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 16 AFRICA
Background: Right ventricular (RV) dysfunction has been
shown to occur early and has major prognostic implications
for patients with group 1 pulmonary hypertension (PH), but
in patients with PH due to left heart disease (LHD), data are
scarce. We aimed to compare echocardiographic RV changes in
patients with LHD with PH (PHLHD) and LHD without PH
(LHDnPH) in Douala, Cameroon.
Methods: This was a cross-sectional study. All participants had
a detailed echocardiographic study with structural and func-
tional RV assessment. PH was defined as an estimated right
ventricular systolic pressure > 35 mmHg. Thirty-four patients
with PHLHD were compared to 65 patients with LHDnPH.
Comparison was done using the chi-squared test and one-way
ANOVA. Data were analysed using SPSS v. 22.
Results: Overall, mean age was 59.1 years and 56.6% were
female with no age or gender difference between the LHDnPH
and PHLHD groups. Patients with PHLHD had a longer dura-
tion of hypertension (9.6 vs 4.8 years, p = 0.001) and presented
with more dyspnoea, cough, fatigue, pedal oedema and lower
systolic and diastolic blood pressure. RV free wall thickness (0.8
± 0.2 vs 0.6 ± 0.2cm, p = 0.014), RV basal diameter (4.1 ± 0.7 vs
3.6 ± 0.6 cm, p < 0.001), and RA area (21.6 ± 8.1 vs 13.9 ± 3.4
cm2, p < 0.001) were higher in those with PHLHD compared
to those with LHDnPH, while tricuspid annular plane systolic
excursion (TAPSE) (1.9 ± 0.5 vs 2.3 ± 0.5 cm, p < 0.001) was
lower in those with PHLHD. Tricuspid annular tissue Doppler
imaging systolic velocity was similar between the two groups.
Conclusion: Our findings suggest that right heart changes occur
in parallel with LHD and probably worsen with superimposi-
tion of PH. A multicentre study of a larger sample is warranted
to confirm these findings.
RATIONALE AND DESIGN OF THE AFRICAN GROUP
A STREPTOCOCCAL INFECTION REGISTRY: THE
AFROStrep STUDY
Engel Mark*1, Barth Dylan D1, Whitelaw Andrew2, Dale
James3, Mayosi Bongani1
*1Department of Medicine, Faculty of Health Sciences, Groote
Schuur Hospital, University of Cape Town, South Africa;
2Stellenbosch University, South Africa
3University of Tennessee Health Science Center,USA
Introduction: Group A β-haemolytic Streptococcus (GAS),
a gram-positive bacterium also known as Streptococcus
pyogenes, causes skin, mucosal, systemic and autoimmune
diseases. Repeated pharyngeal and skin infections with GAS
may lead to serious autoimmune diseases such as acute
post-streptococcal glomerulonephritis, acute rheumatic fever
(ARF) and rheumatic heart disease (RHD). Invasive GAS
disease (iGAS) is associated with significant morbidity and
mortality in children and young adults worldwide. Increases
in the number of cases of both invasive and non-invasive
GAS diseases have been observed globally since the 1980s.
The reasons for these observations are not well understood
and have subsequently, caused many countries to commence
active surveillance systems for iGAS, to closely document the
epidemiology of the disease.
A patient disease registry is a powerful surveillance tool in
epidemiology. Guided by research questions, registries are devel-
oped to serve multiple purposes and provide a platform to study
the natural history of disease, clinical features, cost effectiveness
of treatment strategies and care, to assess safety and harm, and
to provide measures of improved quality of care. Registries for
streptococcal surveillance have been established in some devel-
oped countries, for example Canada, England and USA, where
iGAS is a notifiable disease. Currently, there is no registry for
the documenting of GAS-related disease in Africa, despite the
importance of GAS infections in this region.
Methods: The African group A streptococcal infection registry
(the AFROStrep Study) is a collaborative multicentre study
of clinical, microbiological, epidemiological and molecular
characteristics for GAS infection in Africa. The AFROStrep
registry comprises two components: (1) active surveillance of
GAS pharyngitis cases from sentinel primary care centres (non-
iGAS), and (2) passive surveillance of invasive GAS disease
(iGAS) from microbiology laboratories. Isolates will also be
subjected to DNA isolation to allow for characterisation by
molecular methods and cryo-preservation for long-term storage.
Discussion and Conclusion: Given that systematically collected
data are essential for an effective disease-control programme,
we have established the AFROStrep Registry as an essential
first step towards understanding the prevalence of laboratory-
confirmed GAS disease in African countries. The AFROStrep
study is a collaborative study that aims to establish the first regis-
try and biorepository of laboratory-confirmed GAS isolates in
Africa, with one of its main objectives being to collect compre-
hensive epidemiological, clinical, microbiological and molecular
data for GAS infections on the continent. AFROStrep will serve
as a platform for further investigations, including molecular
characterisation of isolates in order to contribute to the growing
body of knowledge informing vaccine development.
THE PREVALENCE AND TYPES OF ELECTROCAR-
DIOGRAPHIC ABNORMALITIES IN PATIENTS WITH
DILATED CARDIOMYOPATHY AT THE KENYATTA
NATIONAL HOSPITAL
Gituma Bernard*, Ogola Elijah
University of Nairobi, Kenya;
Background: Electrocardiographic abnormalities are common in
dilated cardiomyopathy (DCM) and portend adverse prognosis,
for example heart failure, embolic stroke and sudden death. We
studied the pattern of electrocardiographic abnormalities in
DCM at the Kenyatta National Hospital (KNH).
Methods: This was a hospital-based, cross-sectional study
of ECG abnormalities in patients with echocardiographic
diagnosis of DCM, from the cardiac clinic and the medical
wards in KNH, carried out between March and August 2013.
Patients had a focused clinical evaluation and New York Heart
Association (NYHA) class determined. Patients then had