Cardiovascular Journal of Africa: Vol 30 No 3 (May/June 2019)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019

AFRICA

157

Coronary angiographic findings in dilated

cardiomyopathy in a sub-Saharan African population

Roland N’Guetta, Hermann Yao, Esther Ehouman, Arnaud Ekou, Jean-Baptiste Anzouan-Kacou,

Iklo Coulibaly, Marie-Laure Hauhouot-Attoungbre, Euloge Kramoh, Yves Yapobi, Remi Seka

Abstract

Aim:

To describe the coronary angiographic aspects observed

in patients with dilated cardiomyopathies (DCM) in a sub-

Saharan African country in order to improve their manage-

ment.

Methods:

This was a cross-sectional study conducted from

1 January 2010 to 31 March 2016. All patients aged 18 years

and older, presenting with DCM and admitted to Abidjan

Heart Institute, who underwent coronary angiography were

included. One hundred and eight patients were selected. We

analysed and compared the coronary angiographic features

observed.

Results:

The median age of our patients was 52 years (46–61).

There was a male predominance (sex ratio

3). Hypertension

(53.7%) was the major cardiovascular risk factor found.

Coronary angiography was abnormal in 37 patients (34.3%).

Twenty-three patients (21.3%) had obstructive coronary

artery disease (CAD). Patients with CAD were older than

those with normal coronary arteries, but with no statistically

significant difference (

0.06). Hypertension (

0.001)

and diabetes (

0.0003) were statistically significantly more

commonly reported in patients with CAD.

Conclusion:

Ischaemic heart disease is likely to be under-

diagnosed in sub-Saharan Africa. A coronary angiographic

assessment of patients receiving treatment for DCM, espe-

cially in the presence of cardiovascular risk factors, should

help optimise their management and improve prognosis.

Keywords:

dilated cardiomyopathy, coronary angiography, sub-

Saharan Africa

Submitted 4/10/18, accepted 15/1/19

Published online 24/5/19

Cardiovasc J Afr

2019;

: 157–161

www.cvja.co.za

DOI: 10.5830/CVJA-2019-006

Heart failure (HF) is now a major cause of morbidity and

mortality in developing countries. Reliable estimates of the

burden of HF are not available, but recent literature suggests

that HF is the cardiovascular condition in sub-Saharan Africa

whose prevalence is increasing the most.

HF is the main reason

for admission to cardiology departments.

There is a significant

socio-economic impact in our context. Since HF affects younger,

economically active subjects with income-generating activities,

it has a higher mortality rate in this group of people than in the

rest of the world.

Whereas coronary artery disease (CAD) is the major cause

of HF in developed countries, in sub-Saharan Africa, the

predominant underlying conditions historically are dilated

cardiomyopathies (DCM) and rheumatic heart disease.

In recent

data from The Sub-Saharan African Survey of Heart Failure

(THESUS-HF),

ischaemic heart disease accounts for only 7.7%

of hospitalisations for HF, the predominant causes of which are

hypertension (45.4%) and presumed idiopathic DCM (18.8%).

This rate of ischaemic heart disease seems to be underestimated,

due to limited access to diagnostic tools, especially coronary

angiography.

The identification of ischaemic heart disease in sub-Saharan

Africa could help improve the management and prognosis of

patients by implementing tailored treatment strategies. The aim

of this study was to describe the coronary angiographic features

observed in DCM in a sub-Saharan African population.

Methods

Our study was carried out at the Abidjan Heart Institute. It is the

national referral centre for the management of cardiovascular

diseases in Côte d’Ivoire, capable of providing cardiovascular

care 24 hours a day and seven days a week. The centre includes

emergency department, intensive care unit, a department

for non-invasive exploration (including echocardiography

laboratories and other cardiac diagnostic tests), paediatric

cardiology department, operating rooms for cardiovascular

and thoracic surgery, interventional cardiology laboratory and

cardiac rehabilitation department.

We conducted a cross-sectional observational study over a

period from 1 January 2010 to 30 April 2016. All patients aged 18

years and older who were admitted to Abidjan Heart Institute to

undergo coronary angiography for DCM over the study period

were systematically and unselectively included.

Patients included underwent a standard 12-lead electro-

cardiogram (ECG) and an ultrasound examination. Left

ventricular internal diastolic diameter (using the American

Society of Echocardiography convention) and left ventricular

ejection fraction (with biplane Simpson’s method) were measured

to confirm DCM. We used a General Electric Vivid S6 cardiac

ultrasound system (2010).

Abidjan Heart Institute, Abidjan, Côte d’Ivoire

Roland N’Guetta, MD,

rolandnguetta@hotmail.com

Hermann Yao, MD

Esther Ehouman, MD

Arnaud Ekou, MD

Jean-Baptiste Anzouan-Kacou, MD

Iklo Coulibaly, MD

Marie-Laure Hauhouot-Attoungbre, MD

Euloge Kramoh, MD

Yves Yapobi, MD

Remi Seka, MD