Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy.

BACKGROUND: The aim of this study was to describe maternal and fetal outcomes after pregnancy complicated by peripartum cardiomyopathy (PPCM). METHODS: We included women that had subsequent pregnancy (SSP) after PPCM and assessed maternal prognosis and pregnancy outcomes, in-hospital up to one week after discharge. Clinical and echocardiographic data were collected comparing alive and deceased women. Factors associated with pregnancy outcomes were assessed. RESULTS: Twenty-nine patients were included, with a mean age of 26.7 ± 4.6 years and a mean gravidity number of 2.3 ± 0.5 of. At the last medical control before subsequent pregnancy, there was no congestive heart failure, the mean left ventricular diastolic diameter (LVDD) was 53 ± 4 mm and the left ventricular ejection fraction (LVEF) was ≥50% in 13 cases (44.8%). Maternal outcomes were marked by 14 deaths (48.3%). Among the factors tested in univariate analysis, LVEF at admission had an excellent receiver-operating characteristic (ROC) curve to predict maternal mortality (AUC = 0.95; 95% CI 0.87-1, p < 0.001), with a cut off value of < 40% (sensitivity = 93% and specificity = 87%). Concerning fetal outcomes, baseline LVEF had the best area under the curve (AUC) to predict abortion or prematurity among all variables (AUC = 0.75; 95% CI 0.58-092, p = 0.003), with a cut-off value of < 50% (sensitivity = 79%, specificity = 67%). CONCLUSIONS: SSP outcomes are still severe in our practice. Maternal mortality remains high and is linked to ventricular systolic function at admission (due to pregnancy), while fetal outcomes are linked to baseline LVEF before pregnancy.

[Performance of the 4-level probability score 4PEPS for the diagnosis of pulmonary embolism in a sub-Saharan African population : Data from the Pulmonary Embolism Registry of the Bogodogo University Hospital, Burkina Faso]. / Performance du score de probabilité à 4 niveaux 4PEPS pour le diagnostic de l'embolie pulmonaire dans une population d'Afrique subsaharienne : données du Registre des Embolies Pulmonaires du Centre Hospitalier Universitaire de Bogodogo, Burkina Faso.

OBJECTIVE: To evaluate the performance of the 4PEPS score in the diagnosis of pulmonary embolism at the University Hospital of Bogodogo from January 1, 2021 to July 31, 2023. METHODOLOGY: This was a cross-sectional descriptive and analytical diagnostic study, running from January 1, 2021 to July 31, 2023. It took place in the infectious and tropical diseases departments, including a pneumology unit and a cardiology unit, of the Bogodogo University Hospital. Patients of both sexes with suspected pulmonary embolism who had undergone CT scan were included. The 4PEPS score was calculated and dichotomized into probable and improbable. It thus constituted the diagnostic test. CT scan was the gold standard. The accuracy of the diagnostic test was judged by the area under the ROC curve. An area under the curve between 0.70 and 1 would mean that the score was moderately informative to perfect. RESULTS: Our study included 472 patients with suspected pulmonary embolism out of a total population of 1228 patients. Hospital prevalence was 21.7%. The mean age of patients was 54.3 years. Females accounted for 52.1% of cases, with a sex ratio of 0.93. The prevalence of pulmonary embolism in the different probability levels of the 4PEPS score was 13.3% for the very low level, 11.7% for the low level, 84.6% for the intermediate level and 93.3% for the high level. Sensitivity and specificity were 92.1% and 86.82% respectively. The positive and negative predictive values were 90.1% and 89.4% respectively. The area under the ROC curve was 0.91. CONCLUSION: In our study, the 4PEPS score showed good negative and positive predictive values. The use of this score will enable practitioners faced with diagnostic difficulties to make therapeutic decisions, reducing inappropriate prescriptions for thoracic angioscan.

[Accidents in patients under anticoagulant therapy in the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, Ouagadougou (Burkina Faso)]. / Les accidents du traitement anticoagulant dans le Service de Cardiologie du Centre Hospitalier Universitaire Yalgado Ouedraogo de Ouagadougou (Burkina Faso).

This study aimed to evaluate the profile of patients hospitalized for anticoagulant-induced hemorrhage. We conducted a retrospective, descriptive study within the Department of Cardiology at the Yalgado Ouedraogo Teaching Hospital, in Ouagadougou, over a period of 2 years from 1 January 2007 to 31 December 2008. All hospitalized patients with anticoagulant-induced hemorrhage were included in the study. The average age of patients was 49,31 ± 17,68 years, the sex-ratio was 2,17. Myocardial infarction was the first indication for anticoagulant treatment, with a rate of 21.05%. Anti vitamin K (AVK) was associated with hemorrhage in 63,16% (n=12) of patients versus 36,84% (n=7) of patients treated with low molecular weight heparins (LMWH); 10 patients had major hemorrhage while nine patients had minor hemorrhage. The average duration of Anti vitamin K (AVK) treatment was 16 ± 58 weeks. Hemorrhage in the digestive tract was the most frequent symptom (31,58%) and, in 89,47% of patients, treatment was associated with platelet aggregation. Treatment of hemorrhagic accident was based on definitive cessation of anticoagulant therapy in 73,68% of patients. Four patients (21.05%) died. The inaccessibility to antidotes such as protamine sulphate and PPSD (Prothrombin, Proconvertine, Stuart factor, and anti-haemophilia B factor) constitutes a real obstacle to adequate treatment for complications; a better education of patients receiving these drugs would be the most important preventive measure, because more than 50% of these accidents are preventable.

Combination of left ventricular noncompaction and partial atrioventricular canal defect in a 21-year-old male: a case report.

INTRODUCTION: Left ventricular noncompaction (LVNC) is classified as a genetic cardiomyopathy characterized by a progressive systolic dysfunction. It may occur alone or in association with congenital cardiac anomalies. The combination of left ventricular noncompaction with partial atrioventricular canal defect is rare and has not, to our knowledge, been described previously. CASE PRESENTATION: A 21-year-old male who traveled to our center from a neighboring country presented with signs of heart failure. Transthorarcic echocardiography showed prominent trabeculations in the left ventricle predominantly in the left ventricle involving the apical lateral and mid anterolateral segments associated with a partial atrioventricular canal defect. There was a biventricular systolic dysfunction. There was good response to medical treatment. CONCLUSION: This case stresses the importance of maintaining a high degree of suspicion for this rare cardiomyopathy and the need to systematically look for other associated anomalies in order to institute proper short- and long-term managements.