N-terminal pro BNP and galectin-3 are prognostic biomarkers of acute heart failure in sub-Saharan Africa : Lessons from the BAHEF trial

Journal article

Sani, Mahmoud U., Damasceno, Albertino, Davison, Beth A., Cotter, Gad, Mayosi, Bongani M., Edwards, Christopher, Azibani, Feriel, Adam, Tasneem, Arif, Gulnaze, Jessen, Neusa and Sliwa, Karen. (2021). N-terminal pro BNP and galectin-3 are prognostic biomarkers of acute heart failure in sub-Saharan Africa : Lessons from the BAHEF trial. ESC Heart Failure. 8(1), pp. 74-84. https://doi.org/10.1002/ehf2.13032
AuthorsSani, Mahmoud U., Damasceno, Albertino, Davison, Beth A., Cotter, Gad, Mayosi, Bongani M., Edwards, Christopher, Azibani, Feriel, Adam, Tasneem, Arif, Gulnaze, Jessen, Neusa and Sliwa, Karen
Abstract

Aims
The relationship between N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and galectin-3 and outcomes has not been studied in African patients with acute heart failure (AHF). The current analysis sought to describe the association between plasma levels of NT-pro-BNP and galectin-3 and cardiovascular (CV) death or heart failure (HF) hospitalization, as well as their associations with symptoms and echocardiography markers of left and right ventricular remodelling among AHF patientsv in sub-Saharan Africa.

Methods and results
In a subset of 80 patients with complete data in a study assessing the effects of hydralazine and nitrates in patients with AHF (BAHEF trial; NCT01822808), NT-pro-BNP and galectin-3 analyses were performed, and the association with various characteristics and outcome measures assessed. The mean age of the patients for whom the aforementioned biomarkers were measured was 52.6 years, with 52.5% women. Galectin-3 at baseline predicted changes (Week 24 to baseline) in left ventricular ejection fraction, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and tricuspid annular plane systolic excursion. Biomarkers and their changes were not associated with changes in 6 min walk test at 24 weeks. Baseline galectin-3 and change in NT-pro-BNP were associated with improvements in dyspnoea at 24 weeks. Nine patients had an HF readmission or died of CV causes through 24 weeks (11.6%). Both biomarkers at baseline predicted combined CV death or HF hospitalization through Week 24 (P-values = 0.0328 and 0.0001, respectively).

Conclusions
In a cohort of patients with AHF from sub-Saharan Africa, NT-pro-BNP and galectin-3 at baseline and their changes were associated with some changes in dyspnoea, echocardiographic remodelling, and CV death or HF hospitalization through Week 24. These tests have potential of being used for risk stratification of AHF patients in sub-Saharan Africa where resources are scarce.

KeywordsNT‐pro‐BNP; Galectin‐3; outcomes; acute heart failure; Africa
Year2021
JournalESC Heart Failure
Journal citation8 (1), pp. 74-84
PublisherJohn Wiley & Sons
ISSN2055-5822
Digital Object Identifier (DOI)https://doi.org/10.1002/ehf2.13032
Scopus EID2-s2.0-85096852118
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Publisher's version
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Open
Output statusPublished
Publication dates
Online28 Nov 2020
Publication process dates
Accepted10 Sep 2020
Deposited29 Jun 2021
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Azibani, Feriel and Sliwa-Hahnle, Karen. (2018). Peripartum cardiomyopathy: an update. Current Heart Failure Reports (Print). 15(5), pp. 297 - 306. https://doi.org/10.1007/s11897-018-0404-x
Rationale and design of the comparison of 3 combination therapies in lowering blood pressure in black Africans (CREOLE study): 2 x 3 factorial randomized single-blind multicenter trial
Ojji, Dike, Poulter, Neil R., Damasceno, Albertino, Sliwa-Hahnle, Karen, Smythe, Wynand, Kramer, Nicky, Badri, Motasim, Francis, Veronica, Aje, Akinyemi, Barasa, Felix, Dzudie, Anastase, Jones, Erika, Kana, Shehu S., Mntla, Pindile, Mondo, Charles, Ogah, Okechukwu, Ogola, Elijah, Ogunbanjo, G., Okpechi, Ikechi, ... Mayosi, Bongani. (2018). Rationale and design of the comparison of 3 combination therapies in lowering blood pressure in black Africans (CREOLE study): 2 x 3 factorial randomized single-blind multicenter trial. American Heart Journal. 202, pp. 5 - 12. https://doi.org/10.1016/j.ahj.2018.03.023
Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy
Hilfiker-Kleiner, Denise, Haghikia, A., Masuko, David, Nonhoff, Justus, Held, Dominik, Libhaber, Elena, Petrie, Mark C., Walker, Niki L., Podewski, Edith, Berliner, Dominik, Bauersachs, J. and Sliwa-Hahnle, Karen. (2017). Outcome of subsequent pregnancies in patients with a history of peripartum cardiomyopathy. European Journal of Heart Failure. 19(12), pp. 1723 - 1728. https://doi.org/10.1002/ejhf.80
Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon
Aminde, Leopold N., Dzudie, Anastase, Kengne, Andre P., Ndjebet, J., Mapoh, S., Kuelang, X., Kamdem, F., Ngahane, B. H. M., Doualla, M. S., Ngu, K. B., Sliwa-Hahnle, Karen and Thienemann, Friedrich. (2017). Gender disparities in pulmonary hypertension at a tertiary centre in Cameroon. SAMJ South African Medical Journal. 107(10), pp. 892 - 899. https://doi.org/10.7196/SAMJ.2017.v107i10.12321
Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study
Hilfiker-Kleiner, Denise, Haghikia, A., Berliner, Dominik, Vogel-Claussen, Jens, Schwab, Johannes, Franke, Annegret, Schwarzkopf, Marziel, Ehlermann, Philipp, Pfister, Roman, Michels, Guido, Westenfeld, Ralf, Stangl, Verena, Kindermann, Ingrid, Kühl, Uwe, Angermann, Christiane E., Schlitt, Axel, Fischer, D., Podewski, Edith, Bohm, Michael, ... Bauersachs, J.. (2017). Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. European Heart Journal. 38(35), pp. 2671 - 2679. https://doi.org/10.1093/eurheartj/ehx355
Soluble ST2 correlates with some indicators of right ventricular function in hypertensive heart failure
Ojji, Dike, Lecour, Sandrine, Adeyemi, O. M. and Sliwa-Hahnle, Karen. (2017). Soluble ST2 correlates with some indicators of right ventricular function in hypertensive heart failure. Vascular Health and Risk Management. 13, pp. 311 - 316. https://doi.org/10.2147/VHRM.S127430
Organisation of care for pregnancy in patients with congenital heart disease
Roos-Hesselink, Jolien W., Budts, Werner, Walker, Fiona, De Backer, Julie F. A., Swan, Lorna, Stones, William, Kranke, Peter, Sliwa-Hahnle, Karen and Johnson, Mark R.. (2017). Organisation of care for pregnancy in patients with congenital heart disease. Heart. 103(23), pp. 1854 - 1859. https://doi.org/10.1136/heartjnl-2017-311758
Addressing the shortage of research capacity in cardiovascular disease in Africa via leadership training
Dzudie, Anastase and Sliwa-Hahnle, Karen. (2017). Addressing the shortage of research capacity in cardiovascular disease in Africa via leadership training. Heart Asia. 9(1), pp. 96 - 98. https://doi.org/10.1136/heartasia-2016-010834
Parvovirus b19-induced vascular damage in the heart is associated with elevated circulating endothelial microparticles
Bachelier, Katrin, Biehl, Susanne, X., Viktoria, Kindermann, Ingrid, Kandolf, Reinhard, Sauter, Martina, Ukena, C., Yilmaz, Ali, Sliwa-Hahnle, Karen, Bock, Claus-Thomas, Klingel, Karin and Bohm, Michael. (2017). Parvovirus b19-induced vascular damage in the heart is associated with elevated circulating endothelial microparticles. PLoS ONE. 12(5), pp. 1 - 13. https://doi.org/10.1371/journal.pone.0176311
Imbalanced angiogenesis in peripartum cardiomyopathy: diagnostic value of placenta growth factor
Mebazaa, Alexandre, Seronde, Marie-France, Gayat, Etienne, Tibazarwa, Kemi, Anumba, Dilly O. C., Akrout, Najla, Sadoune, Malha, Sarb, Jamela, Arrigo, M., Motiejunaite, Justina, Laribi, Said, Legrand, Matthieu, Deschamps, Lydia, Fazal, Loubina, Bouadma, Lila, Collet, Corinne, Manivet, Philippe, Solal, Alain Cohen, Launay, Jean-Marie, ... Sliwa-Hahnle, Karen. (2017). Imbalanced angiogenesis in peripartum cardiomyopathy: diagnostic value of placenta growth factor. Circulation Journal. 81(11), pp. 1654 - 1661. https://doi.org/10.1253/circj.CJ-16-1193
Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study
Dokainish, Hisham, Teo, Koon K., Zhu, Jun, Roy, Ambuj, Alhabib, Khalid F., Elsayed, Ahmed, Palileo-Villaneuva, Lia, Lopez-Jaramillo, Patricio, Karaye, Kamilu M., Yusoff, Khalid, Orlandini, Andres, Sliwa-Hahnle, Karen, Mondo, Charles, Lanas, Fernando, Prabhakaran, Dorairaj, Badr, Amr, Elmaghawry, Mohamed, Damasceno, Albertino, Tibazarwa, Kemi, ... Yusuf, Salim. (2017). Global mortality variations in patients with heart failure: results from the International Congestive Heart Failure (INTER-CHF) prospective cohort study. The Lancet Global Health. 5(7), pp. 665 - 672. https://doi.org/10.1016/S2214-109X(17)30196-1
Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM)
Sliwa-Hahnle, Karen, Mebazaa, Alexandre, Hilfiker-Kleiner, Denise, Petrie, Mark C., Maggioni, Aldo P., Laroche, Cecile, Regitz-Zagrosek, Vera, Schaufelberger, Maria, Tavazzi, Luigi, van der Meer, Peter, Roos-Hesselink, Jolien W., Seferovic, Petar, van Spandonck-Zwarts, Karin, Mbakwem, Amam, Bohm, Michael, Mouquet, Frederic, Pieske, Burkert, Hall, Roger, Ponikowski, Piotre and Bauersachs, J.. (2017). Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM). European Journal of Heart Failure. 19(9), pp. 1131 - 1141. https://doi.org/10.1002/ejhf.780
Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa
Ojji, Dike, Lamont, Kim, Ojji, Olubunmi I., Egenti, Bibiana N. and Sliwa-Hahnle, Karen. (2017). Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa. Cardiovascular Journal of Southern Africa (South Africa). 28(4), pp. 251 - 256. https://doi.org/10.5830/CVJA-2016-082
Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the pan-African pulmonary hypertension cohort (PAPUCO) study
Balieva, Irina, Dzudie, Anastase, Thienemann, Friedrich, Mocumbi, Ana O., Karaye, Kamilu M., Sani, Mahmoud U., Ogah, Okechukwu, Voors, Adriaan A., Kengne, Andre Pascal and Sliwa-Hahnle, Karen. (2017). Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the pan-African pulmonary hypertension cohort (PAPUCO) study. Cardiovascular Journal of Southern Africa (South Africa). 28(6), pp. 370 - 376. https://doi.org/10.5830/CVJA-2017-020
Echocardiographic predictors of outcome in acute heart failure patients in sub-saharan africa: insights from THESUS-HF
Sani, Mahmoud U., Davidson, Beth A., Cotter, Gad, Damasceno, Albertino, Mayosi, Bongani, Ogah, Okechukwu, Mondo, Charles, Dzudie, Anastase, Ojji, Dike, Kouam, Charles K., Suliman, Ahmed, Yonga, Gerald, Ba, Sergine A., Maru, Fikru, Alemayehu, Bekele, Edwards, Christopher and Sliwa-Hahnle, Karen. (2017). Echocardiographic predictors of outcome in acute heart failure patients in sub-saharan africa: insights from THESUS-HF. Cardiovascular Journal of Africa. 28(1), pp. 60 - 67. https://doi.org/10.5830/CVJA-2016-070
Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
Bohm, Michael, Schumacher, Helmut, Teo, Koon K., Lonn, Eva M., Mahfoud, Felix, Mann, Johannes F.E., Mancia, Giuseppe, Redon, Josep, Schmieder, Roland E., Sliwa-Hahnle, Karen, Weber, Michael A., Williams, Bryan and Yusuf, Salim. (2017). Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. The Lancet. 389(10085), pp. 2226 - 2237. https://doi.org/10.1016/S0140-6736(17)30754-7
Roadmap to achieve 25% hypertension control in Africa by 2025
Dzudie, Anastase, Rayner, Brian, Ojji, Dike, Schutte, Aletta E., Twagirumukiza, Marc, Damasceno, A., Ba, Seringe A., Kane, Abdoul, Kramoh, Euloge, Kacou, Jean B.A., Onwubere, Basden, Cornick, Ruth, Sliwa-Hahnle, Karen, Anisiuba, Benedict, Mocumbi, Ana O., Ogola, Elijah, Awad, Mohamed, Nel, George, Otieno, Harun, ... Mayosi, Bongani. (2017). Roadmap to achieve 25% hypertension control in Africa by 2025. SAMJ South African Medical Journal. 28(4), pp. 262 - 273. https://doi.org/10.5830/CVJA-2017-040
Ventricular tachyarrhythmia during pregnancy in women with heart disease : Data from the ROPAC, a registry from the European Society of Cardiology
Ertekin, Ebru, van Hagen, Iris M., Salam, Amar M., Ruys, Titia P. E., Johnson, Mark R., Popelova, Jana, Parsonage, William A., Ashour, Zeinab, Shotan, Avraham, Oliver, José M., Veldtman, Gruschen R., Hall, Roger, Roos-Hesselink, Jolien W., ROPARC Investigators* and Sliwa, Karen. (2016). Ventricular tachyarrhythmia during pregnancy in women with heart disease : Data from the ROPAC, a registry from the European Society of Cardiology. International Journal of Cardiology. 220, pp. 131-136. https://doi.org/10.1016/j.ijcard.2016.06.061
Health in times of uncertainty in the eastern Mediterranean region, 1990-2013 : A systematic analysis for the Global Burden of Disease Study 2013
Mokdad, Ali H., Forouzanfar, Mohammad Hossein, Daoud, Farah, El Bcheraoui, Charbel, Moradi-Lakeh, Maziar, Khalil, Ibrahim, Afshin, Ashkan, Tuffaha, Marwa, Charara, Raghid, Barber, Ryan M., Wagner, Joseph, Cercy, Kelly, Kravitz, Hannah, Coates, Matthew M., Robinson, Margaret, Estep, Kara, Steiner, Caitlyn, Jaber, Sara, Mokdad, Ali A., ... Murray, Christopher J. L.. (2016). Health in times of uncertainty in the eastern Mediterranean region, 1990-2013 : A systematic analysis for the Global Burden of Disease Study 2013. The Lancet Global Health. 4(10), pp. e704-e713. https://doi.org/10.1016/S2214-109X(16)30168-1
A global view of pulmonary hypertension
Hoeper, Marius, Humbert, Marc, Souza, Rogerio, Idrees, Majdy, Kawut, Steven M., Sliwa-Hahnle, Karen, Jing, Zhi-Cheng and Gibbs, J. Simon. (2016). A global view of pulmonary hypertension. The Lancet Respiratory Medicine. 4(4), pp. 306 - 322. https://doi.org/10.1016/S2213-2600(15)00543-3
Pulmonary hypertension and pregnancy outcomes: data from the Registry Of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology
Sliwa-Hahnle, Karen, van Hagen, Iris M., Budts, Werner, Swan, Lorna, Sinagra, Gianfranco, Caruana, Maryanne, Blanco, Manuel Vasquez, Wagenaar, Lodewijk J., Johnson, Mark R., Webb, Gary, Hall, Roger and Roos-Hesselink, Jolien W.. (2016). Pulmonary hypertension and pregnancy outcomes: data from the Registry Of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology. European Journal of Heart Failure. 18(9), pp. 1119 - 1128. https://doi.org/10.1002/ejhf.594
Risk assessment for pregnancy with cardiac disease - A global perspective
Sliwa-Hahnle, Karen and Anthony, John. (2016). Risk assessment for pregnancy with cardiac disease - A global perspective. European Journal of Heart Failure. 18(5), pp. 534 - 536. https://doi.org/10.1002/ejhf.522
Comparison of the American PPCM registry data with international registries
Hilfiker-Kleiner, Denise, Sliwa-Hahnle, Karen and Bauersachs, J.. (2016). Comparison of the American PPCM registry data with international registries. Journal of the American College of Cardiology. 67(6), pp. 733 - 734. https://doi.org/10.1016/j.jacc.2015.09.112
The heart of Africa: Succeeding against the odds
Sliwa-Hahnle, Karen. (2016). The heart of Africa: Succeeding against the odds. The Lancet. 388(10063), pp. 28 - 36. https://doi.org/10.1016/S0140-6736(16)31660-9
Current management of patients with severe acute peripartum cardiomyopathy: Practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy
Bauersachs, Johann, Arrigo, Mattia, Hilfiker-Kleiner, Denise, Veltmann, Christian, Coats, Andrew J. S., Crespo-Leiro, Maria G., de Boer, Rudolf A., van der Meer, Peter, Maack, Christoph, Mouquet, Frederic, Petrie, Mark C., Piepoli, Massimo F., Regitz-Zagrosek, Vera, Schaufelberger, Maria, Seferovic, Petar, Tavazzi, Luigi, Ruschitzka, Frank, Mebazaa, Alexandre and Sliwa-Hahnle, Karen. (2016). Current management of patients with severe acute peripartum cardiomyopathy: Practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. European Journal of Heart Failure. 18(9), pp. 1096 - 1105. https://doi.org/10.1002/ejhf.586
Human immunodeficiency virus-related heart disease
Thienemann, Friedrich, Carrington, Melinda, Sliwa-Hahnle, Karen, Ntsekhe, Mpiko and Stewart, Simon. (2016). Human immunodeficiency virus-related heart disease. In In S. Stewart, K. Sliwa and A. Mocumbi, A. Damasceno and M. Ntsekhe (Ed.). The heart of Africa: Clinical profile of an evolving burden of heart disease in Africa pp. 145 - 154 John Wiley & Sons. https://doi.org/10.1002/9781119097136.ch9
Topic reviews need to be robust
Ntusi, Ntobeko B. A., Kraus, Sarah, Ogunbanjo, Gboyega and Sliwa-Hahnle, Karen. (2016). Topic reviews need to be robust. South African Medical Journal. 106(7), pp. 644 - 645. https://doi.org/10.7196/SAMJ.2016v106i7.10903
Rheumatic heart disease
Stewart, Simon, Carrington, Melinda and Sliwa-Hahnle, Karen. (2016). Rheumatic heart disease. In In S. Stewart, K. Sliwa and A. Mocumbi, A. Damasceno and M. Ntsekhe (Ed.). The heart of Africa: Clinical profile of an evolving burden of heart disease in Africa pp. 121 - 135 John Wiley & Sons. https://doi.org/10.1002/9781119097136.ch7
The causes, treatment, and outcome of pulmonary hypertension in Africa: Insights from the Pan African Pulmonary Hypertension Cohort (PAPUCO) Registry
Thienemann, Friedrich, Dzudie, Anastase, Mocumbi, Ana, Blauwet, Lori, Sani, Mahmoud U., Karaye, Kamilu M., Ogah, Okechukwu, Mbanze, Irina, Mbakwem, Amam, Udo, Patience, Tibazarwa, Kemi, Damasceno, Albertino, Keates, Ashley K., Stewart, Simon and Sliwa-Hahnle, Karen. (2016). The causes, treatment, and outcome of pulmonary hypertension in Africa: Insights from the Pan African Pulmonary Hypertension Cohort (PAPUCO) Registry. International Journal of Cardiology. 221, pp. 205 - 211. https://doi.org/10.1016/j.ijcard.2016.06.242
The African INTERHEART study
Steyn, Krisela and Sliwa-Hahnle, Karen. (2016). The African INTERHEART study. In In S. Stewart, K. Sliwa and A. Mocumbi, A. Damasceno and M. Ntsekhe (Ed.). The heart of Africa: Clinical profile of an evolving burden of heart disease in Africa pp. 1 - 9 John Wiley & Sons.
Bi treatment with hydralazine/nitrates vs. placebo in Africans admitted with acute HEart Failure (BA-HEF)
Sliwa-Hahnle, Karen, Damasceno, Albertino, Davidson, Beth A., Mayosi, Bongani, Sani, Mahmoud U., Ogah, Okechukwu, Mondo, Charles, Ojji, Dike, Dzudie, Anastase, Kouam, Charles Kouam, Yonga, Gerald, Ba, Serigne Abdou, Ogola, Elijah, Edwards, Christopher, Milo, Olga and Cotter, Gad. (2016). Bi treatment with hydralazine/nitrates vs. placebo in Africans admitted with acute HEart Failure (BA-HEF). European Journal of Heart Failure. 18(10), pp. 1248 - 1258. https://doi.org/10.1002/ejhf.581
Late maternal deaths: A neglected responsibility
Sliwa-Hahnle, Karen and Anthony, John. (2016). Late maternal deaths: A neglected responsibility. The Lancet. 387(10033), pp. 2072 - 2073. https://doi.org/10.1016/S0140-6736(16)30391-9
Ten-year coronary artery disease risk in 1571 newly presenting hypertensive black subjects
Ojji, Dike, Stewart, Simon, Atherton, John J., Ajayi, Samuel, Mamven, Manmak H., Ngabea, Murtala, Ojji, O. and Sliwa-Hahnle, Karen. (2016). Ten-year coronary artery disease risk in 1571 newly presenting hypertensive black subjects. Journal of Community Medicine & Health Education (online). 6(3), pp. 1 - 5. https://doi.org/10.4172/2161-0711.1000442
Cord blood samples: A less explored tool in early diagnosis of neonatal cardiovascular disease
Sliwa-Hahnle, Karen and Hilfiker-Kleiner, Denise. (2015). Cord blood samples: A less explored tool in early diagnosis of neonatal cardiovascular disease. Journal of the American College of Cardiology. 66(8), pp. 940 - 942. https://doi.org/10.1016/j.jacc.2015.07.001
Heart failure in the developing world
Sliwa-Hahnle, Karen and Stewart, Simon. (2014). Heart failure in the developing world. In In D. L. Mann and G. Michael Felker (Ed.). Heart Failure: A Companion to Braunwald's Heart Disease pp. 410 - 419 Elsevier.
Pathophysiology and epidemiology of peripartum cardiomyopathy
Hilfiker-Kleiner, Denise and Sliwa-Hahnle, Karen. (2014). Pathophysiology and epidemiology of peripartum cardiomyopathy. Nature Reviews Cardiology. 11(6), pp. 364 - 370. https://doi.org/10.1038/nrcardio.2014.37
Is all heart failure the same around the globe?
Sliwa-Hahnle, Karen. (2013). Is all heart failure the same around the globe? European Heart Journal. 34(40), pp. 3091 - 3092. https://doi.org/10.1093/eurheartj/eht385
Acute heart failure: Is it peripartum cardiomyopathy or not?
Bachelier-Walenta, Katrin, Hilfiker-Kleiner, Denise and Sliwa-Hahnle, Karen. (2013). Acute heart failure: Is it peripartum cardiomyopathy or not? Obstetric Medicine. 6(1), pp. 42 - 44. https://doi.org/10.1258/OM.2012.120042
Sex and gender differences in cardiovascular disease
Sliwa-Hahnle, Karen. (2012). Sex and gender differences in cardiovascular disease. European Heart Journal. 33(11), pp. 1298 - 1299. https://doi.org/10.1093/eurheartj/ehs103