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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
30
AFRICA
Methods:
A retrospective study of 384 patients with HFPEF
(LVEF
>
45%) from the heart failure registry of the Ibn Rochd
University Hospital of Casablanca, Morocco. Pulmonary
hypertension was defined as pulmonary artery systolic pressure
(PASP)
>
35 mmHg, measuring tricuspid regurgitation veloc-
ity and atrial pressure using Doppler echocardiography. The
primary endpoint was all-cause readmissions for acute heart
failure decompensation (AHFD) during a six-year follow up.
Results:
A total of 71 patients (18.5%) had PASP
>
35 mmHg
and 164 patients had PASP
<
35 mmHg (47%). The average age
was 64
±
3 years, 40.30% were women and 59.70% were men.
The primary endpoint was observed in 20 patients with PH
(28%) who were readmitted for AHFD, whereas 112 patients
without PH had a rate of 7% of developing AHFD. Patients
with PH were an increased adjusted risk for the primary
endpoint.
Conclusions:
Pulmonary hypertension (PASP
>
35 mmHg),
measured by non-invasive methods, is a strong and independent
predictor of an unfavourable outcome in patients with heart
failure and normal or only mildly reduced ejection fraction.
PREVALENCE AND OUTCOMES OF PULMONARY
HYPERTENSION AND DIASTOLIC DYSFUNCTION IN A
HEART FAILURE POPULATION
Sabri Fatima Ezzahra*, Abelhad Meriam, Habbal Rachida
Department of Cardiology, Ibn Rochd University Hospital,
Casablanca, Morocco;
dr.sabri.fz@gmail.comBackground:
Pulmonary hypertension due to left heart disease
is very common. Our aim was to investigate the prevalence and
relationship between the severity of left ventricular diastolic
dysfunction and pulmonary hypertension (PH) in a heart failure
(HF) population.
Methods:
We retrospectively studied 1 613 patients with chronic
heart failure in the HF registry of the University Hospital of Ibn
Rochd, Casablanca. Transthoracic echocardiography was used
to categorise diastolic function and estimate pulmonary artery
pressure. Systolic pulmonary artery pressure (PASP) was deter-
mined by echocardiography and pulmonary hypertension was
defined as PASP
>
35 mmHg. Grade 1 diastolic dysfunction was
determined if the E/A ratio was
<
0.8. An E/A ratio of 0.8–1.5
was classified as grade 2 diastolic dysfunction, and E/A
>
1.5 as
grade 3. If no data on E/A ratio were available, the ratio of early
transmitral flow velocity (E) to mitral annular diastolic velocity
(e’) was used. Grade 1 was assumed if E/e’ was
<
8, representing
impaired relaxation with normal filling pressures. E/e’ of 8–15
was classified as grade 2, and E/e’
>
15 as type 3.The endpoint was
the readmission for AHFD (acute heart failure decompensation).
Results:
Among 1 613 HF patients, PH was present in 21% of
patients with grade 1 diastolic dysfunction, in 20% of patients
with grade 2, and in 41% of patients with grade 3. Outcomes
were not related to the severity of diastolic dysfunction but were
worse in patients with PH. Patients with PH had a rate of 21%
occurrence of AHFD, while only 13% of patients without PH
had AHFD.
Conclusions:
Our data indicate that HF patients with even mild
diastolic dysfunction often have PH. Given the discrepancy in
influence of diastolic dysfunction and PH on outcome, PH may
play an independent and previously underestimated pathophysi-
ological role in HF.
DEVISING USEFUL ALGORITHMS BASED ON ELEC-
TROCARDIOGRAPHIC FINDINGS TO DISCRIMINATE
BETWEEN RIGHT CORONARY ARTERY AND LEFT
CIRCUMFLEX ARTERY OCCLUSION IN ACUTE INFE-
RIOR WALL MYOCARDIAL INFARCTION PATIENTS
Sachin Ramdhany *, Ning Guo
*Flacq Hospital, Telfair Moka, Mauritius; drsachin17@yahoo.
com
1
First Affiliated Hospital of Xian Jiaotong University, China
Background:
Although it is generally considered that patients
with acute ST-segment elevation myocardial infarction (STEMI)
in the inferior wall have a more favourable prognosis than those
with STEMI in the anterior wall, potential complications exist
when the culprit artery is the right coronary artery (RCA). We
therefore compared old and new electrocardiographic (ECG)
criteria, which could be useful for early identification of the
culprit vessel between the RCA and left circumflex (LCX) artery
in patients with inferior wall STEMI.
Methods:
A total of 194 patients with acute STEMI in the infe-
rior wall admitted consecutively to our hospital were enrolled
into this study. Eighteen-lead ECGs recorded on admission, at
a speed of 25 mm/s and voltage of 10 mm/mV, were analysed.
ST-segment deviation was measured with a hand-held calli-
per and magnifying glass at the J-point in all available leads.
Coronary angiography was performed within the first 12 hours
from symptom onset. Of these, 166 patients were identified with
the culprit lesion in the RCA and 28 patients with the lesion in
the LCX.
Results:
Altogether the sensitivity and specificity of 10 old and
six new ECG criteria were examined. Two of the new criteria
proved their utility in identifying the RCA and the LCX as
the infarct-related artery: (1) the ratio of std I/aVL
≤
1, which
yielded a sensitivity of 86.7%, a specificity of 92.8% and a posi-
tive predictive value of 98.6%, made it an accurate marker for
an RCA occlusion; (2) STE or isoelectric ST in lead I, which
yielded a sensitivity of 93%, a specificity of 88% and a positive
predictive value of 56.5%, made it a highly accurate criterion to
diagnose LCX as the infarct-related artery in patients with acute
inferior wall STEMI.
Conclusions:
Two new ECG criteria in combination with previ-
ous criteria can be used to discriminate the RCA from the LCX
as the culprit artery at the bedside in patients with acute inferior
wall STEMI. The ECG is useful in differentiating between RCA
and LCX involvement in acute inferior wall STEMI before
primary percutaneous coronary intervention, allowing decisions
about therapy to be taken at the earliest possible time.