Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 208 AFRICA
Cardiovascular Topics
Pulmonary hypertension as seen in a rural area in
sub-Saharan Africa: high prevalence, late clinical
presentation and a high short-term mortality rate during
follow up
Anastase Dzudie, Bonaventure Suiru Dzekem, Cabral Tantchou Tchoumi, Leopold Ndemnge Aminde,
Ana O Mocumbi, Martin Abanda, Friedrich Thienemann, Andre Pascal Kengne, Karen Sliwa
Abstract
Introduction: The epidemiology of pulmonary hypertension
(PH) in low- to middle-income countries is poorly character-
ised. We assessed the prevalence, baseline characteristics and
mortality rate in patients with echocardiographically diag-
nosed PH at a rural cardiac centre in Cameroon.
Methods: We conducted a prospective cohort study in a sub-
sample of 150 participants, aged 18 years and older, diag-
nosed with PH [defined as right ventricular systolic pressure
(RVSP) ≥ 35 mmHg in the absence of pulmonary stenosis and
right heart failure]. PH was classified as mild (RVSP: 35–50
mmHg), moderate (RVSP: 51–60 mmHg) and severe (RVSP:
> 60 mmHg).
Results: Of 2 194 patients screened via echocardiograms,
343 (crude prevalence 15.6%) had PH. The sub-sample of
150 patients followed up (54.7% women, mean age of 62.7 ±
18.7 years) had a mean RVSP of 68.6 mmHg. They included
7.3% mild, 29.3% moderate and 63.4% severe PH cases.
Co-morbidities included log smoke (80.7%), hypertension
(52.0%), family history of cardiovascular disease (50.0%),
diabetes (31.3%), alcohol abuse (21.3%) and HIV infection
(8.7%). Main clinical features were dyspnoea (78.7%), fatigue
(76.7%), palpitations (57.3%), cough (56.7%), jugular venous
distension (68%) and peripheral oedema (66.7%). Overall,
70% presented in World Health Organisation functional
class III/IV. PH due to left heart disease (PHLHD) was the
commonest (64.7%), and rheumatic valvular disease account-
ed for 36.1%. The six-month mortality rate was 28%.
Conclusion: PH, dominated by PHLHD, was common among
adults attending this rural centre and was associated with
a high mortality rate. Related co-morbidities and late clini-
cal presentation reflect the poor socio-economic context.
Improved awareness of PH among physicians could promote
early diagnosis and management.
Keywords: pulmonary hypertension, prevalence, mortality,
Shisong, Cameroon
Departments of Internal Medicine and Physiology, Faculty
of Medicine, University of Yaoundé, Yaoundé, Cameroon
Anastase Dzudie,MD, PhD, FESC
Bonaventure Suiru Dzekem, MD,
Martin Abanda, MD
Douala General Hospital and Clinical Research Education,
Networking and Consultancy, Douala, Cameroon
Anastase Dzudie,MD, PhD, FESC
Bonaventure Suiru Dzekem, MD
Leopold Ndemnge Aminde, MD
Martin Abanda, MD
Soweto Cardiovascular Research Group, Department of
Medicine, University of the Witwatersrand, Johannesburg,
South Africa
Anastase Dzudie,MD, PhD, FESC
NIH Millennium Fogarty Chronic Disease Leadership
Programme
Anastase Dzudie,MD, PhD, FESC
Karen Sliwa, MD, PhD, FESC
Shisong Cardiac Centre, Kumbo, Cameroon
Cabral Tantchou Tchoumi,MD, PhD
Instituto Nacional de Saúde, and Faculty of Medicine,
Eduardo Mondlane University, Maputo, Mozambique
Ana O Mocumbi, MD, PhD, FESC
Non-communicable Diseases Unit, South African Medical
Research Council, Cape Town, South Africa
Andre Pascal Kengne, MD, PhD
Clinical Infectious Diseases Research Initiative, Institute of
Infectious Diseases and Molecular Medicine, Faculty of Health
Science, University of Cape Town, Cape Town, South Africa
Friedrich Thienemann, MD
Hatter Institute for Cardiovascular Research in Africa,
Faculty of Health Sciences, University of Cape Town, Cape
Town, South Africa
Karen Sliwa, MD, PhD, FESC
School of Public Health, Faculty of Medicine and Biomedical
Sciences, University of Queensland, Brisbane, Australia
Leopold Ndemnge Aminde, MD