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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S8
First degree atrioventricular block is associated with troponin T release and hypertrophic remodelling in males with African
ancestry: The SABPA study
Rhena Delport*, Madelein Griffiths
#
and Leone Malan
#
*University of Pretoria, Pretoria, South Africa.
#
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
Introduction:
First degree atrioventricular block (1oHB) is most commonly observed in males with African ancestry and may increase cardiovascular risk. The
clinical relevance of 1oHB is investigated to establish associations with race, atherosclerosis and myocardial injury.
Methods:
A target-population study included a bi-racial cohort (n=385) with similar socio-economic status (African ancestry/Blacks: n=179, European
ancestry/Whites n=206, aged 20 - 65 years). Ambulatory 24-hour blood pressure (BP) and electrocardiogram (ECG), 10-lead ECG and fasting blood samples
were obtained. High-sensitivity cardiac troponin T (cTnT) was deemed to reflect the degree of myocardial injury and remodelling or emergent atherosclerosis.
B-mode ultrasound images of the left carotid intima-media thickness of the far wall (L-CIMTf) and left cross-sectional wall area (L-CSWA) were obtained as
measures of subclinical atherosclerosis.
Results:
First degree atrioventricular block was observed in 39% of all males and 2% of white females. Accumulative CAD burden was observed in Blacks,
evidenced by concurrent hypertension and 1oHB (23%) compared with Whites (7%), and in addition, a higher number of silent myocardial ischaemic events
as well as a higher degree of L-CIMTf remodelling (p≤0.05). Significant positive associations were observed only in the sub-group of Black males with 1oHB
between L-CIMTf and cTnT [Adj. R2=0.36; ß=0.46 (0.17; 0.75), p≤0.05] as well as L-CSWA and cTnT [Adj. R2=0.30; ß=0.42 (0.12; 0.71), p≤0.05].
Conclusion:
Subclinical atherosclerosis was associated with cTnT release in Black males with prevailing 1oHB, suggesting increased susceptibility for
hypertrophic remodelling and/or ischaemic heart disease in this race group. These findings support concerns expressed regarding 1oHB and adverse
cardiovascular outcomes and mortality.
Evaluation of life-threatening chest pain in a resource-poor setting
Alfred Doku and Mark Tettey
School of Medicine and Dentistry, University of Ghana, Accra, Ghana
Introduction:
Chest pain is a common symptom encountered at emergency departments worldwide. An estimated 25% of the general population
experience chest pain during their lifetime, some of which heralds a life-threatening cardiovascular disease (CVD). Cardiovascular diseases are leading
causes of death in adult Africans and can present as chest pain. Prompt identification of underlying cause/s of chest pain is essential to avoid delay and fatal
misdiagnosis. In resource-poor clinical settings, as seen in Africa, evaluation of life-threatening chest pain is important to shape clinical practise and policy and
to direct resource allocation. This study evaluated the occurrence of life-threatening chest pain in Accra, Ghana.
Methods:
This was a cross-sectional study done at the emergency departments of 2 leading tertiary hospitals, the Korle Bu Teaching Hospital and the 37
Military Hospital, in Accra, Ghana. Consecutive adult patients, aged 18 years and older, presenting with acute chest pain at the emergency departments
between April and June 2018, were enrolled in the study. Descriptive and cross-tabulation analysis was performed. The results were presented in tables and
graphics.
Results:
Two hundred and twenty-seven patients presented with acute chest pain at the emergency department of the 2 tertiary hospitals during the study
period. The mean age of patients was 55.0 ± 17.2 years. Life-threatening conditions presenting with chest pain occurred in 89 (39%) patients and included:
acute coronary syndrome (68.5%), acute left ventricular failure (16.9%) and pulmonary embolism (12.4%) and acute chest syndrome (2.2%). Seventy percent
presented 24 hours after onset of life-threatening chest pain and only 7.8% arrived in an ambulance. None of the pulmonary embolism patients had a CT
pulmonary angiogram done and only 5 (8.2%) acute coronary syndrome had a coronary angiogram.
Conclusion:
Life-threatening chest pain is common and associated with delayed presentation at the facility level. Emergency pre-hospital care is not well
developed, the non-affordability and low availability of modern care facilities hamper proper care of patients.
Clinical assessment and outcome of chest pain in a sub-Saharan African setting
Alfred Doku and Mark Tettey
School of Medicine and Dentistry, University of Ghana, Accra, Ghana
Introduction:
Pre-hospital care response teams as well as structured protocols for the assessment of chest pain are absent in most African countries. Delayed
presentation and poor clinical assessment lead to adverse outcomes in patients with chest pain. We sought to characterise the epidemiology and clinical
process of assessing patients presenting with acute chest pain to the 2 leading tertiary care centres in Accra, Ghana.
Methods:
A structured questionnaire was administered to extract demographic data and clinical details of patients with chest pain.
Results:
There were 4 607 patients (55.0 ± 17.2 years) who presented to the emergency units. Acute chest pain prevalence was 4.9%. Public transport (46%)
was the most common means of transportation, the ambulance service was used in only 3.4% of cases. Acute coronary syndrome (ACS) was the leading
source of acute chest pain (26.9%) followed by gastroesophageal reflux disease GERD (22.9%). Investigation of acute chest pain did not often follow best
practice guidelines.
Conclusion:
There has been a shift in the epidemiology of acute chest pain in Ghana. Efforts to increase physician awareness and best practices are urgently
required.