated with physiological heart hypertrophy of pregnancy are reversed postpartum. J Appl Physiol 2012; 113: 1253–1259. PMID: 22923507. DOI:10.1152/japplphysiol.00549.2012

Nwagha UI, Ogbodo SO, Nwogu-Ikojo EE, et al. Copper and selenium status of healthy pregnant women in Enugu, south-eastern Nigeria. Niger J Clin Pract 2011; 14(4): 408-412. PMID: 22248939. DOI:10.4103/1119-3077.91745

Adeniyi MJ, Agoreyo FO. Nigeria and the Selenium Micronutrient: A Review. Curr Trends Biomedical Eng & Biosci 2018; 14(1): 555876.

Diaz-Alarcon JP, Navarro-Alarcon M, Lopez-Ga de la Serrana H, Lopez-Martinez MC. Determination of selenium in meat products by hydride generation atomic absorption spectrometry: selenium levels in meats, organ meats, and sausages in Spain. J Agric Food Chem 1996; 44: 1494-1497.

Li Y, Yang Y, Chen H. Detection of enteroviral RNA in paraffin-embedded myocardial tissue from patients with Keshan by nested PCR. Zhonghua Yi Xue Za Zhi 1995; 75: 344-345, 382. (In Chinese.) PMID:7553145

Peng T, Li Y, Yang Y, et al. Characterization of enterovirus isolates from patients with heart muscle disease in a selenium deficient area of China. J Clin Microbiol 2000; 38: 3538-3543. PMID:11015360

Davidson NM, Hudson B, Parry EHO. Defaulters from follow-up after peripartum cardiac failure. Trop Geogr Med 1975; 27: 103-108.

Shewan LG, Coats AJS, Henein MY. Authors’ Responsibilities and Ethical Publishing. International Cardiovascular Forum Journal 2018; 13: 3-4. DOI: 10.17987/icfj.v13i0.525






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