CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013
12
AFRICA
has emerged as a valid measurable end-point and one of the goals
of effective treatment. As a cheap and easy-to-administer tool, that
has prognosticating ramifications; its use in the sub-Saharan Africa
would be invaluable in the evaluation and prognosis of patients
with heart failure.
Subjects and methods:
Eighty-six consecutive patients (38 men,
48 women) with a mean age of 56.6 ± 15 years attending the cardi-
ology outpatient clinic of University College Hospital, Ibadan,
and diagnosed with and receiving treatment for heart failure were
recruited. The Minnesota Living with Heart Failure Questionnaire
(MLHF), a disease-specific outcome instrument, was used to meas-
ure QOL.
Results:
Seventy-one (82.6%) of the heart failure patients had a
history of hypertension, while 18 (21.2%) had coexisting diabetes
mellitus. There was a large variation in MLHF scores (0–96) with
scores exhibiting significant reliability statistics demonstrated by
Cronbach alpha (0.95–0.96) among study subjects. Significant
univariate correlations (
p
<0.05) were found between age, pulse
pressure, mean arterial pressure and total MLHF score (including
subscales except emotional subscale). In the multivariate analysis,
the backward stepwise protocol (r2=0.23; r=0.48) detected age as
an important simultaneous influent variable to the total MLHF
score (
p
=0.03) and the overall score (
p
=0.04); and pulse pressure
as a simultaneous influent variable to the overall subscale score
(
p
=0.04).
Interpretation:
The evaluation of QOL using the disease-specific
questionnaire (MLHF) was shown to be statistically reliable with
significant associations with age and pulse pressure as independent
predictive variables. There is need for further studies (prospective) to
determine the level of prediction of mortality and morbidity among
heart failure patients in sub-Saharan Africa.
A 3-YEAR EXPERIENCE WITH CARDIAC CATHETERISA-
TION IN LAGOS, NIGERIA
Johnson A*, Bode F, Barakat A, Ifeoluwa A, Kofo O
Reddington Hospital, Lagos, Nigeria
Introduction:
Cardiac catheterisation facilities are mandatory for
the practice of invasive cardiology and as a supportive diagnostic
tool for open heart surgery. This facility has however been severe-
ly limited in Nigeria. A private cardiac catheterisation facility has
been established in Lagos. The experience of this facility was
analysed to highlight the range of procedures now available.
Subjects and methods:
Data of all cardiac catheterisation proce-
dures was extracted from a prospectively maintained database.
Fields selected for analysis were age, sex, type of procedure and
procedural outcome. Results are expressed as numbers, mean ±
standard deviation and percentages as appropriate.
Results:
Three hundred and twelve patients underwent 352
procedures between July 2009 and December 2012; 40 patients
(12.9%) had multiple procedures. Of the 312 patients 197 were
males (63.1%) and 115 females (36.9%). Age range was from 1
to 92 years with mean age of 55.5 ± 17.1 years. One hundred and
fifty-six patients underwent isolated coronary angiograms (50%),
75 percutaneous transluminal coronary angioplasties (24%),
19 pulmonary angiograms (6.1%), 18 permanent pacemaker
implantations (6.1%), 11 right heart catheterisations (3.5%), 10
device closures of patent ductus arteriosus (3.2%), 8 peripheral
arteriograms (2.6%), 3 vascular angioplasties (1%), 3 inferior
vena cava filters (1%), 2 implantable cardioverter defibrillators
(0.6%), 2 renal angiograms (0.6%), 2 device closures of atrial
septal defect (0.6%), 1 carotid angiogram (0.3%), 1 pulmonary
angioplasty (0.3%) and 1 cardiac resynchronisation therapy
device implantation (0.3%). There was no mortality from any of
these procedures.
Interpretation:
A wide range of invasive procedures are now
being performed in the cardiac catheterisation facility in Lagos.
These procedures include invasive diagnostic and therapeutic
procedures for acquired and congenital disease in both the paedi-
atric and adult population. More such facilities need to be devel-
oped to limit the need for medical tourism for these procedures.
PERCUTANEOUS CORONARY INTERVENTION WITHOUT
ON-SITE SURGICAL BACKUP IN A NIGERIAN CARDIAC
CENTRE
Johnson A*, Bode F, Ifeoluwa A, Kofo O
Reddington Hospital, Lagos, Nigeria
Introduction:
Percutaneous coronary intervention has been estab-
lished in a private centre in Lagos which does not have on-site surgi-
cal backup. Though stand-alone percutaneous coronary intervention
has been shown to be safe in the western world, this has yet to be
examined in Nigeria. The aim of this study was to describe our expe-
rience with stand-alone percutaneous coronary intervention.
Subjects and methods:
Data were extracted from a prospectively
maintained database of all percutaneous coronary interventions
performed at our centre between July 2009 and August 2012. The
data fields selected for analysis were patient demographics, indica-
tion for procedure, euroscore, angiographic outcome and adverse
events. Data analysis was done using Microsoft Excel 2010, and
results were expressed as mean ± standard deviation, numbers or
percentages as appropriate.
Results:
Seventy-five patients (55 males (73.3%), 20 females
(26.7%)) underwent percutaneous coronary intervention. Mean age
was 58.9 ± 8.7 years. Sixty-nine patients (91.4%) were classified in
angina class 3 and 4, 52 patients (69%) had had recent myocardial
infarction and 29 cases (38.7%) were done as emergencies. Mean
euroscore was 5.8 ± 3. Angiographic outcome was good in all the
patients (100%). Adverse outcome was seen in just 1 patient (1.3%)
who required urgent referral to a public facility for emergency coro-
nary artery bypass grafting. There was no in-hospital mortality in
this series.
Interpretation:
Stand-alone percutaneous coronary intervention has
been performed safely in our centre with good results, a low inci-
dence of adverse outcomes and no mortality. While access to open
heart surgery facilities is being further developed, our experience has
shown that stand-alone percutaneous coronary intervention is a safe
alternative in our environment.
ARARE PRESENTATION OF NON-COMPACTION CARDIO-
MYOPATHY IN KENYA
Kamotho C*
International Clinic, Nairobi, Kenya
Introduction:
Ever since non-compaction myocardium was first
described in Africans it has remained a rare diagnosis on the conti-
nent. No cases have been published from Kenya. This would be the
first publication of non-compaction cardiomyopathy (NCCM) from
Kenya. Clinically, NCCM in adults typically presents with heart fail-
ure or atrial embolic event. There are no cases reported from Africa
with syncope as a presenting feature. This rare presentation is a first
from Africa.
Subjects and methods:
We present the case of a 24-year-old Kenyan
man who presented with recurrent syncope. Thorough examination
suggested a diagnosis of biventricular NCCM with unstable ventricu-
lar tachycardia. He was referred to a public tertiary centre for amio-
darone loading and 24-hr Holter monitoring. He was asymptomatic
on discharge and was prescribed amiodarone 200 mg bd, warfarin 5
mg od, and carvedilol 3.125 mg bd. He is scheduled to receive an
implantable cardioverter defibrillator (ICD).
Results:
Isolated NCCM and the characteristic echocardiographic
features were first described in 1984, and in African patients in 2007.
Left ventricular non-compaction has been described in South Africa,
Gabon and Djibuti. NCCM remains rare in Kenya and no cases have
been published yet from Kenya.
Interpretation:
This then is the first publication of NCCM in a
Kenyan patient. It is also the first publication of syncope as a present-
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