[Heart rate recovery and presence of coronary lesions in case of ischemic heart disease at the Abidjan Cardiology Institute in Côte d'Ivoire]. / Fréquence cardiaque de récupération et présence de lésions coronaires au cours des cardiopathies ischémiques à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

Introduction: Heart rate recovery (HRR) measured during stress tests, assesses the vago-sympathetic balance. It is a known prognostic and predictive parameter of cardiovascular mortality that is believed to be correlated with the presence and severity of coronary artery disease. The aim of this work was to assess the predictive value of heart rate recovery in the diagnostic and severity of coronary lesions in a major metropolis of sub-Saharan Africa where access to specialist care is unevenly distributed. Patients and method: We conducted a retrospective observational study from January 2010 to February 2020 at the Abidjan Cardiology Institute, including patients who performed a diagnostic coronary angiography after a positive exercise test. Clinical, angiographic and exercise parameters were analyzed and compared in patients with abnormal heart rate recovery (HRR) and those with normal one. Results: The main study limitation is small sampling due to the cost of the angiographic procedure which limits its realization. We recorded 41 subjects whose mean age was 53.4 ± 9.6 years with a male predominance (sex ratio of 3.6). The predominant age group was between 50 and 60 years. Males were older than females with no significant difference. The predominant cardiovascular risk factors were overweight/obesity (68.29%) and hypertension (61%). Eight patients (19.5%) presenting an abnormal HRR (≤12 bpm) had more significant coronary disease (p=0.02) and more severe ones (p=0.003). Patients with abnormal HRR tended to be older without statistical significance (p=0.081), and had lower chronotropic reserve and maximum heart rate (p=0.008 and p=0.042, respectively). The positive predictive value of HHR was 87.5% and its negative predictive value was 60.6%. Conclusion: Abnormal HRR can predict the presence of coronary artery disease and its severity. Evaluating HRR during stress tests could help in the detection, evaluation, and monitoring of ischemic heart disease in our resource-limited countries.

Prevalence of hypertension and other cardiovascular disease risk factors among university students from the National Polytechnic Institute of Côte d'Ivoire: A cross-sectional study.

BACKGROUND: Cardiovascular diseases (CVD) are the leading causes of death in the world, mainly occurring in low-and-middle income countries. The aim of this study was to estimate the prevalence of hypertension and other cardiovascular risk factors among university students at a National Polytechnic Institute in Côte d'Ivoire. METHODS: A cross-sectional study was conducted among students of the National Polytechnic Institute of Côte d'Ivoire. Sample was selected using a non-probabilistic convenient sampling method. Anthropometric measurements, blood pressure and capillary blood glucose were measured. A logistic regression model allowed to determine factors associated with hypertension. RESULTS: A total of 2,030 students, 79.7% males and 20.3% females, with a median age of 20 years (IQR = [19-22]) participated in the study. On hypertension knowledge, 96.9% (n = 1,968) of students reported having heard of hypertension; salty foods were reported by more than a third as a cause of hypertension (n = 734; 37.3%), while 114 (5.8%) and 157 (8.0%) selected tobacco and alcohol as causes of hypertension, respectively. The overall prevalence of hypertension was 6.0%, higher in males (6.8%) compared to females (2.7%) (p < 0.001). As for CVD risk factors, 148 (7.3%) were overweight or obese; 44.0% of males and 36.6% of females reported alcohol consumption. In multivariate analysis, being a female (OR = 4.16; CI 95% = [1.96-9.09]; p<0.001), being 25 years old and older (OR = 3.34; CI 95% = [2.01-5.55]; p = 0.001), tobacco use (OR = 2.65; CI 95% = [1.41-4.96]; p = 0.002), being overweight or obese (OR = 3.75; CI 95% = [2.13-6.59]; p<0,001) and having abnormal waist circumference (OR = 6.24; CI 95% = [1.99-19.51]; p = 0.002) were significantly associated with high blood pressure. CONCLUSION: CVD risk factors are prominent among young adults in Côte d'Ivoire. Appropriate behavioural health interventions promoting a healthy lifestyle for young adults should be urgently implemented for CVD burden reduction.

[Do West African cardiologists adhere to the guidelines for the management of heart failure ?] / Les cardiologues ouest-africains suivent-ils les « guidelines ¼ sur la prise en charge de l'insuffisance cardiaque ?

INTRODUCTION: Adherence to guidelines for the management of heart failure (HF) has been shown to be a strong predictor of reduced hospitalisations. The aim of this study was therefore to investigate the adherence of West African cardiologists to guidelines for the management of HF. METHODOLOGY: This was a prospective cross-sectional multicentric study (Côte d'Ivoire, Togo, Benin and Burkina-Faso). The "ADDress your Heart" survey developed was administered online to assess cardiologists' adherence to the guidelines for the management of heart failure. RESULTS: 62.3% of the 106 participants reported that they followed the guidelines closely. The therapeutic classes indicated as first-line by the latest guidelines were insufficiently suggested by physicians: 57.5% for mineralocorticoid receptor antagonists, 41.5% for gliflozins and 30.1% for sacubitril-valsartan In univariate logistic regression, affiliation with a teaching hospital OR [95% CI] = 3.0 [1.3-6.8], p < 0.01 ; access to scientific cardiology journals OR [95 % CI] = 3.4 [1.3-8.9], p = 0.01; and frequent attendance at conferences OR [95% CI]=1.8 [1.2-2.9], p < 0.01, were associated with guideline compliance. These factors persisted in multivariate analysis. CONCLUSION: Adherence of West African cardiologists to guidelines on the management of heart failure was moderate. If affiliation to a university hospital is difficult to apply to all cardiologists, access to scientific cardiology journals and frequent attendance in conference should be encouraged.

Virtual Reality Hypnosis in the Electrophysiology Lab: When Human Treatments Are Better than Virtual Ones.

Aims: Virtual reality hypnosis (VRH) has been used successfully in various clinical settings to decrease anxiety and the sensation of pain. We aimed to investigate the feasibility and safety of VRH in patients undergoing electrophysiology and pacing procedures under conscious sedation. Methods: During a two-month period, VRH support was proposed and accepted by 25 patients undergoing electrophysiological procedures. Data were compared with a control group (n = 61) enrolled during the following three-month period. Both groups underwent the measurement of the duration of intervention, the consumption of analgesics and hypnotics, and their pain and comfort using a validated visual analogue scale (VAS 0−10). Results: The baseline characteristics were comparable in both groups, including age. There were no differences in procedure duration (46 (±29) vs. 56 (±32) min, p = 0.18) or in hypnotic/antalgic consumption (midazolam 1.95 (±1.44) vs. 2.00 (±1.22) mg, p = 0.83; sufentanyl 3.78 (±2.87) vs. 3.58 (±2.48) µg, p = 0.9) between the control and VRH groups. In a multivariate analysis, the use of VRH was independently associated with lower comfort during the procedure assessed by postoperative visual analogue scale (OR 15.00 [95% CI 4.77−47.16], p < 0.01). There was no influence of VRH use on pain or drug consumption. Conclusions: In our experience, compared with VRH, human care is preferable during procedures in electrophysiology lab to improve the comfort of the patient. VRH has no influence on pain or drug consumption.

[Career choice of ivorian medical students at the end of curriculum: influencing factors and aspirations]. / Choix de carrière des étudiants en médecine ivoiriens en fin de cursus : facteurs d'influence et aspirations.

Introduction: The implantation of health structures in Côte d'Ivoire to improve geographical accessibility to care remains unequal between rural and urban areas. The medical student has to decide on his or her career choice in this context, while also taking into account personal preferences. The aim of our study was to evaluate the factors influencing the speciality choice of medical students at the faculty of medicine of Félix Houphouët-Boigny University in Abidjan. Methodology: Medical students enrolled in the 6th year completed an anonymous self-administered questionnaire. The questionnaire was in paper format and was divided into three parts: socio-demographic criteria; speciality choice; and factors influencing career choice. Students were asked to rate the extent to which they perceived each of the 24 items as influencing their career choice using a Likert scale ranging from 1 (no influence) to 5 (strong influence). The factors were compared according to the speciality choice (medical or surgical). Results: The 3 most chosen specialties were: cardiology (17.9%), gynaecology-obstetrics (15.7%) and paediatrics (9.6%). The desire to take the internship competition was more frequent among students who chose a surgical speciality (p = 0.02). The choice of a medical speciality was more influenced by the willingness to work part-time (p = 0.04). Students who choose a medical speciality were more guided by social commitment than those who chose a surgical speciality (p = 0.04). In contrast, the latter were more influenced by prestige among colleagues (p = 0.04) and immediate postoperative outcomes (p = 0.01). Conclusion: The efficient equipment of health structures could contribute to the development of other less chosen specialities by making them more attractive. A reorganisation of the system with the deployment of teachers in regional hospitals with a minimum of equipment is indispensable in order to allow a "decentralization" of the specialization curriculum, especially for the surgical specialties.As for the aspiration to part-time work, it can be explained by the need to reconcile family and professional life, but also by a sometimes unspoken project to develop a lucrative extra-medical activity in order to make up insufficient wages.

Biochemical properties, nutritional values, health benefits and sustainability of palm oil.

Palm oil (PO), although subject of controversies, is the most consumed oil and the first source of oil widely produced. In this review, we discussed its biochemical composition in fatty acids, carotenoids, vitamin E, its phenolic compounds, and its nutritional benefits. We addressed its biochemical properties in relation with the stereospecific distribution of its unsaturated fatty acids at the sn-2 position in triacylglycerols. PO is one of the most stable oils, which help it prolong food storability mostly due not only to its content of saturated fatty acids, but also to its antioxidant compounds. PO plays an important role in the prevention of many pathologies (diabetes, cardiovascular diseases, obesity and cancers). It is widely use in nutrition especially in the food industry and in biodiesel industry. Faced with attacks from environmentalists who blame PO for destorying biodiversity, there is an urgent need to develop a sustainable PO production plan. Compliance with sustainable PO goals would help ease those controversies. The use and consumption of PO in normal or moderate amounts in a varied, balanced and adequate diet does not present any known health risk. Education campaigns on the nutritional benefits of PO should be promoted.

Coronary angiographic findings in dilated cardiomyopathy in a sub-Saharan African population.

AIM: To describe the coronary angiographic aspects observed in patients with dilated cardiomyopathies (DCM) in a sub-Saharan African country in order to improve their management. METHODS: This was a cross-sectional study conducted from 1 January 2010 to 31 March 2016. All patients aged 18 years and older, presenting with DCM and admitted to Abidjan Heart Institute, who underwent coronary angiography were included. One hundred and eight patients were selected. We analysed and compared the coronary angiographic features observed. RESULTS: The median age of our patients was 52 years (46-61). There was a male predominance (sex ratio = 3). Hypertension (53.7%) was the major cardiovascular risk factor found. Coronary angiography was abnormal in 37 patients (34.3%). Twenty-three patients (21.3%) had obstructive coronary artery disease (CAD). Patients with CAD were older than those with normal coronary arteries, but with no statistically significant difference (p = 0.06). Hypertension (p < 0.001) and diabetes (p = 0.0003) were statistically significantly more commonly reported in patients with CAD. CONCLUSIONS: Ischaemic heart disease is likely to be underdiagnosed in sub-Saharan Africa. A coronary angiographic assessment of patients receiving treatment for DCM, especially in the presence of cardiovascular risk factors, should help optimise their management and improve prognosis.

May Measurement Month 2017: an analysis of blood pressure screening results in Cote d'Ivoire-Sub-Saharan Africa.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. In Cote d'Ivoire, high BP is the first risk factor for stroke and myocardial infarction. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the standard MMM17 protocol. A Coordinators Team was created. All doctors in cardiology training of Abidjan Institute of Cardiology (N = 72) were briefed to carry out the MMM study as investigators, and 55 sites were created. These were major urban transport stations, supermarkets and markets, and churches. BP was calculated from the mean of the 2nd and 3rd readings, and hypertension was defined as a systolic BP of at least 140 mmHg and/or a diastolic BP of at least 90 mmHg or being on BP-lowering treatment. We screened 24 563 individuals during MMM17, with mean age of 37 years. After multiple imputations, 5015 (20.4%) had hypertension. Of individuals not receiving anti-hypertensive medication, 3943 (16.8%) were hypertensive. Of individuals receiving anti-hypertensive medication, 583 (54.4%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Cote d'Ivoire. MMM allowed us to identify many undiagnosed and inadequately treated hypertension cases and could usefully lower the burden attributed to increased BP. MMM should be continued.

[Direct current cardioversion in Abidjan: report of a ten-year practice in Institute of Cardiology of Abidjan, Ivory Coast]. / Choc électrique externe à Abidjan : bilan de dix ans de pratique à l'Institut de Cardiologie d'Abidjan, Côte d'Ivoire.

UNLABELLED: Direct current cardioversion is effective in arrhythmias' termination. Few is known about its use in our practice. This work aims to report its outcomes over a ten-year period in Abidjan. METHOD: One thousand, three hundred and ninety one charts of arrhythmic patients were reviewed. RESULTS: Cardioversion was attempted in 102 patients. One hundred and eighty one shocks were delivered with a mean energy of 262, 1 joules. Success occurred in 84 patients (82,3%). Cardioversion failed in 18 patients mostly in atrial fibrillation. Eight serious complications (7,8%) occurred including 1 sinus node dysfunction, 1 pulmonary oedema, 1 metrorrhagia, 2 stroke, 1 pulmonary embolism. Two patients with ventricular tachycardia died of end-stage heart failure and aftermath of a mitral valve surgery. CONCLUSION: Direct current cardioversion is effective and safe in our practice. Complications are predominantly due to the medical environment such as antiarrhythmic drugs use or clinical conditions.

Hypertension management in an outpatient clinic at the Institute of Cardiology of Abidjan (Ivory Coast).

BACKGROUND: Elevated blood pressure is one of the most important modifiable risk factors for cardiovascular diseases. AIM: To evaluate blood pressure management in Côte d'Ivoire. METHODS: A retrospective study was conducted among 2575 hypertensive patients from the Institute of Cardiology of Abidjan, who were followed for at least 10 years, between January 2000 and December 2009. RESULTS: The patients' mean age ± standard deviation was 59.1 ± 12.5 years; 54.3% were women. At first presentation, hypertension was stage 1 in 21.7%, stage 2 in 32.3% and stage 3 in 46.0% of patients. According to the European guidelines' stratification of the cardiovascular risk-excess attributable to high blood pressure, 46.7% had a very high added risk, 37.8% had a high added risk and 14.9% had a low-to-moderate added risk. Pharmacological therapy was prescribed in 97.8% of patients; more than 66% were receiving at least two antihypertensive drugs, including fixed-dose combination drugs. The most common agents used were diuretics (59.7%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (59.6%). The most common agents for monotherapy were calcium antagonists. When two or more drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were most commonly used. Blood pressure control was achieved in 43.7% of cases. CONCLUSION: In our series, severe hypertension with high added risk or very high added risk was very common. Treatment--mostly diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers--required at least two antihypertensive drugs to meet the recommended blood pressure target.

[Not Available]. / Choc électrique externe à Abidjan : bilan de dix ans de pratique à l'Institut de Cardiologie d'Abidjan, Côte d'Ivoire.

UNLABELLED: Direct current cardioversion is effective in arrhythmias' termination. Few is known about its use in our practice. This work aims to report its outcomes over a ten-year period in Abidjan. METHOD: One thousand, three hundred and ninety one charts of arrhythmic patients were reviewed. RESULTS: Cardioversion was attempted in 102 patients. One hundred and eighty one shocks were delivered with a mean energy of 262, 1 joules. Success occurred in 84 patients (82,3%). Cardioversion failed in 18 patients mostly in atrial fibrillation. Eight serious complications (7,8%) occurred including 1 sinus node dysfunction, 1 pulmonary oedema, 1 metrorrhagia, 2 stroke, 1 pulmonary embolism. Two patients with ventricular tachycardia died of end-stage heart failure and aftermath of a mitral valve surgery. CONCLUSION: Direct current cardioversion is effective and safe in our practice. Complications are predominantly due to the medical environment such as antiarrhythmic drugs use or clinical conditions.

Unusual giant right atrium in rheumatic mitral stenosis and tricuspid insufficiency.

Dilation and hypertrophy of the atria occur in patients with valvular heart disease especially in mitral regurgitation, mitral stenosis or tricuspid abnormalities. In sub-saharan Africa, rheumatic fever is still the leading cause of valvular heart disease. We report a case of an unusual giant right atrium in context of rheumatic stenosis and severe tricuspid regurgitation in a 58-year-old woman.