Performance of systolic pressure index for lower limb peripheral arterial disease in a group of elderly in sub-Saharan Africa.

BACKGROUND: The automatic measurement of the ankle-brachial index (ABI) constitutes a reliable, simple, safe, rapid, and inexpensive alternative diagnostic screening test compared with the Doppler method for peripheral arterial disease (PAD). We aimed to compare the diagnostic performance of automatic ABI measurement tests to Doppler ultrasound for PAD in a group of patients aged 65 years and above, in Sub-Saharan Africa. METHODS: This was an experimental comparative study of the performance of Doppler ultrasound to the automated ABI test in the diagnosis of PAD in patients aged ≥ 65 years followed-up at the Yaoundé Central Hospital, Cameroon between January to June 2018. An ABI threshold < 0.90 is defined as a PAD. We compare the sensitivity, and specificity of the high ankle-brachial index (ABI-HIGH), low ankle-brachial index (ABI-LOW), and the mean ankle-brachial index (ABI-MEAN) for both tests. RESULTS: We included 137 subjects with an average age of 71.7 ± 6.8 years. In the ABI-HIGH mode, the automatic device had a sensitivity of 55% and a specificity of 98.35% with a difference between the two techniques of d = 0.024 (p = 0.016). In the ABI-MEAN mode, it had a sensitivity of 40.63% and a specificity of 99.15%; d = 0.071 (p < 0.0001). In the ABI-LOW mode, it had a sensitivity of 30.95% and a specificity of 99.11%; d = 0.119 (p < 0.0001). CONCLUSION: The Automatic measurement of systolic pressure index has a better diagnostic performance in the detection of Peripheral Arterial Disease compared to the reference method by continuous Doppler in sub-Saharan African subjects aged ≥ 65 years.

Association between measures of adiposity and blood pressure levels in adult Cameroonians.

INTRODUCTION: Several anthropometric measurements are variably recommended to assess adiposity in routine practice, with less agreement on their comparative performance. We assessed and compared the relationship of seven anthropometric measures of adiposity-waist circumference (WC), waist-to-height ratio (WHtR), Body Mass Index (BMI), Ponderal Index (PI), Conicity Index (C index), A Body Shape Index (ABSI), and Body Roundness Index (BRI)-with blood pressure (BP) levels and prevalent hypertension in adult Cameroonians. METHODS: Data were collected as Cameroon's contribution to the global May Measurement Month 2017(MMM17) survey. Participants were nonpregnant adults, who had no BP measurement in the past year and with no prior hypertension diagnosis. Hypertension was defined as systolic BP ≥140 mm Hg and/or diastolic ≥90 mm Hg. Odds ratios (ORs) for the presence of hypertension per 1 SD increase in each adiposity metrics were estimated in separate logistic regression models. Assessment and comparison of discrimination used the area under the receiver operating characteristics curve (AUC) and nonparametric methods. RESULTS: We included 14 424 participants (8210 [58.25%] female; 39.84 ± 14.33 years). There was a graded association between measures of adiposity and prevalent screen-detected (newly diagnosed) hypertension, with effect sizes being mostly within the same range across measures of adiposity. AUC for hypertension prediction ranged from 0.709 with PI to 0.721 with BRI for single measures, and from 0.736 to 0.739 with combinations of measures of adiposity. CONCLUSION: WC, WHtR, and BRI were strongly associated with BP and better predicted prevalent hypertension, with effects enhanced with the inclusion of BMI.

Prevalence and determinants of masked hypertension among obese individuals at the Yaoundé Central Hospital: a cross-sectional study in sub-Saharan Africa.

OBJECTIVES: The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaounde. METHODS: We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaounde Central Hospital. Masked hypertension was defined when the mean 24 h SBP was greater than or equal to 130 mmHg and/or the mean 24 h DBP was greater than or equal to 80 mmHg with normal office blood pressure (SBP/DBP) <140/90 mmHg. Logistic regression was used to examine the relationship of masked hypertension with associated factors. RESULTS: Among the 90 participants included, 67.8% were females. The mean age (±SD) was 46 (±8) years. The mean clinical measurements were 120 ± 9.4 mmHg and 75.5 ± 7.9 mmHg, respectively, for the SBP and the DBP. On 24 h ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mmHg, respectively, for the SBP/DBP. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) = 2.90, P = 0.02] and to dyslipidemia (OR = 3.60, P = 0.01), but not to the male sex, diabetes, physical activity, and tobacco/alcohol. CONCLUSION: Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure or dyslipidemia.

Biventricular hypertrabeculations or noncompaction in a 54-year-old woman in Sub-Saharan Africa: A case report.

Ventricular noncompaction or hypertrabeculation is rare and unclassified cardiomyopathy that mostly affects the left ventricle. We report the case of biventricular hypertrabeculation in a 54-year-old woman who presented with congestive heart failure de novo associated with arrhythmia in a low-income setting. We also discussed the therapeutic challenges.

Factor associated with progression to chronic arterial hypertension in women with preeclampsia in Yaoundé, Cameroon.

INTRODUCTION: Hypertensive diseases in pregnancy are the leading medical problem during pregnancy. Some of the women affected remain hypertensive after pregnancy and the post-partum period. This study aimed to assess the factors associated to the persistence of hypertension after preeclampsia. METHODS: This was a retrospective cohort study which included all women who had preeclampsia. The minimal follow-up period was 12 months. We excluded from the study all women who had superimposed preeclampsia. Sociodemographic data and past history were recorded and a physical exam was performed for all participants. Multivariate logistic regression was used to determine factors independently associated to the persistence of hypertension. RESULTS: Our cohort consisted of 136 women. The mean follow-up period was 3.7 years. Thirty two women (23.53%) remained hypertensive. This represented an incidence rate of 2.85% per year. Old age (≥ 40 years), housewife occupation, multigravidity (> 4), onset of preeclampsia before 34 weeks' gestation, obesity and the presence of hypertension in siblings were factors independently associated to persistent hypertension. CONCLUSION: Many women affected by preeclampsia remain hypertensive after pregnancy. It is important to provide adequate follow-up for this patients in order to intervene on the factors leading to this outcome.

Low-pitch peripheral systolic murmur associated with pulmonary embolism in the acute phase: a report of two cases.

Acute pulmonary embolism with significant right ventricular strain could be associated with a low-pitch peripheral systolic murmur radiating to the axillae.

Vascular hyperreactivity in black Cameroonian hypertensive and normotensive patients: a comparative study.

INTRODUCTION: Vascular hyperreactivity is a risk factor and a factor predicting hypertension (high blood pressure). Unlike other continents where several studies were carried out, it has rarely been studied in black Africa in general and in Cameroon in particular. METHODS: Vascular reactivity was measured by the cold test. Vascular hyperreactivity was defined as an increase in blood pressure > 20 mmHg for systolic and/or > 15 mmHg for diastolic. Khi2, Man-Withney, Wilcoxon's signed ranks and logistic regression tests were used for statistical analysis. RESULTS: A total of 31 hypertensive and 31 normotensive patients matched by age and sex participated in this study. Vascular hyperreactivity was present in 77.4% hypertensive patients and 51.6% normotensive patients. There was a significant association between vascular hyperreactivity and hypertension [OR = 3.2 (1.07 - 9.63), p = 0.034]. The median arterial pressure was higher in responders compared to non-responders in the normotensive group. Age > 45 years, female sex, obesity and family history of hypertension appeared to be associated with vascular hyperreactivity, but only in normotensive patients. CONCLUSION: Vascular hyperreactivity appears to be a risk factor for high blood pressure in black Cameroonians. It appeared to be associated with low blood pressure, age, sex, obesity and family history of hypertension but this was only in the normotensive.

Prevalence and correlates of chronic kidney disease in a group of patients with hypertension in the Savanah zone of Cameroon: a cross-sectional study in Sub-Saharan Africa.

BACKGROUND: The prevalence of chronic kidney disease (CKD) is increasing worldwide due to an increase in the risk factors such as hypertension. The greatest burden is in low-income settings, coupled with late diagnosis and limited management resources. This work aimed at studying the prevalence and risk factors of CKD in a group of patients with hypertension in the Savanah zone in Sub-Saharan Africa (SSA). METHODS: We carried out a cross-sectional study between January and May 2016 in the regional Hospital of Garoua-Cameroon. Participants were adults ≥18 years of both sexes, who had a diagnosis of hypertension. Patients underwent a comprehensive clinical, biological, and electrocardiographic evaluation. RESULTS: A total of 400 patients with hypertension were included, of whom 132 (33%; 95% CI: 28.6-37.8%) were males. Their mean age was 54.16±11.17 years. Hypertension was controlled in 122 (30.5%; 95% CI: 26.2-35.2%) participants. Twelve percent had a positive urine dipstick for proteins. The mean glomerular filtration rate (GFR) was 75.27±24.87 mL/min/1.73m2. The prevalence of CKD was seen in 129 (32.3%; 95% CI: 27.9-36.98) participants. Stage 3A was the most frequent (62.01%). The main comorbidities were anemia (44.5%), obesity (39.75%), diabetes (32%), consumption of traditional medicines (15.75%), and hyperuricemia (10.75%). After multivariate analysis, age >50 years (aOR: 1.75; 95% CI: 1.06-2.89; P=0.027), female sex (aOR: 2.21; 95% CI: 1.29-3.78; P=0.0035), obesity (aOR: 1.58, 95% CI: 1.01-2.44; P=0.026) and the hyperuricemia (aOR: 3.67; 95% CI: 1.78-7.58; P<0.001) were independently associated with CKD. CONCLUSIONS: The prevalence of CKD in adults with hypertension was high. This was associated with age greater than 50 years, female sex, obesity and the hyperuricemia.

Echocardiographic and electrocardiographic abnormalities in adults living with human immunodeficiency virus: a cross-sectional study in the Yaoundé Central Hospital, Cameroon.

BACKGROUND: Cardiac involvement is frequent in the course of human immunodeficiency virus (HIV) infection disease. This work aimed at studying the profile of echocardiographic and electrocardiography (ECG) abnormalities in adults living with HIV (PLHIV), compared to those not infected with HIV at the treatment unit of the Yaoundé Central Hospital. METHODS: We carried out a case-control study over three months at the HIV treatment unit. We included adults of both sexes, aged ≥21 years, HIV-infected (cases), and age and sex matched controls. Those with a history of heart disease were excluded. We collected sociodemographic, clinical, ECG, and echocardiographic data. RESULTS: We included 59 PLHIV and 59 age-sex matched controls without HIV infection. The prevalence of echocardiographic abnormalities was 28.8% in cases, and 8.5% in the control group (P=0.005). The prevalence of ECG abnormalities was 28.8% in the cases, and 18.6% in the control group (P=0.195). The main echocardiographic abnormalities (cases versus controls) were aortic regurgitation (10.2% versus 3.4%, P=0.144), right atrial dilation (6.8% versus 1.7%, P=0.178), diastolic dysfunction (5.1% versus 1.7%, P=0.310), and Left ventricular hypertrophy (5.1% versus 0%, P=0.080). The main ECG abnormalities (cases versus controls) were abnormal repolarization (11.9% versus 5.1%, P=0.187), sinus tachycardia (10.2% versus 6.8%, P=0.510), and atrial fibrillation (5.1% versus 0%, P=0.080). HIV infection was significantly associated with echocardiographic abnormalities and not with ECG abnormalities. The degree of immune deficiency was independently associated with the occurrence of echocardiographic and ECG abnormalities. CONCLUSIONS: HIV infected adults have more echocardiographic and ECG abnormalities compared to non-infected adults. The ECG and echocardiographic anomalies varied, and depends on the severity of immune deficiency.

Sudden cardiac death in low-resource settings: lessons from a resuscitated cardiac arrest.

We report on the case of an adult black African who was resuscitated from several cardiac arrests but suffered behavioural impairment, and discuss diagnostic pitfalls. The aetiology of coronary free lesion myocardial infarction with depressed left ventricular function was diagnosed when the patient travelled abroad. The low prevalence of recognised sudden cardiac arrest (SCA), as well as the lack of diagnostic and appropriate resuscitation facilities in parts of sub-Saharan Africa lead to the mismanagement of victims. Increased awareness of SCA and its causes is urgently needed.

Rationale and design of the Pan-African Sudden Cardiac Death survey: the Pan-African SCD study.

BACKGROUND: The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. METHODS: The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. CONCLUSION: This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.

Epidemiology of sudden cardiac death in Cameroon: rationale and design of the Douala-SUD survey.

BACKGROUND: The burden of sudden unexplained death in sub-Saharan Africa is unknown. AIM: The aim of this study is to establish the epidemiology of sudden cardiac death in Cameroon. METHODS: The Douala sudden unexplained death (Douala-SUD) study is a prospective, multiple-source, community-based surveillance of all cases of unexpected death (< 24 hours from onset of symptoms) occurring in victims aged>15 years. After approval from institutional boards, all deaths occurring in residents of four areas of Douala city will be checked for circumstances of death and past medical history. Subjects who die naturally will be further investigated. Unexpected death victims will be checked for detailed demographic, clinical, electrocardiographic, echocardiographic and biological records. Autopsy background and genetic analysis (postmortem or in first relatives if the young victim is aged<40 years) will be performed as far as possible. Finally, the use of cardiopulmonary resuscitation efforts during the timeframe of sudden cardiac arrest will also be evaluated. CONCLUSION: The Douala-SUD study will provide comprehensive, contemporary data on the epidemiology of sudden unexplained and cardiac death in sub-Saharan Africa and will help in the development of strategies to prevent and manage cardiac arrest in Cameroon as well as in other sub-Saharan countries.

Rationale and Design of the Pan-African Sudden Cardiac Death Survey: the Pan-African SCD Study : Cardiovascular Topic

Background: The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300 000 to 400 000 annually; which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. Methods: The Pan-Africa SCD study is a prospective; multicentre; community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards; we will record demographic; clinical; electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history; circumstances of death; and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. Conclusion: This study will provide comprehensive; contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world

Prevalence and significance of early repolarisation in a black African population: data of 246 individuals with cardiovascular morbidity.

BACKGROUND: Early repolarisation (ER) is commonly seen on electrocardiograms (ECG). Recent reports have described the relationship between ER and sudden cardiac death (SCD). The prevalence and significance of ER have not been studied in black Africans. METHOD: We matched clinical and ECG records of subjects over 18 years of age who consulted a cardiac unit in two medical centres of Douala, Cameroon. A questionnaire focusing on past history of syncope or family history of sudden unexplained death (SUD) was filled in by each subject. A 12-lead ECG was recorded by a trained nurse and analysed by two independent physicians. RESULTS: Of the 752 ECGs recorded, we studied 246 index cases. The mean age of subjects was 45 ± 16 years and 53% were female. Almost 57% had hypertension, 41% had palpitations and 18% reported a history of syncope. ER pattern was found in 20% [slurring in three (3%), notching in 13% and both in three (7%)]. ER subjects were younger than those without (41 ± 16 vs 49 ± 16 years, p = 0.0048). Lead localisation was predominantly the laterals for the slurring pattern, whereas the inferior and lateral leads were equally involved for the notching pattern. Negative T waves in the infero-lateral leads were associated with ER (p = 0.00025). Among the subjects with syncope, 41% displayed ER and 13% did not have ER (p = 0.00014). The notching pattern seemed to be associated with syncope (p = 0.00011). CONCLUSION: Early repolarisation is frequent in black Africans, especially in the setting of cardiovascular morbidity. Early repolarisation may be associated with a past history of syncope, especially the notched pattern.