CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
AFRICA
91
last two readings was taken as the patient’s office blood pressure.
Hypertension was defined as blood pressure
≥
140/90 mmHg or
use of antihypertensive medication.
For all patients, a thorough physical examination was carried
out and the New York Heart Association (NYHA) functional
state was determined. HIV clinical staging was done using the
WHO classification. Venous blood was taken and analysed
for comprehensive blood chemistry, full blood count and CD
4
+
T-lymphocyte cell counts (CD
4
cell count). Anaemia was defined
as a haemoglobin level
<
12 g/dl in women and
<
13 g/dl in
men.
14
All tests were done at the Muhimbili National Hospital
laboratory, which is their reference laboratory.
The same licensed cardiologist (PC) performed all echocar-
diograms on a SONOS 7500 Phillips machine with a 3.5-MHz
transducer. Patients were examined in the left lateral decu-
bitus position and the procedure followed the joint European
Association of Echocardiography and American Society of
Echocardiography guidelines.
15
All tests were recorded onto
magnetic optic disks and measurements were then done offline
using the same Phillips echocardiogram machine.
Left ventricular (LV) mass was calculated using an autopsy-
validated formula by Devereux
et al
. and indexed to body surface
area to determine LV mass index (LVMI).
16
Left ventricular
hypertrophy (LVH) was considered present when LVMI was
>
104 g/m
2
in women and
>
116 g/m
2
in men.
17
Relative wall thickness (RWT) was calculated as twice the
posterior wall thickness at end-diastole divided by LV internal
radius at end-diastole, and considered increased if
≥
0.43 cm.
18
LV end-diastolic and systolic volumes were measured using
Simpson’s biplane method and were used to calculate ejection
fraction, stroke volume and cardiac output as currently recom-
mended.
15
LV systolic dysfunction was considered present when
the ejection fraction was
<
50%, and diastolic dysfunction was
defined as the presence of any of the following: E/A ratio
<
1,
mitral valve deceleration time
≥
240 ms, or isovolumic relaxation
time
≥
105 ms.
19
Pericardial effusion was considered present when there was
an echo-free space between the visceral and parietal pericardia
that persisted throughout the whole cardiac cycle. Effusion was
graded as small when it was
≤
2 cm, and large when it was
>
2
cm on two-dimensional pictures during diastole.
Pulmonary hypertension was defined as echocardiographi-
cally estimated pulmonary arterial pressure
>
35 mmHg with or
without dilated and/or hypertrophied right ventricle and in the
presence of dyspnoea.
Dilated cardiomyopathy was defined as the presence of
all-chamber dilatation and global hypokinesia in the absence
of features of hypertensive heart disease or any other apparent
cause of global dilatation and hypokinesia. Patients were clas-
sified as having hypertensive heart disease (HHD) if they were
hypertensive and found to have LVH or concentric remodelling
(i.e. increase in RWT with normal LVMI), with either systolic or
diastolic dysfunction, or both.
A second independent cardiologist (JL) re-read all the
magnetic optical disks, and a consensus between the two cardi-
ologists had to be reached before the final diagnosis was made.
Statistical analysis
Data were entered and analysed using the Statistical Package
for Social Sciences (SPPS) version 18. Continuous data are
expressed as mean (
±
SD) and categorical data as number
(%). Comparison between groups was done using the unpaired
Student’s
t
-test for continuous variables and Chi-square test for
categorical variables. Univariate and finally multivariate binary
logistic regressions were performed to determine the predictors
of having the different echocardiographically determined diag-
noses in the HIV-positive patients. A
p
-value of less than 0.05
was considered to indicate statistical significance.
Results
A total of 102 patients constituted the study population, 70
(68.6%) of whom were women. The patients’ mean age was 42.4
(
±
11.3) years (range of 18–72). As shown in Table 1, at presenta-
tion, most patients were in the WHO HIV clinical stages 2 (42%)
and 3 (42%). Five patients (4.9%) had asymptomatic HIV and 13
(12.7%) were in clinical stage 4.
TABLE 1. SOCIO-DEMOGRAPHIC CHARACTERISTICSAND
LABORATORY FINDINGS
Characteristic
Men (32) Women (70)
p
-value
Mean age (SD)
44.8 (12.6) 41.3 (10.6) 0.154
Source of referral,
n
(%)
CTC
Wards
13 (40.6)
19 (59.4)
36 (51.4)
34 (48.6)
0.394
Marital status,
n
(%)
Single
Married
Other*
10 (31.3)
18 (56.3)
4 (12.5)
15 (21.4)
26 (37.1)
29 (41.4)
0.015
HIV duration,
n
(%)
<
1 month
1 month – 1 year
>
1 year
7 (21.9)
9 (28.1)
16 (50.0)
6 (8.6)
18 (25.7)
46 (65.7)
0.136
WHO stage,
n
(%)
Stage 1
Stage 2
Stage 3
Stage 4
1 (3.1)
10 (31.3)
16 (50.0)
5 (15.6)
4 (5.7)
32 (45.7)
26 (37.1)
8 (11.4)
0.457
Smoking,
n
(%)
9 (28.1)
0 (0.0)
<
0.001
Alcohol consumption,
n
(%)
16 (50.0)
7 (10.0)
<
0.001
Taking illegal drugs,
n
(%)
3 (9.4)
0 (0.0)
0.029
Patients on HAART,
n
(%)
20 (62.5)
50 (71.4)
0.370
Mean (SD) BMI (kg/m
2
)
22.7 (3.6)
25.3 (5.4)
0.013
Mean (SD) pulse rate (beats/min)
97 (19)
94 (16)
0.404
Mean (SD) SBP (mmHg)
130 (23)
129 (20)
0.750
Mean (SD) DBP (mmHg)
80 (19)
81 (14)
0.881
Hypertension,
n
(%)
16 (50.0)
29 (41.4)
0.520
Mean (SD) RBG (mmol/l)
5.00 (1.08) 5.15 (1.37) 0.613
Diabetes,
n
(%)
2 (6.3)
4 (5.7)
0.915
Mean (SD) Hb (g/dl)
11.29 (3.44) 10.13 (3.5) 0.126
Patients with anaemia
n
(%)
27 (84)
48 (69)
0.146
Mean (SD) WBC (
×
10
9
cells/l)
5.69 (2.60) 5.62 (3.67) 0.920
Mean (SD) platelets (
×
10
3
cells/
µ
l) 282 (129)
311 (131)
0.297
Mean (SD) ESR (mm/h)
69 (29)
71 (45)
0.823
Mean (SD) creatinine (
µ
mol/l)
241 (407)
166 (250)
0.256
Mean (SD) cholesterol, (mmol/l)
4.55 (1.91) 4.67 (1.55) 0.729
Mean (SD) CD
4
count (cells/
µ
l)
203 (140)
341 (269)
0.007
Proportion with CD
4
< 200,
n
(%)
16 (50.0)
29 (41.4)
0.520
CTC = outpatient care and treatment centre, RGB
=
random blood
glucose, Hb
=
haemoglobin, WBC
=
white blood cell count, ESR
=
erythrocyte sedimentation rate *Other: cohabiting, separated, divorced,
widowed.
