[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.

[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.

[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.

Infarctus du myocarde a coronaires saines chez un sujet apres consommation de marijuana

"Introduction. Encore appele ""Cannabis""; la marijuana est la drogue illicite la plus consommee dans le monde avec des effets psychoactifs et medicinaux. Sa consommation peut avoir des consequences gravissimes. L'objectif de ce travail etait de rapporter un cas d'un homme de 32 ans; sans risque cardiovasculaire. Cas clinique et commentaire. Nous rapportons le cas d'un patient de 32 ans; sans facteur de risque cardiovasculaire; admis aux urgences de l'Institut de Cardiologie d'Abidjan pour une douleur thoracique infarctoide prolongee survenue cinq heures auparavant. L'interrogatoire retrouvait une prise de marijuana une heure avant le debut de la douleur. Les elements cliniques et l'electrocardiogramme avaient permis de retenir le diagnostic de syndrome coronarien aigu avec sus-decalage persistant du segment ST. Une revascularisation coronaire par thrombolyse a ete realisee; avec des suites simples. La coronarographie a retrouve des coronaires saines. L'hypothese retenue etait un spasme coronaire prolonge; du a la consommation de marijuana. Conclusion. Ce cas clinique doit attirer l'attention des praticiens et de la population sur les consequences cardiovasculaires possibles inherentes a la consommation de marijuana "

Infarctus du myocarde a coronaires saines chez un sujet jeune apres consommation de marijuana

"Introduction. Encore appele "" Cannabis ""; la marijuana est la drogue illicite la plus consommee dans le monde avec des effets psychoactifs et medicinaux. Sa consommation peut avoir des consequences gravissimes. L'objectif de ce travail etait de rapporter un cas d'un homme de 32 ans; sans risque cardiovasculaire.Cas clinique et commentaire. Nous rapportons le cas d'un patient de 32 ans; sans facteur de risque cardiovasculaire; admis aux urgences de l'Institut de Cardiologie d'Abidjan pour une douleur thoracique infarctoide prolongee survenue cinq heures auparavant. L'interrogatoire retrouvait une prise de marijuana une heure avant le debut de la douleur. Les elements cliniques et l'electrocardiogramme avaient permis de retenir le diagnostic de syndrome coronarien aigu avec sus-decalage persistant du segment ST. Une revascularisation coronaire par thrombolyse a ete realisee; avec des suites simples. La coronarographie a retrouve des coronaires saines. L'hypothese retenue etait un spasme coronaire prolonge; du a la consommation de marijuana. Conclusion. Ce cas clinique doit attirer l'attention des praticiens et de la population sur les consequences cardiovasculaires possibles inherentes a la consommation de marijuana."

[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.

[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 the cost of the curative treatment of myocardial infarction in the Abidjan Cardiology Institute]. / Evaluation du coût du traitement curatif de l'infarctus du myocarde à l'Institut de cardiologie d'Abidjan (ICA), Côte d'Ivoire.

We carried out an economical study on a period of four years from august 2001 to june 2005 in 100 patients with acute myocardial infarction admitted in the intensive care unit and in the medicine department of the Abidjan Cardiology institute. The aim of this study was to evaluate the total cost of an hospitalisation for myocardial infarction in a sub-saharan country. The average estimated cost was 944 481 F CFA (1439.7 euros) (range: 105,4237.7 euros) This cost was mainly explained by medical treatment with 324,996 F CFA, being 34.4% of the mean total cost followed by the cost of bedroom (300,200 F CFA (31.8%) and explorations costs (31.8%). 55% of our patients spent more than one million for the treatment. Neither the siege nor the appearance of left ventricular insufficiency had any incidence on the cost.

Facteurs de la mauvaise observance therapeutique de l'hypertendu en Côte d'Ivoire

Objectifs : Evaluer le niveau d'observance thérapeutique chez des patients hypertendus suivis en ambulatoire et rechercher les facteurs liés à une mauvaise observance. Méthodes : A travers une étude multicentrique réalisée dans deux villes de la Côte d'Ivoire, nous avons évalué l'observance thérapeutique de 332 hypertendus traités depuis plus de 6 mois. Cette évaluation s'est faite à l'aide d'un questionnaire appelé test d'évaluation de d'observance (TEO) permettant de définir des patients ayant une bonne observance thérapeutique, ceux ayant un minime problème d'observance et ceux ayant une mauvaise observance. Les facteurs de mauvaise observance ont été recherchés en analyse univariée puis en analyse multivariée à l'aide d'une régression logistique. Résultats : Dans notre population d'hypertendus, le TEO a objectivé 26,8% de patients bons observants, 53,8% ayant un minime problème d'observance et 19,6% de mauvais observants du traitement antihypertenseur. En analyse univariée, la mauvaise observance était associée à un plus jeune âge, au sexe féminin, à l'absence d'assurance-maladie et à la présence de complications cardiovasculaires. Mais en analyse multivariée, seule la présence de complications constitue un facteur de risque indépendant de mauvaise observance (OR = 0,44, IC [0,23 ; 0,87] p < 0,018). Conclusion : L'observance thérapeutique est mauvaise dans notre population d'hypertendus, particulièrement chez ceux qui ont déjà des complications liées à l'HTA. Il importe d'insister sur l'éducation thérapeutique dans les pays africains

Aspects echocardiographiques des endocardites infectieuses a Abidjan : a propos de 50 cas

L'endocardite infectieuse (EI) represente a l'Institut de Cardiologie d'Abidjan 1;6 pour cent des hospitalisations. Les auteurs etudient 50 dossiers dans lesquels l'hemoculture n'a ete positive que dans 30 pour cent des cas alors que l'echocardiographie l'a ete dans 92 pour cent. Les auteurs ont observe surtout des vegetations volumineuses (82 pour cent). Des lesions mutilantes existaient dans 26 pour cent. La fonction contractile ventriculaire gauche etait le plus souvent normale. Dans 20 pour cent des cas; il existait soit un epanchement; soit un decollement pericardiques. Les lesions predominaient sur les valves du coeur gauche (79 pour cent) mais 11 lesions interessaient le coeur droit isolement (21 pour cent) le plus souvent sur cardiopathie congenitale. Dans 47 pour cent des cas; les lesions sont survenues sur coeur sain; dans 30 pour cent des cas sur valvulopathies rhumatismales; dans 17 pour cent des cas sur cardiopathie congenitale et dans 6 pour cent des cas sur prothese. Chez les 21 patients non operes; on a constate la disparition des vegetations chez 4 patients. Les auteurs soulignent l'interet de l'echocardiographie notamment dans le contexte de l'Afrique Noire

[Echocardiographic myocardial performance in the normal postpartum in black African women]. / La performance myocardique échocardiographique dans le post-partum normal chez la femme noire africaine.

The authors have carried out a prospective ultrasound study of normal post-partum myocardial performance in black African women free from any systemic and/or cardiovascular disorder. The volume overload, reduction in ejection indices and increase in telesystolic constraint, which are significant essential changes observed immediately post-partum, return to normal values within two months. According to the authors, these disturbances reflect a transient change in myocardial function which expresses the potentially harmful effect of the natural changes during the normal post-partum phase.

[Etiological factors of deep vein thromboses in the limbs of Black African subjects]. / Facteurs étiologiques des thromboses veineuses profondes des membres chez le sujet Noir Africain.

Deep thrombosis of limbs are unknown in Africa South of the Sahara. Looking for their etiological factors, the authors reviewed 82 cases admitted with an undisputable diagnosis of thrombosis. They underline the coming in of the disease which appears to strike two targets populations female in strong genital activity and males between 40 and 60 years of age. The authors are of opinion that etiological factors are similar to those described in the literature but they underline some peculiarities. Anemia, mainly because of iron deficiency (30.5 p.c.) gyneco-obstetrical context with oral contraception (26.8 p.c.) dysmetabolism (19.5 p.c.) heredity (15 p.c.) and infections (14.5 p.c.) are on the top of etiological factors. Then we have congestive cardiopathies (9.7 p.c.) digestive lesions (6.1 p.c.) and neoplasiae, hemoglobinopathies, quite frequent in the region as well as surgical context without preventive anticoagulants (7.3 p.c.) do not seen to play a significant role: they start again the discussion about the natural protection of Black African against thrombo-embolic diseases. Finally, they point out the interest of antithrombine III and proteins C and S tests in any known causal factor.

[Acute thrombosis of the brachial artery and beta-thalassemia-sickle cell anemia]. / Thrombose aiguë de l'artère humérale et beta-thalasso-drépanocytose.

The authors report about one case of left branchial arterial thrombosis in a 6-year-old child with thalassemia-sickle cell disease. In their opinion, although this hemoglobinopathy usually causes microthrombosis, its existence at the same time as that of the brachial thrombosis does not seem to be a coincidence. The actual origin of this disease remains to be found, as well as the role that thrombocytosis may play. The authors emphasize the relative rarity of thrombolytic arterial diseases in African Negroes and advise practitioners to recognize them, because their diagnosis, often established late in our climates, has severe consequences.

[Chronic left parietal endocarditis. Clinical, paraclinical and peroperative study of 22 cases]. / Endocardite pariétale chronique gauche. Etude clinique, paraclinique et per-opératoire de 22 cas.

From 22 patients with left chronic parietal endocarditis (CPE), conducted an epidemiological, clinical, paraclinical and per-operative study. The CPE is frequently encountered in the Ivory Coast in Akan children living in forest areas in 81 p. cent of the cases. It causes a mitral insufficiency, of the which the essential mechanism is fibrosis of the sub-valvular apparatus. The clinical examination is that of a severe advanced mitral insufficiency. Cardiomegaly is the rule. In 31 p. cent of cases, the ECG shows a Qr in V1. The dip plateau on the apexocardiogram is never found and the protodiastolic endocardial resonance is inconstant on phonomechanical processor. The aspect in M of the interventricular septum, found in 72 p. cent of the cases on echo TM is of major importance when direct signs are missing on bidimensional sonograms. Angiocardiography remains the reference diagnostic examination. But only the surgical survey enables to demonstrate limited forms.

Coronary heart disease in the diabetic African: frequency clinical and angiographic features.

The frequency and clinical and coronarographic features of coronary heart disease (CHD) in black African diabetic patients were assessed in a two-part study. The aim of part I was to determine the frequency of CHD in 50 diabetic patients selected by the following criteria: male, age between 40 and 60 years, diabetes history less than 20 years, no history of CHD and normal E.K.G. All 50 of these patients underwent a stress test and those who failed or for whom results were inconclusive were submitted to coronary arteriography. Part II was a retrospective study of 104 patients with CHD. Its aim was to compare the clinical and coronarographic features of CHD patients with (27 cases) and without (77 cases) diabetes mellitus. The frequency of CHD in the 50 diabetics selected for this study was 10% (31 negative exercise tests, 19 inconclusive exercise tests, 5 coronary arteriographies with significant narrowing). Of these 5 diabetics with CHD, 3 had single vessel involvement (left descending artery: 2 cases, circumflex artery: 1 case), 1 patient had double vessel involvement (right coronary circumflex artery) and 1 had triple vessel involvement (left descending, circumflex, and right coronary artery). In the retrospective study the clinical profile of the diabetic and non-diabetic CHD patients was the same with respect to sex, age, angina, myocardial infarction, and death rate. As regard the risk factors, blood cholesterol level was higher in diabetics while cigarette smoking was higher in non-diabetics. The frequency of hypertension was the same in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anatomo-clinical forms of left endomyocardial fibrosis. Study of 22 surgically treated cases]. / Les formes anatomo-cliniques de la fibrose endomyocardique gauche. Etude de 22 cas opérés.

The authors studied 22 patients with operated left sided endomyocardial fibrosis (EMF). Twenty patients had pure left sided and 2 bilateral (mainly right sided) EMF. The mean age of the patients was 14 years (range 7-51 years). Three clinico-pathological forms of the disease were identified: obliterating, diffuse and limited. The mechanism of associated mitral regurgitation was papillary muscle and/or posterior leaflet involvement. The anterior mitral leaflet was not affected in any of these cases. Echocardiographic diagnosis was possible in 18 cases by M mode recording showing M-shaped septal wall motion. The diagnosis was made in 5 out of 13 patients by 2D echocardiography. This method was satisfactory in the obliterating form of the disease but direct visualisation of the fibrosis in the diffuse and limited forms was very difficult. Catheter studies showed severe pulmonary hypertension in all cases. The presence of a dip-plateau pressure recording was inconstant and was only observed in the obliterating and diffuse forms of EMF. Angiocardiography was characteristic in the obliterating and diffuse forms and enabled an accurate anatomical diagnosis before surgery. The diagnosis of the limited form was difficult and could only be suspected in cases of mitral regurgitation associated with right ventricular EMF or in the presence of parietal recesses. This surgical series does not include cases of EMF limited to the ventricular apex without mitral regurgitation or adiastole, treated medically.

Right ventricular dysfunction after endocardiectomy for right ventricular endomyocardial fibrosis.

Early right ventricular failure following a large endocardiectomy in right endomyocardial fibrosis (EMF) is reported. This diagnosis was confirmed upon echocardiography by the presence of a dilated right ventricle, and hemodynamically (upon postoperative control catheterization) by the presence of right ventricular diastolic dysfunction. The role of the endocardiectomy and of the pericardium in the genesis of this ventricular dysfunction are discussed in the light of this case which was documented by a hemodynamic study and surgically confirmed.