Post discharge management of heart failure patients: clinical findings at the first medical visit in a single-center study.

BACKGROUND: The Post Discharge Management of patients with heart failure impact significantly their incomes. This study aims to analyze the clinical findings and management at the first medical visit of these patients in our context. MATERIAL AND METHODS: This is a retrospective cross-sectional descriptive study on consecutive files of patients hospitalized for heart failure from January to December 2018 in our Department. We analyse data from the first post discharge medical visit including medical visit time, clinical conditions and management. RESULTS: Three hundred and eight patients (mean age: 53.4 ± 17.0 years, 60% males) were hospitalized on median duration of 4 days [1-22 days]. One hundred and fifty-three patients (49,67%) were presented at the first medical visit after 66.53 days[0.06-369] on average, 10 (3.24%) patients died before this first medical visit and 145 (47.07%) had been lost to follow-up. The re-hospitalization and treatment non-compliance rates were 9.4% and 3.6%, respectively. Male gender (p = 0.048), renal failure (p = 0.010), and Vitamin K antagonist (VKA) /direct oral anticoagulant (DOAC) (p = 0.049) were the main lost to follow-up factors in univariate analysis without statistic signification in multivariate analysis. Hyponatremia (OR = 2.339; CI 95% = 0.908-6.027; p = 0.020) and atrial fibrillation (OR = 2.673; CI 95% = 1.321-5.408; p = 0.012) were the major mortality factors. CONCLUSION: The management of patients with heart failure after discharge from hospital seems to be insufficient and inadequate. A specialized unit is required to optimize this management.

[Acute heart failure with altered ejection fraction : Electrocardiographic signs with mortality at the Abidjan cardiology institute]. / Insuffisance cardiaque aiguë à fraction d'éjection altérée : signes électrocardiographiques associés à la mortalité à l'institut de cardiologie d'Abidjan.

INTRODUCTION: Heart failure with impaired ejection fraction (HFIEF) represents the end-stage of most cardiac diseases, and is responsible for a high mortality rate. In order to identify patients at risk, numerous clinical and paraclinical prognostic factors have been proposed. The electrocardiogram (ECG), easy to perform and inexpensive, retains a powerful role in the prognostic evaluation of heart failure patients. The aim was to evaluate ECG signs associated with mortality in a retrospective cohort of patients with ICFEA. METHODOLOGY: The study was observational and analytical based on retrospective data collected from patients benefiting from a primary hospitalization for ICFEA at the Abidjan Heart Institute from January 2018 to July 2020. RESULTS: Of the 370 patients included, 197 had died by August 1, 2020, representing an overall mortality of 53%. Mortality progressed gradually up to one year, then remained unchanged up to 30 months. In multivariate Cox regression including ECG variables only, the presence of intra-ventricular conduction disorders (OR: 1.80; 95% CI [1.01-3.25]), microvoltage (OR: 1.82; 95% CI [1.05-16]), and pathological Q waves (OR: 1.70; 95% CI [1.02-2.83]), were significantly associated with overall mortality. When ECG variables and clinical, paraclinical and therapeutic demographic variables were included, only the presence of pathological Q waves (OR:1.74; 95% CI [1.01-3.01]) persisted as a risk factor for mortality. Hypertension and treatment of heart failure, in particular ACEI/ARII, beta-blockers and ARM, were protective factors. The presence of Q waves was associated with a significant reduction in survival, based on curves obtained using the Kaplan-Meier model. CONCLUSION: ICFEA is responsible for high mortality, mainly in the year following the 1st hospitalization for cardiac decompensation. The presence of pathological Q waves is the only electrocardiographic sign that remains statistically associated with a poor prognosis, after adjustment.

[Diagnostic approach and treatment of hypertension in healthcare workers in Abidjan's district (Ivory Coast)]. / Approche diagnostique et prise en charge de l'hypertension artérielle chez le personnel soignant du district d'Abidjan (Côte d'Ivoire).

BACKGROUND: Epidemiological data concerning hypertension among health care workers are scarce. PURPOSE: The aim of this study was to assess the diagnostic process and treatment of hypertension among a healthcare worker population in order to improve treatment. METHODS: This was a prospective study including 821 healthcare workers from Abidjan's publics hospitals. There were 208 medical doctors, 464 nurses and 149 assistant nurses. There were 59% women, 41% men. The mean age was 42.9 years. RESULTS: The prevalence of hypertension was 17.5%: 48.1% among teaching medical doctors, 13.6% in the group of other medical doctors, 14.9% in the nurses group and 18.8% in the assistant nurse group. After recruitment as a healthcare worker, 86.9% of the cases of hypertension were diagnosed. When hypertension was diagnosed, 74.3% had presented symptoms. The disease was diagnosed by a physician in 77.8% of cases and by a nurse in 22%. In many cases (67.8%), the follow-up was done by a cardiologist; 15.7% by general practitioners. However, 10.7% of the healthcare workers with hypertension had no medical follow-up. Single-drug treatment was most commonly used (49.7%); 36.4% were taking two drugs. Poor compliance with treatment was noted in 71.1% of he healthcare workers with hypertension (clearly poor compliance for 40.5% and problems with compliance for 30.6%). Among those with clearly poor compliance, 29% had stopped taking their medication and seven individuals had declined taking any medication. Poor compliance was most commonly observed among assistant nurses (52.9%) and nurses (42.6%). People taking a combination of two or three drugs complied better with their treatment.

[Atrial fibrillation: epidemiological data from the Cardiology Institute in Abidjan, Côte d'Ivoire]. / Fibrillation auriculaire: epidémiologie i l'institut de cardiologie d'Abidjan (Côte d'Lvoire).

UNLABELLED: The purpose of this retrospective study covering a 10-year period was to analyze epidemiological data and associated conditions related to atrial fibrillation (AF) in a cardiology hospital setting in SubSaharan Africa. PATIENTS AND METHODS: A total of 217 charts of patients hospitalized in the Medical Department of the Abidjan Cardiology Institute between August 1995 and August 2005 were reviewed. RESULTS: During the study, a total of 3,908 patients were admitted to the department, including 217 for AF for a hospital prevalence of 5.5%. There were 113 men (52%) and 104 women (48%) for a sex ratio of 1.08. Overall mean patient age was 58.9 years (range, 18 to 91 years). The difference in the mean age of men and women was not statistically significant: 57.8 versus 60 years respectively. The main symptoms at the time of admission to the hospital were exertional dyspnea (55.7%) and palpitations (22.1%). A total of 136 patients (62.6%) exhibited cardiac insufficiency. Heart disease was diagnosed in 192 patients including hypertensive cardiopathy in 48% and rheumatic valvular heart disease in 28%. The thromboembolic risk was moderate in 47% of patients (CHADS2 score, between 1 and 2) and high in 18.4% (CHADS2 score > or = 3). CONCLUSION: In our practice, hypertensive and rheumatic valvular heart disease were the main causes of AF that was associated with an alarming thromboembolic risk. These findings indicate that further effort is needed to prevent arterial hypertension and acute rheumatic joint disease.

[Unusual association of endomyocardial fibrosis and aberrant migration of Dracunculus medinensis in the pericardium]. / Association inhabituelle d'une fibrose endomyocardique et d'une impasse parasitaire péricardique de Dracunculus medinensis.

We report one case of endomyocardial fibrosis with a relapsing pericarditis, associated with an aberrant migration of Dracunculus medinensis in the pericardium, in a 22-year-old patient from an endemic zone of bilharziasis and dracunculosis in Côte d'Ivoire. The evolution has been marked by the appearance of thrombus in the right atrium. The patient died on the 49th day of hospitalization following an refractory cardiac insufficiency.

[Assessment of Contraindications to Percutaneous Mitral Commissurotomy (PMC) in Abidjan Heart Institute, Côte d'Ivoire]. / Evaluation des contre-indications à la commissurotomie mitrale percutanée (CMP) à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

Rheumatic mitral stenosis is still common in sub-Saharan Africa. The aim of this study was to evaluate the clinical and echocardiographic contraindications to the realization of percutaneous mitral commissurotomy (PMC) in Abidjan Heart Institute. We conducted a prospective, transversal and analytical study in the Exploration Unit from March 30, 2017 to March 30, 2018. Mitral stenosis was severe with an average anatomical surface area of 0.87cm2, an average gradient of 13.7 mmHg and an upstream repercussion (dilatation of the left atrium (78 ml/m2); moderate dilatation of the right atrium (22.3 cm2) and average pulmonary arterial hypertension (PAH) of 55 mmHg). The main clinical contraindications were a history of rest dyspnoea at 66.7%, permanent atrial fibrillation at 53.3 % and clinical manifestations of severe PAH in 40 %. Unfavourable anatomy (95.7 %) evaluated by scores of Wilkins, Cormier and especially Echoscore revisited; bicommissural fusion (95.7 %) and severe aortic valvulopathy (31.1%) were the main barriers in transthoracic echocardiography. In multivariate analysis after linear regression, valvular anatomy, as assessed by the various scores, was significantly related to low socioeconomic status (p=0.018), level of education (p=0.04), severity of mitral stenosis evaluated by the mean gradient (p=0.033) and the impact on the left atrium (p=0.015). Mitral stenosis presents several clinical and echocardiographic contraindications. Adverse anatomy is the main obstacle and is related to low socio-economic status, educational level and severity of stenosis.

La sténose rhumatismale mitrale est courante en Afrique subsaharienne. Le but de cette étude était d'évaluer les contre-indications cliniques et échocardiographiques de la commissurotomie mitrale percutanée (CMP) à l'Institut de cardiologie d'Abidjan. Nous avons mené une étude prospective, transversale et analytique dans l'unité d'exploration du 30 mars 2017 au 30 mars 2018. La sténose mitrale était sévère, avec une surface anatomique moyenne de 0,87 cm2, un gradient moyen de 13,7 mmHg et une répercussion en amont (dilatation) de l'oreillette gauche (78 ml/m2) ; dilatation modérée de l'oreillette droite (22,3 cm2) et hypertension artérielle pulmonaire moyenne (HAP) de 55 mmHg). Les principales contre-indications cliniques étaient des antécédents de dyspnée de repos à 66,7 %, de fibrillation auriculaire permanente à 53,3 % et de manifestations cliniques de HAP sévère à 40 %. L'anatomie défavorable évaluée par les scores de Wilkins, Cormier et surtout l'échoscore revisité ; la fusion bicommissurale (95,7 %) et la valvulopathie aortique sévère (31,1 %) étaient les principaux obstacles à l'échocardiographie transthoracique. Dans l'analyse multivariée après régression linéaire, l'anatomie valvulaire, évaluée par les différents scores, était significativement liée au faible statut socio-économique (p = 0,018), au niveau d'éducation (p = 0,04), à la gravité de la sténose mitrale évaluée par le gradient moyen (p = 0,033) et l'impact sur l'oreillette gauche (p = 0,015). La sténose mitrale présente plusieurs contre-indications cliniques et échocardiographiques. L'anatomie défavorable est le principal obstacle et est liée au faible statut socio-économique, au niveau d'éducation et à la gravité de la sténose.

[Unusual venous thrombosis revealing a human immunodeficiency virus infection and a protein S deficiency. Two cases and literature review]. / Thromboses veineuses inhabituelles révélatrices d'une infection par le virus de l'immunodéficience humaine et d'un déficit en protéine S. A propos de deux cas et revue de la littérature.

The authors report two cases of unusual venous thrombosis associated with protein S deficiency in patients with the acquired immunodeficiency syndrome. The first case was a superior mesenteric vein thrombosis caused by HIV-1 infection associated with protein S deficiency in a 53-year-old patient. The second case was a cerebral venous thrombosis in a 34-year-old patient with HIV-1 and HIV-2 infections associated with protein S deficiency. None of the two patients were receiving antiretroviral therapy at the time of diagnosis. The evolution of thrombosis was favorable in both patients with heparin therapy and antivitamin K (AVK).

[Left atrial mass observed in a patient in Abidjan, Ivory Coast]. / Tumeur de l'oreillette gauche à Abidjan (Côte d'Ivoire).

The purpose of this report is to present a case involving a tumor-like mass in the left atrium of a 27-year-old woman in Abidjan, Ivory Coast. The mass was discovered by echocardiography carried out after cardiomegaly was detected by roentgenography performed in the context of debilitated general condition, fever and positive serology for HIV1. The patient responded favorably to anti-tuberculosis treatment with complete regression of the mass and improvement of general condition. Based on this outcome, the most likely diagnosis was cardiac tuberculoma, a rare complication of tuberculosis.

[Percutaneous coronary intervention in the management of acute coronary syndromes in Ivory Coast: Challenges and outcomes]. / Angioplastie coronaire dans les syndromes coronariens aigus en Côte d'Ivoire : difficultés et résultats.

AIM: Assess the challenges and outcomes of percutaneous coronary intervention (PCI) in the management of ACS at Abidjan Heart Institute. PATIENTS AND METHODS: Prospective survey carried out from April, 1st, 2010 to April, 29th, 2016. Whole patients aged 18-year-old, admitted at Abidjan Heart Institute for ACS, and who underwent PCI were included in the Registre prospectif des actes de cardiologie interventionnelle de l'institut de cardiologie d'Abidjan (REPACI). Indications and outcomes of PCI were analyzed. RESULTS: Seven hundred and forty-nine patients were admitted for ACS, of which 165 underwent PCI. Ratio PCI/ACS was 0.22. Mean age was 55.6±9.8 years. Male were predominant (sex-ratio=12.7). Main clinical presentation was ST-elevation myocardial infarction (STEMI) in 75.1% of cases. One-vessel disease was predominant in STEMI (52.4%), and multi-vessel disease in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (51.2%). Most of patients (86.7%) underwent PCI with stent implantation. PCI was performed successfully in 97.0% of cases. Main non-fatal complications were hematoma (2.4%). In-hospital mortality-rate was 1.2%, and one-year mortality-rate was 1.6%. CONCLUSION: PCI is performed in Subsaharan Africa with safety, despite encountered difficulties in its implementation.

Status of cardiac arrhythmia services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force report.

BACKGROUND: There is limited information on the availability of health services to treat cardiac arrhythmias in Africa. METHODS: The Pan-African Society of Cardiology (PASCAR) Sudden Cardiac Death Task Force conducted a survey of the burden of cardiac arrhythmias and related services over two months (15 October to 15 December) in 2017. An electronic questionnaire was completed by general cardiologists and electrophysiologists working in African countries. The questionnaire focused on availability of human resources, diagnostic tools and treatment modalities in each country. RESULTS: We received responses from physicians in 33 out of 55 (60%) African countries. Limited use of basic cardiovascular drugs such as anti-arrhythmics and anticoagulants prevails. Non-vitamin K-dependent oral anticoagulants (NOACs) are not widely used on the continent, even in North Africa. Six (18%) of the sub-Saharan African (SSA) countries do not have a registered cardiologist and about one-third do not have pacemaker services. The median pacemaker implantation rate was 2.66 per million population per country, which is 200-fold lower than in Europe. The density of pacemaker facilities and operators in Africa is quite low, with a median of 0.14 (0.03-6.36) centres and 0.10 (0.05-9.49) operators per million population. Less than half of the African countries have a functional catheter laboratory with only South Africa providing the full complement of services for cardiac arrhythmia in SSA. Overall, countries in North Africa have better coverage, leaving more than 110 million people in SSA without access to effective basic treatment for cardiac conduction disturbances. CONCLUSION: The lack of diagnostic and treatment services for cardiac arrhythmias is a common scenario in the majority of SSA countries, resulting in sub-optimal care and a subsequent high burden of premature cardiac death. There is a need to improve the standard of care by providing essential services such as cardiac pacemaker implantation.

[Coronary artery aneurysms probably due to Kawasaki's disease]. / Anévrismes coronaires chez un adulte jeune évocateurs d'une probable maladie de Kawasaki.

We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.

[Prevalence and characteristics of acute coronary syndromes in a sub-Saharan Africa population]. / Prévalence et caractéristiques des syndromes coronariens aigus dans une population d'Afrique subsaharienne.

AIM: To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population. PATIENTS AND METHODS: Prospective survey from January, 2010 to December, 2013, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for acute coronary syndrome (ACS). RESULTS: Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13.5%. Mean age was 55.4±11 years. Clinical presentation was predominantly ST-segment elevation myocardial infarction (STEMI) in 71.5% of subjects, non-ST-segment elevation acute coronary syndrome (NSTE-ACS) accounted for 28.5%. Two hundred and eighty patients (65.9%) were transferred by unsafe transportation. Among the 89 patients admitted within 12hours of the onset of symptoms, primary percutaneous coronary intervention was performed in 20 patients (22.5%), or 6.6% of STEMI as a whole. Twenty-five patients (8.2%) received fibrinolytic therapy with alteplase. In-hospital death rate was 10%. CONCLUSION: The prevalence of acute coronary syndromes is increasing in sub-Saharan Africa. Excessive delays of admission and limited technical facilities are the major difficulties of their management in our regions.

[Prevalence and characteristics of metabolic syndrome among hypertensive patients in Abidjan]. / Prévalence et caractéristiques du syndrome métabolique chez les hypertendus à Abidjan.

AIM: Assess prevalence of metabolic syndrome (MetS) in black Africans hypertensive patients. POPULATION: Prospective survey from 3rd November 2014 to 12th June 2015, at Abidjan Heart Institute. Study was carried out among patients aged 18 years old, admitted to external consultation. Oral consent was obtained. MetS was established based on the definitions of the NCEP-ATP III 2005 and the International Diabetes Federation (IDF). RESULTS: Over 1246 hypertensive patients, 404 were included in our study. The prevalence of MetS was 48.8% according to the criteria of the NCEP-ATP III 2005 and 51% according to the IDF. We noticed a female predominance (69% against 31%, P<0.001). Central obesity (49.5%) and low HDL-cholesterol (42.1%) were the factors defining the SM most predominant in our series. Low blood pressure control was higher in the presence of MetS (43.6%). The average number of antihypertensive prescribed drugs were significantly higher (2.2±0.8 against 2±0.8, P<0.001). MetS was significantly associated with obesity (BMI≥30kg/m(2) : 40.6% against 14%, P<0.001). Cardiovascular complications were observed in 54.8% of hypertensive patients in the presence of MetS. CONCLUSION: MetS is a reality in sub-Saharan Africa. Adequate preventive measures are needed to limit its progression.

[Giant pulmonary artery aneurysm: etiology and an exceptional 17 years natural course]. / Anévrisme géant de l'artère pulmonaire : aspects étiologiques et évolutifs exceptionnels sur 17ans.

True pulmonary artery aneurysm (AAP) is rare and represent less than 1% of intra-thoracic aneurysms. We report a case of a AAP in a patient with a likely cor triatrium sinister, with an obstructive membrane responsible for pulmonary hypertension, explaining AAP. The long-term evolution of 17 years is made to an uncomplicated myocardial infarction. The patient died eight months later suddenly probably due to the rupture of the PAA.

[African histoplasmosis with ganglionic localisation. Apropos of 1 case in an HIV negative patient]. / L'histoplasmose africaine à localisation ganglionnaire. A propos d'une observation chez un sujet VIH négatif.

This study concerns one case of ganglionary African histoplasmosis observed in a pregnant woman. The diagnosis of this histoplasmosis case has been based on histological presentation. This patient has a HIV negative serologic reaction. The histoplasmosis clinical presentation is like tuberculosis, so its diagnosis is difficult. The prevalence of this pathology is unknown in our region but it is increasing since the discovery of AIDS.

[Transthoracic echocardiography in a heart institute in Abidjan (Ivory Coast): Indications and evaluation of the request appropriateness]. / Échocardiographie transthoracique dans un institut de cardiologie à Abidjan (Côte d'Ivoire) : motifs et évaluation de la pertinence des indications.

OBJECTIVES: The aim of this study was to clarify the clinical situations motivating indications of transthoracic echocardiography (TTE) in a cardiology institute in Côte d'Ivoire and to assess the appropriateness of indications. PATIENTS AND METHODS: This is a prospective and observational study conducted over a period of 6 months. The 1733 enrolled were classified according to the indications and their relevance defined by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Echocardiography and the American Heart Association (ACCF/ASE/AHA). RESULTS: In five cases (0.3%), indications were not listed in the document ACCF/ASE/AHA. The most common indication was the initial evaluation of hypertension (HTA) and suspicion of hypertensive heart disease (47.3%). All indications, the assessment in the context of hypertension represented 853 examinations (49.2%). Heart failure accounted for 5.3% of indications, but consisted of 302 applications (17.4%) when was associated hypertension with signs suggestive of heart failure. Requests were considered as appropriate in 95.3%, inappropriate in 3.2% and uncertain in 1.6%. In the group of inappropriate indications patients were significantly younger, and were examinations more often normal and less often absolutely abnormal. CONCLUSION: The profile of cardiovascular morbidity in our institution is dominated by the spectrum of hypertension and heart failure. Each indication must be balanced for the profitability of the ETT.

[Early detection of anthracyclines cardiotoxicity by tissue Doppler echocardiography about 45 cases at Abidjan institute of cardiology]. / Dépistage précoce de la cardiotoxicité des anthracyclines par l'écho-Doppler tissulaire à propos de 45 cas à l'institut de cardiologie d'Abidjan.

OBJECTIVE: Evaluate the early anthracyclines cardiotoxicity. METHODS: It is a prospective study made on 10 months of period from October 2008 to July 2009 and on patients who contracted a solid canny tumor hospitalized or followed in their movement and who would receive chemotherapy with an anthracycline molecule. On this effect, we have used tissue Doppler of mitral ring to detect clinic infratoxicity. RESULT: Forty-five patients (43 women and 2 men) who contracted the solid cancers were included in the study. The patients were 48 of age in average ± 10.12. All our patients did not show any cardiovascular symptoms at the time of the study. Cardiothoracic and electrocardiograms were not significantly modified by the chemotherapy. The cardioecography with the use of tissue Doppler revealed as followed: (a) significant low of the ejection fraction and the pick of systolic myocardia wave (Sa) on four patients (8.8%). These concerned patients were considered as having anthracycline cardio toxicity. The factor causing this cardiotoxicity was the nature of the anthracycline, which was used: the doxorubicin. The quantity accumulated threshold of the doxorubicin that shod (where toxicity appeared was 150 mg/m(2)); (b) a low of Sa pick without that of left ventricular fraction ejection observed on five patients (11.11%). These concerned patients were considered as having potential risks to develop anthracyclines cardiotoxicity; (c) the left ventricular ejection fraction was not a good indicator the check up of the patients under chemotherapy made up with anthracyclines. CONCLUSION: The tissue Doppler not only enables to make diagnostics of early myocardia dysfunctions but it mainly allows to identify people with risks of a cardiotoxicity due to a going on chemotherapy.

Management of hypertension in the elderly patient at abidjan cardiology institute (ivory coast).

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire. Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009. Results. The patients mean age was 73.1 ± 5.3 years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was 169.4 ± 28.4 mmHg for systolic, 95.3 ± 15.7 mmHg for diastolic, and 74.1 ± 22.8 mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%. Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target.

Prevalence of cardiac dyssynchrony and correlation with atrio-ventricular block and QRS width in dilated cardiomyopathy: an echocardiographic study.

INTRODUCTION: Cardiac dyssynchrony causes disorganised cardiac contraction, delayed wall contraction and reduced pumping efficiency. We aimed to assess the prevalence of different types of dyssynchrony in patients with dilated cardiomyopathy (DCM), and to establish the correlation between atrio-ventricular block and atrio-ventricular dyssynchrony (AVD), and between impaired intra-ventricular conduction and the existence of inter-ventricular dyssynchrony (inter-VD) and intra-left ventricular dyssynchrony (intra-LVD). METHODS: We included 40 patients in New York Heart Association stage III or IV, admitted consecutively with DCM with severe left ventricular dysfunction (left ventricular end-diastolic diameter ≥ 60 mm and/or ≥ 30 mm/m(2)) and left ventricular ejection fraction < 35%. Electrocardiographic and echocardiographic data were evaluated in all patients. Patients were divided into two groups: group 1: eight patients, with a QRS duration ≥ 120 ms, and all presented with left bundle branch block; group 2: 32 patients with a narrow QRS < 120 ms. RESULTS: Overall, the mean age was 54.7 ± 16.8 years and patients in group 1 were older (67.2 ± 13.6 vs 51.5 ± 15.8 years, p = 0.01). The prevalence of atrio-ventricular dyssynchrony (AVD), inter-VD and intra-LVD was respectively 40, 47.5 and 70%. Two patients (5%) did not exhibit dyssynchrony. AVD was present with a similar frequency in the two groups (37.5% in group 1 vs 40.6% in group 2, p = 0.8). There was no correlation of the magnitude of AVD with the duration of the PR interval (from the beginning of the P wave to the beginning of the QRS complex) (r(2) = 0.02, p = 0.37) or the QRS width (r(2) = 0.01, p = 0.38). A greater proportion of patients with inter-VD was observed in group 1 (87.5 vs 60%, p = 0.03). There was a trend towards a more important inter-ventricular mechanical delay according to QRS width (r(2) = 0.009, p = 0.06). The proportion of intra-LVD was similar in all groups, with a high prevalence (87.5% in group 1 and 65.6% in group 2, p = 0.39). CONCLUSION: The assessment of cardiac dyssynchrony is possible in our country. Intra-ventricular mechanical dyssynchrony had a high prevalence in patients with DCM, irrespective of the QRS width. These data emphasise the usefulness of echocardiography in the screening of patients.