Page 33 - 4th All African Conference on Heart Disease, Diabetes and Stroke

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, May 2013 AFRICA 31
Results: Seventeen cases of SCD (10 males and 7 females) were
identified. Their ages ranged from 22 years to 75 years with 41%
aged ≤35 years. Eleven SCD occurred in hospital, while 6 were
recorded out of hospital. Eight (47%) were presumed to be due to
ischaemic cardiomyopathy. There were 2 (11.7%) cases of postpar-
tum cardiomyopathy, 1 (5.9%) case of alcoholic cardiomyopathy, and
3 (17.7%) cases each of idiopathic dilated cardiomyopathy (DCM)
and rheumatic heart disease. Hypertension was present in 41.2%,
while 28.6% had diabetes. Fifty-seven per cent of the victims gave
a history of dyspnoea compatible with NYHA II. Only 1 patient
survived following CPR. This patient was regarded as SCD before
resuscitation. Angiotensin-converting enzyme inhibitors (ACEIs)
were prescribed in 93%, while 79% were on beta-blockers. Echo
revealed an ejection fraction of less than 35% in 58.8%. ECG
revealed sinus tachycardia in 41%, pathologic Q waves in 11.8% and
prolonged QTc in 11.8% of cases.
Interpretation: SCD is common among patients admitted with
cardiovascular diseases. Ischaemic cardiomyopathy constituted the
major aetiology followed by idiopathic DCM and rheumatic heart
diseases.
PREVALENCE OF OPERATEDACQUIRED HEART DISEAS-
ES AT THE CARDIAC CENTRE OF SHISONG
Tantchou Tchoumi JC*, Ambassa JC, Butera G
St. Elizabeth Catholic General Hospital, Cardiac Centre, Kumbo,
Cameroon
Introduction: The aim of the study was to investigate the preva-
lence of acquired heart diseases operated on at the cardiac centre of
Shisong.
Subjects and methods: A total of 300 patients were operated on at
the cardiac centre from November 2009 till November 2011. Their
files were reviewed.
Results: Of the 300 patients, 192 had acquired heart disease. Patients
were aged 7–72 years old (mean 30.6 ± 16.6). Females represented
50.7% of the population. Isolated mitral regurgitation and isolated
mitral stenosis were present in 24% and 1% respectively. Isolated
aortic valve regurgitation and isolated aortic stenosis were present
in 11.6% and 2.3% respectively. Ischaemic heart disease with
severe lesions on the coronary arteries was seen in 4%. Constrictive
pericarditis and myxomas were seen in 1.75 and 1.7% respectively.
Combined valve pathology was diagnosed in 21%, combined mitral
regurgitation and aortic regurgitation being the pathology most
encountered (85%). Postrheumatic aetiology of valvulopathies was
the main aetiologic factor diagnosed echocardiographically in 82%
of cases. Mitral plasty was performed in 12% of cases, mostly in
women. Coronary bypass graft surgery was done in all patients with
coronary artery disease. The acute and late postsurgical mortality
rates were 4.5% and 5.6% respectively.
Interpretation: Isolated mitral regurgitation having postrheumatic
aetiology is the pathology most operated in the cardiac centre.
Ischaemic heart disease with important lesion of the coronary arteries
is rare. Postsurgical mortality is comparable to the rates of European
centres.
SUBOPTIMALBLOOD PRESSURE CONTROLAND ITSASSO-
CIATED FACTORS IN HYPERTENSIVE PATIENTS ATTEND-
ING MULAGO HOSPITALHYPERTENSION CLINIC
Temu GA*, Freers J, Katamba A, Kayima J
Mulago Hospital, Kampala, Uganda
Introduction: Hypertension is an important worldwide public-
health challenge; however, it is treatable and the degree to which it
is controlled determines the risk of development of cardiovascular
and kidney-related morbidity and mortality. Despite treatment, rates
of control of blood pressure (BP) are often inadequate. Therefore
the risk of cardiovascular and kidney complications of hypertension
remains high. The aim of this study was to determine the prevalence
of suboptimal control of BP in known hypertensive patients attending
Mulago Hospital hypertension clinic.
Subjects and methods: This was a cross-sectional study at Mulago
Hospital hypertension clinic in Kampala, Uganda, from January to
March 2011. Eligible subjects were screened for age, sex, medication
compliance, smoking history, alcohol intake, salt intake, current anti-
hypertensive medication, and comorbidities, e.g. diabetes mellitus,
obesity, chronic kidney disease. BP was measured using standard
protocol. Data were also collected on previous BP measurements.
Results: Three hundred and fifteen participants were recruited, 40
(12.7%) were male and 275 (87.3%) were female. Mean age was
58 years, standard deviation 12.73, median 58 years. Prevalence of
suboptimal BP control (BP ≥ 140/90 mmHg) was found to be high at
74.9%; therefore only 25.1% of the study participants had optimal BP
control. Poor compliance regarding antihypertensive medication (i.e.
taking <80% of prescribed dose in the preceding week by recall) had
odds ratio (OR) 2.564 (p =0.006, confidence interval (CI) 1.375–4.778)
for suboptimal BP control. Having ≥2 antihypertensive drug classes
was significantly associated with suboptimal BP, OR 2.659 (p =0.004,
CI 1.368–5.166). Increasing age was associated with a positive trend
towards suboptimal BP control (p= 0.054, CI 1.000–1.048).
Interpretation: There is a high prevalence of suboptimal BP control
in Mulago hypertension clinic. We suggest poor compliance with
treatment is a likely root cause. Management should emphasise BP
control, adherence counselling, patient education and use of combi-
nation pills.
AETIOLOGY OF PULMONARY HYPERTENSION IN AFRI-
CA: PRELIMINARY DATA ANALYSIS AFTER ONE YEAR
OF RECRUITMENT: THE PAN AFRICAN PULMONARY
HYPERTENSION COHORT STUDY (PAPUCO)
Thienemann F*, Blauwet L, Dzudie A, Karaye KM, Mahmoud S,
Mbakwem A, Udo P, Mocumbi AO, Sliwa K
The PAPUCO Group, Hatter Institute for Cardiovascular Research in
Africa, University of Cape Town, South Africa
Introduction: Pulmonary hypertension (PH) is a devastating,
progressive disease, with increasingly debilitating symptoms and,
usually, shortened overall life expectancy.
Subjects and methods: A prospective observational study of
patients with newly diagnosed and previously untreated PH based on
echocardiography. Preliminary data analysis after 1 year of recruit-
ment is presented.
Results: Among the 107 recruited cases, the median age was 41
years (range 1–86 years) with a female-to-male ratio of 1.5:1.
Cardiovascular (CV) risk factors were family history of CVD (34%),
hypertension (38%), hypercholesterolaemia (7%), diabetes (8%)
and smoking (5%). The HIV prevalence of the cohort was 25%
with a median CD4 count of 352 cells/µl (interquartile range (IQR)
201–516 cell/µl) at presentation. Twenty-five per cent of patients had
previous episodes of TB. Presenting symptoms were shortness of
breath (SOB) (93%), fatigue (81%), palpitation (69%), cough (54%),
cyanosis (14%) and syncope (or near syncope) (5%); 64% of patients
presented at WHO-FC III or IV. The mean right ventricle systolic
pressure (RVSP) was 56 mmHg (IQR 46–68 mmHg), whereas the
median RVSP in HIV-PH was 60 mmHg (53–73 mmHg, p =0.08).
At the time of writing, 6-month follow-up data were available for
33 patients. Of those, 9 (27%) died within the first 6 months. All but
one were HIV-positive. Median time from diagnosis of PH to death
was 3.0 months (IQR 1.5–3.7). The median RVSP at baseline was 72
mmHg (IQR 60–83 mmHg) of patients who died within 6 months
compared to a median RVSP of 55 mmHg (IQR 45–65) at baseline of
patients alive at 6-month follow-up (p =0.03). Final diagnosis accord-
ing to WHO classification: idiopathic PH (2%), HIV-PH (11%),
congenital heart disease PH (5%), PH due to left heart disease (56%),
PH due to lung disease and hypoxia (17%), chronic thromboembolic
PH (2%) and unclear and/or multifactorial mechanisms (8%).
Interpretation: Left heart disease, HIV, chronic lung disease and
congenital heart disease are common contributors to PH in Africa.