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

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019 158 AFRICA
DCM was defined as left ventricular dilatation > 31 mm/m2 in
men and > 32 mm/m2 in women, and impaired systolic function
with a left ventricular ejection fraction < 50%. 6 Invasive coronary
angiography was obtained by radial or femoral access using
a Philips Integris V5000 Cath Lab (2008). From the selection
criteria, we selected 108 patients.
Data were collected using a standardised survey formdeveloped
with Epi data 3.1 software. The parameters investigated were: (1)
socio-demographic data (age, gender, health coverage) as well as
clinical data (cardiovascular risk factors, clinical presentation); (2)
ECG (repolarisation disorders, Q-wave) and cardiac ultrasound
data (left ventricular ejection fraction, regional wall-motion
abnormalities: hypokinesia, dyskinesia or akinesia); (3) coronary
angiography findings: the coronary angiography was normal when
the coronary arteries were smooth, without atheromatous plaque
and spastic phenomena. Obstructive CAD was considered if there
was any narrowing of the lumen of an epicardial vessel ≥ 70% and
of the left main artery ≥ 50%.7 The severity of coronary lesions
was assessed using the American College of Cardiology/American
Heart Association (ACC/AHA) classification8 and the SYNTAX
score.9 Depending on the number of vessels affected, we described
one-, two- and three-vessel disease. (4) Ventriculographic data
were used to assess regional wall motion and left ventricular
ejection fraction during cardiac catheterisation.
Statistical analysis
Qualitative variables, presented as numbers and percentages,
were compared using the Mantel–Haenszel chi-squared test
or Fisher’s exact test. The quantitative variables, presented as
medians (quartiles), were compared using the Student’s t-test.
We used Epi Info 3.5.8 (CDC, Atlanta, USA) and defined
statistical significance using a two-sided p -value < 0.05.
Results
The median age of our study population was 52 years (46–61).
There was a clear male predominance (75%) among patients,
with a sex ratio of 3. The vast majority of cases (83 patients,
76.9%) had no healthcare coverage. Hypertension (53.7%) was
the most common cardiovascular risk factor (Table 1).
Repolarisation disorders and a necrotic Q-wave were
observed in 25.9 and 8.3% of cases, respectively. Transthoracic
echocardiography showed regional wall-motion abnormalities in
43 patients (39.8%).
Coronary angiography was abnormal in 37 patients (34.3%).
Twenty-three patients had obstructive CAD, or 21.3% of our
sample size (Table 2). Of the total number of narrowing lesions,
the left anterior descending artery (LAD) was the most affected
(30/56 lesions, 53.6%). The average number of significant lesions
was 2.43 lesions per patient (Table 3).
According to the severity of CAD, assessed by the ACC/
AHA classification, type-B2 and type-C lesions were reported in
almost half of the obstructive lesions (27/56, 48.2%) (Table 4).
The majority of patients with obstructive CAD had a SYNTAX
Table 1. Baseline characteristics of the study population according to coronary angiogram
Total (n = 108) Abnormal CA ( n = 37) Normal CA (n = 71) p-value
Cardiovascular risk factors
Age (years), median (IQR) 52.0 (46–61) 55.0 (49.5–64.5) 51.0 (43.0–61.0) 0.06
Male gender, n (%) 81 (75.0) 31 (83.8) 50 (70.4) 0.13
Hypertension, n (%) 58 (53.7) 32 (86.5) 26 (36.6) < 0.001
SBP level, median (IQR) 134.4 (120.0–144.5) 143.7 (123.5–165.0) 128.5 (113.5–140.8) 0.001
DBP level, median (IQR) 80.9 (70.0–90.0) 85.0 (73.5–94.0) 78.3 (70.0–85.5) 0.04
Diabetes, n (%) 12 (11.1) 10 (27.0) 2 (2.8) 0.0003
Active smoking, n (%) 8 (7.4) 3 (8.1) 5 (7.0) 0.99
BMI, median (IQR) 26.4 (22.9–30.0) 26.4 (22.9–30.0) 26.4 (22.9–30.0) 0.69
Dyslipidaemia, n (%) 13 (12.0) 4 (10.8) 9 (12.7) 0.99
Total cholesterol, median (IQR) 1.8 (1.6–2.1) 1.8 (1.6–2.0] 1.8 (0.77–2.3) 0.96
Obesity, n (%) 18 (16.7) 4 (10.8) 14 (19.7) 0.29
Physical inactivity, n (%) 22 (20.4) 8 (21.6) 14 (19.7) 0.81
Electrocardiogram, n (%)
Repolarisation disorders, n (%) 28 (25.9) 16 (43.2) 12 (16.9) 0.003
Q-wave 9 (8.3) 7 (18.9) 2 (2.8) 0.007
Cardiac ultrasound
LVEDD (mm), median (IQR) 65.0 (60–71) 65.0 (59.4–70.0) 65.0 (60.0–72.0) 0.41
RWMA, n (%) 43 (39.8) 19 (51.4) 24 (33.8) 0.07
LVEF (%), median (IQR) 36.5 (30–45) 40.0 (31.0–45.0) 35.0 (29.0–46.5) 0.41
Ventriculography, n (%) 45 (41.7) 16 (43.2) 29 (40.8) 0.81
RWMA, n (%) 12 (11.1) 7 (18.9) 5 (7.0) 0.06
LVEF (%), median (IQR)] 35 (25.0–40.0) 35.0 (30.0–40.0) 30.0 (25.0–40.0) 0.37
CA: coronary angiogram, SBP: systolic blood pressure, DBP: diastolic blood pressure, LVEDD: left ventricular end-diastolic diameter, LVEF: left ventricular ejection
fraction. RWMA: regional wall-motion abnormalities.
Table 2. Coronary angiography findings
Coronarographic aspects Number (n = 108) Percentage (%)
Normal coronary angiogram 71 65.7
Abnormal coronary angiogram 37 34.3
Non-obstructive CAD 14 13.0
Obstructive CAD 23 21.3
One-vessel disease 12 52.2
Two-vessel disease 5 21.7
Three-vessel disease 6 26.1
CAD: coronary artery disease, LAD: left anterior descending artery, CX: left
circumflex artery, RCA: right coronary artery.