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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S16
Anterior mitral valve leaflet restriction: A common variant amongst South African children
Luke Hunter*, Mark Monaghan
#
, Guy Lloyd
†
, Alfonso Pecoraro*, Anton Doubell* and Philip Herbst*
*Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville,
South Africa.
#
Kings College Hospital, London, United Kingdom.
†
Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom
Introduction:
The World Heart Federation (WHF) criteria for echocardiographic diagnosis of RHD rely on the use of colloquial terms such as dog-leg to
define AMVL restriction rather than a strict, reproducible definition. We recognise AMVL restriction when the tip of the leaflet is seen to point away from
the interventricular septum and towards the posterior left ventricular (LV) wall at peak diastole in the parasternal long axis (PSLAX) view. This definition risks
inclusion of a finding commonly identified in our high-risk screening programme (Echo in Africa - EIA) which demonstrates gradual AMVL bowing (so-called
slow-bow) from the proximal to mid-leaflet but with free motion (fluttering) of the tip during diastole. We propose that this is a normal variant of the AMVL
and is unrelated to the RHD process, provided no concomitant morphological features of RHD are identified.
Methods:
Retrospective analysis of EIA data obtained from children (aged 13 - 18) attending 2 separate South African schools with a documented high- and
low-RHD prevalence. Cases of AMVL restriction were identified and classified according to the definitions provided above.
Results:
A total of 941 screening studies (HR cohort n=577/LR cohort n=364) were evaluated. Seventy-four cases of AMVL restriction (12.82%, 95%, CI 10.34 -
15.80) were identified in the HR cohort of which 8 cases demonstrated AMVL-tip restriction (1.39%, 95%, CI 0.70 - 2.71) and 65 cases demonstrated slow bow
(11.27%, 95%, CI 8.94 - 14.11). There were no cases of AMVL-tip restriction observed in the LR-cohort and 35 cases of slow-bow (9.62%, 95%, CI 7 - 13.08).
Conclusion:
Our results support the hypothesis that slow-bow AMVL restriction is a common variant of the AMVL amongst South African school children
and unrelated to the RHD process. Further research is required to investigate the exact mechanism underlying this form of AMVL restriction.
Epidemiology of heart failure in sub-Saharan Africa: Republic of the Niger
Ali Touré Ibrahim, B. Dodo, H. Saley, M. Arzika, K. Souley, A.Z. Zakarya, H.K. Soumana, M. Aichatou, D.K. Sambou, I. Coulidiati,
I. Arzika, Ô. Yahaya and O. Moustapha
Lamorde Teaching Hospital, Niamey, Niger
Introduction:
Heart Failure (HF) is a common cardiac disease which occurs in 2% - 3% of the world’s adult population. This translates to 23 million people
globally, 10% - 20% of these individuals being 70-years-old and older. In Africa, hospital-based studies reveal the following incidences of HF in patients <45
years: RCI 40%, Sénégal 37.7% and Togo 28.6%. A high mortality rate of 45% - 60% in 5 years is recorded in this cohort of patients.
Methods:
This is a 9-year retrospective/prospective study done at the cardiology department of the Lamorde Teaching Hospital from January 2010 -
September 2018. Inclusion criteria stated that all patients admitted for HF, consequently diagnosed on clinical and echocardiographical findings, could be
admitted to the study.
Result:
From 1 January 2010 - 30 September 2018 (105 months): 1 447 patients were diagnosed with HF from a possible 3 021 cardiac patients. The
prevalence of HF was 47.88% in 105 months, equivalent to 13 - 14 cases per month and approximately 1 case every 2 days. The principal aetiologies were: DCI
(26.74%), ischaemic HD (4.63%), dysthyroiditis (0.34%), PPCM (12.85%), HBP (45.75%), pericarditis (0.48%) and valvulopathy (9.19%). Management of these HF
cases are discussed within our context.
Conclusion:
In most African countries heart failure is due to hypertension cardiomyopathies and valvular diseases, most often associated with anaemia and
infection. The prevention of these cases should be prioritised to avoid late stage HF with significant mortality and morbidity.
Knowledge gaps amongst rheumatic heart disease post-surgical patients and the impact of education
Olukemi Ige, Christopher Yilgwan, A.T. Larab and Fidelia Bode-Thomas
Heart Aid Trust plc., Jos, Nigeria
Introduction:
Rheumatic heart disease (RHD) is totally preventable by the appropriate management of streptococcal sore throat and rheumatic fever (RF). In
Africa, however, many patients present with advanced disease. We sought to identify RHD knowledge gaps among post-surgical RHD patients and evaluate
the impact of education provided about the disease.
Methods:
As part of the “Kick rheumatic heart disease out of Plateau State”project, a focus group discussion (FGD) was conducted amongst post-surgical
RHD patients. Baseline knowledge of sore throat, RF and RHD was assessed. After a lecture on RHD, their knowledge was reassessed. Content analysis using
codes and themes was used.
Results:
Fifteen females participated in the FGD; many attributed a sore throat to eating hot foods, taking cold drinks and said it could result in fever, one said
it was a bacterial infection. After the lecture, Group A ß haemolytic streptococcus infection was the only cause mentioned, while RF and RHD were named
as complications. Before the lecture, RF was attributed to an infection that may have been present at birth, to heart failure or, in one instance, to a genetic
problem. One participant had never heard of RHD and many said sore throat could be treated with potash solution, salt-water gargle or over-the-counter
drugs. After the lecture, RF as a complication of sore throat was the most common response. The majority said they would now go to the hospital if they had
a sore throat while others said avoiding cold drinks would suffice.
Conclusion:
Our cohort of post-surgical RHD patients demonstrated significant misconceptions and knowledge gaps which the information, provided in
lecture form, served to improve. Education of RHD patients/relatives about the disease should be a continuous process and the ready availability of culturally
relevant educational materials will help to facilitate this process.