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

14 / 76

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 212 AFRICA
Limitations
Our study has some limitations. Some cases of PH could have
been missed because indications for cardiac echocardiography
are usually symptom driven. This would lead to over-diagnosis
of patients with severe disease, and accordingly, poor outcomes.
Therefore whether our finding reflects those of a typical
population with PH in this setting is unknown. Diagnosis
of PH in our study was done by echocardiography, which is
more a screening tool for PH, while right heart catheterisation
(RHC), which is the gold standard for diagnosing PH, was
not used. Therefore, cases of mild PH could have been missed
in our study. Furthermore the operator-dependent nature
of echocardiography could lead to over- or under-diagnosis.
Despite the fact that echocardiography is only a screening tool,
it is paramount in the diagnosis of PH as it is non-invasive,
more available and less expensive compared to RHC. Moreover,
in expert hands, it yields reliable and reproducible results.
Indeed, studies carried out to evaluate the diagnostic accuracy
of echocardiography compared to RHC have demonstrated a
sensitivity of 83% and a specificity of 72%.21
Conclusion
Our findings suggest that PH is very common among patients
attending our rural cardiac centre, with PHLHD being the most
frequent type, and the short- to medium-term mortality rate
being excessively high. Patients tend to present in advanced stages
of disease and usually with several co-morbidities, most of which
are cardiovascular conditions. Healthcare practitioners in this
setting should be made more aware of this devastating condition,
in order to prompt timely referral to specialised centres for proper
evaluation and care of patients with suspected PH.
We are grateful to Sister Jethro Nkengelefack and her staff at the Shisong
Cardiac Centre, and all cardiologists who referred their patients to this cardi-
ac centre. The study was partly funded by the Pulmonary Vascular Research
Institute, Bayer Healthcare, and the Maurice Hatter Foundation and the
Non-communicable Disease Research and Leadership Programme of the
National Institute of Health, University of the Witwatersrand, Johannesburg,
South Africa.
References
1. Galiè N, Humbert M, Vachiery J-L, Gibbs S, Lang I, Torbicki A, et al.
2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary
hypertension: the Joint Task Force for the Diagnosis and Treatment
of Pulmonary Hypertension of the European Society of Cardiology
(ESC) and the European Respiratory Society (ERS): endorsed by:
Association for European Paediatric and Congenital Cardiology
(AEPC), International Society for Heart and Lung Transplantation
(ISHLT). Eur Respir J 2015; 46(4): 903–975.
2. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna
M, et al. Definitions and diagnosis of pulmonary hypertension. J Am
Coll Cardiol 2013; 62(25 Suppl): D42–50.
3. Simonneau G, Gatzoulis MA, Adatia I, Celermajer D, Denton C,
Ghofrani A, et al. Updated clinical classification of pulmonary hyper-
tension. J Am Coll Cardiol 2013; 62(25 Suppl): D34–41.
4. Simonneau G, Robbins IM, Beghetti M, Channick RN, Delcroix M,
Denton CP, et al. Updated clinical classification of pulmonary hyperten-
sion. J Am Coll Cardiol 2009; 54(1 Suppl): S43–54.
5. Butrous G, Ghofrani HA, Grimminger F. Pulmonary vascular disease in
the developing world. Circulation 2008; 118(17): 1758–1766.
6. Mocumbi AO, Thienemann F, Sliwa K. A global perspective on the
epidemiology of pulmonary hypertension. Can J Cardiol 2015; 31(4):
375–381.
7. Thienemann F, Dzudie A, Mocumbi AO, Blauwet L, Sani MU, Karaye
KM, et al. The causes, treatment, and outcome of pulmonary hyperten-
sion in Africa: Insights from the Pan African Pulmonary Hypertension
Cohort (PAPUCO) Registry. Int J Cardiol 2016; 221: 205–211.
8. Steenekamp JH, Simson IW, Theron W. Cardiovascular causes of death
at Tshepong Hospital in 1 year, 1989–1990. A necropsy study. South Afr
Med J 1992; 81(3): 142–146.
9. Health and Social Care Information Centre. National Audit of
Pulmonary Hypertension 2013, Report for the audit period 2012.
UK; 2013.nih.gov/pubmed/173455
pubmed/1734552.
10. Todd NW, Lavania S, Park MH, Iacono AT, Franks TJ, Galvin JR,
et al. Variable prevalence of pulmonary hypertension in patients with
advanced interstitial pneumonia. J Heart Lung Transplant 2010; 29(2):
188–194.
11. Accessed
on 20 June 2014.
12. Thienemann F, Dzudie A, Mocumbi AO, Blauwet L, Sani MU, Karaye
KM, et al. Rationale and design of the Pan African Pulmonary hyper-
tension Cohort (PAPUCO) study: implementing a contemporary regis-
try on pulmonary hypertension in Africa. Br Med J Open 2014; 4(10):
e005950.
13. Strange G, Playford D, Stewart S, Deague JA, Nelson H, Kent A, et
al. Pulmonary hypertension: prevalence and mortality in the Armadale
echocardiography cohort. Heart Br Card Soc 2012; 98(24): 1805–1811.
14. Thenappan T, Shah SJ, Rich S, Gomberg-Maitland M. A USA-based
registry for pulmonary arterial hypertension: 1982–2006. Eur Respir J
2007; 30(6): 1103–1110.
15. Badesch DB, Raskob GE, Elliott CG, Krichman AM, Farber HW, Frost
AE, et al.Pulmonary arterial hypertension: baseline characteristics from
the REVEAL Registry. Chest 2010; 137(2): 376–387.
16. Er F, Ederer S, Nia AM, Caglayan E, Dahlem KM, Semmo N, et al.
Accuracy of Doppler-echocardiographic mean pulmonary artery pres-
sure for diagnosis of pulmonary hypertension. PloS One 2010; 5(12):
e15670.
17. Dzudie A, Kengne AP, Muna WFT, Ba H, Menanga A, Kouam CK,
et al. Prevalence, awareness, treatment and control of hypertension in
a self-selected sub-Saharan African urban population: a cross-sectional
study. Br Med J Open 2012; 2(4): e001217.
18. Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, et
al. The causes, treatment, and outcome of acute heart failure in 1006
Africans from 9 countries. Arch Intern Med 2012; 172(18): 1386–1394.
19. Karaye KM, Saidu H, Bala MS, Yahaya IA. Prevalence, clinical charac-
teristics and outcome of pulmonary hypertension among admitted heart
failure patients. Ann Afr Med 2013; 12(4): 197–204.
20. Pulmonary Hypertension in Portugal: First Data from a Nationwide
Registry [Internet]. [cited 2016 Jul 27]. Available from: http://www.
21. Janda S, Shahidi N, Gin K, Swiston J. Diagnostic accuracy of echocar-
diography for pulmonary hypertension: a systematic review and meta-
analysis. Heart Br Card Soc 2011; 97(8): 612–622.