Early diastolic functional abnormalities in normotensive offspring of Nigerian hypertensives.

BACKGROUND: Some studies have suggested that diastolic dysfunction precedes the clinical manifestation of hypertension. Whether changes in cardiac structure and function predate the clinical manifestation of hypertension later in life is now being investigated. The aim of this study was to assess the differences in cardiac structure and function between the offspring of hypertensive and normotensive parents. METHODS: Eighty normotensive offspring of hypertensive parents (OHyp) (41 females and 39 males) and 62 normotensive offspring of normotensive parents (ONorm) (31 males and 31 females) were recruited for echocardiography. RESULTS: The mean age was 25.0 (5.31) and 24.3 (3.60) years in the OHyp and ONorm participants, respectively (p = 0.369). Other baseline parameters were comparable between the two groups. Septal wall thickness in systole was higher in the OHyp than the ONorm subjects [1.3 (0.35) vs 1.1 (0.25), p = 0.0173]. Indexed left ventricular mass [28.1 (7.33) vs 27.5 (7.23), p = 0.631] and relative wall thickness [(0.3 (0.10) vs 0.3 (0.90), p = 0.280] were similar in the two groups. The offspring of hypertensives had lower deceleration time [149.9 (38.89) vs 169.0 (50.08) ms, p = 0.012], prolonged duration of pulmonary A reverse flow [113.5 (70.69) vs 81.7 (38.31) ms, p = 0.024], increased myocardial isovolumic relaxation time [173.4 (47.98) vs 156.1 (46.74) ms, p = 0.033] and a lower myocardial Em [0.2 (0.05) vs 0.3 (1.38), p = 0.037] and myocardial Em/Am ratio [1.6 (0.01) vs 2.1 (0.01), p = 0.019] than the offspring of normotensives. CONCLUSION: This study showed that offspring of OHyp subjects had early diastolic functional abnormalities when compared with offspring of ONorm participants. Longitudinal studies are needed to determine the implications of this finding in this African population.

Feasibility of early diagnosis and treatment of acute chest syndrome in sickle cell anaemia--a case report.

Acute chest syndrome is a serious complication and one of the causes of mortality in sickle cell disease. Twenty eight year old male was admitted in our hospital with fever, severe chest pain and haemolytic crisis. He was treated with intravenous antibiotics, fluids, parenteral analgesics and blood transfusion. Severe hypoxemia developed after 72 hours of hospitalization. The patient was transferred to the intensive care unit of our hospital. Oxygen therapy and ionotropic support were initiated. Vital parameters and organ functions returned to normal after treatment.

Audit of Echocardiographic Services at the University College Hospital Ibadan.

BACKGROUND: Echocardiography is useful in the diagnosis of cardiovascular diseases and it influences management. It is becoming widely available in our Teaching Hospitals though expensive. It is therefore important to know the value of echocardiography in patients' diagnosis. METHODS: One thousand five hundred and forty four patients referred for transthoracic echocardiography over 19-month period (March 2003 to September 2004) were studied. M mode, two dimensional and Doppler studies were out using ALOKA SSD 1700. RESULTS: One thousand five hundred and forty four patients (778 males and 766 females) had echocardiography. Mean age was 51.4 +/- 15.5. Minimal age was 15 years while maximum was 100 years. The commonest indication for echocardiography include Hypertension 727 (47.1%), Pre-Chemotherapy assessment 127 (8.2%), Heart failure 117 (7.6%) and Routine Medical Check Up 99 (6.4%). The highest source of referral came from Cardiology unit 746 (48.3%). Staff Clinic 128 (8.3%), Surgery 127 (8.2%) and Nephrology 88 (5.7%). Six hundred and eighty seven (44.6%) were diagnosed as Hypertensive Heart Disease, 674 (36.5%) were Normal Study and 54 (3.5%) had Valvular Heart Disease. CONCLUSION: The study showed the different indications for echocardiography, source of referral and diagnosis. There is an emerging need for echocardiography in our patients so as to improve their management.

Blood Pressure Control and Left Ventricular Hypertrophy in Hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications; leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital; Ibadan; Nigeria; using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital; Ibadan; Nigeria. Methods : Patients had 6 visits; when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2) of the normotensive group; 40 (20.8) of the uncontrolled hypertensive group and 14 (24.1) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height; left ventricular hypertrophy was found in none of the subjects of the normotensive group; while it was found present in 43 (22.4) and 14 (24.1) subjects of the uncontrolled and controlled hypertensive groups; respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects; based on office blood pressure; cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events

Electrocardiographic left ventricular hypertrophy with strain pattern: prevalence, mechanisms and prognostic implications.

BACKGROUND: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence, mechanism and prognostic implications of this ECG abnormality. MATERIALS AND METHODS: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches. RESULTS: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36%. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50%, while the specificity was in the range of 89.8 to 100%. Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality. ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects. CONCLUSION: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality.

Electrocardiographic Left Ventricular Hypertrophy with Strain Pattern : Prevalence; Mechanisms and Prognostic Implications : Review Article

Background: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence; mechanism and prognostic implications of this ECG abnormality. Materials and methods: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches. Results: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50; while the specificity was in the range of 89.8 to 100. Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality. ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects. Conclusion: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality

Association between electrocardiographic left ventricular hypertrophy with strain pattern and left ventricular structure and function.

BACKGROUND AND PURPOSE: Electrocardiographic left ventricular hypertrophy (LVH) with strain pattern has been documented as a marker for LVH. Its presence on the ECG of hypertensive patients is associated with poor prognosis. The study was carried out to assess the association of the electrocardiographic strain with left ventricular mass (LVM) and function in hypertensive Nigerians. MATERIAL AND METHODS: ECG as well as echocardiograms were performed in 64 hypertensive patients with ECG-LVH and strain pattern, 65 patients with ECG-LVH by Sokolow-Lyon (SL) voltage criteria and 62 normal controls. RESULTS: The study showed that electrocardiographic left ventricular (LV) strain pattern is associated with dilated left atrium, larger LV internal dimensions and greater absolute and indexed LVM in hypertensive Nigerians compared with ECG-LVH by SL voltage criteria alone or normal controls. CONCLUSION: The findings of this study support the fact that the ECG strain pattern is associated with increased LVM and an increased risk of developing abnormal LV geometry.