CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013
AFRICA
1
APPROPRIATENESSOFECHOCARDIOGRAPHYUSE INAN
AFRICAN TERTIARY INSTITUTION: A 5-YEAR REVIEW
Oni OO, Nwosu M, Adeoye AM*, Adebiyi AA, Oladapo OO, Aje A
Division of Cardiovascular Medicine, Department of Medicine,
University College Hospital, Ibadan, Nigeria
Introduction:
Echocardiography has emerged as a major tool in clin-
ical practice. However, inappropriate use of echocardiography may
be potentially harmful to patients and generate unwarranted costs to
the healthcare system. We report the frequency of inappropriate use
of echocardiography at Ibadan.
Subjects and methods:
A 5-year (2008-2012) review of indications
for echocardiography at the cardiac unit, University College Hospital,
was carried out. Using Appropriate Use Criteria for Echocardiography
(2011), screening in hypertension without sign of hypertensive heart
disease, routine preoperative, routine screening in normal person, prior
echocardiography without cardiac deterioration, among others, were
classified as inappropriate use of echocardiography.
Results:
Data of 4 782 patients were analysed. One hundred and
twenty-one patients with incomplete data were excluded from the
study. The most common indication for echocardiography was
systemic hypertension without sign of hypertensive heart disease
(23.8%), followed by hypertensive heart disease (20.3%). Others
include pre-chemotherapy assessment (7.9%), preoperative cardiac
evaluation (9.8%), previous abnormal ECG (5.2%), heart failure
(4.6%), routine screening (5.5%),chest pain (3.6%), stroke (2.9%),
palpitation (2.2%), ischaemic heart disease (1.9%), arrhythmia
(2.2%), cardiomyopathy (1.4%), and others (8.6%). Almost half of
the requests satisfied the criteria for inappropriate use of echocar-
diography.
Interpretation:
There is a need for a rational system of referral for
echocardiography, especially in resource-poor environments. This
will reduce the strain on manpower and help conserve the resources
of patients who do not really need to have echocardiography.
WAIST CIRCUMFERENCE: AN ANTHROPOMETRIC
MEASURE OF ADIPOSITY IN HYPERTENSIVE AFRICAN
POPULATION
Adeoye AM*, Adebiyi A, Tayo B, Salako BL, Ogunniyi A, Cooper R
Division of Cardiovascular Medicine, Department of Medicine,
University College Hospital, Ibadan, Nigeria
Introduction:
Studies differ on which anthropometric measure of
adiposity best correlates with cardiovascular diseases. In this study
we re-examined the role of waist circumference as the correlate of
elevated blood pressure in an African population.     
Subjects and methods:
A cross-sectional prospective study was
carried out on a total of 1 858 subjects (mean age 49 ± 9; 1 411 females
and 447 males) over 2.5 years between June 2009 and December
2011. All subjects underwent a standardised clinical examination and
anthropometric measurements. Correlation analysis was used to assess
the relationship between blood pressure and body mass index (BMI),
waist height ratio and waist circumference respectively.     
Results:
Females were significantly older, shorter, heavier and had
greater arm circumference and heart rates when compared with
males. Blood pressure parameters were comparable between the two
groups. Anthropometric measurements showed that 587 (34.1%)
were overweight, 372 (21.6%) were obese and 186 (10.8%) had
morbid obesity. Compared with their male counterparts, females were
significantly more obese (
p
<0.0001). Similarly 51.6% of the subjects
had abdominal obesity, with female preponderance (
p
<0.0001).
Compared with other measures of adiposity, waist circumference
best correlated with blood pressure (
p
<0.01).     
Interpretation:
This study shows that obesity is a major cardiovas-
cular risk factor among the study population. Waist circumference
correlates most with blood pressure. Significant reduction in hyper-
tension is possible if the waist size is reduced in this population.
Intervention programmes targeted at waist circumference reduction
through lifestyle modification, including exercise and diet, may have
significant public health significance in reducing the incidence of
hypertension among the population. 
ACTIVITIES REPORT OF ABIDJAN CARDIOLOGY INSTI-
TUTE PACING UNIT FROM 2006 TO 2012
Adoubi KA*, Kendja KF, Tano M, Koffi F, Ndjessan JJ, Meneas C,
Ayegnon KG, Angate KH.
Cardiology Institute of Abidjan, University of Bouaké, Côte d’Ivoire   
Introduction:
The aim of this work was to report the results of activ-
ity of a pacing unit in a cardiology centre in sub-Saharan Africa.
Subjects and methods:
Data were collected from January 2006 to
December 2012 and involved all the activities carried out during this
period at the Institute of Cardiology of Abidjan.     
Results:
During this period, 369 procedures were performed in 195
patients aged 66.3 ± 13.7 years (female: 47.7%). These included
primo-implantations (156 cases), change of generators (14 cases),
reimplantations (14 cases), leads extractions (8 cases) and temporary
pacing. The main symptoms were syncope (42.1%) and heart failure
(21%). Atrioventricular blocks (83.6%) were the main indications for
permanent pacing. Single chamber pacemakers type VVI were most
often used (72.9%) followed by dual chamber pacemakers type DDD
(26.6%). Haematoma (4.8%) and lead dislodgement (3.7%) were the
major complications encountered.
Interpretation:
Cardiac pacing is in the process of becoming estab-
lished in sub-Saharan Africa, so It is important to help the develop-
ment of this discipline in all countries.
TEMPORARYPACEMAKERS:CURRENTUSEANDCOMPLI-
CATIONS IN ABIDJAN CARDIOLOGY INSTITUTE
Adoubi KA*, Koffi F, Ndjessan JJ, Tano M, Yao H, Niamkey T, Diby
F, Diomande M, Yangni-Angate KH, Adoh AM
Cardiology Institute of Abidjan, University of Bouaké, Côte d’Ivoire
Introduction:
Temporary pacemakers (TP) are used in the emer-
gency treatment of patients with severe bradyarrhythmia. They are
often used in emergency situations.The aim of this study was to
review and analyse the indications, incidence, and type of compli-
cations associated with TP implanted in our centre during a 6-year
period (2006-2012).
Subjects and methods:
We analysed significant clinical variables,
indication, route of insertion, follow-up, complications,and duration
of temporary pacing.
Results:
A total of 155 TP were implanted, (mean age 66.5 [± 12]
years, 43.2% female). The main indications were symptomatic
complete AV block (65.6%), prophylaxis for replacement with a
definitive pacemaker (22.6%), bradyarrhythmia due to drug intoxi-
cation (5.1%), blockage in the acute phase of myocardial infarction
(4.5%), and symptomatic sick sinus syndrome (0.6%). The route
of insertion was via the femoral vein in 100% of the cases. The
duration of TP use was 4.6 ± 4.1 days (range, 0–26 days). A
total of 136 patients (87.7%) required a permanent pacemaker.
Complications: 2 patients died (1.2%), attributable to TP implanta-
tion. Other severe complications were seen in 23 patients (14.8%).
Malfunction of the TP occurred in 10 patients (6.5%) because of
electrode displacement.
Abstracts
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