CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 2, March 2012
92
AFRICA
The overall mean BMI was 24.5 (
±
6.06) kg/m
2
, while the
mean systolic and diastolic blood pressures were 129 and 81
mmHg, respectively. Anaemia was present in 73.5% of the
total population. Forty-five (44.1%) patients had hypertension.
Compared to the men, the women had a higher mean BMI (25.3
vs 22.7 kg/m
2
,
p
=
0.013) and higher CD
4
counts (341 vs 203
cells/
µ
l,
p
=
0.007) at the time of recruitment. On the other hand,
significantly more men were smokers, consuming alcohol and
taking illicit drugs (Table 1).
The most common presenting cardiac symptom was palpi-
tations (91%), while the least common was chest pain (28%).
Shortness of breath, orthopnoea, paroxysmal nocturnal dysp-
noea, oedema of the lower limbs and cough were present in
69, 31, 20, 40 and 46% of the patients, respectively. Multiple
complaints were common and excluding palpitations, 63% of
the patients had two or more symptoms, while 37% had three
or more symptoms. Thirty-two per cent of the patients were in
NYHA class 4, 29% in class 3 and the rest (39%) were in class
2. Neither the presenting symptoms nor the NYHA class differed
significantly between men and women.
The most common echocardiographic diagnosis was pericar-
dial effusion, present in 41.2% of the study participants. Among
these, six (5.9% of total) had symptomatic large effusions, while
36 (35.3% of total) had small effusions that were haemodynami-
cally insignificant. Pulmonary hypertension (PHT) and dilated
cardiomyopathy (DCM) were present in 12.7 and 9.8% of the
participants, respectively. Hypertensive heart disease (HHD) was
present in 34.3% of the participants, while mitral valve prolapse
(MVP) was the diagnosis in 5.9% (Table 2).
Six (5.9%) patients had ‘other’ diagnoses, among whom two
(both males, aged 47 and 31 years) had a markedly dilated aortic
root and ascending aorta. The remaining four were a 33-year-old
male with segmental wall motion abnormality, a 33-year-old
female with rheumatic mitral valve disease, a 25-year-old female
with post-partum cardiomyopathy, and a 29-year-old female with
congenital valvular pulmonary stenosis and a ventricular septal
defect. Eighteen (17.6%) patients had normal echocardiographic
findings.
As shown in Table 2, the echocardiographic diagnoses did not
differ significantly between men and women, or between patients
on HAART and those not on HAART. Following a univariate
analysis, it was found that compared to those without the condi-
tion, patients with small pericardial effusions were more likely to
be young (39 vs 44 years,
p
=
0.033), with a higher resting pulse
rate (103 vs 90 beats/min,
p
<
0.001), lower haemoglobin level
(9.0 vs 11.3 g/dl,
p
=
0.002) and higher white blood cell (WBC)
count (6.9 vs 4.9
×
10
9
cells/l,
p
=
0.005). They also had higher
serum creatinine levels (328 vs 129 µmol/l,
p
=
0.006), lower
cholesterol levels (3.9 vs 5.0 mmol/l,
p
=
0.001) and lower CD
4
cell counts (162 vs 373 cells/µl,
p
<
0.001).
Patients with HHD were older (51 vs 38 years,
p
<
0.001),
with a higher BMI (26 vs 23 kg/m
2
,
p
=
0.003), higher systolic
(148 vs 119 mmHg,
p
<
0.001) and diastolic (92 vs 74 mmHg,
p
<
0.001) blood pressure and lower mean resting pulse rate (87
vs 99 beats/min,
p
≤
0.001). They also had higher haemoglobin
levels (12.1 vs 9.6 g/dl,
p
<
0.001), higher serum creatinine (285
vs 139
µ
mol/l,
p
=
0.022) and serum cholesterol levels (5.4 vs 4.2
mmol/l,
p
<
0.001), and higher mean duration on HAART (41 vs
25 months,
p
=
0.020) (Table 2).
Patients with DCM were more likely to be young (35 vs 43
years,
p
=
0.029), with lower mean systolic (116 vs 130 mmHg,
p
=
0.047) and diastolic (67 vs 82 mmHg,
p
=
0.005) blood pres-
TABLE 2. DEMOGRAPHICAND CLINICAL CHARACTERISTICS OF ECHOCARDIOGRAPHIC DIAGNOSES (UNIVARIATEANALYSIS
COMPARING PATIENTSWITH ECHOCARDIOGRAPHIC DIAGNOSISAND THOSEWITHOUT)
Small
effusion
(
n
=
36)
Large
effusion
(
n
=
6)
HHD
(
n
=
35)
PHT
(
n
=
13)
DCM
(
n
=
10)
MVP
(
n
=
6)
Normal
(
n
=
18)
Mean (SD) age (years)
39.2 (9.6)* 33.7 (8.1)* 50.6 (10.4)** 42.0 (9.1)
35.0 (8.2)* 36.6 (9.2)
40.2 (9.3)
Males (%)
31
50
40
46
20
13
17
Mean (SD) BMI (kg/m
2
)
24.5 (4.3)
24.2 (4.3)
26.7 (5.0)* 24.7 (2.9)
22.3 (5.0) 18.5 (2.7)** 23.7 (5.0)
Mean (SD) SBP (mmHg)
128 (20)
128 (20)
146 (18)** 118 (20)* 116 (16)* 115 (14)
122 (10.0)
Mean (SD) DBP (mmHg)
81 (12)
73 (12)
90 (12)** 71 (18)* 67 (22)*
75 (10)
78 (8.7)
Mean (SD) pulse rate (b/min)
103 (20)*
96 (5)
87 (13)*
96 (12)
105 (7)
90 (17)
94 (16)
Mean (SD) Hb (g/dl)
9.0 (3.1)* 8.9 (2.3)
11.8 (3.8)* 10.1 (2.0)
9.8 (1.7)
9.8 (3.4)
10.7 (3.5)
Mean (SD) WBC count in cells
×
10
9
/l
6.9 (4.6)* 6.88 (3.38)
5.0 (3.1)
4.9 (1.9)
6.6 (4.5)
4.9 (1.2)
5.6 (5.6)
Mean (SD) serum creatinine (
µ
mol/l)
328 (526)* 87 (17)
295 (503)* 204 (336)
115 (36)
158 (131)
171 (301)
Mean (SD) serum cholesterol (mmol/l)
3.9 (1.5)* 3.4 (0.7)
5.3 (1.8)* 3.9 (1.3)
3.7 (1.2)
4.7 (1.4)
5.2 (1.4)
Mean (SD) CD
4
cell count (cells/
µ
l)
162 (170)** 304 (283)
321 (214)
242 (208)
82 (57)* 394 (241)
449 (295)*
% on HAART
72
50
63
46
70
62
72
Mean (SD) duration on HAART (months)
24 (26)
17 (17)
41 (32)*
17 (18)
24 (24)
39 (25)
27 (20)
Mean (SD) duration after HIV diagnosis (months) 23.9 (28.9)
12 (12.4)
41.3 (40.4)
§
18.6 (19.6) 17.0 (19.0) 34.5 (24.4) 36.2 (56.9)
Presenting cardiac symptoms (%)
Palpitations
SOB
Orthopnoea
PND
Oedema
Cough
Chest pain
89
83*
33
19
53
61*
31
67
100
83
67
83
67
33
94
60
37
11
40
29
20
92
95
23
15
23
46
31
80
100*
100**
90**
100**
100**
40
100
67
33
17
17
33
50
89
50
0**
6
11*
28
22
SOB
=
shortness of breath, PND
=
paroxysmal nocturnal dyspnoea, HHD = hypertensive heart disease, PHT = pulmonary hypertension, DCM = dilated
cardiomyopathy, MVP = mitral valve prolapse. *
p
<
0.05, **
p
<
0.01
§
p
=
0.064. Note: multiple diagnoses were present.
