[Prevalence of cardiovascular risk factors in semi-rural area in Senegal]. / Prévalence des facteurs de risque cardio-vasculaire en milieu semi-rural au Sénégal.

OBJECTIVES: We aim to determine the prevalence of cardiovascular risk factors in the semi-rural population of the community of Gueoul in Senegal. PATIENTS AND METHOD: This is a cross-sectional, observational and descriptive study. We conducted an exhaustive survey in 2012 according to the STEPS wise approach of the world health organization against Senegalese aged of 35 years and over who resided for at least 6 months in semi-rural area in the community of Gueoul. Pregnant women were excluded. Classical cardiovascular risk factors were collected and data analyzed using SPSS 18.0 software. The significance level was agreed for a value of P<0.05. RESULTS: We examined 1411 subjects (1052 women) with a mean age of 48.5±12.68 years. The main cardiovascular risk factors were dyslipidemia (61,1%), physical inactivity (56.2%), abdominal obesity according to the International Diabetes Federation (53.9%), hypertension (46.4%), global obesity (13%), diabetes (7.2%) and smoking (2.5%). Hypertension was significantly associated with diabetes (P=0.001), abdominal obesity (P=0.001) and global obesity (P=0.0001). Sedentarity (P=0.001), global obesity (P=0.0001) and hypertension (P=0.001) were more frequent in women. CONCLUSION: Cardiovascular risk factors are frequent and often associated in semi-rural area of Senegal, particularly in women. This condition should lead to develop prevention strategies of cardiovascular complications.

[Left ventricular hypertrophy in black African subjects with artery hypertension: Results of a cross-sectional survey conducted in semi-rural area in Senegal]. / L'hypertrophie ventriculaire gauche chez le sujet noir Africain hypertendu : résultats d'une enquête transversale, réalisée en milieu semi-rural au Sénégal.

OBJECTIVES: To assess the prevalence of left ventricular hypertrophy according to electrocardiographic and echocardiographic criteria among hypertensive patients living in semi-rural Senegalese area. PATIENTS AND METHODS: According to the World Health Organization STEPSwise approach, we conducted, in November 2012, a cross-sectional and exhaustive study in the population aged at least 35 years old and living for at least six months in the semi-rural area of Guéoul. We researched electrocardiographic and echocardiographic left ventricular hypertrophy in hypertensive subjects. Data were analyzed with SPSS 18.0 software version. The significance level was agreed for a value of P<0.05. RESULTS: We examined 1411 subjects aged on average of 48.5±12.7 years. In total, 654 subjects were hypertensive and screening of left ventricular hypertrophy (LVH) was effective in 515 of them. According to Sokolow-Lyon index, 86 subjects (16.7%) presented electrocardiographic LVH, more frequently in men (P=0.002). According to Cornell index and Cornell product, LVH was founded respectively in 66 (12.8%) and 52 subjects (10.1%), more frequently in female (P=0.0001; P=0.004). It was more common in grade 3 of hypertension however criteria. In echocardiography, prevalence of LVH was 2.2% (13 cases) according to the left ventricular mass, 9.3% (48 cases) according to the left ventricular mass indexed to body surface area and 8.2% (42 cases) according to the left ventricular mass indexed to height2.7. LVH was significantly correlated with the electrocardiographic LVH according to Sokolow-Lyon index (P<0.0001) and the grade 3 of hypertension (P=0.003). CONCLUSION: Although rare in hypertensive Senegalese living in semi-rural area, left ventricular hypertrophy is correlated with severity of grade of hypertension. Screening by electrocardiogram will allow better follow-up of these hypertensive subjects.

[Comparative Study Of Coronary Artery Disease In Diabetics And Non-Diabetics In The Department Of Cardiology Of Aristide Le Dantec University Hospital]. / Etude Comparative De La Maladie Coronaire Chez Les Diabétiques Et Non Diabétiques Au Service De Cardiologie Du CHU Aristide Le Dantec.

The aim of this study was to compare the features of coronary artery disease between diabetic and non-diabetic patients. PATIENTS AND METHODS: A case-control study was carried out from 1 May 2013 to 31 July 2015 in the department of cardiology of Aristide le Dantec university hospital. Forty-five diabetic patients and forty-five non-diabetic patients who underwent coronary angiography and / or angioplasty were included. RESULTS: There was a male predominance with a sex ratio of 1.6 in both groups. The mean age was 62.26 years for diabetics and 59.06 years for non-diabetics (p = 0.6). In diabetics, symptomatology was dominated by silent ischemia (48.9%) versus typical angina pain (68.9%) in non-diabetics. Myocardial infarction was the most common indication of coronary angiography in both groups. Coronary angiography revealed one-vessel disease (46.6% versus 41.7% p = 0.822), double vessel disease (26.7% versus 41.7% p = 0.091) and triple vessel disease (26.7% versus 16.6% p = 0.561). Angioplasty was indicated in 37.8% of diabetics versus 63.9% of non-diabetics. Nine diabetic patients and three non-diabetic patients had an indication of coronary artery bypass grafting. CONCLUSION: Our study confirms the greater frequency of silent ischemia and multiple-vessel disease in diabetics as well as a more frequent indication of coronary artery bypass grafting in these patients.

L'objectif de cette étude était de comparer les aspects de la maladie coronaire entre les patients diabétiques et non diabétiques. PATIENTS ET MÉTHODES: Une étude cas-témoins a été réalisée du 1er mai 2013 au 31 juillet 2015 au service de cardiologie du CHU Aristide le Dantec. Quarante cinq patients diabétiques et 45 patients non diabétiques ayant bénéficié d'une coronarographie et/ou d'une angioplastie avaient été inclus. RÉSULTATS: Nous avions retrouvé une prédominance masculine avec un sex ratio de 1,6 dans les deux groupes. L'âge moyen était de 62,26 ans pour les diabétiques et de 59,06 ans pour les non diabétiques (p=0,6). Chez les diabétiques, la symptomatologie était dominée par l'ischémie silencieuse (48,9%) et la douleur angineuse typique (68,9%) chez les non diabétiques. L'infarctus du myocarde était l'indication de la coronarographie la plus fréquente dans les deux groupes. La coronarographie retrouvait respectivement chez les diabétiques et non diabétiques une atteinte mono-tronculaire (46,6% versus 41,7% p=0,822), une atteinte bi-tronculaire (26,7% versus 41,7% p=0,091) et une atteinte tri-tronculaire (26.7% versus 16,6 % p=0,561). Une angioplastie avait été indiquée chez (37,8%) des diabétiques et (63,9%) des non diabétiques. Neuf patients diabétiques et trois patients non diabétiques avaient eu une indication de pontage coronaire. CONCLUSION: Notre étude confirme une plus grande fréquence de l'ischémie silencieuse et de l'atteinte multi tronculaire chez les diabétiques ainsi qu'une indication plus fréquente de pontage aorto coronaire.

[Prevalence of atherosclerotic carotid plaques in semi-rural Gueoul, Senegal: Survey of 1411 subjects]. / Prévalence des porteurs de plaques d'athérome carotidiennes dans la population semi-rurale de Guéoul au Sénégal : enquête sur 1411 sujets.

AIMS: The purpose of this study was to investigate the prevalence of atherosclerotic carotid plaques and association with cardiovascular risk factors and vascular diseases in a semi-rural area of Gueoul in Senegal. PATIENTS AND METHOD: This was a cross-sectional, descriptive study over a period of one month in 2012 in Senegalese people who were older than 35 years, and resided in semi-rural Gueoul for at least six months. Carotid plaques were measured with a portable Doppler Diadop 50(®) and defined by an intima-media thickness greater than 1.5mm. P-values less than 0.05 were considered statistically significant. RESULTS: The survey involved 1411 individuals with a sex ratio of 2.93 and an average age of 48.5 years. Prevalence of risk factors was high: dyslipidemia (61.1 %), physical inactivity (56.2 %), abdominal obesity (53.9 %), hypertension (46.4 %), obesity (12 %), diabetes (7.2 %) and smoking (2.5 %). Prevalence of atherosclerotic carotid plaques was 6.8 %, including 42.7 % with bilateral plaques. Prevalence increased with age (P=0.001), hypertension (P=0.0001), diabetes (P=0.004) and metabolic syndrome (P=0.008). There were no significant associations with the other risk factors. The presence of carotid plaques was associated with medical history of stroke (P=0.01), myocardial infarction (P=0.02) and peripheral artery obstructive disease (P=0.5). CONCLUSION: Prevalence of atherosclerotic carotid plaques seems weak but it is associated with many cardiovascular risk factors. It requires measures for early diagnosis and prevention of cardiovascular diseases in Senegal.

[Prevalence of congenital heart diseases in Koranic schools (daara) in Dakar: a cross-sectional study based on clinical and echocardiographic screening in 2019 school children]. / Prévalence des cardiopathies congénitales en milieu scolaire coranique (daara) à Dakar : étude transversale basée sur le dépistage clinique et échographique de 2019 élèves.

Congenital heart diseases are one of the major cardiovascular diseases in developing countries. Most prevalence studies were based on clinical examination of children with echocardiographic confirmation of suspected cases and underestimate its prevalence. The objective of this study was to investigate the prevalence of congenital heart disease in "daara" (Koranic schools) in the city of Dakar and its suburbs on the basis of clinical examination and Doppler echocardiography in school children. This cross-sectional survey was carried out from 9(th) August to 24(th) December 2011, and included a population of 2019 school children aged 5 to 18 years in 16 selected "daaras" under the Academic Inspectorate of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were recorded in a validated questionnaire. A p < 0.05 was considered to be statistically significant in bivariate analysis. 2 019 school children were included out of which 60.1% were male (sex-ratio: 0.66). The average age was 9.7 years (± 3.3 years). 18 cases of congenital heart diseases were detected being a prevalence of 8.9 per 1 000 (95 % CI: 1.8 to 7.9). This included 6 cases of inter-atrial septal aneurysm, 5 cases of peri-membranous ventricular septal defects, 4 cases of patent ductusarteriosus and 3 cases of tetralogy of Fallot. Factors correlated with the presence of congenital heart disease were ageless than 8 (p <0.001) and residence in the suburbs of Dakar (p <0.001). We also detected 10 cases of rheumatic valvular disease, a prevalence of 4.9 per 1 000 (95% CI: 2.4 to 9.1). Our study shows a high prevalence of congenital heart diseases, which is almost identical to the WHO estimates and that ultrasound screening is more sensitive than clinical screening. Reducing the prevalence of these diseases requires implementation of appropriate policies, focusing on awareness and early detection.

[Prevalence survey of cardiovascular risk factors in the general population in St. Louis (Senegal)]. / Enquête de prévalence des facteurs de risque cardiovasculaire en population générale à Saint-Louis (Sénégal).

BACKGROUND: Cardiovascular diseases are becoming with their risk factors a real health problem in Africa. The objectives of this study were to assess the prevalence of risk factors for cardiovascular diseases in the general population in Saint-Louis, Senegal. METHODOLOGY: This is a cross-sectional, descriptive and analytical made in May 2010, in the Senegalese aged 15, residing in the city of Saint-Louis, Senegal. A systematic random sampling and stratified cluster has been achieved. Cardiovascular risk factors for research were: hypertension, diabetes, dyslipidemia, smoking, obesity, physical inactivity and metabolic syndrome. RESULTS: The survey involved 1424 individuals with 983 women (69%). The average age was 43.4±17.8years. The prevalence of risk factors was: hypertension (46%), diabetes (10.4%), total cholesterol (36.3%), hyperLDLcholesterol (20.6%), obesity (body mass index≥30kg/m(2)) (23%), abdominal obesity (48.7% according to International Diabetes Federation and 33.2% according to National Cholesterol Education Program) physical inactivity (64.7%), smoking (5.8%) and metabolic syndrome (15.7%). There was predominance in women of risk factors except for smoking and diabetes. The overall cardiovascular risk was high in 24.9% according to the Framingham model, 28.8% (European Society of Hypertension) and 6.1% (SCORE). CONCLUSION: This survey found a high prevalence of cardiovascular risk factors in a general population in Senegal, predominant in women. This should lead to better develop a strategy to prevent cardiovascular diseases.

[A familial form of ventricular non compaction in a mother and two of his sons in St. Louis, Senegal]. / Une forme familiale de la non-compaction ventriculaire chez une mère et deux de ses fils à Saint-Louis du Sénégal.

We report a familial form of ventricular non compaction in a mother and two of her sons. It was a young man of 25 years who presented with NYHA stage III dyspnea and a cough with bloody sputum. The clinical examination found left ventricular failure. The echocardiogram done showed left ventricular dilatation with large trabeculae separated by deep intertrabecular recesses in both ventricles suggestive of a non-biventricular compaction. It was possible to note from the family screening by echocardiography of the mother and half-brother a left ventricular non compaction while they were asymptomatic. Thus we concluded a familial form of ventricular non-compaction. This is the first familial case described in Senegal.

[Study of echocardiographic parameters of type 2 black African diabetics at high cardiovascular risk. A cross-sectional study of 79 cases in Senegal]. / Étude des paramètres échocardiographiques du diabétique de type II noir africain à haut risque cardiovasculaire. Étude transversale de 79 cas sénégalais.

INTRODUCTION: The discovery of silent myocardial ischemia in a diabetic placed in a logic of secondary prevention. The objectives of this study were to investigate the echocardiographic parameters of type 2 Senegalese diabetics at high cardiovascular risk and identify those that are predictors of silent myocardial ischemia. PATIENTS AND METHODS: We conducted a cross-sectional study in 79 diabetic patients at high cardiovascular risk. After clinical examination, we conducted laboratory tests (glucose, creatinine, lipid profile, blood count and blood chemistry panel), ECG, standard echocardiography and dobutamine stress echocardiography looking for silent myocardial ischemia. Data were analyzed using SPSS 17 and echocardiographic parameters determining predictors of silent myocardial ischemia using a multivariate analysis. RESULTS: Seventy-nine with type 2 diabetics at high cardiovascular risk were assessed, including 56 women. The mean age was 58.8±11.8 years (44-72ans). The abnormalities found in echocardiography were dominated by left atrium dilation (72.2%), increased filling pressures of left ventricle and increased left ventricular mass in 62.02% cases respectively. At stress echocardiography, regional wall motion abnormalities were found in 67.1% of patients. These disorders were significantly more frequent in patients who had a dilated left atrium (P=0.0001), increased filling pressures (P=0.001) and high left ventricular mass (P=0.001). CONCLUSION: In diabetic patients at high cardiovascular risk, the existence of a dilation of the left atrium to left ventricular hypertrophy or increased filling pressures of the left ventricle may indicate a silent myocardial ischemia.

[Screening for asymptomatic peripheral arterial occlusive disease of the lower limbs by measuring the ankle-brachial index in the general population (Senegal)]. / Dépistage de l'artériopathie oblitérante asymptomatique des membres inférieurs par la mesure de l'index de pression systolique dans la population générale de Saint-Louis (Sénégal).

OBJECTIVES: The purpose of this study was to investigate the prevalence of peripheral arterial disease (PAOD) and cardiovascular risk factors associated with the ankle-brachial index (ABI) in Senegalese patients aged 40 years and over. METHODOLOGY: We prospectively studied a random sample of Senegalese aged 40 years and older, residing in the city of St.-Louis, Senegal. The ABI was measured with a portable doppler (DIADOP 50) using 4 and 8Hz dual frequency probes. The standards were: normal ABI 0.9 to 1.3; peripheral artery obstructive disease (PAOD) ABI less than 0.9; incompressible artery ABI greater than 1.3. Cardiovascular risk factors were also studied. RESULTS: Seven hundred and seventy-one subjects (mean age 57 ± 11.2 years, 559 women) were examined. Cardiovascular risk factors were: sedentary lifestyle (76.4%), hypertension (68%), obesity (32.1%), elevated LDL-cholesterolemia (27.8%), diabetes (18.3%) and tobacco smoking (6.9%). Ninety-three subjects (12.1%) had PAOD and 37 subjects (4.8%) had an incompressible artery. PAOD was significantly more common in sedentary subjects (P=0.008), in the elderly (P=0.0006) and in patients with a history of coronary artery disease (P=0.04). Smoking was not strongly associated with PAOD. CONCLUSION: PAOD is common in Senegalese and is associated with high prevalence of cardiovascular risk factors.

[Pulmonary embolism mimicking acute anterior myocardial infarction: diagnostic trap]. / Embolie pulmonaire simulant un infarctus aigu du myocarde antéroseptal : le piège diagnostique.

Pulmonary embolism remains the major malingerer of acute chest disease. The clinical and electrocardiographic manifestations may deviate to a diagnosis of myocardial infarction. We report a case of bilateral pulmonary embolism in a patient of 50 years. The electrocardiogram showed ST elevation in anteroseptal and lateral leads. The diagnosis of acute myocardial infarction was selected and a fibrinolysis achieved. Getting out under beta-blocker therapy, antiplatelet, statin and angiotensin-converting enzyme inhibitors after 10 days hospitalization, the patient was readmitted one month later for a massive pulmonary embolism. Coronary angiography performed after the second hospitalization was normal.

[Screening of silent myocardial ischaemia by dobutamine stress echocardiography among type 2 diabetics at high cardiovascular risk in Senegal]. / Dépistage de l'ischémie myocardique par l'échocardiographie de stress à la dobutamine chez le diabétique de type 2 à haut risque cardiovasculaire au Sénégal.

INTRODUCTION: Diabetes is a major risk factor for coronary artery disease witch may develop insidiously. Several non-invasive methods are used to detect silent myocardial ischaemia, especially in diabetic patients at high cardiovascular risk. We project to screen, by dobutamine stress echocardiography, silent myocardial ischaemia in type 2 diabetics in Senegal. METHODOLOGY: We randomly recruited in hospital in Senegal type 2 diabetics aged at least 40 years and a dobutamine stress echocardiography was performed in those selected according to the French Society of Cardiology and the French Language Association for the Study of Diabetes and Metabolic Diseases. RESULTS: Dobutamine stress echocardiography was performed in 79 diabetics at high cardiovascular risk, including 56 women. The average age was 58.8±11.8 years. The exam was positive in 67.1% of cases (53/79), with a predominance of motion abnormalities in anterior territory (83%). Cardiovascular risk factors associated with positivity of test were microalbuminuria (p=0.0001), inactivity (p=0.0001), dyslipidemia (p=0.0002), arterial hypertension (p=0.001), smoking (0.003) and male sex (p=0.004). CONCLUSION: In Africa, dobutamine stress echocardiography has the advantage of its accessibility and its feasibility. Early detection of silent myocardial ischaemia in diabetics at high risk could optimize their care.

[Huge right atrial myxoma revealed by right heart failure]. / Un volumineux myxome de l'oreillette droite révélé par une insuffisance cardiaque droite.

Right atrial myxoma is a heart benignant tumor characterized by an important clinical polymorphism. We report a case of a 30-year-old female with a diagnosis of a big right atrial myxoma. The diagnosis has been done by transthoracic echocardiography which showed an important tumorous mass in the right atrium. It was moving, inhomogeneous and takes over the whole of right atrium cavity. The surgical excision of the tumor has been done under extracorporal circulation. The patient died after a second intervention for tricuspid failure.

[Permanent cardiac stimulation in Senegal: preliminary experience at the Cardiology Clinic of Dakar]. / Stimulation cardiaque definitive au Sénégal: experience préliminaire à la Clinique Cardiologique de Dakar.

We report a prospective and descriptive study in 12 patients who had pacemaker implantation from may. 1996 and dec. 1997. Our patients benefited from complete clinical examination, ECG (12 derivations), standard laboratory tests, chest X ray. Pulsed-Doppler, two dimensional and TM echocardiography have been performed. Stimulation was achieved using endocardial lead introduced percutaneously. During the study, 12 patients over 22, representing 55% of the subjects with symptomatic conduction defects, had definitive pacemaker implantation. Mean age was 53.8 years +/- 18. Most of the patients lived in Dakar. Sex-ratio was 0.58 (7 males/5 females). Most of the patients (83%) had low socio-economical status. Before implantation mean heart rate was 47 bpm +/- 20.8. Mean blood pressure was 155 mmHg +/- 26.7 (systolic) and 71.6 +/- 20.8 mmHg (diastolic). Heart failure was present in 5 patients/12. Others symptoms were mainly syncope (83%). Mean cardiothoracic ratio was 0.56 +/- 0.09. Over a 14 months period we have implanted 7 double chamber stimulators (DDD) and 5 monochamber (VVI). Over a 210 days follow-up, main problems are infection of the pocket in 2 patients. In one of them culture was positive. In Senegal, it is necessary to develop cardiac stimulation. Pacemakers should be available for all patients with symptomatic conduction defects. A national center for electrophysiologic studies and pacemaker implantation is a priority.

[Congenital heart disease surgery in Senegal. Indications, evaluation and perspectives]. / La chirurgie des cardiopathies congénitales au Sénégal. Indications opératoires, bilan et perspectives.

In Senegal, congenital heart diseases (CHD) raise important issues. Their late detection makes more complicated the non yet resolved issue of the medico-surgical care. 108 patients with congenital heart diseases have been studied prospectively from February 1992 to May 1994. Epidemiological, clinical, paraclinical data are analysed. Prognosis and treatment are discussed. Congenital heart diseases represent 1% of the outpatient cardiovascular pathology. Diagnosis of the malformation based on echocardiography shows that most of congenital heart diseases are ventricular septal defect (25%); followed by Tetralogy of Fallot (13%). Average age of the patients is 6.86 years. 31% of the cases have heart failure. ECG is abnormal in 103 patients. On the radiologic side, average cardio-thoracic ration is 0.61. Because of heart failure, pulmonary hypertension and hypoxia, the spontaneous prognosis is cautious in 71 patients (66%) who should receive surgical treatment. Among them, 5 patients non operated died and 10 (14%) have been operated. Among the 10 patients who got surgery, 3 with wide persistent ductus arteriosus got in Dakar. All these patients have excellent operative results. In Senegal, only close heart surgery is available and prognosis of the vast majority of patients, including those with valvular and coronary heart diseases, is very cautious. Intervention of Europe-based aid organizations for evacuation is not useful. It is very important to promote, in Senegal, open heart surgery.

[Low birth weight: rate and risk factors in the Guédianwaye district (suburb of Dakar, Senegal)]. / Les faibles poids de naissance: fréquence et facteurs de risque dans le district de Guédiawaye (Banlieue de Dakar-Sénégal).

The authors report the results of a six months survey about the low weight of birth (L.W.B.) in the district of Guédiawaye, suburb of Dakar. The purpose is to determine the rate of L.W.B. in two main maternity hospitals of that locality and the associated risk factors. It is a survey with a control group. This survey results in a 10.7% rate, according to the data of another retrospective survey in the same maternity hospitals in 1992 (10.03%). The risk factors are mainly: celibacy, primiparity, an associated pathology with the pregnancy, the physical strain of mothers correlated to the income and to the previous L.W.B.