Left ventricular recovery in an African cohort of patients with peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening disease associated with pregnancy. There are limited data regarding the outcome of PPCM and its predictive factors in sub-Saharan African patients. We prospectively conducted a double-center (cardiology unit of the department of medicine, Regional Hospital Center of Tenkodogo, Burkina Faso and the department of cardiology of the National Referral Teaching Hospital of N´Djamena, Chad) cohort study in patients with PPCM. Patients were consecutively enrolled from January 2015 to December 2017. Outcomes of interest were left ventricular recovery and poor outcome at one year. Ninety-four patients enrolled with a median age of 28 years. At one-year follow-up, 40.5% of them recovered their left ventricular function. Cox multiple regression analysis revealed that higher left ventricle ejection fraction (LVEF), lower natremia and use of betablockers were baseline variables predicting this end-point. Of the entire study population, 26.60% exhibited the composite end-point of death (n=15) or remaining in New York Heart Association (NYHA) class III-IV or LVEF < 35%. Predictors of poor outcome were lower LVEF at baseline, hyponatremia and use of digoxin. The current cohort study demonstrated that PPCM in sub-Saharan Africa is associated with limited myocardial recovery and significant rate of poor outcome at one year. Therefore, additional studies are needed to better address the disease.

Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso.

INTRODUCTION: Heart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso. METHODS: We conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1st January 2015 to 31st December 2016 and followed up until June 2017. Primary outcome of interest was mortality. RESULTS: Overall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF < 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years. CONCLUSION: Heart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.

Epidemiology and long-term prognosis of atrial fibrillation in rural African patients.

BACKGROUND: Few studies have addressed the pattern of atrial fibrillation (AF) in rural Africa. The purpose of the study was to assess the epidemiology and long-term prognosis of AF in rural African patients in the Regional Hospital Center (RHC) of Tenkodogo, Burkina Faso. RESULTS: Overall, 107 of 1805 cardiac cases presented with AF (prevalence of 5.9%). Six patients were excluded. Mean age was 66.56 ± 14.92 years, and 53.47% were female. Hypertension was the most prevalent cardiovascular risk factor (59.41%). Congestive heart failure (HF) was reported in 85.15% of the study patients at presentation. Most of the study population presented with severe underlying heart disease (93.1%), and hypertensive heart disease was the most prevalent with 45.54% of the cases. The mean CHA2DS2VASc score in patients with non-valvular heart disease (n = 91) was 3.33 ± 1.25 (extremes 1-6) while the risk of bleeding was low (HAS-BLED score ≤ 1) in 82 patients (81.2%). Oral anticoagulation was prescribed in few cases (5.26%). During a follow-up period of 74.43 ± 23.94 weeks, acute HF and stroke occurred in respectively 43 and 6 patients. Forty-one patients (40.59%) died. The overall survival rate was 69% at 6-month and 59.4% at 1-year follow-up. Patients with idiopathic dilated cardiomyopathy were at higher risk of death than other patients (log-rank test = 11.88, p < 0.001) over time. CONCLUSION: AF is not rare in rural African patients and is associated with an increased long-term risk of HF, stroke, and mortality.

[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.

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.

[Prevalence and adverse effects of antihypertensive agents in patients followed up on an ambulatory basis at the University Hospital Yalgado Ouédraogo]. / Prévalence et caractéristiques des effets indésirables des antihypertenseurs chez les patients suivis en ambulatoire au Centre Hospitalier Universitaire Yalgado Ouédraogo.

Medicinal treatment of arterial hypertension (AH) may cause adverse effects which can be annoying and thus influence patient's compliance with treatment. Our study focused on these undesirable effects in patients followed up for AH on an ambulatory basis in the Department of Cardiology at the University Hospital Yalgado Ouédraogo from July to September 2015. Our aim was to determine their rates and their characteristics. Data were obtained from patients' interview, from the examination of patients' follow-up records and of medical consultation forms. A total of 278 patients were included in the study, 69.1% of them were women. The average age was 52.2 ranging between 23 and 86 years; 87.8% of patients lived in urban areas. Smoking, dyslipidemia and a family history of AH accounted for 9%, 35.6% and 57.2% of cases respectively. From a therapeutic perspective, 43.2% of patients were under monotherapy, 35.6% under bitherapy at the start of treatment. Calcium channel blockers (59.7%) were the most used therapeutic drugs. The overall incidence of adverse effects was 60.1%. Calcium channel blockers were involved in 53.6% of adverse events of patients, diuretics in 48.6%. Molecule-specific prevalence was 28.1% for the amlodipine and 24.5% for the hydrochlorothiazide. Excessive diuresis (13.7%), cough (12.9%) and vertigo (11.5%) were the most frequent adverse events reported by the patients. The central and peripheral nervous system and the osteo-muscular system were the most affected systems. Adverse effects are a major determinant of patient's compliance with antihypertensive treatments, because they may have a significant impact on patient's daily life.

Hypertension and Associated Factors in Rural and Urban Areas Mali: Data from the STEP 2013 Survey.

BACKGROUND: Our study aims to estimate hypertension (HTN) prevalence and its predictors in rural and urban area. METHODS: We conducted a cross-sectional population-based study involving subjects aged 15 to 65 years. Collected data (sociodemographic, blood pressure, weight, height, and blood glucose) were analyzed using SPSS version 20. A logistic regression was conducted to look for factors associated with HTN. RESULTS: Mean was 47 years. High blood pressure (HBP) prevalence was 21.1 and 24.7%, respectively, in rural and urban setting. In rural area age group significantly predicted hypertension with age of 60 years having more-than-4-times risk of hypertension, whereas, in urban area age group, sex and body mass index were predictors with OR: HTN raising from 2.06 [1.24-3.43] for 30-44 years old to 7.25 [4.00-13.13] for 60 years and more using <30 years as reference. Female sex was protective with OR of 0.45 [0.29-0.71] and using normal weight as reference OR for overweight was 1.54 [1.04-2.27] and 2.67 [1.64-4.36] for obesity. CONCLUSION: Hypertension prevalence is high and associated factors were age group in rural area and age group, female sex, and body mass index in urban area.

[Contribution of stress test to the treatment of ischemic heart disease]. / Apport de l'épreuve d'effort dans la prise en charge des cardiopathies ischémiques.

Stress test is a useful diagnostic tool in patients with suspected angina pectoris with low sensitivity but high specificity. It is also very useful in the evaluation of the risk, of the effectiveness of treatment and it is a useful guidance on medical prescriptions after controlling the symptoms of ischemia. This study aims to analyze the contribution of stress test to the treatment of ischemic heart disease in the Department of Cardiology at the University Hospital CHU YO. We conducted a retrospective study of 60 patients who had undergone stress test from January 2012 to December 2013. Stress test was performed using a treadmill according to the modified Bruce protocol. Sixty patients underwent stress test during the study period. The average age of patients was 49± 10.8 years. Sex-ratio was 1.2. All patients underwent treadmill stress test. Twenty-two patients had a history of coronary artery disease. Estimating presence of coronary artery disease was the indication for stress test in 83% of cases. It was detected in 78% of cases. Stress test was stopped when maximal workload was reached in 46 cases (or 77%). Mean exercise duration was 11,7 mn ± 3,2. Ten percent of patients had a positive stress test and 10% a dubious test. Our study will also contribute to transfer knowledge on this diagnostic test which is still little prescribed in our environment and even among cardiologists. However, efforts should be made in order to improve the quality of stress test practice in the management of coronary artery disease in a context of countries with limited resources.

[Contribution of the myocardial scintigraphy to the management of stable angina in Burkina Faso]. / Apport de la scintigraphie myocardique d'effort dans le diagnostic de l'angor stable au Burkina Faso.

OBJECTIVE: The objective of our work was to analyze the contribution of stress myocardial scintigraphy in the diagnosis of stable angina in the Cardiology Department of CHU YO. METHOD: This was a retrospective study of 47 patients who received a stress myocardial scintigraphy from January 2012 to December 2013 for the diagnosis of stable angina. The scintigraphic sections were made after injection of the radiotracer (MibiTc99m) during the treadmill stress test. RESULTS: Myocardial scintigraphy accounted for 16% of all scintigraphy and stress myocardial scintigraphy for diagnosis of stable angina accounted for 64% of all myocardial scintigraphy. The average age of the patients was 47 ± 10 years. The sex ratio was 1.1. All patients had completed the treadmill stress test. The treadmill stress test was stopped for maximum effort in 42 cases (89%). The average duration of the effort was 12 minutes ± 2.4. Treadmill stress test was positive in three patients. Nineteen percent of patients had a pathologic myocardial scintigraphy. Scintigraphy was pathologic in all patients with a positive treadmill stress test. CONCLUSION: Myocardial scintigraphy remains a sensitive examination for the diagnosis of stable angina. It helps to better stratify risk and adjust patient treatment.

OBJECTIF: L'objectif de notre travail était d'analyser l'apport de la scintigraphie myocardique d'effort dans le diagnostic de l'angor stabledans le service de Cardiologie du CHU YO. MÉTHODE: Il s'est agi d'une étude rétrospective sur 47 patients ayant bénéficié d'une scintigraphie myocardique d'effort de Janvier 2012 à Décembre 2013 pour le diagnostic d'un angor stable.Les coupes scintigraphiques ont été réalisées après injection du radio-traceur (MibiTc99m) au cours de l'épreuve d'effort. RÉSULTATS: La scintigraphie myocardique représentait 16% des scintigraphies et celle d'effort pour diagnostic d'un angor stable 64% des scintigraphies myocardiques. L'âge moyen des patients était de 47 ± 10 ans.Le sex-ratio était de 1,1. Tous les patients avaient effectué l'épreuve d'effort sur tapis roulant. L'épreuve d'effort était arrêtée pour effort maximal dans 42 cas (soit 89%). La durée moyenne de l'effort était de 12 mn ± 2,4.L'épreuve d'effort était positive chez trois patients. Dix-neuf pour cent des patients avaient eu une scintigraphie myocardique pathologique.La scintigraphie était pathologique chez tous les patients ayant une épreuve d'effort positive. CONCLUSION: la scintigraphie myocardique reste un examen sensible pour le diagnostic l'angor stable. Elle permetde mieux stratifier le risque et ajuster le traitement des patients.

Septal alcoholization in hypertrophic cardiomyopathy: about 11 cases.

Outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy are not enough studied in all centers. The purpose of this study was to determine the outcomes of septal alcoholization in hypertrophic obstructive cardiomyopathy in our hospital. A retrospective and prospective descriptive study focused on all patients aged at least 18 years treated by alcohol septal ablation between July 2005 and June 2010 in the cardiology unit of Clermont-Ferrand teaching Hospital. The inclusion criteria were, hypertrophic obstructive cardiomyopathy with left ventricular outflow tract obstruction ≥ 50 mmHg, symptomatic despite optimal medical therapy. The clinical, paraclinical data and the results of alcohol ablation were collected from medical records of patients and a telephone conversation with the patients or their physicians. These data were analyzed by EPI info 6.04. Eleven patients with average age of 56.27 ± 15, 83 were included of which 81.8% of men. The main indications of alcohol septal were dyspnea stage NYHA II-IV (45.5%), lipothymia (18.2%) and invalidating angina (18.2%). Main electrocardiographic abnormalities were left ventricular hypertrophy and disorders of repolarization with 72.7% each. Minor conductive disorders were found in 45.5% of the cases. The left ventricular outflow tract obstruction was 98.18 ± 25.93 mmHg before alcohol septal ablation and 18.91 ± 31.97 mmHg after a follow-up of 25.64 ± 21.97 months. The success rate was 81.8%. Conductive disorders (45.5%) required the establishment of a definitive pacemaker in 36.4% of the patients. A cardiac defibrillator was implanted at 27.3%. Septal alcoholization was succesful.

[Evaluation of patients' satisfaction in the department of cardiology at the University Hospital Yalgado Ouedraogo]. / Évaluation de la satisfaction des patients dans le service de cardiologie du CHU Yalgado Ouedraogo.

INTRODUCTION: Patients' satisfaction is an important component of health care quality evaluation. Patients and physicians are now care partners. This new relationship deserves to be evaluated. Our study aimed to evaluate the satisfaction of patients hospitalized in the Department of Cardiology at the University Hospital Yalgado Ouedraogo. METHODS: We conducted a cross-sectional descriptive study with a single data collection phase of all the patients hospitalized from 1 January to 30 June 2014. We administered SAPHORA questionnaire adapted to suit our context. The scores and the satisfaction rates were calculated according to the studied parameters. RESULTS: During the study period we collected data from 230 patients. The mean hospitalization time was approximately 10 days. 125 (53.2%) men were enrolled in the study, sex ratio was 1.1. 32% (n = 75) of patients were unschooled. Public servants accounted for 24.3% (n = 57) of our study population. The average age of our sample was 50.7 years. Patients over the age of 65 years accounted for 25.6% of the study population. 113 (48.1%) patients had been admitted as medical emergencies. 21 patients (8.9%) had a history of hospitalization in the Depatment of Cardiology. Dilated cardiomyopathy was the diagnosis made during hospitalization in 75 (32%) cases. The overall score of satisfaction of the patients treated in the Department of Cardiology was 78.3%. Satisfaction score on hospital admission was 68.1% and on patients' comfort was 65.8%. Satisfaction score on health care quality and on hospital discharge planning was 84.7% and 84.5% respectively. Patients' suggestions for improvement were based on comfort during hospital stay in 99 (42.1%) cases and on staff identification in 176 (74.9%) cases. CONCLUSION: The evaluation of the satisfaction is infrequent in our country. It is becoming increasingly frequent in western countries using common and validated tools. It is an important aspect that our hospitals should include in order to increase quality approach to accreditation.

Use of Vitamins K antagonists in non-valvular atrial fibrillation thromboembolic risk prevention in Burkina Faso.

INTRODUCTION: Atrial fibrillation is the commonest cardiac rythm disorder. Thromboembolic accidents are common complications that should be prevented by anticoagulant treatment. The aim of our study is to assess the use of vitamins K antagonists in the prevention of thromboembolic risk in atrial fibrillation. METHODS: It was a descriptive retrospective study of patients folders, performed in the cardiology department from January 1st 2010 to December 31st 2011. The study included all patients with non valvular atrial fibrillation. Thromboembolic risk was assessed through the CHA2DS2VASc score, and hemorrhagic risk through the HAS-BLED score. RESULTS: Atrial fibrillation accounted for 10.6% of all hospitalizations (103/970). Five patients had contra indication to anticoagulants. Non valvular AF was noticed in 68 cases (66%). The non valvular AF was chronic in 40 cases (59%) and paroxystic in eight cases (12%). The median age of the population was 64.5+13.8 years old. Median CHA2DS2VASc score was 3.9 + 1.6. Two patients had a score < 1. Sex, place of residence, age > 65, and cardiac failure did not interfere with prescription of vitamins K antagonists. Ischemic stroke and intra cavity thrombus were the indications for vitamins K antagonists' prescriptions. The median HAS-BLED score was 3.5 + 1.5. The rate of vitamins K antagonists use was 35.3%. One case of death due to hemorrhagic stroke was noticed. CONCLUSION: Guidelines on thromboembolic risk prevention are poorly used in the cardiology department. But the use of scoring systems allows the assessment of vitamins K antagonists treatment benefit/risk in atrial fibrillation, and minimizes the hemorrhagic risk.

Right ventricular outflow tract tachycardia worsened during pregnancy.

We report the case of a 35 years old woman without underlying heart disease who was diagnosed with a right ventricular outflow tract tachycardia worsened during pregnancy. The diagnosis of ventricular tachycardia was made early in her pregnancy course but the patient had symptoms three months earlier. Her disease course was marked by rhythmic storms during the second trimester of pregnancy that led to three hospitalizations accounting for about two weeks in total. The combination of nadolol 80 mg and flecainide tablets 150 mg improved her rhythmic storms. Radiofrequency allowed a radical cure of this ventricular tachycardia. The patient is now asymptomatic 27 months after radiofrequency treatment.