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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
10
AFRICA
3
Global Health Systems Solutions, Limbe, Cameroon
4
Douala Cardiovascular Centre, Bonapriso, Douala, Cameroon
5
Universite de Montagne, Bangante, Cameroon
6
Department of Cardiology, University Teaching Hospital,
Yaounde, Cameroon
7
Hatter Institute for Cardiovascular Research in Africa, Cape
Town and Faculty of Health Sciences, University of Cape
Town, Cape Town, South Africa
8
Clinical Research Education, Networking and Consultancy,
Douala, Cameroon; Non-Communicable Disease Research
Unit, South African Medical Research Council, Cape Town,
South Africa
Introduction:
Pulmonary hypertension (PH) is an ominous prog-
nostic feature of heart failure and has scanty epidemiological
data in Africa. We explored differences in clinical and echocar-
diographic parameters, and outcome with regard to gender in
patients with PH in Douala, Cameroon.
Methods:
This was a prospective study from March 2012 to
December 2013 in which PH patients were consecutively recruit-
ed following echocardiography (RVSP ≥ 35 mmHg) from two
cardiovascular centres in Douala. Patients were followed up for
12 months. Group comparisons were done using chi-square and
t
-tests while survival was estimated using Kaplan–Meier plots.
Results:
In all, 130 patients (54.6% women) with PH (78%,
PH group 2) were recruited. Overall mean age was 58.7
±
17.6
years (59.2
±
16.1 for men and 58.3
±
18.9 for women). While
cigarette smoking and alcohol abuse were more common in men
than women (both
p
<
0.001), women had greater exposure to
log smoke than men (
p
=
0.00). Previous TB infection and S3
gallop rhythm were more common in women (
p
=
0.03 and
p
=
0.01, respectively). Women had a significantly higher mean SBP
(
p
<
0.05) and pulse pressure (53.8 vs 44.9 mmHg,
p
=
0.01),
and lower haemoglobin levels (
p
<
0.05). Echocardiographic
left ventricular systolic dysfunction was found more often in
men (mean LVEF: 42.6 vs 51.5%,
p
=
0.01 and mean FS: 21.4
vs 28.6,
p
=
0.01). Overall mortality rate was 39.2% and survival
was better in females.
Conclusion:
Though women are more affected by PH and had
high blood pressure, conventional cardiovascular risk factors
were more common in men with PH. Interventions targeting
control of CV risk factors should be strengthened to reduce the
overall burden of PH.
ISCHAEMIC GANGRENOUS LOWER LIMB REVEALING
A TYPE-B AORTIC DISSECTION
Ba Fatimata Gatta*, Kharchi Mohamed Issa, Ba Houleymata,
Camara Sirakh
*Centre National de Cardiologie, Nouakchott, Mauritania;
fatygatta@yahoo.frIntroduction:
Aortic dissection is a serious condition that is as a
result of longitudinal tearing of the medial layer of the aorta,
emanating from an intimal tear. It exposes the patient to multi-
ple complications, including acute ischaemia of the lower limb,
but this is rarely described as the main clinical manifestation of
the disease.
Case report:
We describe the case of a 70-year-old man with a
known history of dilated ischaemic cardiomyopathy, who was
seen at our department for assessment of an acute right leg
ischaemia which was gangrenous and was subsequently ampu-
tated at the mid-thigh level. On admission, he was haemody-
namically stable and presented with a left basal pleural effusion
and the right femoral pulse was not detected. ECG determined
an incomplete left bundle branch block, an inferior necrosis and
an atrial extrasystole. The chest X-ray showed cardiomegaly
with a cardiothoracic ratio of 0.86 and a widened mediastinum.
Transthoracic Doppler echocardiography showed a dilated
descending aorta at 67 mm with an intimal flap, and a moder-
ate circumferential pericardial effusion. The left chambers
were dilated with wall motion abnormalities and a LVEF of
29%. Furthermore, the abdominal aorta was dilated at 49 mm
with an intimal flap. The thoraco-abdominal CT angiography
confirmed a type-B aortic dissection. The aortic isthmus was
dilated with a partially thrombosed false lumen. A bilateral
pleural effusion was visualised. The dissection extended to the
abdominal aorta and the right iliac artery with dilatation of the
right and common iliac arteries and a nearly totally thrombosed
false lumen. Medical treatment was given but the patient died.
Conclusion:
The diagnosis of aortic dissection is sometimes
difficult. The absence of severe chest or abdominal pain and
an emboligenic heart disease, a cause of acute lower-limb
ischaemia, could mask the diagnosis. In this case, it was highly
suspected after transthoracic echocardiography. Endovascular
treatment was not discussed due to its unavailability locally.
PREVALENCE AND PREDICTIVE VALUE OF THE ELEC-
TROCARDIOGRAM IN PULMONARY HYPERTENSION:
EVIDENCE FROM THE PAN-AFRICAN PULMONARY
HYPERTENSION COHORT (PAPUCO) STUDY
Balieva Irina,
1,2,3
Dzudie Anastase,
1,4,5
Thienemann Friedrich,
1,6,7
Mocumbi Ana O,
8
Blauwet Lori,
9
Karaye Kamilu,
10
Sani
Mahmoud U,
1,10
Ogah Okechukwu S,
11,12
Voors Adriaan,
3
Kengne
Andre Pascal,
1,13
Sliwa Karen,
1,2
1
Department of Medicine, Faculty of Health Sciences, University
of Cape Town, South Africa
2
Hatter Institute for Cardiovascular Research in Africa,
University of Cape Town, South Africa
3
University of Groningen, Groningen, the Netherlands
4
Cardiology Unit, Douala General Hospital, Cameroon
5
Faculty of Health sciences, University of Buea, Cameroon
6
Clinical Infectious Diseases Research Initiative, IDM,
University of Cape Town, South Africa
7
Integerafrica research & development, Cape Town, South
Africa
8
Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
9
Division of Cardiovascular Diseases, Mayo Clinic, Rochester,
Minnesota, USA
10
Department of Medicine, Bayero University, Kano, Nigeria