Left ventricular recovery in an African cohort of patients with peripartum cardiomyopathy.

Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening disease associated with pregnancy. There are limited data regarding the outcome of PPCM and its predictive factors in sub-Saharan African patients. We prospectively conducted a double-center (cardiology unit of the department of medicine, Regional Hospital Center of Tenkodogo, Burkina Faso and the department of cardiology of the National Referral Teaching Hospital of N´Djamena, Chad) cohort study in patients with PPCM. Patients were consecutively enrolled from January 2015 to December 2017. Outcomes of interest were left ventricular recovery and poor outcome at one year. Ninety-four patients enrolled with a median age of 28 years. At one-year follow-up, 40.5% of them recovered their left ventricular function. Cox multiple regression analysis revealed that higher left ventricle ejection fraction (LVEF), lower natremia and use of betablockers were baseline variables predicting this end-point. Of the entire study population, 26.60% exhibited the composite end-point of death (n=15) or remaining in New York Heart Association (NYHA) class III-IV or LVEF < 35%. Predictors of poor outcome were lower LVEF at baseline, hyponatremia and use of digoxin. The current cohort study demonstrated that PPCM in sub-Saharan Africa is associated with limited myocardial recovery and significant rate of poor outcome at one year. Therefore, additional studies are needed to better address the disease.

Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso.

INTRODUCTION: Heart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso. METHODS: We conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1st January 2015 to 31st December 2016 and followed up until June 2017. Primary outcome of interest was mortality. RESULTS: Overall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF < 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years. CONCLUSION: Heart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.

Epidemiology and long-term prognosis of atrial fibrillation in rural African patients.

BACKGROUND: Few studies have addressed the pattern of atrial fibrillation (AF) in rural Africa. The purpose of the study was to assess the epidemiology and long-term prognosis of AF in rural African patients in the Regional Hospital Center (RHC) of Tenkodogo, Burkina Faso. RESULTS: Overall, 107 of 1805 cardiac cases presented with AF (prevalence of 5.9%). Six patients were excluded. Mean age was 66.56 ± 14.92 years, and 53.47% were female. Hypertension was the most prevalent cardiovascular risk factor (59.41%). Congestive heart failure (HF) was reported in 85.15% of the study patients at presentation. Most of the study population presented with severe underlying heart disease (93.1%), and hypertensive heart disease was the most prevalent with 45.54% of the cases. The mean CHA2DS2VASc score in patients with non-valvular heart disease (n = 91) was 3.33 ± 1.25 (extremes 1-6) while the risk of bleeding was low (HAS-BLED score ≤ 1) in 82 patients (81.2%). Oral anticoagulation was prescribed in few cases (5.26%). During a follow-up period of 74.43 ± 23.94 weeks, acute HF and stroke occurred in respectively 43 and 6 patients. Forty-one patients (40.59%) died. The overall survival rate was 69% at 6-month and 59.4% at 1-year follow-up. Patients with idiopathic dilated cardiomyopathy were at higher risk of death than other patients (log-rank test = 11.88, p < 0.001) over time. CONCLUSION: AF is not rare in rural African patients and is associated with an increased long-term risk of HF, stroke, and mortality.

[Contribution of the myocardial scintigraphy to the management of stable angina in Burkina Faso]. / Apport de la scintigraphie myocardique d'effort dans le diagnostic de l'angor stable au Burkina Faso.

OBJECTIVE: The objective of our work was to analyze the contribution of stress myocardial scintigraphy in the diagnosis of stable angina in the Cardiology Department of CHU YO. METHOD: This was a retrospective study of 47 patients who received a stress myocardial scintigraphy from January 2012 to December 2013 for the diagnosis of stable angina. The scintigraphic sections were made after injection of the radiotracer (MibiTc99m) during the treadmill stress test. RESULTS: Myocardial scintigraphy accounted for 16% of all scintigraphy and stress myocardial scintigraphy for diagnosis of stable angina accounted for 64% of all myocardial scintigraphy. The average age of the patients was 47 ± 10 years. The sex ratio was 1.1. All patients had completed the treadmill stress test. The treadmill stress test was stopped for maximum effort in 42 cases (89%). The average duration of the effort was 12 minutes ± 2.4. Treadmill stress test was positive in three patients. Nineteen percent of patients had a pathologic myocardial scintigraphy. Scintigraphy was pathologic in all patients with a positive treadmill stress test. CONCLUSION: Myocardial scintigraphy remains a sensitive examination for the diagnosis of stable angina. It helps to better stratify risk and adjust patient treatment.

OBJECTIF: L'objectif de notre travail était d'analyser l'apport de la scintigraphie myocardique d'effort dans le diagnostic de l'angor stabledans le service de Cardiologie du CHU YO. MÉTHODE: Il s'est agi d'une étude rétrospective sur 47 patients ayant bénéficié d'une scintigraphie myocardique d'effort de Janvier 2012 à Décembre 2013 pour le diagnostic d'un angor stable.Les coupes scintigraphiques ont été réalisées après injection du radio-traceur (MibiTc99m) au cours de l'épreuve d'effort. RÉSULTATS: La scintigraphie myocardique représentait 16% des scintigraphies et celle d'effort pour diagnostic d'un angor stable 64% des scintigraphies myocardiques. L'âge moyen des patients était de 47 ± 10 ans.Le sex-ratio était de 1,1. Tous les patients avaient effectué l'épreuve d'effort sur tapis roulant. L'épreuve d'effort était arrêtée pour effort maximal dans 42 cas (soit 89%). La durée moyenne de l'effort était de 12 mn ± 2,4.L'épreuve d'effort était positive chez trois patients. Dix-neuf pour cent des patients avaient eu une scintigraphie myocardique pathologique.La scintigraphie était pathologique chez tous les patients ayant une épreuve d'effort positive. CONCLUSION: la scintigraphie myocardique reste un examen sensible pour le diagnostic l'angor stable. Elle permetde mieux stratifier le risque et ajuster le traitement des patients.

[Contribution of stress test to the treatment of ischemic heart disease]. / Apport de l'épreuve d'effort dans la prise en charge des cardiopathies ischémiques.

Stress test is a useful diagnostic tool in patients with suspected angina pectoris with low sensitivity but high specificity. It is also very useful in the evaluation of the risk, of the effectiveness of treatment and it is a useful guidance on medical prescriptions after controlling the symptoms of ischemia. This study aims to analyze the contribution of stress test to the treatment of ischemic heart disease in the Department of Cardiology at the University Hospital CHU YO. We conducted a retrospective study of 60 patients who had undergone stress test from January 2012 to December 2013. Stress test was performed using a treadmill according to the modified Bruce protocol. Sixty patients underwent stress test during the study period. The average age of patients was 49± 10.8 years. Sex-ratio was 1.2. All patients underwent treadmill stress test. Twenty-two patients had a history of coronary artery disease. Estimating presence of coronary artery disease was the indication for stress test in 83% of cases. It was detected in 78% of cases. Stress test was stopped when maximal workload was reached in 46 cases (or 77%). Mean exercise duration was 11,7 mn ± 3,2. Ten percent of patients had a positive stress test and 10% a dubious test. Our study will also contribute to transfer knowledge on this diagnostic test which is still little prescribed in our environment and even among cardiologists. However, efforts should be made in order to improve the quality of stress test practice in the management of coronary artery disease in a context of countries with limited resources.