CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
230
AFRICA
1322: HIV+ MALAWIAN CHILDREN WITH DECREASED
EXERCISE PERFORMANCE AND NORMAL CARDIAC
STRAIN
Amy Sims
1,2
, Mina Hosseinipour
1,3
, Irving Hoffman
3
, Charles van
der Horst
3
, Peter Kazembe
4
, Madeline McCrary
3
, Robert McCarter
2
,
Craig Sable
2
1
Fogarty International Clinical Research Fellows Program, USA
2
Children’s National Medical Centre, Washington, DC, USA
3
University of North Carolina, Chapel Hill, NC, USA
4
Baylor International Centre of Excellence, Lilongwe, Malawi
Background:
Traditional measures of cardiac function are often
normal in HIV+ children on antiretroviral therapy (ART). Previously,
strain analysis has shown subtle cardiac dysfunction in HIV+ adoles-
cents and young adults. We hypothesised that, using speckle tracking,
we would detect subtle cardiac dysfunction in this larger cohort of
Malawian children.
Methods:
In this prospective observational study of children aged
4–18, we recruited 241 HIV+ youth, and 95 HIV– controls. An
echocardiogram and six-minute walk test (6MWT) were performed.
CD
4
count and HIV viral load were performed on HIV+ subjects.
Ejection fraction, strain and strain rate were measured. Within the
HIV+ group, analysis of covariance was implemented to compare
means of cardiac function and performance on the 6MWT in HIV+
children on and off ART as well as HIV– children, controlling for
age, gender and BMI. Multiple linear regression models evaluated
whether cardiac function was related to CD
4
count or log viral load.
T
-tests based on linear contrasts were used to compare function
measures between those with detectable and undetectable viral loads.
Results:
The HIV– subjects performed better on the 6MWT (
p
=
0.001). HIV+ patients on ART averaged 470 m, HIV+ patients off
ART averaged 460 m, and HIV– patients averaged 500 m. Cardiac
function and strain were normal for all groups. EF and strain were
not related to CD
4
count or log viral load. Among HIV+ participants,
children with undetectable viral loads had more negative (better)
global circumferential strain (GCS) compared to those with detect-
able viral loads (
p
=
0.02).
Conclusions:
HIV+ children had decreased exercise performance
but did not exhibit decreased strain compared to controls. Detectable
viral loads were associated with worsened GCS, suggesting that viral
suppression may delay the onset of cardiac dysfunction. Although
these children do not currently exhibit clinical cardiac dysfunction,
long-term evaluation is warranted.
1324: HAND-HELD ECHOCARDIOGRAPHY: INITIAL
EXPERIENCE IN USE FOR ASSESSMENT OF RHEUMATIC
HEART DISEASE IN INDIGENOUS CHILDREN IN THE
KIMBERLEY REGION OF WESTERN AUSTRALIA
Jim Ramsay, Joan Sharpe
Princess Margaret Hospital for Children, Perth, Western Australia
Background:
ARF and RHD remain a major problem in indig-
enous children in Western Australia (WA) particularly in the remote
communities in the Kimberley. It is difficult to triage the care of chil-
dren presenting with signs of ARF without some echocardiographic
assessment. This is difficult in WA as the geography and population
distribution means there is very limited access to any paediatric echo
skills in remote areas. With the recent introduction of hand-held
echocardiographic equipment (HHE), it was decided to trial the use
of such technology in the Kimberley.
Methods:
An HHE was taken to outreach clinics in the Kimberley
over a six-week period and over 30 patients with RHD and a number
with signs suggestive of ARF had an echo study performed using
HHE. This included 2D echo images in long-axis, short-axis and
four-chamber views and colour Doppler images from the same views.
This was followed by a more formal complete study using standard
portable echo equipment (SPE). The images between the studies were
compared to assess whether there was good correlation between the
degree of mitral and/or aortic regurgitation.
Results:
There was very good correlation between the HHE and
SPE studies. It was possible using HHE to detect even trivial to mild
valvar regurgitation. Chamber sizes and significant valvar morpho-
logical changes could be reasonably defined, although this was more
limited than in the SPE studies.
Conclusions:
This initial experience using HHE has been encourag-
ing and warrants further scientific exploration. HHE could be a useful
tool to train non-cardiology staff in remote WA to triage management
of patients with possible ARF, in consultation with paediatric cardi-
ologists. HHE may be useful for quick screens of patients with known
RHD to select patients for more complete echo studies.
1325: EPIDEMIOLOGY OF ACUTE RHEUMATIC FEVER
IN MANITOBA, CANADA: A 10-YEAR RETROSPECTIVE
STUDY
Maria Elena Lautatzis
1
, Lillie Catherine Cholakis
2
, Ilan Buffo-
Sequeira
3
, Reeni Soni
3
, Dionysios Pepelassis
3
1
University of Manitoba, Canada
2
University of Winnipeg, Canada
3
Variety Children’s Heart Centre, Department of Paediatrics,
University of Manito, Canada
Objective:
The aims and objectives of this study were to determine
the incidence of acute rheumatic fever (ARF) between the first-
nation (FN) and non-first nation (n-FN) children in the province of
Manitoba, Canada.
Methods:
This was a retrospective study conducted at the Children’s
Hospital of Winnipeg and Variety Heart Centre, Winnipeg, MB,
Canada. Children with a discharge diagnosis of ARF were identified
through the Children’s Hospital of Winnipeg medical records and the
Electronic Echocardiography data based at the Variety Heart Centre.
The diagnosis of ARF was based on the revised Jones criteria.
Results:
Over a 10-year study period (2000–2010), a total of 61
patients meeting the Jones criteria for the diagnosis of ARF were
included in this study. The overall annual incidence rate of ARF in
the province of Manitoba was 1.613/100 000 with 4.748/100 000
for FN and 0.618/100 000 for the n-FN children (
p
<
0.001). The
overall incidence of ARF among girls was 1.562/100 000 (FN girls
4.984/100 000, n-FN girls 0.475/100 000,
p
<
0.001). Overall inci-
dence of ARF among boys was 1.661/100 000 (FN boys: 4.522/100
000, n-FN: 0.754/100 000,
p
<
0.001).
1327: ACUTE EFFECT OF INHALED ILOPROST IN CHIL-
DREN WITH PULMONARY ARTERIAL HYPERTENSION
ASSOCIATEDWITH CONGENITAL HEART DISEASE
Gu Hong, Li Qiangqiang, Zhang Chen, Liu Haiju, Zhuo Ling, Li
Aijie, Wang Xiaofeng, Wu Bangjun, Guo Baojing
Beijing Anzhen Hospital affiliated to Capital Medical University,
China
Objective
: To evaluate the safety and efficacy of inhaled iloprost in
children with pulmonary arterial hypertension (PAH) associated with
congenital heart disease (CHD) using measurements of haemody-
namic parameters.
Methods
: The study selected children hospitalised with severe PAH
associated with systemic-to-pulmonary shunt-type CHD in the
Department of Paediatric Cardiology of Beijing Anzhen Hospital
between June 2007 and October 2011. All of the children underwent
left- and right-sided cardiac catheterisation, during which iloprost
was administered by atomisation inhalation. Changes in haemo-
dynamic parameters before and after iloprost administration were
recorded. Adverse events were also recorded.
Results
: In total, 89 children with severe PAH associated with
systemic-to-pulmonary shunt-type CHD (mean age 10.8
±
4.7 years)
were enrolled. Following inhalation of iloprost, the mean pulmonary
arterial pressure decreased from 79
±
11 to 74
±
12 mmHg (
p
<
0.01),
while the pulmonary-to-systemic blood flow ratio (Qp/Qs) increased
from 1.15
±
0.45 to 1.71
±
1.36 (
p
<
0.01). Pulmonary vascular
