Non-compaction of left ventricular myocardium in sub-Saharan African adults.

BACKGROUND: Non-compaction of the left ventricle (NCLV) is an unclassified cardiomyopathy due to intrauterine arrest of compaction of the loose interwoven meshwork. Only a few studies involving sub-Saharan Africans insmall numbers have been published. The aim of our study was to determine the diagnostic, therapeutic and prognostic aspects as well as the clinical course of NCLV in a black African population. METHODOLOGY: A multicentre retrospective study was carried out between November 2007 and June 2012 in two cardiology departments in Dakar. Patients who met the echocardiographic criteria for NCLV were included in the study. RESULTS: 35patients with the diagnosis of NCLV were evaluated in the study. Their mean age was 47±18.4 years. Heart failure was found in 77.1% of the patients. The most frequent electrocardiographic abnormalities were left ventricular hypertrophy (LVH) (46%) and sinus tachycardia (43%). Mean non-compaction/compaction ratio was 2.84±0.68 with preferential localization in the apex of the left ventricle. The main complications observed were cardiogenic shock (23.5%), pulmonary embolism (6.3%) and ventricular tachycardia (5.9%). Diuretics and ACE inhibitors were the medications most often prescribed. Age >60 years (p=0.04), male gender (p=0.03) and the occurrence of complications during follow-up (p=0.04) were noted to be predictors of poor prognosis. CONCLUSION: Contrary to previous beliefs, NCLV may not be less common in black Africans than in other ethnic subgroups. Clinicians in Africa should be made aware of NCLV so that it can be diagnosed at earlier stages.

Prevalence of rheumatic heart disease in Senegalese school children: a clinical and echocardiographic screening.

OBJECTIVE: To study the prevalence of rheumatic heart disease (RHD) in schools (locally referred to as 'daaras') located in the city of Dakar and its suburbs using both clinical examination and echocardiography. METHODS: This is a cross-sectional study conducted from 9 August to 24 December 2011 involving 2019 pupils, aged between 5 and 18 years selected from the 16 'daaras' of the Academic Inspectorate (Inspection d'Académie) of the city of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were collected and entered into a questionnaire designed for the study. The World Heart Federation criteria for echocardiographic diagnosis were used to diagnose RHD. p<0.05 was considered statistically significant in bivariate analysis. RESULTS: About 60.1% of the pupils were men and the mean age was 9.7±3.3 years. 10 cases of definite RHD were detected, prevalence being 4.96 per 1000 (95% CI 2.4 to 9.1). This prevalence was five times higher with echocardiographic screening compared with clinical screening. 23 cases (11.4 per 1000) of borderline forms were detected. The populations at risk of definite RHD identified in our study were children over 14 years (p<0.001), those with recurrent sore throat (p=0.003) and those residing in the suburbs of the city of Dakar (p<0.001). CONCLUSION: Our study shows a relatively high prevalence of RHD. Reducing its prevalence should focus on the implementation of appropriate policies, targeting at-risk populations and focusing on raising awareness and early detection.