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OBJECTIVE: To evaluate the role of peak atrial longitudinal strain (PALS) through speckle tracking 2D echocardiography for the assessment of structural and functional left atrial (LA) remodeling in a type 2 diabetes mellitus (T2DM) population. METHODOLOGY: We conducted a cross-sectional study during a 9-month period. T2DM adults aged 18 and above were included. The variables assessed during the study include age and gender of participants, diabetes characteristics, cardiovascular risk factors, clinical anthropometric and hemodynamic parameters, standard echocardiographic parameters, volume-derived LA functions, and 2D PALS. RESULTS: We included a total of 102 patients. The mean age was 58 ± 11.7 years, and the M/F sex ratio was 1:1.5. Coexistent arterial hypertension (HTN) was observed in more than half (59.8%) of the population sample. Mean 2D PALS was 29.2 ± 8.9% with 58.8% (95% CI: 50.0-68.6) of subjects having a reduced LA strain (ie,<32%). Reservoir and pump functions were the most altered LA volumetric phasic functions. Mean indexed LA maximal volume was 22.2 ± 6.8 mL/m2 . There was a significant association between abnormal PALS and age, Body mass index (BMI), indexed LA volume, E/E' ratio, LA active ejection fraction (pump function), and LA expansion index (reservoir function). CONCLUSION: Left atrial remodeling is a recurrent condition in adult T2DM Cameroonians. The reservoir and pump LA functions were the most affected. Assessment of LA global strain allows early detection of LA remodeling with comparison to LA size standard analyses. Age, BMI, indexed LA volume, E/E' ratio, and reservoir and pump LA functions were associated to 2D LA global strain impairment.
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Remodelamento Atrial , Diabetes Mellitus Tipo 2 , Adulto , África Subsaariana , Idoso , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Chronic venous disease is a global public health problem, with high morbidity and economic distress. There is scarcity of data on this disease in sub-Saharan Africa. METHODS: We conducted the first population-based study over a period of 20 months from 1st February 2020 to 30th September 2021 in the 10 regions of Cameroon. A stratify sampling method was chose to select study site. Socio-demographic data, personal and family history, anthropometric parameters, clinical signs, illustrative images, CEAP (Clinical-Etiological-Anatomical-Pathophysiological) classification revised in 2004, VCSS (venous Clinical Severity Score) and risk factor assessment score were used to construct the survey form. Chi-squared test and Fischer exact test were used to compare the prevalence of chronic venous disease across different potential risk factors (sex, age category, previous history of deep vein thrombosis, hypertension, diabetes, smoking status, obesity). Simple and multiple logistic regression models were used to obtain crude and adjusted odds ratio for risk factors associated with chronic venous insufficiency. Statistical analyses were done with R version 4.2 for Linux and the threshold for statistical significance was 0.05. RESULTS: A total of 6578 participants were included in the study, with a mean age of 41.09 ± 16.02 years with female predominance (54.3%). The prevalence of chronic venous disease was 21.8% (95% CI: 20.8-22.9) and the prevalence of chronic venous insufficiency (C3-C6) was 7.02% (n = 462). Night cramps (43.2%), oedema (21.7%), lower limbs pain (20.4%) mostly worsens by walking and heavy legs (16.2%) were more common symptoms. The mean total venous clinical severity score was 0.69 ± 1.76 and this score had a significant positive correlation with C classification (p < .001). In the multivariate analysis, the following factors were independently associated with CVD: Male gender (aOR: 1.27; 95%CI: 1.04-1.56; p = .021), retired people (aOR: 46.9; 95% CI: 12.6-174.5; p < .001), hypertension (aOR: 289.5; 95%CI: 169.69-493.1; p < .001), diabetes (aOR: 2.19; 95% CI: 1.21-3.96; p = .009), obesity (aOR: 10.22; 95%CI: 7.67-13.62; p < .001). Smoking appears as a protective factor (aOR: 0.18; 95%CI: 0.10-0.30; p < .001). CONCLUSION: Chronic venous disease is frequent in Cameroon and main traditional cardiovascular risk factors are associated to this condition. Systematic screening of the CVD in these specific groups could reduce the burden of the disease and its economic impact.
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Diabetes Mellitus , Hipertensão , Insuficiência Venosa , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Prevalência , Camarões/epidemiologia , Fatores de Risco , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/diagnóstico , Obesidade/epidemiologia , Doença CrônicaRESUMO
INTRODUCTION: Hypertension is the leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Current guidelines recommend using two or more antihypertensive agents in single pill combinations (SPCs) to treat hypertension, but data from African patients that support these recommendations are lacking. We assessed the effectiveness and tolerance of three SPCs in lowering blood pressure (BP) amongst hypertensive patients in Douala. METHOD: All patients included in the hypertension registry of the Douala General Hospital and the Douala Cardiovascular Center between January 2010 and May 2020, and receiving a two-drug SPCs (renin-angiotensin system inhibitors (RAASi) + diuretics (DIU), calcium channel blockers (CCB) + RAASi, or DIU + CCB) were tracked from baseline through 16 weeks. Our primary outcome was a decrease in systolic BP (SBP) from baseline up to 16 weeks after initiation of treatment. A mixed linear repeated model was used to evaluate the change of SBP from baseline to week 16, while controlling for age, gender, and baseline SBP. Statistical significance was set at p < 0.05. RESULTS: Of 377 participants on two-drug SPCs, 123 were on CCB + DIU, 96 on RAASi + CCB, and 158 on RAASi + DIU. The mean age was 54.6 (± 11.2) years. At baseline, participants on RAASi + CCB presented with slightly higher SBP compared to the other two groups. Overall, the SBP decreased by 34.3 (± 14.2) mmHg from baseline values and this was comparable across the three groups of SPCs (p = 0.118). The control rate after 16 weeks of follow-up was 62.3% with no significant difference between groups. The occurrence of adverse events was 3.4% and was comparable among the three groups. CONCLUSION: The three two-drug SPCs were highly effective in reducing and controlling BP with low and similar rates of adverse effects. Long-term data documenting safety and whether these agents exert a differential cardiovascular effect in addition to and independent of their BP-lowering effect are needed for SSA populations.
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Cardiologia , Hipertensão , Humanos , Pessoa de Meia-Idade , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea , Camarões , Seguimentos , Hipertensão/epidemiologia , Bloqueadores dos Canais de Cálcio/efeitos adversos , Diuréticos , Combinação de MedicamentosRESUMO
BACKGROUND: Atrial fibrillation is associated with increased risk of morbidity and mortality. There's limited data on the outcomes of atrial fibrillation patients in Africa. We aimed at evaluating the clinical outcomes and their associated factors in patients with atrial fibrillation on antithrombotic therapy in Douala. METHODS: The Douala atrial fibrillation registry is a prospective, observational cohort study of patients with atrial fibrillation followed by cardiovascular specialists in 3 specialized care centres. From January to April 2018, all patients with electrocardiographic diagnosis of atrial fibrillation, aged 21 years or older, were included in the registry provided their consent. The composite endpoint of heart failure, stroke, major bleeding, hospitalisation and mortality as well as their individual occurrence were assessed at 12 months. RESULTS: Of 113 participants that were included, 6(5.3%) were lost to follow-up. The mean age was 70 ± 12 years, with a female predominance (68%). After a mean follow-up time of 12.2 ± 0.7 months, 51 patients (47.7%) had at least one outcome. Hospitalisation, all-cause mortality, heart failure, stroke and major bleeding rates were 33.3%, 16.8%, 15.2%, 4.8% and 2.9% respectively. There was no significant difference in the composite outcome and mortality according to the antithrombotic treatment. Previous heart failure [aHR = 3.07, 95% CI (1.48-6.36) p = 0.003], new onset atrial fibrillation [aHR= 4.00, 95% CI (0.96-8.19) p < 0.001] and paroxystic atrial fibrillation [aHR= 3.74, 95% CI (1.33-10.53) p = 0.013] were significant predictors of outcome. CONCLUSION: Half of patients with atrial fibrillation in this registry developed an outcome after one year of follow-up, with heart failure, new onset and paroxystic atrial fibrillation being the main predicting factors. Diagnosing and managing atrial fibrillation in patients with heart disease should therefore be considered as a key priority.