Prevalence of cardiac dyssynchrony and correlation with atrio-ventricular block and QRS width in dilated cardiomyopathy: an echocardiographic study.

INTRODUCTION: Cardiac dyssynchrony causes disorganised cardiac contraction, delayed wall contraction and reduced pumping efficiency. We aimed to assess the prevalence of different types of dyssynchrony in patients with dilated cardiomyopathy (DCM), and to establish the correlation between atrio-ventricular block and atrio-ventricular dyssynchrony (AVD), and between impaired intra-ventricular conduction and the existence of inter-ventricular dyssynchrony (inter-VD) and intra-left ventricular dyssynchrony (intra-LVD). METHODS: We included 40 patients in New York Heart Association stage III or IV, admitted consecutively with DCM with severe left ventricular dysfunction (left ventricular end-diastolic diameter ≥ 60 mm and/or ≥ 30 mm/m(2)) and left ventricular ejection fraction < 35%. Electrocardiographic and echocardiographic data were evaluated in all patients. Patients were divided into two groups: group 1: eight patients, with a QRS duration ≥ 120 ms, and all presented with left bundle branch block; group 2: 32 patients with a narrow QRS < 120 ms. RESULTS: Overall, the mean age was 54.7 ± 16.8 years and patients in group 1 were older (67.2 ± 13.6 vs 51.5 ± 15.8 years, p = 0.01). The prevalence of atrio-ventricular dyssynchrony (AVD), inter-VD and intra-LVD was respectively 40, 47.5 and 70%. Two patients (5%) did not exhibit dyssynchrony. AVD was present with a similar frequency in the two groups (37.5% in group 1 vs 40.6% in group 2, p = 0.8). There was no correlation of the magnitude of AVD with the duration of the PR interval (from the beginning of the P wave to the beginning of the QRS complex) (r(2) = 0.02, p = 0.37) or the QRS width (r(2) = 0.01, p = 0.38). A greater proportion of patients with inter-VD was observed in group 1 (87.5 vs 60%, p = 0.03). There was a trend towards a more important inter-ventricular mechanical delay according to QRS width (r(2) = 0.009, p = 0.06). The proportion of intra-LVD was similar in all groups, with a high prevalence (87.5% in group 1 and 65.6% in group 2, p = 0.39). CONCLUSION: The assessment of cardiac dyssynchrony is possible in our country. Intra-ventricular mechanical dyssynchrony had a high prevalence in patients with DCM, irrespective of the QRS width. These data emphasise the usefulness of echocardiography in the screening of patients.

[Atrial fibrillation: epidemiological data from the Cardiology Institute in Abidjan, Côte d'Ivoire]. / Fibrillation auriculaire: epidémiologie i l'institut de cardiologie d'Abidjan (Côte d'Lvoire).

UNLABELLED: The purpose of this retrospective study covering a 10-year period was to analyze epidemiological data and associated conditions related to atrial fibrillation (AF) in a cardiology hospital setting in SubSaharan Africa. PATIENTS AND METHODS: A total of 217 charts of patients hospitalized in the Medical Department of the Abidjan Cardiology Institute between August 1995 and August 2005 were reviewed. RESULTS: During the study, a total of 3,908 patients were admitted to the department, including 217 for AF for a hospital prevalence of 5.5%. There were 113 men (52%) and 104 women (48%) for a sex ratio of 1.08. Overall mean patient age was 58.9 years (range, 18 to 91 years). The difference in the mean age of men and women was not statistically significant: 57.8 versus 60 years respectively. The main symptoms at the time of admission to the hospital were exertional dyspnea (55.7%) and palpitations (22.1%). A total of 136 patients (62.6%) exhibited cardiac insufficiency. Heart disease was diagnosed in 192 patients including hypertensive cardiopathy in 48% and rheumatic valvular heart disease in 28%. The thromboembolic risk was moderate in 47% of patients (CHADS2 score, between 1 and 2) and high in 18.4% (CHADS2 score > or = 3). CONCLUSION: In our practice, hypertensive and rheumatic valvular heart disease were the main causes of AF that was associated with an alarming thromboembolic risk. These findings indicate that further effort is needed to prevent arterial hypertension and acute rheumatic joint disease.

[Left atrial mass observed in a patient in Abidjan, Ivory Coast]. / Tumeur de l'oreillette gauche à Abidjan (Côte d'Ivoire).

The purpose of this report is to present a case involving a tumor-like mass in the left atrium of a 27-year-old woman in Abidjan, Ivory Coast. The mass was discovered by echocardiography carried out after cardiomegaly was detected by roentgenography performed in the context of debilitated general condition, fever and positive serology for HIV1. The patient responded favorably to anti-tuberculosis treatment with complete regression of the mass and improvement of general condition. Based on this outcome, the most likely diagnosis was cardiac tuberculoma, a rare complication of tuberculosis.

[Early post-operative arrhythmias in endomyocardial fibrosis or chronic parietal endocarditis in 84 cases studied at the Cardiology Institute of Abidjan]. / Arythmies post-opératoires precoces dans la fibrose endomyocardique ou endocardite pariétale chronique à propos de 84 cas etudiés à l'Institut de Cardiologie d'Abidjan (ICA).

The authors have studied rhythmic events happened during early post-operative period in 84 operated patients for endomyocardial fibrosis, synonym nowadays to chronic parietal endocarditis, in the Institute of Cardiology of Abidjan (Côte d'lvoire), from January 1977 to July 1991. The mean age has been 15.6 +/- 43 years old. Endocardectomy was left in 25 cases, right in 32 and at last bilateral in the 19 others. The surgical way has been a left and/or right atriotomy. Mitral and/ ortricuspide valvular surgery has been always realised. The absolute prevalence of patients having presented one or several arrhythmias, atrial tachycardia and premature ventricular beats. The favouring factors have been the period of exclusion of the aortic root from circulation and number of endomyocardectomy. Atrial fibrillation has been related to auricular volume. Most of nodal arrhythmias have appeared with surgery. Endomyocardial fibrosis surgery has been greatful in rhythmic plan in 16% of patients. Early post-operative arrhythmias have been responsible forone case of the death of the operated patients and they have been present in seven other cases of the death.

[Conduction disorders in chronic parietal endocarditis or endomyocardial fibrosis. 170 cases at the Cardiology Institute of Abidjan]. / Troubles de conduction dans l'endocardite pariétale chronique ou fibrose endomyocardique. A propos de 170 cas colligés à l'Institut de Cardiologie d'Abidjan.

The authors have conducted research on conduction disturbances in the endomyocardial fibrosis, synonymous with chronic parietal endocarditis, about 170 cases at the Institute of Cardiology in Abidjan, from January 1977 to June 1991. The anatomical and/or angiographic examination have permitted to describe 64 cases of right fibrosis, 24 cases of left fibrosis and 82 cases of bilateral fibrosis. Conduction anomalies have been observed among 42.9% of the patients. Among 92 anomalies recorded, the most frequent has been the first degree heart block (43.5%) and the incomplete right bundle branch block (30.4%). The old age of the patients and the right localization were the factors associated with conduction disturbances in endomyocardial fibrosis (difference not significant). Yet, fibrosis surgery, especially the decortication of the fibrous endocardium of the right ventricle, have generated one or many conduction anomalies among most of our operated patients. The right branch of the fasciculus of the His has been the most injured by the fragmented techniques of METRAS who had, therefore, the merit to have minimized the incidence of the complete post-operative heart blocks still high in European and Brazilian series. In term of prognosis, no conduction disturbance has directly caused a patient's death, even if those anomalies cannot be totally ruled out in the 16 cases of sudden death.

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.

[The Flack test: a test exploring the sinus function in athletes. Apropos of 351 tests]. / Le test de Flack: test d'exploration de la fonction sinusale chez les sportifs. A propos de 351 tests.

A standardized Flack's test with continuous electrocardiographic recording was performed in 351 moderately trained athletes (317 men and 34 women; mean age 23.7 years). The test gave normal results in 310 subjects (88.3%). Tachycardia in excess of 100 beats/min was observed in 12 subjects (3.4%), and 56 abnormalities which were not present on previous ECG recordings at rest were noted in 29 subjects (8.3%); 27 of these abnormalities appeared immediately after a previous one. Out of these 56 abnormalities, 26 (44.6%) were associated with sinus dysfunction: sinus bradycardia in 8 cases, second degree sinoatrial block in 2 cases, third degree sinoatrial block in 3 cases and sinus arrest in 13 cases. In 16 cases of third degree sinoatrial block or sinus arrest escape rhythms were observed, including coronary sinus rhythm (3), junctional rhythm (12) and accelerated idioventricular rhythm (1). Five of the 56 abnormalities (8.9%) were disorders of conduction, i.e. first or second degree atrioventricular block, atrioventricular dissociation and blocked P waves. These disorders are known to be frequently associated with sinus dysfunction. In 9 out of 56 abnormalities (16.1%) disorders of excitability were present as atrial, junctional and ventricular extrasystoles. In 8 subjects the Flack's test resulted in the disappearance of disorders of conduction or excitability of the "athlete" type present at rest, as the Ruffier-Dickinson test, or the cycloergometric exercise test.(ABSTRACT TRUNCATED AT 250 WORDS)

[Conservative valve surgery in endomyocardial fibrosis. Apropos of 8 cases among 46 surgically treated patients]. / La chirurgie valvulaire conservatrice dans la fibrose endomyocardique. A propos de 8 cas sur 46 opérés.

The authors report their experience of conservative valvular surgery in endomyocardial fibrosis (EMF) (8 cases among 46 surgical cases). These patients were divided into 3 groups: Group I: bilateral EMF predominating on the left side with associated tricuspid involvement (n: 3). Group II: bilateral EMF predominating on the right side with moderate associated mitral involvement (n: 3). Group III: unilateral EMF with massive mitral insufficiency, (n: 2). At surgery, on the side of the conserved valve, the patients had a transvalvular endocardectomy (n: 3) and a valvuloplasty either tricuspid (n: 3) or mitral (n: 5). The results of the valvuloplasty were satisfactory. Two patients died in the post-operative period. Their death was unrelated with the conservative procedure. The authors study the literature concerning the cases of valvular conservative surgery in EMF (n: 4) and define the conditions under which this surgery can be done. They report 2 original cases of pure left sided limited EMF with massive mitral insufficiency successfully treated by a valvuloplasty.

[57 cases of infectious endocarditis: diagnosis, clinical course, prognostic factors]. / Etude de 57 cas d'endocardite infectieuse: diagnostic, évolution, facteurs du pronostic.

Through a retrospective study on 57 patients, the authors have studied the diagnosis signs, the clinical course, and the factors which affect the prognosis of bacterial endocarditis. Echocardiography has allowed them to establish a diagnosis with 72 p.c. of cases and the bacteriological investigations with 42 p.c. Out of these endocarditides, 39 were found on natural valves, 6 were associated with congenital cardiopathies, 9 followed the replacement of a valvula, and 3 were associated with endomyocardial fibrosis. Cardiac insufficiency (56 p.c.), and renal insufficiency (24 p.c.) were prevailing. The discussion turns on the diagnosis factors and the factors involved in the prognosis. Considering that the death rates were 64 p.c. with the patients who had undergone medical treatment and 14 p.c. with those who had undergone operations, the relevance of the surgical treatment has been emphasized.

Pulmonary arteriovenous fistula coexisting with rheumatic mitral disease. Simultaneous successful correction under cardiopulmonary bypass in one case. Review of the literature.

The authors report a rare case of coexistence of a pulmonary arteriovenous fistula with rheumatic mitral disease. The diagnosis was suspected clinically and with the chest X-ray, and was confirmed by the cardiac catheterization showing mitral disease and a pulmonary arteriovenous fistula with arterial desaturation (70%). Successful surgery (aneurysmal excision and closure of abnormal communication together with mitral valve repair) was undergone under cardiopulmonary bypass. In the literature, 7 cases of this association have been reported, with surgery in 4. None of the cases had a procedure similar to the above-mentioned and simultaneous surgery was not recommended. The authors show that the anatomic situation of the case reported allowed simultaneous surgery, and that cardiopulmonary bypass rendered the procedure easy.

[Acute bilharzial cor pulmonale due to Schistosoma mansoni]. / Coeur pulmonaire aigu bilharzien à Schistosoma mansoni.

The authors report a cause of acute cor pulmonale caused by Schistosoma mansoni bilharziosis. The clinical feature was a collapse with right ventricular failure following a delivery. The hemodynamic exploration showed a pre-capillary and supra-systemic pulmonary hypertension. The histopathologic study in post-mortem showed pulmonary lesions of fibrosis endarteritis with granulomatosis reaction round many eggs of Schistosoma mansoni. The authors discuss the frequency of various anatomic lesions (20, 30%), hemodynamic (20%) and clinical (2,5%) of the pulmonary bilharziosis. They recall the anatomical and histological mechanisms of the pulmonary artery hypertension in this disease. They emphasize the originality of this observation which is due to its super acute character and its Schistosoma mansoni bilharziosis etiology whereas pulmonary demonstrations are usually due to Schistosoma haematobium.

[200 valvular disorders seen in Abidjan]. / A propos de 200 valvulopathies observées à Abidjan

The authors have made a retrospective study of the case notes of 200 patients with valvular disorders seen over the course of 35 months (excluding those due to constrictive endocardial fibrosis). The cases represent the frequency of cardiac failure, especially in the mitral group. The authors found 61% to have mitral valve disease, 28.5% aortic valve disease, and 9.5% disease of more than one valve. Mitral valve lesions were found most frequently in young females (average age 26 years); aortic valve lesions were found more commonly in an older age group of men (average age 47 years). The authors discuss the aetiology. Rheumatic fever was responsible in 60% of cases, and caused particularly mitral valve disease. Atherosclerosis and syphilis were the commonest causes in the aortic group. Indications for surgery were found in 74 cases (37%), and 28% of these were closed heart techniques. The course of the disease is best appreciated during the first hospital admission. The mortality rate was 5.5%, and most of the patients (65%) were stabilised on treatment.