RESUMO
Background: First described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a rare form of restrictive cardiomyopathy found in the tropics. EMF occurs mainly in two phenotypes; biventricular involvement and right ventricular (RV) form. Previously endemic in several countries, there are reports suggesting that the disease is on the decline. Objectives: To describe trends in annual incidence rates of newly diagnosed EMF cases at the Uganda Heart Institute (UHI). Methods: This was a retrospective chart review of all newly diagnosed EMF cases at UHI from January 2007 to December 2020. Cases were divided into two groups A (2007-2013) and B (2014-2020). Results: A total of 155 cases were diagnosed during the period (Group A, n = 124; Group B, n = 31). There were no significant differences between the two groups A and B regarding median age at diagnosis (14 vs. 12 years, p = 0.0940), gender (48.4% female vs. 35.5%, p = 0.1987), and EMF type (66.9% RV EMF vs. 71.0%, p = 0.6634), respectively. The presence of complications such as intracardiac thrombus (5.6 vs. 32.2%, p = 0.0002) and pericardial effusion (57.3% vs. 80.6, p = 0.0172) were more frequent in group B than A, respectively. Pulmonary hypertension (PHT) was predominantly seen in cases with biventricular EMF compared to those with RV EMF (26 vs. 3.8%, p = 0.0001). The number of new cases diagnosed per year remained largely stable in the period 2007-2011, ranging 14-21 per year, peaked in 2012 (26 new cases), and thereafter declined from 10 cases seen in 2013 to 1-5 cases seen per year in the period 2017-2020. Similarly, the annual incidence rates of new EMF diagnosis remained relatively stable in the period 2007-2012, ranging between 22.7 and 29.7 per 10,000 patients seen in the echo labs, and then dramatically declined after 2012 to range between 1.0 and 4.5 new cases per 10,000 patients in the period between 2017 and 2020. Conclusion: There has been a steady decline in the number of new cases of EMF seen at the UHI. However, there were no significant differences in the gender, age at diagnosis and EMF subtype of cases during the period under review. Complication rates were more frequent in the later cohort.
RESUMO
BACKGROUND: Atrial fibrillation (AF) is the most common type of sustained cardiac arrhythmia in adults, accounting for one-third of hospitalizations due to arrhythmia and related complications worldwide. Previously, rheumatic heart disease was documented as the commonest cause of AF in sub-Saharan Africa. However, due to the prevailing epidemiological transition in sub-Saharan Africa, the risk factors and ensuing complications of AF have changed and are on the increase. METHODS: This was a descriptive cross-sectional study involving 102 patients presenting with AF who were recruited from the cardiology unit of Mulago National Referral Hospital, Uganda, over 3 months. Sociodemographic, medical history, and clinical data were obtained. RESULTS: The mean age of study participants was 52±21.3 years with a female predominance (58 [56.9%]). The commonest coexisting medical conditions were hypertension in 42% and rheumatic heart disease in 32% of the patients. The commonest echocardiographic abnormality was chamber dilation, noted in 76.8% of all patients. Heart failure was the most frequent complication encountered (50%) followed by left ventricular diastolic dysfunction and acute thromboembolic stroke documented in 19.6% and 12.8% of the study participants, respectively. Of the enrolled patients, ten (9.8%) died within 3 days of admission. CONCLUSION: AF tends to occur at a younger age in Ugandan patients. The commonest underlying medical conditions among these patients were hypertension and rheumatic heart disease. Hence, all patients with hypertension and rheumatic heart disease should be meticulously screened for AF.
