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

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

160

AFRICA

in lower proportions (8.1%), was more common in patients with

coronary artery anomalies.

Alterations in segmental myocardial contractility were

commonly detected during the echocardiograms of patients with

coronary artery anomalies, but with no statistically significant

difference (

0.07). Regional wall-motion abnormalities in

patients with DCM should be interpreted with caution. They may

reflect myocardial ischaemia and be an indication for coronary

angiographic assessment. However, they may be objectified

in the absence of coronary heart disease. The only reliable

echocardiographic evidence of ischaemic origin is regional wall

akinesia with thinning, suggesting an absence of viability.

Of the total number of narrowing lesions, the LAD was

the most commonly affected artery. In the African series on

ischaemic heart disease, the distribution of coronary heart

diseases was not specified.

Patients presenting with obstructive CAD had multi-vessel

disease (two- or three-vessel disease) in 47.8% of cases. In a

previous study conducted by Velazquez

et al

. in patients with left

ventricular dysfunction and known CAD suitable for coronary

artery bypass graft (CABG), three-vessel disease was reported in

60.5% of patients.

This study included selected patients with CAD

suitable for CABG, and this may explain why the patients had

worse coronary anatomy. Our findings suggest that the coronary

arteries can be severely affected in patients with DCM, which is

underestimated due to lack of screening tests in our regions.

There were some limitations to our study. Compared to

Western registries, our study included a small number of patients.

There is potential selection bias because this study was performed

on a consecutive sample of patients who presented to the

interventional cardiology department for coronary exploration.

In our practice, as in the majority of countries in sub-Saharan

Africa, there is no universal healthcare system for patients. The

cost of coronary angiography is 800 US$ in our country, while

the guaranteed minimum wage is 120 US$. This is a major socio-

economic limitation in the optimal management of patients.

Lack of interventional cardiologists in our country is another

reason for the relatively small size of our sample. A larger study

population would add more significance to this study.

Conclusion

Ischaemicheartdiseaseislikelytobeunderdiagnosedinsub-Saharan

Africa. Among the cases of presumed idiopathic DCM, 21.3%

of cases were ischaemic cardiomyopathy. Better availability of

diagnostic methods used to make an angiographic assessment

of the coronary arteries would enable better identification of

ischaemic cardiomyopathies among patients with DCM, more

particularly in the presence of cardiovascular risk factors, so as to

improve the management and outcomes of these patients.

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