Differential Clubbing and a Triad of Patent Ductus Arteriosus, Ventricular Septal Defect and Supravalvular Ring Mitral Stenosis: A Case Report.

It is not uncommon for congenital heart defects to occur in clusters. Those involving a right to left heart shunt commonly cause cyanosis and finger clubbing. Differential clubbing involving only the lower limb digits is a strong pointer to the presence of patent ductus arteriosus with reversal of shunt. We report a case of 25-year-old man with effort intolerance and differential clubbing. He was found to have the uncommon triad of patent ductus arteriosus, ventricular septal defect and supravalvular ring mitral stenosis. The presence of differential clubbing on a background of patent ductus arteriosus usually indicates a reversal of shunt and negates surgical intervention. This general rule may however not apply with co-existing mitral stenosis as the elevated pulmonary pressure may be predominantly post-capillary. The finding of mitral stenosis in a patient with patent ductus arteriosus and differential limb clubbing may signify a good prognostic surgical outcome.

Il n'est pas rare que des malformations cardiaques congénitales surviennent en clusters. Celles impliquant un shunt cardiaque droitegauche provoquent souvent une cyanose et un hippocratisme digital. L'hippocratisme digital différentiel touchant uniquement les orteils des membres inférieurs est un indicateur fort de la présence d'un canal artériel persistant avec inversion du shunt. Nous rapportons le cas d'un homme de 25 ans présentant une intolérance à l'effort et un hippocratisme digital différentiel. Il a été diagnostiqué avec la triade peu commune de canal artériel persistant, de communication interventriculaire et de sténose mitrale à anneau supravalvulaire. La présence d'un hippocratisme digital différentiel sur un fond de canal artériel persistant indique généralement une inversion du shunt et exclut une intervention chirurgicale. Cependant, cette règle générale peut ne pas s'appliquer en présence d'une sténose mitrale concomitante, car la pression pulmonaire élevée peut être principalement post-capillaire. La découverte d'une sténose mitrale chez un patient atteint de canal artériel persistant et d'un hippocratisme digital différentiel peut indiquer un bon pronostic pour l'intervention chirurgicale.

Premature Atherosclerotic Cardiovascular Disease: A Case of Myocardial Infarction Seven Years after Bentall Procedure in a Nigerian Man.

Surgical procedures often carry varying risk of post-procedural complications. The Bentall procedure for managing aortic root diseases has known complications including graft infection, pseudoaneurysm of the aorta or coronary arteries, embolisation and coronary insufficiency. The last three complications can cause myocardial infarction, are evaluated with coronary angiography and have been well described in the literature. Surprisingly, none of these possible complications was found in our patient. This case report describes a young Nigerian man with atherosclerotic coronary artery disease seven years after Bentall procedure.

Les interventions chirurgicales comportent souvent un risque variable de complications postopératoires. L'intervention de Bentall pour traiter les maladies de la racine aortique présente des complications connues, notamment l'infection du greffon, le pseudo-anévrisme de l'aorte ou des artères coronaires, l'embolisation et l'insuffisance coronarienne. Les trois dernières complications peuvent provoquer un infarctus du myocarde, sont évaluées par coronarographie et ont été bien décrites dans la littérature. Il est surprenant de constater qu'aucune de ces complications possibles n'a été constatée chez notre patient. Ce rapport de cas décrit un jeune homme nigérian avec une maladie coronarienne athérosclérotique sept ans après la procédure de Bentall. Mots-clés: Procédure de Bentall, Coronaropathie, Cardiopathie ischémique, Infarctus du myocarde, Nigeria.

Clinical Characteristics, Management, and Six-Month Outcomes after Discharge of Patients Admitted for Acute Heart Failure in Ibadan, Nigeria.

BACKGROUND: The burden of acute heart failure (AHF) is on the increase globally however, there are few studies on AHF in Nigeria and among black populations. OBJECTIVE: This study described the clinical profile, conventional management and six-months outcome after discharge of patients admitted for acute heart failure at the University College Hospital, Ibadan, Nigeria. METHODS: The study was a prospective study of 160 consecutive AHF patients. Socio-demographic details, clinical history, basic laboratory parameters electrocardiographic and echocardiographic parameters were assessed. They were followed-up for six-months after discharge to ascertain death or readmission. RESULTS: The mean ± standard deviation (SD) age of all the patients was 58.0 ±15.1 years. Those aged 60 years and above constituted about half of the participants. Males comprised 59.3% and hypertension was the most common risk factor (77.5%). One hundred and thirty-four subjects (83.8%) were in New York Heart Association functional classes III or IV. The most common AHF type was heart failure with reduced ejection fraction and mostly presented de novo. The mean duration of admission was 11 days while intrahospital mortality and mortality at 6 months after discharge were 6.3% and 25.6% respectively. CONCLUSION: This study provided a real-world data of AHF at UCH, Ibadan, Nigeria. It showed AHF was predominantly associated with hypertension. There was high mortality among these AHF subjects. There is a need for more strategy in our environment for preventing AHF and its adverse outcomes.

CONTEXTE: Le fardeau de l'insuffisance cardiaque aiguë (ICA) est en augmentation dans le monde entier ; cependant, il existe peu d'études sur l'ICA au Nigeria et parmi les populations noires. OBJECTIF: Cette étude décrit le profil clinique, la prise en charge conventionnelle et le résultat six mois après la sortie des patients admis pour une insuffisance cardiaque aiguë à l'University College Hospital, Ibadan, Nigeria. MÉTHODES: L'étude était une étude prospective de 160 patients consécutifs souffrant d'insuffisance cardiaque aiguë. Les détails sociodémographiques, l'histoire clinique, les paramètres de laboratoire de base, les paramètres électrocardiographiques et échocardiographiques ont été évalués. Ils ont été suivis pendant six mois après leur sortie de l'hôpital pour vérifier le décès ou la réadmission. RÉSULTATS: L'âge moyen ± écart-type (ET) de tous les patients était de 58,0 ±15,1 ans. Les personnes âgées de 60 ans et plus constituaient environ la moitié des participants. Les hommes représentaient 59,3 % et l'hypertension était le facteur de risque le plus fréquent (77,5 %). Cent trente-quatre sujets (83,8 %) appartenaient aux classes fonctionnelles III ou IV de la New York Heart Association. Le type d'AHF le plus fréquent était l'insuffisance cardiaque avec fraction d'éjection réduite et se présentait le plus souvent de novo. La durée moyenne d'admission était de 11 jours tandis que la mortalité intrahospitalière et la mortalité à 6 mois après la sortie étaient respectivement de 6,3% et 25,6%. CONCLUSION: Cette étude a fourni des données réelles de l'AHF à l'UCH, Ibadan, Nigeria. Elle a montré que l'AHF était principalement associée à l'hypertension. Il y avait une mortalité élevée parmi ces sujets AHF. Il y a un besoin de plus de stratégie dans notre environnement pour prévenir l'AHF et ses résultats défavorables. Mots-clés: Insuffisance cardiaque. Insuffisance cardiaque aiguë, Nigeria, Hypertension, Maladie cardiovasculaire.

Comparative analysis of fibroblast growth Factor-23 as a correlate of cardiovascular disease among individuals with chronic kidney disease, hypertensives, and healthy controls.

Background: Chronic kidney disease (CKD) is a global growing public health epidemic with attending morbidity and huge financial cost. Cardiovascular disease (CVD), a major complication of CKD, contributes to its excessive mortality rate. The aetio-pathogenesis of the excess burden of CVD in CKD is a feature yet to be unravelled. Fibroblast growth factor-23 (FGF-23) has been implicated as a risk factor for CVD among patients with CKD. However, most of these studies were predominantly among the Caucasian population. Aim: This study aims to determine the correlation between FGF-23 and CVD among Nigerians with CKD. Patients and Methods: A cross-sectional comparative study composed of three groups: participants with CKD, hypertensives without CKD, and healthy individuals, represented as group 1, 2, and 3, respectively. Information obtained included demographic data and occurrence of risk factors for CVD. Cardiovascular risks were assessed by echocardiography and all the participants had kidney function tests done with plasma FGF-23. Results: The study sample size consisted of 135 participants. The mean (SD) age for participants with CKD and controls were 50.2 (12.7), 54.3 (15.5), and 40.2 (14.1) years, respectively. The median [interquartile range (IQR)] of plasma FGF-23 for participants with CKD 210 (139-304) RU/ml, and controls 124 (86-170) RU/ml, and 71 (38 - 89) RU/ml P < 0.001. Most participants with CKD had left ventricular hypertrophy (LVH) (80.0%), compared to the controls; 28.9% and 6.7% P < 0.001. Similarly, majority of participants with CKD had elevated plasma FGF-23 with LVH (85.7%) compared to controls 55.6% and 11.5%, whereas for aortic valve calcification with elevated plasma FGF-23 among CKD and controls were 53.6% (P = 0.29), 37.0% (P = 0.03), and 19.2% (P = 0.06), respectively. Conclusion: Individuals with CKD had frequencies of elevated plasma FGF-23, LVH, and cardiac valve calcification, which are surrogates of cardiovascular events.

Comparative Analysis of Left Ventricular Geometry in Adult Nigerians with and without Chronic Kidney Disease: Results from Ibadan CRECKID STUDY.

BACKGROUND: Chronic kidney disease (CKD) is associated with increased risk of cardiovascular morbidity and mortality. Left ventricular hypertrophy (LVH) is considered the strongest independent predictor of cardiovascular disease and events among CKD patients. We reported the echocardiographic left ventricular geometry in CKD patients compared to non-CKD hypertensive and apparently healthy controls in Ibadan. MATERIALS AND METHODS: A total of 683 participants in the CRECKID STUDY comprising 220(32.2%) CKD patients, 281(41.1%) non-CKD hypertensive patients and 182(26.6%) healthy controls were included in this analysis. Basic demographic and clinical information with echocardiographic parameters were obtained. RESULTS: Study participants in the non-CKD hypertensive group were on average older than the CKD and the healthy controls (56.2±13.1 vs 47.2±14.6, and 46.8±13.3 years, respectively; p<0.01). Compared with other groups, greater proportions of participants with CKD were men (40.5% vs.38.1% and 21.3%; p<0.0001). The left atrial and left ventricular dimensions were significantly higher in CKD compared with others. LVH was significantly more prevalent among CKD patients (68.2%) compared to hypertensive (43.9%) and normotensive (19.5%) group (p<0.01). The participants with CKD had a greater proportion of abnormal LV geometry with concentric LVH predominating (p<0.0001). Having LVH was associated with lower mean estimated glomerular filtration rate (eGFR) (40.6±37.71 vs 67±37.38, p<0.0001). CONCLUSION: In our study, patients with CKD had the highest prevalence of abnormal LV geometry and functions. A unit decrease in eGFR was associated with increased left ventricular mass. Early detection and prompt management of abnormal LV geometry may help in reducing adverse cardiovascular outcome in patients with CKD.

CONTEXTE: L'insuffisance rénale chronique (MRC) est associée àrisque accru de morbidité et de mortalité cardiovasculaires. Gauche l'hypertrophie ventriculaire (LVH) est considérée comme la plus forte prédicteur indépendant des maladies cardiovasculaires et des événements chez Patients atteints d'IRC. Nous avons rapporté l'échocardiographie ventriculaire gauche géométrie chez les patients atteints d'IRC par rapport aux patients hypertendus non atteints d'IRC etcontrôles apparemment sains à Ibadan. MATÉRIAUX ET MÉTHODES: Un total de 683 participants à la ÉTUDE CRECKID portant sur 220 (32.2%) patients atteints d'IRC,281 (41.1 %) patients hypertendus non atteints d'IRC et 182 (26.6 %) en bonne santé ont été inclus dans cette analyse. Démographie et clinique de base des informations avec des paramètres échocardiographiques ont été obtenues. RÉSULTATS: Participants à l'étude dans le groupe hypertendu non atteint d'IRC étaient en moyenne plus âgés que l'IRC et les témoins sains(56.2±13.1 vs 47.2±14.6 et 46.8±13.3 ans, respectivement; p<0.01). Par rapport à d'autres groupes, plus grande proportion de participants avec l'IRC étaient des hommes (40.5 % contre 38.1 % et 21.3 %; p<0.0001). Les dimensions auriculaire gauche et ventriculaire gauche étaient significativement plus élevées chez CKD par rapport à d'autres. La LVH était significativement plus répanduechez les patients atteints d'IRC (68.2 %) par rapport aux patients hypertendus (43.9 %) et le groupe normotensif (19.5 %) (p<0.01). Les participants avec CKD avait une plus grande proportion de géométrie LV anormale avec LVH concentrique prédominante (p<0.0001). Avoir LVH était associé à un débit de filtration glomérulaire estimé moyen plus faible (DFGe)(40.6±37.71 contre 67±37.38, p<0,0001). CONCLUSION: Dans notre étude, les patients atteints d'IRC avaient le plus haut prévalence d'une géométrie et de fonctions LV anormales. Une diminution unitaire de Le DFG était associé à une augmentation de la masse ventriculaire gauche. Tôt la détection et la gestion rapide de la géométrie LV anormale peuvent aider à réduire les résultats cardiovasculaires indésirables chez les patients atteints de CKD. Mots-clés: Maladie rénale chronique, Hypertensives, ventriculaire gauche géométrie.

BURDEN OF ERECTILE DYSFUNCTION AMONG HEART FAILURE PATIENTS IN A CENTRE IN THE SOUTH-WESTERN NIGERIA: A PILOT STUDY.

Background: Erectile dysfunction (ED) is a common problem among heart failure (HF) patients but is usually ignored in busy clinics in developing countries like Nigeria. Evidence abound that it has a great impact on the quality of life, survival, and prognosis of HF patients. Objective: This study sought to evaluate the burden of ED among HF patients at the University College Hospital, Ibadan. Methods: This pilot cross-sectional study was conducted in the Cardiology clinic of the Medical Outpatient Unit of the Department of Medicine, University College Hospital, Ibadan. Consenting male patients with chronic HF were consecutively recruited into the study between June 2017 and March 2018. The International Index of Erectile Function-version five (IIFE-5) was used to access the presence and degree of ED. Statistical analysis was done with SPSS version 23. Results: A total of 98 patients were recruited with a mean± standard deviation (SD) age of 57.6 ±13.3 years, and age range of 20-88 years. The majority of the participants were married (78.6%), and the mean ± SD duration of HF diagnosis was 3.7 ±4.6years. The overall frequency of ED was 76.5%, and those with previous self-reported ED were 21.4%. Mild erectile dysfunction, mild to moderate erectile dysfunction, moderate erectile dysfunction, and severe erectile dysfunction were present in 24(24.5%), 28(28.6%), 14(14.3%), and 9(9.2%) respectively. Conclusion: Erectile dysfunction is common among chronic heart failure patients in Ibadan. Therefore, adequate attention is needed for this sexual health issue among males with heart failure to improve their quality of care.

GENDER DIFFERENCES IN THE CLINICAL PROFILE AND SOCIODEMOGRAPHIC CHARACTERISTICS OF DILATED CARDIOMYOPATHY IN IBADAN, NIGERIA.

Background: Cardiomyopathies contribute about 18.2-40.2% (average- 21.4%) to the global burden of heart failure of which dilated cardiomyopathy (DCM) is a major cause. DCM is the second commonest cause of heart failure in Ibadan. The gender differences in the clinical profile has not been described in our setting. Objective: In this study, we set out to describe the gender differences in the pattern and presentation of DCM at the University College Hospital, Ibadan, Nigeria. Methods: This was an analysis of a prospectively collected data over a period of 5 years (August 1, 2016 to July 31, 2021). Results: A total of 117 subjects, 88 males (75.3%) and 29 females (24.8%) aged 50.30 ± 14.7 years (range, 17 to 86 years). Males had significantly achieved a higher educational level than females (p = 0.004). Males were more likely to be employed and had more monthly income compared to females. Males were significantly more likely to use alcohol and smoke cigarette (p = 0.0001 and 0.001 respectively). Females were more likely to be in NYHA class III/IV. There was no statistically significant difference in the relationship between any medication and gender of participants (p > 0.05). Conclusions: DCM is a disease of young and middle-aged adults in our population. The commonest age group was 20-39 years and there was male preponderance. There were some gender differences in the clinical profile of the disease in our environment.

Screening for Atrial Fibrillation in Sub-Saharan Africa: A Health Economic Evaluation to Assess the Feasibility in Nigeria.

Background: Cardiovascular disease reflects a major burden of non-communicable disease in Sub-Saharan Africa (SSA). Early detection and treatment of atrial fibrillation (AF), as a preventive measure against stroke, is currently not in the scope of the World Health Organization recommendation to reduce cardiovascular disease. Objective: We hypothesized that screening for AF would be an important approach to determine the true AF prevalence in the general population in African countries and to identify asymptomatic AF patients at risk for stroke to optimize prevention. Methods: A decision analytic model was developed to study the health-economic impact of AF screening in Nigeria over a life-time horizon. The patient population explored in the model was a population of newly detected AF cases that would be diagnosed with a one-time systematic screening for AF with a single lead ECG device in community health centres across Nigeria. Conclusions: The health gain per newly detected AF patient (N = 31,687) was 0.41 QALY at a cost of $5,205 per patient with 100% NOAC use, leading to an ICER of $12,587 per QALY gained. The intervention was cost-effective with a 99.9% warfarin use with an ICER of $1,363 per QALY gained. The total cost of a single screening session was $7.3 million for the total screened population in Nigeria or $1.60 per patient screened. Screening for AF to detect AF patients in need for stroke prevention can be a cost-effective intervention in the Sub-Saharan region, depending on type of anticoagulant used and drug costs.

Pregnancy-associated Acute Myocardial Infarction (PAMI): Case Report.

Cardiovascular diseases are recognised complications of pregnancy, however, pregnancy-associated acute myocardial infarction (PAMI) is uncommon. Pregnancy is known to increase risk of myocardial infarction even in the absence of traditional risk factors for atherosclerotic vascular disease. Our patient presented with acute chest pain two weeks after delivery and her electrocardiogram was in keeping with STelevation myocardial infarction (STEMI). Coronary angiography revealed coronary artery dissection and she was managed conservatively. Various pathophysiological mechanisms of PAMI have been described in literature including spontaneous coronary artery dissection (SCAD) found in our case. The diagnosis is often missed and earlier reported cases were diagnosed at autopsy. Therefore, we report this case as a learning tool. Also, there is a need for a high index of suspicion in pregnant patients presenting with features suggestive of aortic dissection, and its diagnosis should be thought of in peripartum women presenting with acute chest pain.

Les maladies cardiovasculaires sont des complications reconnues de la grossesse, cependant, l'infarctus aigu du myocarde associé à la grossesse (IPAM) est rare. La grossesse est connue pour augmenter le risque d'infarctus du myocarde même en l'absence de facteurs de risque traditionnels de maladie vasculaire athéroscléreuse. Notre patiente s'est présentée avec une douleur thoracique aiguë deux semaines après l'accouchement et son électrocardiogramme était conforme à l'infarctus du myocarde avec élévation de l'échelle (STEMI). La coronarographie a révélé une dissection de l'artère coronaire et elle a été gérée de manière conservatrice. Divers mécanismes physiopathologiques de PAMI ont été décrits dans la littérature, y compris la dissection spontanée des artères coronaires (SCAD) trouvée dans notre cas. Le diagnostic est souvent manqué et les cas signalés antérieurement ont été diagnostiqués à l'autopsie. Par conséquent, nous rapportons ce cas comme un outil d'apprentissage. En outre, il existe un besoin d'un indice de suspicion élevé chez les patientes enceintes présentant des caractéristiques suggérant une dissection aortique, et son diagnostic doit être envisagé chez les femmes en péripartum présentant une douleur thoracique aiguë.

OROFACIAL CLEFTS AND CARDIOVASCULAR RISK AND DISEASES: THE CAUSAL RELATIONSHIP AND ASSOCIATIONS.

There is a complex interplay between orofacial clefts (OFCs) or cleft of the lip and palate and cardiovascular risk factors and cardiac diseases. The presence of maternal cardiovascular risk factors serves as a potent predisposing factor to the development of OFCs during foetal development in addition to the fact that various congenital anomalies are associated with OFCs either in syndromic or non-syndrome relationship. This article narratively explores this complex interplay, which is not uncommon.

Self-reported Sleep Disorder and Ambulatory Blood Pressure Phenotypes in Patients with or without Chronic Kidney Disease: Findings from Ibadan CRECKID Study.

BACKGROUND: Sleep disordered breathing has been closely linked to pathogenesis, poor control of hypertension, and progression of chronic kidney disease (CKD). Though hypertension and CKD are highly prevalent in Nigeria, the effects of sleep disorders on CKD and hypertension phenotypes have not been widely studied. This study investigated the relationship between self-reported sleep disorders, and ambulatory blood pressure phenotypes in patients with hypertension and those with or without CKD. METHODS: Participants aged 18 years and above who consented were recruited into the study. Anthropometric measurements including height, weight, and waist and hip circumferences were obtained, Office/clinic hypertension was defined as SBP =140mmHg and/or DBP =90mmHg or being on pharmacological treatment for hypertension. 24-hour ambulatory blood pressure monitoring were done. Obstructive sleep apnea was assessed using Stop Bang questionnaire. Estimated GFR was calculated using CKD-EPI Creatinine 2Equation and CKD was defined as eGFR<60ml/min/1.73m . RESULTS: A total of three hundred and forty-nine (349) patients were enrolled for the study: 175 males and 174 females. Moderate to severe risk for obstructive sleep apnea (OSA) was observed in 51.4% of patients with CKD, 58.5% of hypertensive and 17.3% of apparently healthy participants. Male participants were more likely than female patients to have moderate and high OSA risk (41.7% vs 32.8%) and (10.3% vs 4.6%) respectively. Compared with other groups, CKD patients had the highest office and ambulatory blood pressure parameters; p<0.0001. CONCLUSION: This study has demonstrated that obstructive sleep apnoea is prevalent among patients with chronic kidney disease and hypertension. Furthermore, the phenotypes of hypertension are accentuated in CKD and therefore, OSA may well be an important risk factor for CKD.

Participation in research improves overall patient management: insights from the Global Rheumatic Heart Disease registry (REMEDY).

BACKGROUND: Rheumatic heart disease (RHD) is a major public health problem in low- and middle-income countries (LIMCs), with a paucity of high-quality trial data to improve patient outcomes. Investigators felt that involvement in a recent large, observational RHD study impacted positively on their practice, but this was poorly defined. AIM: The purpose of this study was to document the experience of investigators and research team members from LMICs who participated in a prospective, multi-centre study, the global Rheumatic Heart Disease Registry (REMEDY), conducted in 25 centres in 14 countries from 2010 to 2012. METHOD: We conducted an online survey of site personnel to identify and quantify their experiences. Telephone interviews were conducted with a subset of respondents to gather additional qualitative data. We asked about their experiences, positive and negative, and about any changes in RHD management practices resulting from their participation in REMEDY as a registry site. RESULTS: The majority of respondents in both the survey and telephone interviews indicated that participation as a registry site improved their management of RHD patients. Administrative changes included increased attention to follow-up appointments and details in patient records. Clinical changes included increased use of penicillin prophylaxis, and more frequent INR monitoring and contraceptive counselling. CONCLUSION: Our study demonstrates that participation in clinical research on RHD can have a positive impact on patient management. Furthermore, REMEDY has led to increased patient awareness and improved healthcare workers' knowledge and efficiency in caring for RHD patients.

ASSESSMENT OF MEASURES OF ADIPOSITY THAT CORRELATE WITH BLOOD PRESSURE AMONG HYPERTENSIVE AFRICANS.

BACKGROUND: Studies differ on which anthropometric measure of adiposity shows good correlation with cardiovascular diseases. In this study, we evaluated the effects of common epidemiological measures of adiposity as a correlate of elevated blood pressure in an African population. METHODOLOGY: The study was carried out between June 2009 and December 2011 at the medical out-patient department of a tertiary healthcare center in Nigeria. Correlation analysis was used to assess the relationship between blood pressure and body mass index (BMI), waist to height ratio (WHtR), and waist circumference (WC). RESULTS: A total of 1,416 Hypertensives comprising 1090 (77%) adult females recruited over two and half years. Women were significantly older (49.2±8.1 vs. 48.0±10.0 years, p=0.039) and shorter (1.6±6.3 vs 1.7±6.8 meters, p<0.0001) when compared with men. Blood pressure parameters were comparable between women and men. Approximately 1 out of 5 participants had good blood pressure control with no gender difference. Anthropometric measurements showed that 446(32%) were overweight, 404(29%) obese and 40(3%) were morbidly obese. Compared with their male counterparts, females were significantly more likely to be obese (P<0.0001). Similarly, 51.6% of the subjects had abdominal obesity, with female preponderance (P<0.0001). Likewise, a greater proportion of women had substantially higher measured waist circumference risk. Compared with other measures of adiposity, body mass index correlated best with diastolic blood pressure in both gender (P< 0.05). CONCLUSION: This study adds to the evidence that obesity is a major cardiovascular risk factor. BMI, as a measure of adiposity, was found to correlate best with blood pressure. These findings support other observations in other populations that BMI rather than waist to height ratio (WHtR), and waist circumference (WC) is a better correlate of hypertension.

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.

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.