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 19
in NYHA III–IV and 48% in heart failure. Nineteen per cent
had atrial fibrillation, 6% stroke and 13% previous surgery. Only
34% of patients were receiving secondary penicillin prophylaxis,
of whom 35% oral Pen VK. Of patients needing anticoagula-
tion, 39% were receiving warfarin, 38% were aware of the target
INR and 73% had no INR analysis the preceding six months.
Conclusion: The RHD burden is highly significant. Gaps
identified in the organisation and delivery of care pointed to
the need for a national programme for the prevention and
control of RHD. Patients are seen late with advanced disease.
Low numbers of patients over 50 years of age (4%) reflect
high mortality rates. Low numbers on secondary penicillin
prophylaxis and poor compliance with anticoagulation proto-
cols reflect a lack of awareness of RHD among health work-
ers. A national advisory committee (NAC) for RHD, the first
in Africa, was established in May 2015. The NAC will now
elaborate on a national programme ‘ASAP’. This example of
‘research to action’ emphasises profound public policy benefits
from clinical science.
RIGHT VENTRICULAR DYSFUNCTION IN NIGERIANS
WITH PERIPARTUM CARDIOMYOPATHY
Karaye Kamilu*, Lindmark Krister1, Henein Michael1
*Department of Medicine, Bayero University; and Aminu Kano
Teaching Hospital, Kano, Nigeria;
1Department of Public Health and Clinical Medicine, Umea
University, Sweden
Introduction: Right ventricular systolic dysfunction (RVSD) in
relation to outcome in peripartum cardiomyopathy (PPCM) has
not been previously well described. The present study therefore
aimed to assess RVSD in a cohort of PPCM patients in Kano,
Nigeria.
Methods: This longitudinal study was carried out in three refer-
ral hospitals in Kano, Nigeria. Consecutive PPCM patients who
had satisfied the inclusion criteria were recruited and followed
up for 12 months. RVSD was defined as the presence of either
tricuspid annular plane systolic excursion (TAPSE) < 16 mm
or peak lateral wall systolic myocardial velocity (S’) by tissue
Doppler imaging (TDI) of < 10 cm/s. Dilated RV and right
atrium (RA) were defined as RV basal diameter (RVb) > 42 mm
and RA end-systolic area (RAA) > 18 cm2 or RA length (RAL)
> 53 mm, respectively.
Results: A total of 54 patients were consecutively recruited over
six months, but only 33 of them were followed up, of whom 12
died (36.4%), eight (66.7%) within the first six months, four were
lost to follow up (12.1%) and the remaining 17 (51.5%) survived
the one-year follow up. RAA, RAL and RVb reduced from 18.0
± 7.9 cm2, 42.0 ± 10.5 mm and 48.4 ± 9.7 mm at baseline to 13.3
± 4.1 cm2 (p = 0.022), 36.9 ± 9.7 mm (p = 0.08) and 44.7 ± 10.2
mm (p = 0.180) at one year, respectively. At baseline, 61.1% of
patients had RVSD, which fell to 17.7% at the one-year follow
up (p = 0.004), implying RV remodelling, but this was not asso-
ciated with the use of specific treatments such as renin–angio-
tensin–aldosterone blockers. There was no relationship between
RVSD and mortality in the regression models.
Conclusion: RVSD was common in Nigerians with PPCM but
improved during the first 12 months. It was neither related to
medical treatment nor to mortality.
CONTEMPORARY AETIOLOGY, CLINICAL CHAR-
ACTERISTICS AND PROGNOSIS OF ADULTS WITH
HEART FAILURE IN TANZANIA: THE PROSPECTIVE
TANZANIA HEART FAILURE (TAHEF) STUDY
Kisenge Peter*, Makubi Abel1
Cardiovascular Medicine, Muhimbili National Hospital,
Cardiovascular Medicine Unit, School of Medicine, 1Muhimbili
University of Health and Allied Sciences, Dar es Salaam,
Tanzania;
Introduction: In developed countries, the prevalence and inci-
dence of heart failure (HF) are 2–3 and 0.5%, respectively and
increase with age. The aetiology, clinical characteristics, therapy
and prognosis of this syndrome have been extensively studied
in developed countries but considerably less so in developing
countries, and HF is largely unexplored in sub-Saharan Africa
(SSA). Aetiologies in SSA may be changing towards developed-
world patterns but may also vary according to setting and
geographical region. Co-morbidities, predictors of prognosis,
and the beneficial effects and widespread use of neurohormo-
nal antagonist drugs have been well described in the developed
world but such data are limited in SSA, and there are concerns
that mortality rates remain high. Therefore, the objective was to
assess the contemporary aetiology, clinical characteristics, prog-
nosis and predictors of prognosis of HF in Tanzania.
Methods: This was a prospective, observational study in the
Cardiovascular Centre of the Muhimbili National Hospital
in Dar es Salaam, Tanzania. Patients were 18 years of age or
older with HF defined by the Framingham criteria. The main
outcome measure was all-cause mortality.
Results: Among 427 included patients, 217 (51%) were females
and the mean age (standard deviation) was 55 years (17). Heart
failure aetiologies included hypertension (45%), cardiomyopa-
thy (28%), rheumatic heart disease (12%) and ischaemic heart
disease (9%). Concurrent atrial fibrillation, clinically significant
anaemia, diabetes, tuberculosis and HIV were found in 16, 12,
12, 3, and 2%, respectively, while warfarin was used in 3% of
the patients. The mortality rate, 22.4 per 100 person-years of
observation over a median follow up of seven months, was
independently associated with the presence of atrial fibrillation,
hazard ratio 3.4 (95% confidence interval 1.6–7.0); in-patient
status 3.2 (1.5–6.8); anaemia 2.3 (1.2–4.5); pulmonary hyperten-
sion 2.1 (1.1–4.2) creatinine clearance 0.98 (0.97–1.00) and lack
of formal education 2.3 (1.3–4.2).
Conclusion: In HF in Tanzania, patients are younger than in
the developed world, but aetiologies are becoming more similar,
with hypertension becoming more prevalent and rheumatic
heart disease less so. Predictors of mortality that are possible
to intervene against are anaemia, atrial fibrillation and lack
of education. Efforts directed toward diagnosing and treating