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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S37
AFRICA
in Uganda and Tanzania as well as support from the Medtronic Foundation. The Small Grants Programme focuses on 3 domains: people and communities,
medicines and technologies and systems and services. It is designed to support patient and community groups in promoting awareness and to advocate and
build health workers’capacity to prevent and treat RHD in LMICs.
Methods:
Requests for proposals were issued through RHD Action, PASCAR and WHF email distribution lists and cross-promoted on websites. A review
panel with representation from Reach, WHF and demonstration projects used structured criteria for scoring based on clear, feasible, measurable objectives.
Preference was given to proposals with dissemination plans using local publicity and social platforms, and for garnering support from local MOH officials.
Final selections were approved by the Medtronic Foundation. Funding increased from $2 000 to $2 500 after the first round.
Results:
Initiated in 2017, 13 proposals have been funded from a pool of 60 submissions. Recipient countries include Zambia, Uganda, Namibia, Rwanda,
Mozambique, Cameroon, Fiji, the Philippines and Nepal. Project directors are primarily junior doctors and project managers supervised by senior mentors. In
most cases, this is their first funding award. These projects have demonstrated tangible impacts and have provided content for first manuscript and abstract
submissions and presentations at professional conferences. Grant reports are presented as website stories showcasing the achievements of small local efforts
with meaningful impact.
Conclusion:
For RHD Action, there is a large return on a modest monetary investment resulting in a very visible, viable global RHD networking platform for
enthusiastic community and provider activists.
Clinical and angiographic impact of smoking on the prognosis of STEMI: Cathlab experience of UH of Casablanca
Zakaria Qechchar*, Fatima Ezzahra Talhi
#
, Monia El Mourid
#
, Salim Arous
#
, Mohamed Elghali Benouna
#
, Abdennaser Drighil
#
,
Leila Azzouzi
#
and Rachida Habbal
#
*Ibn Rochd University Hospital, Casablanca, Morocco.
#
Ibn Rochd University Hospital, Cardiology Department, Casablanca, Morocco
Introduction:
Smoking is a known risk factor for coronary artery disease and is associated with increased rates of myocardial infarction and cardiovascular
death. However, some data show lower mortality in smokers than non-smokers in patients with ST-elevation myocardial infarction (STEMI). The aim of this
study is to evaluate the influence of smoking on clinical outcomes and its impact on mortality in patients admitted for STEMI.
Methods:
A prospective study between October 2017 and April 2018 included a total of 98 patients. They were divided into 2 groups, based on smoking
status during the STEMI presentation, namely active smokers (47 patients, 36%) and non-smokers (51 patients, 64%). The cathlab is closed at night and on
weekends due to a lack of suitable staff in the catheter room. All STEMIs received lysis with tenecteplase and were prepared for angiographic exploration the
following day. After discharge all patients were followed up for 12 months in consultation.
Results:
Mean age was 52 ± 6 years, 68% of smokers were below 60 years old, sex ratio m/f to 4, history of myocardial infarction (p=0.042) and coronary
angioplasty (p<0.05) were significantly associated with smoking. At admission, 87% of all STEMI smokers were treated with thrombolysis compared to
37% in the non-smoker group (p<0.05). The mean ejection fraction was 47% in the non-smoking group compared to 43% in the other group. Rhythmic
complications were significantly greater in the non-smoking group. Biological markers of myocardial infarction were significantly higher in smokers.
Angiographic comparative study showed more single vessel disease in patients who smoked (p=0.015) and double and triple vessel disease in the non-
smoker group (p=0.037). One-year mortality was significantly higher amongst smokers (12.8%) than 6% in the non-smokers group (p=0.003).
Conclusion:
Smokers admitted for STEMI are younger and have a higher mortality rate at 1 year when compared to non-smokers. These results highlight the
role of efforts to encourage smoking cessation in the primary prevention of myocardial infarction.
Variability of renal function and impact on mitral regurgitation in the elderly
Zakaria Qechchar*, Fatima Ezzahra Talhi
#
, Monia El Mourid
#
, Abdenasser Drighil
#
, Leila Azzouzi
#
and Rachida Habbal
#
*Ibn Rochd University Hospital, Casablanca, Morocco.
#
Ibn Rochd University Hospital, Cardiology Department, Casablanca, Morocco
Introduction:
Despite improvement in diagnosis and management, mitral regurgitation (MR) remains associated with high morbidity and serious
complications. Therefore, this study focuses on the elderly population with mitral regurgitation and renal dysfunction.
The aim was to assess renal dysfunction and its impact on the grade of MR to thus determine prognosis factors in elderly patients.
Methods:
This is a single centric prospective study, from 1 October 2017 - 1 January 2019. We included patients 65 years and older with MR isolated
or associated with another valvulopathy. Renal function was defined by levels of serum creatinine and GFR was calculated by CKD-Epi method in initial
consultation. We divided the patients into 2 groups with MR in elderly G1 with good GFR >60ml/min/m² and G2 <60ml/min/m². We excluded patients with
MR in shock or with acute renal injury due to other causes.
Results:
A total of 58 patients were included. The average age was 74 ± 6.4 years, sex ratio was 0.48 and predominant cardiovascular risk factors were
diabetes mellitus, hypertension and smoking. Mean serum creatinine 1.00 ± 0.46mg/dL and median GFR was 81ml/min/m2. MR was isolated in 34 cases,
main mechanism was rhumatismal in 29.3%, severe MR was observed in 20.7%, HFrEF and HFmEF in 7 and 14 cases, respectively, with mean SGL at -16.6 ± 4,
LV and LA dilatation observed in 31 and 42 patients, respectively, with no statistical signification between the 2 groups. LA volume was correlated with renal
dysfunction 51 ± 12mL/m
2
in G2 and 42ml/m
2
in G1 patients, p=0.01 OR1.2 (1.05 - 1.3). PAH in MR was present in 50% in G1 vs. 38% in G2 (p=0.08). A follow
up at 6 months showed aggravation of MR grade in 3.4% in G1 and 8.6% in G2 (p=0.06) and at 12 months 5.2% in G1 and 17.2% in G2 (p=0.025). Four patients
died during follow-up in G2, despite optimal medical treatment.
Conclusion:
Few studies have focused on renal function with MR in the elderly. Lower GFR was significantly correlated to MR grade progression and was an
independent prognostic factor for mortality.
Outcomes of cognitive impairment in the elderly with valvular heart disease
Zakaria Qechchar, Monia Elmourid, Fatima ezzahra Talhi, Abdenasser Drighil, Leila Azzouzi and Rachida Habbal
Ibn Rochd University Hospital, Cardiology Department, Casablanca, Morocco
Introduction:
Cognitive impairment causes changes that are serious enough to be noticed by a patient’s inner circle. Approximately 15% - 20% of people
65 years and older have mild cognitive impairment (MCI) which could increase the risk of cardiovascular events. Few studies have investigated the impact of
altered mental status on mortality and cardiovascular events, even less in elderly patients with valvular heart disease.