Selenium Deficiency as a Risk Factor for Peripartum Cardiomyopathy.

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a multifactorial disease. Although the specific aetiology and pathogenesis of PPCM are unknown, several hypotheses have been proposed, including selenium deficiency. However, the risk of PPCM from selenium deficiency was not previously quantified. This posthoc analysis of peripartum cardiomyopathy in Nigeria (PEACE) registry data aimed to determine if selenium deficiency is an independent risk factor for PPCM. METHODS: Apparently healthy women who delivered within the previous 8 weeks and PPCM patients in Kano, Nigeria, were compared for selenium deficiency (<70µg/L) and other relevant socio-demographic and clinical characteristics. Selenium level was measured at recruitment for each subject. Independent predictors of PPCM were determined using logistic regression models. RESULTS: 159 PPCM patients and 90 age-matched controls were consecutively recruited. 84.9% of the patients and 3.3% of controls had selenium deficiency. Selenium deficiency independently increased the odds for PPCM by 167-fold while both unemployment and lack of formal education independently increased the odds by 3.4-fold. CONCLUSION: Selenium deficiency was highly prevalent among PPCM patients in Kano, Nigeria, and significantly increased the odds for PPCM. These results could justify screening of women in their reproductive years for selenium deficiency, particularly those living in regions with high incidence of PPCM. The results also call for the setting up of a definitive clinical trial of selenium supplementation in PPCM patients with selenium deficiency, to further define its benefits in the treatment of PPCM.

CONTEXTE: La cardiomyopathie péripartum (CMPP) est une maladie multifactorielle. Bien que l'étiologie spécifique et la pathogenèse de la CMPP soient inconnues, plusieurs hypothèses ont été proposées, notamment la carence en sélénium. Cependant, le risque de CMPP lié à la carence en sélénium n'a pas été précédemment quantifié. Cette analyse post-hoc des données du registre de la cardiomyopathie péripartum au Nigéria (PEACE) visait à déterminer si la carence en sélénium est un facteur de risque indépendant de la CMPP. MÉTHODES: Des femmes apparemment en bonne santé ayant accouché dans les 8 semaines précédentes et des patientes atteintes de CMPP à Kano, au Nigéria, ont été comparées pour la carence en sélénium (<70µg/L) et d'autres caractéristiques socio-démographiques et cliniques pertinentes. Le taux de sélénium a été mesuré au recrutement pour chaque sujet. Les prédicteurs indépendants de la CMPP ont été déterminés à l'aide de modèles de régression logistique. RÉSULTATS: 159 patientes atteintes de CMPP et 90 témoins appariés selon l'âge ont été recrutés consécutivement. 84,9% des patientes et 3,3% des témoins présentaient une carence en sélénium. La carence en sélénium augmentait indépendamment les chances de CMPP de 167 fois, tandis que le chômage et le manque d'éducation formelle augmentaient indépendamment les chances de 3,4 fois. CONCLUSION: La carence en sélénium était très répandue parmi les patientes atteintes de CMPP à Kano, au Nigéria, et augmentait significativement les chances de CMPP. Ces résultats pourraient justifier le dépistage de la carence en sélénium chez les femmes en âge de procréer, en particulier celles vivant dans des régions à forte incidence de CMPP. Les résultats appellent également à la mise en place d'un essai clinique définitif sur la supplémentation en sélénium chez les patientes atteintes de CMPP présentant une carence en sélénium, afin de définir davantage ses avantages dans le traitement de la CMPP. MOTS-CLÉS: Cardiomyopathie Péripartum; Carence en Sélénium; Facteur de Risque.

Peripartum Cardiomyopathy: A Review Article.

Peripartum cardiomyopathy (PPCM) is an important cause of heart failure (HF) in northern Nigeria and many other regions of the world. Although the aetiology is unknown, several aetiopathogenic mechanisms have been proposed, including myocarditis, vasculo-hormonal (16-kDa prolactin and Cathepsin D), genetic susceptibility and selenium deficiency hypotheses. The peripartum cardiomyopathy in Nigeria (PEACE) registry has revealed that three socioeconomic factors (lack of formal education, unemployment, underweight status), pre-eclampsia and selenium deficiency were independently associated with higher risk for PPCM. However the customary postpartum practices previously implicated in the aetio-pathogenesis of postpartum cardiac failure, comprising regular hot baths and pap enriched with dried lake salt, were not associated with PPCM. Maternal age <20 years, tachycardia, hypotension and ejection fraction <25% independently increased the risk for mortality. Regular use of beta-blockers and obesity were independently associated with higher survival, and selenium supplementation is a promising treatment strategy for PPCM.

La cardiomyopathie du péripartum (PPCM) est une cause importante d'insuffisance cardiaque (IC) dans le nord du Nigeria et dans de nombreuses autres régions du monde. Bien que l 'ét iol ogi e soi t i nconnue, pl usi eurs mécani smes éti opat hogéni ques ont ét é proposés, not amment les hypothèses de myocardite, vasculo-hormonale (prolactine 16kDa et cathepsine D), de susceptibilité génétique et de carence en sélénium. Le registre PEACE (peripartum cardiomyopathy in Nigeria) a révélé que trois facteurs socio-économiques (absence d'éducation formelle, chômage, insuffisance pondérale), la pré-éclampsie et la carence en sélénium étaient indépendamment associés à un risque plus élevé de PPCM. Cependant , l es prat iques post-part um habit uel l es, précédemment i mpl iquées dans l'éti opat hogéni e de l'insuffisance cardiaque post-partum, comprenant des bains chauds réguliers et des bouillies enrichies de sel de lac séché, n'étaient pas associées au PPCM. L'âge maternel <20 ans, la tachycardie, l'hypotension et la fraction d'éjection <25% augmentaient indépendamment le risque de mortalité. L'utilisation régulière de bêta-bloquants et l'obésité étaient indépendamment associées à une survie plus élevée, et la supplémentation en sélénium est une stratégie de traitement prometteuse pour le PPCM. . Mots clés: Cardiomyopathie du péripartum; Facteurs de risque; Étiologie; résultats.

Impact of Parity on Cardiac Structure and Function in Apparently Healthy Pregnant Nigerian Women.

BACKGROUND: There are few and conflicting reports in the literature about the relationship between parity and maternal cardiac function. The study aimed to assess the impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria. METHODS: This was a cross-sectional study carried out in 3 tertiary centers in Kano, and 1 in Ile-Ife, Nigeria. 112 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation, and their cardiac structure and function assessed using echocardiography. Left ventricular (LV) systolic dysfunction was defined as LV ejection fraction of below 50%, and diastolic dysfunction was graded using mitral filling and tissue Doppler velocities. RESULTS: LV systolic dysfunction and diastolic dysfunction were found in 6 (5.4%) subjects and 20 (17.9%) subjects, respectively. Age (p= <0.0001), left atrial (LA) size (P<0.0001), interventricular septal thickness at end diastole (IVSD) (p= 0.005), posterior wall thickness at end diastole (PWTD) (p=0.004) and QRS duration (p= <0.0001) all increased progressively with higher parity, while tricuspid annular systolic excursion (p=0.320) decreased with higher parity. There was significant positive correlation between parity and age (r= 0.475, p= <0.0001), LA size (r=0.332, p= <0.0001), IVSD (r=0.264, p= 0.005) and PWTD (r= 0.343, p= <0.0001). LV systolic function was not significantly associated with parity. CONCLUSION: Our findings suggested that parity was significantly associated with myocardial remodeling in apparently healthy pregnant women.

CONTEXTE: Il existe peu de données contradictoires dans la littérature sur la relation entre la parité et la fonction cardiaque maternelle. L'étude visait à évaluer l'impact de la parité sur la structure et la fonction cardiaques chez des femmes enceintes apparemment en bonne santé au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans 3 centres tertiaires à Kano et 1 à Ile-Ife, au Nigeria. 112 femmes enceintes apparemment en bonne santé ont été recrutées consécutivement entre la 28* et la 38* semaine de gestation, et leur structure et fonction cardiaques ont été évaluées par échocardiographie. La dysfonction systolique du ventricule gauche (VG) a été définie comme une fraction d'éjection du VG inférieure à 50 %, et la dysfonction diastolique a été graduée en utilisant le remplissage mitral et les vitesses Doppler tissulaires. RESULTATS: Un dysfonctionnement systolique VG et un dysfonctionnement diastolique ont été trouvés chez 6 (5,4 %) sujets et 20 (17,9 %) sujets respectivement. Âge (p=<0,0001), taille de l'oreillette gauche (LA) (P<0,0001), épaisseur du septum interventriculaire en fin de diastole (IVSD) (p=0,005), épaisseur de la paroi postérieure en fin de diastole (PWTD)(p=0,004) et La durée du QRS (p = <0,0001) a augmenté progressivement avec une parité plus élevée, tandis que l'excursion systolique annulaire tricuspide (p = 0,320) a diminué avec une parité plus élevée. Il y avait une corrélation positive significative entre la parité et l'âge (r = 0,475, p = <0,0001), la taille LA (r = 0,332, p = <0,0001), IVSD (r = 0,264, p = 0,005) et PWTD (r = 0,343, p=<0,0001). La fonction systolique VG était associée à la parité. CONCLUSION: Nos résultats suggèrent que la parité est significativement associée au remodelage du myocarde chez les femmes enceintes apparemment en bonne santé. n'était pas significatif. Mots clés: Grossesse, Parité, Structure Cardiaque, Registre peace.

Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

The impact of income on the echocardiographic pattern of heart diseases in Kano, Nigeria.

BACKGROUND: The aims of the present study were to assess the echocardiographic pattern of heart diseases, and to compare the pattern seen in a private echocardiography centre patronized by high income earners (group 1), with that in Murtala Mohammed Specialist Hospital patronized by low income earners (group 2), in Kano, Nigeria. METHODS: the study was retrospective in design. The records of patients aged > or =15 years for a one year period (July 2006-June 2007) were reviewed. RESULTS: Hypertensive heart disease (in 56.7%) was the most common heart disease, more common among group 1 patients (p=0.027). Dilated cardiomyopathy was the 2nd most common heart disease (in 15.2%), more common among group 2 patients (p=0.037). Ischemic Heart Disease (IHD) was the 3rd most common (in 8.7%) heart disease in the study, more common than rheumatic heart disease (in 8.3%). Peripartum cardiomyopathy was exclusively found among group 2 patients (4.3%). CONCLUSION: The pattern of heart diseases in Kano differs between low and higher income earners. HHD was the commonest heart disease among both low income and higher income earners. The relatively high frequency of IHD might be a demonstration of the advanced stage of epidemiologic transition in Kano Nigeria.

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.

Cardiovascular risk factors in Nigerians with systemic hypertension.

BACKGROUND: Hypertension is the commonest risk factor for cardiovascular disease, and it frequently coexists together with other risk factors, thereby increasing the absolute cardiovascular risk. This study is primarily aimed at assessing cardiovascular risk factors in patients with hypertension in comparison with controls. It is also aimed at assessing target organ damage and absolute cardiovascular risk among the hypertensives. STUDY DESIGN: The study was case-control in design, conducted at the General outpatient and Cardiology Clinics of Aminu Kano Teaching Hospital, Kano, Nigeria. Three groups of patients (treated hypertensives, untreated hypertensives and controls), each 70 in number, were matched for age and sex. Patients were selected by balloting, using simple random sampling method. RESULTS: The most prevalent cardiovascular risk factor was Increased Body Mass Index, which was significantly more prevalent among treated (70%) than untreated (45.7%) hypertensives and controls (44.3%). Left Ventricular Hypertrophy was the most prevalent Target Organ Damage, found in 54.3% of treated and 42.9% of untreated hypertensives, and 0% of controls. Very high cardiovascular risk was detected in 75.6% of treated and 68.5% of untreated hypertensives. CONCLUSION: Even before the commencement of treatment, hypertenisves had high prevalence of cardiovascular risk factors and evidence of target organ damage. These were more pronounced in treated hypertensives. The basis and prognosis are discussed.

Cardiac morbidity in subjects referred for echocardiographic assessment at a tertiary medical institution in the Nigerian savanna zone.

Cardiovascular diseases constitute a major public health problem both in the developed and developing countries. The profile of morbidity and mortality however, varies between regions and countries and even within countries. The importance of recognizing the cardiovascular conditions that prevail in a particular area is very important in health planning and for improving healthcare services. We therefore set out to describe the cardiac morbidity pattern from our echocardiographic data. Between August 2002 and September 2004 (24 months), we reviewed the echocardiographic diagnosis of all patients aged 15 years referred for echocardiography. Information obtained from the records included age, gender, names of referring hospital/physician, clinical diagnosis and echocardiogram findings. Data was analyzed using SPSS version 10.0 software. A total of 594 persons were referred for echocardiographic examination in the 2 year study period. Of these, 489 (82.3%) had an abnormal echocardiogram. We analyzed those with abnormal echocardiograms. There were 272 males and 217 females. The male to female ratio was 1.3:1. Hypertensive heart disease was the commonest echocardiographic diagnosis, present in 228 (46.6%) of the patients. This is followed by dilated cardiomyopathy seen in 82 (16.8%) and then rheumatic heart disease in 55 (11.2%). Other findings were Non dilated cardiomyopathy (6.1%), Hypertrophic cardiomyopathy (5.7%), pericardial diseases (3.7%), Ischemic heart disease (4.7%), Cor pulmonale (1.4%) and Endomyocardial fibrosis (0.4%) of patients. It was noted that majority of the cases were advanced with irreversible myocardial damage. Systemic hypertension remains the most important cause of CVD morbidity in savanna region of Nigeria. Addressing the major cardiovascular risk factors especially systemic hypertension will go a long way in reducing the burden of cardiovascular diseases.

Prevalence and predictors of right ventricular diastolic dysfunction in peripartum cardiomyopathy.

BACKGROUND: This study aimed to assess the prevalence of right ventricular diastolic dysfunction (RVDD) and its potential predictors in peripartum cardiomyopathy (PPCM) patients. METHODS: This was a cross-sectional study carried out in Nigeria. RVDD was defined and graded using Doppler filling and myocardial tissue Doppler velocities obtained at tricuspid annular level. RESULTS: Forty-three subjects with PPCM and mean age of 26.6 ± 7.0 years were recruited over 6 months. RVDD was found in 30 (69.8 %) subjects, of whom 16 (53.3 %) had grade I, 12 (40.0 %) had grade II and 2 (6.7 %) had grade III severity. RV systolic dysfunction (RVSD), defined as RV fractional area change <35 %, was found in 88.4 %, while combined RVSD and RVDD was found in 58.1 % of patients. Subjects with RVDD had significantly higher tricuspid E/e' ratio (5.1 ± 2.8 versus 3.5 ± 1.0, p = 0.012) and prevalence of pulmonary hypertension (76.7 versus 46.2 %; p < 0.05), and lower serum selenium concentration (55.6 ± 12.1 versus 72.5 ± 12.0 µg/L, p = 0.001) than those with preserved RV diastolic function. Regression analyses showed serum selenium [odds ratio (OR) = 1.14; 95 % confidence interval (CI) = 1.0-1.3; p = 0.049] and combined RVSD and pulmonary hypertension (OR = 79.2; CI = 3.9-1593.7; p = 0.004) as the only predictors of RVDD, and serum selenium <70 µg/L increased the odds of RVDD by 6.67-fold (CI = 1.18-37.78; p = 0.032). CONCLUSIONS: Both RVDD and RVSD were common in PPCM patients. Selenium deficiency and combined RVSD and pulmonary hypertension seemed to be the only determinants of RVDD in this small cohort, a finding that needs verification in a larger sample of patients.

Ischaemic heart disease in Aminu Kano Teaching Hospital, Kano, Nigeria: a 5 year review.

BACKGROUND: Socio-economic changes and rural urban migration have led to emergence of non-communicable disease including ischaemic heart disease (IHD) and many others. The actual prevalence of IHD in Nigeria is not known. The non communicable disease (NCD) survey sought to determine the prevalence of major risk factors, rather than the prevalence of the disease itself. The prevalence is generally considered low in Nigeria but the current impression about its importance stems mostly from anecdotal reports. We therefore set out to describe the prevalence as well as the spectrum of IHD at Aminu Kano Teaching Hospital, Kano. METHOD: Between July 2000 and June 2005, we reviewed the prevalence as well as the spectrum of presentation of IHD in Aminu Kano Teaching Hospital. Information was obtained from the medical records of patients in the medical unit of the hospital. Age, sex, diagnosis, risk factors for IHD, other relevant clinical and laboratory data and outcome of patients for myocardial infarction (MI) were extracted from the records. Data was analyzed using SPSS version 10.0 software. RESULTS: There were 5124 medical patients admitted over the period under review, out of which 1347 had cardiovascular diseases. Forty six patients were diagnosed to have IHD giving it a prevalence of 0.9% of medical conditions and 3.4% of all cardiovascular cases. There were 33 males and 13 females (M : F = 2.5:1). Twenty two patients (47.8%) had myocardial infarction, 14 (30.4%) had ischemic cardiomyopathy and 10 (21.7%) had angina. The patients consist of 41 (89.1%) Nigerians, 3 (6.5%) Lebanese, 1 (2.2%) Indian and 1 (2.2%) Pakistani. The risk factors found were Hypertension in 37 (80.4%) of patients, diabetes in 16 (34.8%), and Dyslipidaemia in 20 (43.5%). Others were cigarette smoking and obesity. CONCLUSION: IHD is an important cause of morbidity and mortality in our population. There is need for us to be on the alert and prepare ourselves to manage these cases. Focus should be on preventive cardiology.

Structural heart diseases in Nigerian children.

BACKGROUND: Cardiovascular diseases both in adults and children constitute a major public health problem and structural heart diseases are an important group of disorders in children worldwide. The pattern of this group of disorders however, varies between regions and countries and even within countries. Recognizing the structural cardiac conditions that prevail in a particular area is important in health planning and for improving health care services. The present survey sets out to describe the pattern of structural heart diseases among children in Aminu Kano Teaching Hospital, Kano from our echocardiography data. METHODS: The echocardiographic reports of all children seen in Aminu Kano Teaching Hospital, Kano between August 2002 and September 2004 (24 months) were reviewed. Information obtained from the records includes age, gender, clinical diagnosis and echocardiographic findings. Data was analyzed using SPSS version 10.0 software. RESULTS: A total of 108 children, aged between two weeks and eighteen years, were referred for echocardiographic examination in the 2-year study period. Of these, 88 had an abnormal echocardiogram. There were 55 boys and 31 girls, giving a male and female ratio of 1.8:1. Congenital heart diseases accounted for 55 (62.5%) of the studied subjects while acquired heart diseases were responsible for 33 (37.5%). Isolated ventricular septal defect (VSD) was the commonest congenital heart disease. Rheumatic valvular heart diseases were the commonest acquired structural heart disease. CONCLUSION: With the establishment of tertiary healthcare institutions in Nigeria, availability of echocardiographic facilities as well as increasing number of paediatric cardiologists, more of these cases are likely to be seen in the future. There is an urgent need for the government to establish a well equipped cardiothoracic surgical centre to cater for these patients either free or at highly subsidized rates.

Common atrium: a rare cause of acute decompensated heart failure.

We report a rare case of common atrium and acute decompensated heart failure most likely precipitated by acute bacterial pericarditis leading to premature death, in a 25-year-old male footballer. The silent course of the disease for decades as well as the diagnostic and management pitfalls of this case illustrates the importance of early detection by echocardiography and urgent appropriate treatment in intensive care settings to limit the poor prognosis of the condition.

Assessment of right ventricular systolic function using tricuspid annular-plane systolic excursion in Nigerians with systemic hypertension.

AIM: Right ventricular (RV) systolic function in patients with hypertensive heart disease (HHD) is not well characterised. The primary aim of this study was to assess the systolic function of the right ventricle in patients with HHD using tricuspid annular-plane systolic excursion (TAPSE). METHODS: The study was cross-sectional in design and carried out in Kano, Nigeria. Patients were recruited if they had HHD on echocardiography and were at least 15 years of age. Patients with other cardiac pathologies such as ischaemic and valvular heart diseases were excluded. Patients were considered to have abnormal RV systolic function if they had reduced values of TAPSE ( < 15 mm). A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 186 patients were serially recruited over seven months. Of these, 131 (70.4%) had normal RV systolic function (group 1) and 55 patients (29.6%) had abnormal function (group 2). Group 2 patients were older (p = 0.002) and had a higher prevalence of peripheral oedema (p = 0.002), moderate to severe dyspnoea, higher heart rate and lower left ventricular ejection fraction (p < 0.001). Atrial arrhythmias were also more prevalent among group 2 patients (p < 0.05). The best correlate to TAPSE was the septal mitral annularplane systolic excursion (r = +0.541, p < 0.001). Several variables such as age predicted the presence of reduced TAPSE. CONCLUSION: The study found that almost one-third of patients with HHD in Kano had RV systolic dysfunction as defined by reduced TAPSE, and these patients had a greater prevalence of factors associated with morbidity and mortality.

Impact of income on the profile of cardiovascular risk factors among hypertensives in a Nigerian tertiary health centre: a cross-sectional study.

BACKGROUND: In most developed countries, risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However, the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano, Nigeria. METHODS: The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital, Kano, Nigeria. Seventy treatment-naïve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics, and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension. RESULTS: The low-income group comprised 45 patients (32.1%) while the remaining 95 (67.9%) had a high income. The most prevalent CVD risk factor was dyslipidaemia, found in 77.8 and 71.6% of low- and high-income earners, respectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2%) compared with high-income earners (15.8%) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5% of low- and high income earners, respectively (p = 0.535). CONCLUSION: Dyslipidaemia and very high CVD risk were found in over 71% of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects, particularly those in the low-income group, given that in Nigeria, healthcare is largely paid for directly out of their pockets.

Prevalence and pattern of rheumatic heart disease in the Nigerian savannah: an echocardiographic study.

BACKGROUND: Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Whereas Africa has 10% of the world's population, as many as half of the 2.4 million children affected by RHD globally live on the continent. RHD accounts for a major proportion of all cardiovascular disease in children and young adults in African countries. While acute rheumatic fever is on the decline even in the developing world, there are still a large number of chronic rheumatic heart disease cases, often complicated by chronic congestive heart failure and recurrent thrombo-embolic phenomena, both posing greater challenges for management. We report on the prevalence and pattern of valve involvement in RHD using echocardiography from our centre. METHODS: In this retrospective study, transthoracic echocardiography (TTE) data collected from two echocardiography laboratories in Kano over a period of 48 months (June 2002 to May 2006) were reviewed. Patients with a diagnosis of rheumatic heart disease were selected. Information obtained from the records included the age, gender, clinical diagnosis and echocardiographic diagnoses. RESULTS: A total of 1 499 echocardiographic examinations were done in the two centres over the four-year study period. One hundred and twenty-nine of the 1 312 patients (9.8%) with abnormal results had an echocardiographic diagnosis of RHD. There were 47 males and 82 females (ratio 1:1.7) and their ages ranged from five to 60 (mean 24.02 +/- 12.75) years. Mitral regurgitation was the commonest echocardiographic diagnosis present in 49 patients (38.0%). Thirty-six (27.9%) patients had mixed mitral valve disease, 25 (19.5%) had mixed aortic and mitral valve disease, 10 (7.8%) had pure mitral stenosis and four (3.1) had pure aortic regurgitation. Complications of RHD observed included secondary pulmonary hypertension in 103 patients (72.1%), valvular cardiomyopathy in 41 (31.8%), and functional tricuspid regurgitation was seen in 39 (30.2%). CONCLUSION: Our data show that RHD is still an important cause of cardiac morbidity and a large proportion of the patients already had complications at diagnosis. There is an urgent need to implement the ASAP programme of the Drakensberg declaration to avert this scourge.