Low birth weight and risk of hypertension in African school children.

BACKGROUND: In accordance with Baker's programming hypothesis, many studies have demonstrated a relationship between low birth weight (LBW) and high risk of hypertension in adulthood. The present study examines a possible association between LBW and the risk of a child having hypertension later in life. METHODS: The study was a cross-sectional, semi-urban survey. Information on the perinatal characteristics of 2648 randomly sampled school children was collected retrospectively in Kinshasa town, Democratic Republic of Congo. RESULTS: High risk of hypertension in these African school children was related to LBW (<2.500 g); the odds ratio was 2 (95% confidence interval 0.9-8.2, P<0.01) and 2.3 (95% confidence interval 0.6-11.5, P<0.01) for systolic and diastolic hypertension respectively. Birth weight was inversely related with both blood pressure and heart rate; the strongest association was shown in females and adolescents. CONCLUSIONS: Antenatal stress leading to LBW may be associated with programming induced by foetal undernutrition, which in turn leads to the emergence of cardiovascular disease and increased risk of hypertension.

Survey of rheumatic heart disease in school children of Kinshasa town.

STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease and study the association of this disease to factor such as personal host and environment. DESIGN: A cross sectional survey was carried out by a specially trained medical team. SETTING: The study involved high risk school children aged 5-16 years from Binza-Kinshasa urban area and adjoining slums in semi-urban area of Kinshasa town. METHODS: A total of 4848 children randomly selected on the list of semi-urban and urban schools and representing 10% of the schools population were included in the survey with clinical echocardiographic examinations. RESULTS: Of the 4848 children screened, prevalence of rheumatic heart disease was 14.03/1000. The prevalence was significantly greater in slums schools (22.2/1000) than in urban school (4/1000). In slums area, the mitral valve was the valve most commonly affected by rheumatic heart disease. Risk factors such as birth in rainy season (RR=2.2), low birth weight (RR=1.81), low socioeconomic status (RR=2.68), malnutrition8 persons/household (RR=4.10) and migrant status (RR=4.79) predicted significantly rheumatic heart disease occurrence in children living in the semi-urban area (slums). Only birth in rainy season (RR=3.24) predicted significantly rheumatic heart disease onset in children having residence in the urban area. CONCLUSIONS: Rheumatic heart disease runs a more severe course in Kinshasa, because appropriate medical care, sanitary conditions, primary and secondary prophylaxis are not available. Echocardiograpy is necessary to identify cases of rheumatic heart disease.

Heart involvement and HIV infection in African patients: determinants of survival.

In Africa, recent studies have reported that HIV may exhibit a cardiac tropism. The purpose of this study was to determine if clinical features, sex, age at onset, biological or echocardiographic variables have any influence on survival of African HIV-infected patients and AIDS progression. One hundred and fifty seven consecutive HIV-seropositive patients without cardiac lesions and no other AIDS-defining illnesses underwent physical, electrocardiographic and Doppler echocardiographic examinations at the Heart of Africa Cardiovascular Centre, Lomo Medical, Kinshasa, Congo, between July 1987 and July 1994. Odds ratios were calculated to assess the influence of potential risk factors on cardiac lesions, opportunistic diseases, and death outcomes. Cardiac lesions had occurred in 87 patients (55%) during 7-year follow up. The onset of heart involvement was associated with a protection against opportunistic comorbidity. In multiple regression model, cardiac mass/volume ratio, body temperature, deceleration time, body mass index and socio-economic status were each independently associated with AIDS outcome. In a multivariate analysis the lowest socioeconomic status and the pericardial effusion were the independent predictors of death. The higher CD4 count and cardiac lesions outcome were connected with slower progression to AIDS. Dilated cardiomyopathy was associated with longer survival.

PIP: Cardiac involvement with HIV infection has been documented worldwide in various forms among people with AIDS, including myocarditis, cardiomyopathies, pericardial effusions, ventricular tachycardia, neoplastic infiltration, and non-bacterial thrombotic endocarditis. Recent studies in Africa have reported that HIV may exhibit a cardiac tropism. The authors investigated whether clinical features, sex, age at onset, biological or echocardiographic variables influence the survival of African HIV-infected patients and the progression of AIDS. 157 consecutive Black African HIV-seropositive patients of mean age 38 years with neither cardiac lesions nor other AIDS-defining illnesses underwent physical, electrocardiographic, and Doppler echocardiographic examinations at the Heart of Africa Cardiovascular Center, Lomo Medical, Kinshasa, Congo, between July 1987 and July 1994. The sample was comprised of 89 men and 68 women. Cardiac lesions occurred in 87 patients (55%) during the 7-year follow-up. The onset of heart involvement was associated with a protection against opportunistic comorbidity. In the multiple regression model, cardiac mass/volume ratio, body temperature, deceleration time, body mass index, and socioeconomic status were each independently associated with AIDS outcome. The lowest socioeconomic status and pericardial effusion were the independent predictors of death in a multivariate analysis, while higher CD4 count and cardiac lesions outcome were associated with slower progression to AIDS. Dilated cardiomyopathy was associated with longer survival.

[The effect of HIV infection on high incidence of heart diseases in Kinshasa (Zaire). Echocardiographic study]. / Influence de l'infection par le VIH sur la fréquence elevée des cardiopathies a Kinshasa (Zaïre). Etude echocardiographique.

Invasion of the heart by HIV has become a clinical problem over the last decade. The objective of the present study was to systematically detect the excess HIV-related cardiac lesions in Kinshasa by performing echocardiography. The study population consisted of 166 HIV-infected patients and 166 HIV-seronegative patients with heart disease (control group). 69% of patients were at stage A of HIV infection and 31% were at stage AIDS C3 according to CDC 1993 criteria. A higher incidence of echocardiographic abnormalities was observed in HIV-seropositive subjects (28.3%) than in control subjects (13%) (p = 0.035). Systolic function was very severely impaired at the stage of AIDS (%R = 21,6 +/- 8.7) showing a highly significant difference (p < 0.01) compared to HIV-seropositive patients at stage A (% R = 29.2 +/- 11.9) and control subjects (%R = 28.9 +/- 5). One patient (0.6%) developed Salmonella enteritidis infectious endocarditis. Echocardiography, a noninvasive technique, contributes to the diagnosis of cardiac lesions associated with HIV infection. HIV has a predominant role in the severity of dilatation and alteration of the left ventricular systolic function in black Africans compared to Caucasian populations.

[HIV infection and pericardial disease invasion in Africa]. / Irruption de l'infection par le VIH et des pèricardites en Afrique.

The number of cases with pericardial disease has been increasing in Africa and particularly in Zäire, after AIDS was defined. To investigate a possible link between HIV infection and risen incidence of pericardial effusions, 64 patients randomly selected (32 HIV carriers and 32 HIV-seronegative as controls), with suspected pericardial disease were studied in a longitudinal trial from January 1991 to December 1994. Central and accessory cells of immune system were measured in conjunction with blood screening, electrocardiogram (ECG), chest X-ray and cardiac ultrasound. Haematological examination included also microscopical examination of blood films after May-Grünwald-Giemsa staining. There were significant decreases of hemoglobin, CD4 cells, and basophils in HIV-seropositive patients. Pericardial disease was estimated 8.8% of in-hospital prevalence, in which 70% of cases were related to HIV infection. The HIV related pericardial disease had an incidence of 1.8% per year. Etiology of pericardial disease depends on evolution and immunodepression level; 90.5% of pericardial effusions related to HIV are caused by tuberculosis as shown at the second pericardiocenthesis.

[A clinical study of cardiac manifestations related to acquired immunodeficiency syndrome (AIDS) in Kinsaha]. / Etude clinique des manifestations cardiaques au cours du syndrome d'immunodéficience acquise (sida) à Kinshasa.

A prospective study was performed from march 31 st 1991 to september 30th 1992 on cardiac involvement in course of AIDS. Clinical, electric, sonographic and radiologic aspects were analysed within 83 patients of the study. In this cohort, 45.8% of patients had shown a cardiac involvement through all strates and respectively: a pericarditis with effusion in 24 patients (27.7%), a dilated cardiomyopathy in 14 patients (16.9%) and infective endocarditis in 1 patient (1.2%). Dispncea between classes II and IV of NYHA was the main complaint. Tachycardia, silent cardiac sounds and congestive heart failure were the prominent features of the clinical examination of the cohort. Because of the likely high prevalence of cardiac manifestations in course of AIDS, clinicians and researchers have to pay attention to this situation.