Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 AFRICA 15
abuse (21.3%) and HIV (8.7%). Clinical features at presentation
were dyspnoea (78.7%), fatigue (76.7%), palpitation (57.3%),
cough (56.7%), jugular venous distension (68%) and peripheral
oedema (66.7%). In all, 70% of patients presented in the World
Health Organisation functional class III/IV.
Conclusion: PH was common among patients in this rural
cardiac centre, with PHLHD being the most frequent type. High
prevalence of indoor smoking, rheumatic heart diseases and
late presentation to hospital may reflect poor a socio-economic
context. These findings should increase awareness of PH among
physicians in this setting, thus leading to early diagnosis and
management.
PULMONARY HYPERTENSION DUE TO LEFT HEART
DISEASE: DATA FROM THE PAN-AFRICAN PULMO-
NARY HYPERTENSION COHORT (PAPUCO) STUDY
Dzudie Anastase*, Thienemann Friedrich1, Mocumbi Ana O 2,
Blauwet Lori3, Karaye Kamilu M4, Sani Mahmoud U4, Ogah
Okechukwu S5, Mbanze Irina6, Mbakwem Amam 7, Tibazarwa
Kemi8, Aminde Leopold9, Ndjebet Jules 10, Tantchou Tchoumi
Cabral11, Damasceno Albertino12, Kengne Andre Pascal13, Sliwa
Karen8
*Department of Medicine, Faculty of Health Sciences,
University of Cape Town, Cape Town, South Africa; Cardiology
Unit, Douala General Hospital, Douala, Cameroon; Faculty of
Health Sciences, University of Buea, Cameroon; aitdzudie@
1Department of Medicine, Faculty of Health Sciences, University
of Cape Town, Cape Town, South Africa; Clinical Infectious
Diseases Research Initiative, Institute of Infectious Diseases and
Molecular Medicine, Faculty of Health Science, University of
Cape Town, Cape Town, South Africa; IntegerAfrica Research
& Development, Cape Town, South Africa
2Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
3Department of Medicine, Division of Cardiovascular Diseases,
Mayo Clinic, Rochester, Minnesota, USA
4Department of Medicine, Bayero University and Aminu Kano
Teaching Hospital, Kano, Nigeria
5Department of Medicine, University College Hospital Ibadan,
Ibadan, Nigeria; Ministry of Health, Umuahia, Nigeria
6Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
7Department of Medicine, College of Medicine, University of
Lagos, Nigeria
8Hatter Institute for Cardiovascular Research in Africa, Faculty
of Health Sciences, University of Cape Town, Cape Town,
South Africa
9Faculty of Health Sciences, University of Buea, Cameroon;
Clinical Research Education, Networking and Consultancy,
Douala, Cameroon
10Douala Cardiovascular Centre, Douala, Cameroon
11Shisong Cardiac Centre, Kumbo, Cameroon
12Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
13Department of Medicine, Facultyof HealthSciences,University
of Cape Town, Cape Town, South Africa; Non-communicable
Diseases Unit, South African Medical Research Council, South
Africa
Background: Little is known about pulmonary hypertension
(PH) due to left heart disease (PHLHD) in sub-Saharan
Africa (SSA). We investigated the clinical profile and short-
term outcomes of patients with PHLHD from the multicentre
Pan-African Pulmonary hypertension Cohort (PAPUCO) study.
Methods: Suspected cases of PH underwent echocardiography
with measurement of right ventricular systolic pressure (RVSP)
and tricuspid annular plane excursion (TAPSE). PH was clas-
sified as mild (RVSP: 35–50 mmHg), moderate (RVSP: 51–60
mmHg) and severe (RVSP: > 60 mmHg). Cox models were used
to relate baseline characteristics with admission and mortality
during follow up.
Results: Of 209 patients diagnosed with any PH, 144 (mean
age 53.3 ± 18.5 years, 40.4% men) had PHLHD. Mean RVSP
was 60.4 ± 16.7 mmHg overall, and 41.6 ± 3.4, 51.9 ± 4.4, 78.1
± 12.5 mmHg, respectively for mild (n = 47), moderate ( n = 32),
and severe PH (n = 62). Of all patients, 72 (50.0%) had hyper-
tension, 16 (11.1%) had diabetes, and 16 (11.1%) were HIV
infected. Patients presented at advanced stage [97 (67.4%) in
WHO functional class III–IV]. Left atrial diameter (β = 0.55;
p < 0.001) and TAPSE (β = –0.99; p < 0.001) were independent
predictors of RVSP. A total of 35 (24.3%) deaths and 43 (29.9%)
hospital admissions were recorded during a median follow up of
202 days. There was a positive association between RVSP and
admissions (p = 0.03) but none with mortality.
Conclusion: PHLHD was the commonest cause of PH in this
multi-country cohort. Left atrium size and TAPSE were predic-
tors of RVSP in those with PHLHD, and RVSP predicted short-
term hospitalisation but not mortality. Extended follow up of a
larger sample will help refine these observations.
RIGHT HEART REMODELLING IN PATIENTS WITH
PULMONARY HYPERTENSION DUE TO LEFT HEART
DISEASE AT THE DOUALA GENERAL HOSPITAL,
CAMEROON: AN ECHOCARDIOGRAPHIC STUDY
Dzudie Anastase*, Abanda Martin1, Aminde Leopold2,
Kamdem Félicité 3, Dzekem Bonaventure2
*Faculty of Health Sciences, University of Buea, Cameroon;
Clinical Research Education, Networking and Consultancy,
Douala, Cameroon; Cardiology Unit, Douala General Hospital,
Douala, Cameroon; Department of Medicine, Faculty of
Health Sciences, University of Cape Town, Cape Town, South
Africa;
1Faculty of Health Sciences, University of Buea, Cameroon;
Clinical Research Education, Networking and Consultancy,
Douala, Cameroon
2Clinical Research Education, Networking and Consultancy,
Douala, Cameroon
3Cardiology Unit, Douala General Hospital, Douala, Cameroon