Assessment of ventricular diastolic function in AIDS patients from Congo: a Doppler echocardiographic study.

OBJECTIVE: To investigate the prevalence of left ventricular dysfunction in African patients infected with the human immunodeficiency virus (HIV). The hypothesis was that HIV infected patients with left ventricular dysfunction are asymptomatic. METHODS: M mode, cross sectional, and Doppler echocardiography were performed in 49 consecutive patients (30 HIV positive (HIV+) carriers and 19 AIDS patients). None of the patients or 58 controls had a medical history of cardiovascular abnormalities. RESULTS: Cardiac abnormalities were not suspected on physical, electrocardiographic, and radiological examination. Forty-two of the HIV infected patients had left ventricular diastolic dysfunction; this was more pronounced in AIDS patients than in HIV+ carriers. Systolic function was normal in both stages of HIV infection. Left ventricular isovolumic relaxation time (mean SD)) increased from 87.2 (12.4) ms in the carrier state to 103.9 (19.3) ms in AIDS (p < 0.05, Bonferoni correction), peak early filling velocity declined from 0.54 (0.1) to 0.44 (0.1) m/s (p < 0.05), and late velocity increased from 0.64 (0.1) to 0.69 (0.2) m/s. A restrictive filling pattern was explained by concentric hypertrophy in 23 HIV infected patients, and by systemic amyloidosis with left ventricular dilatation in 12 of 49 HIV infected patients. CONCLUSIONS: Echocardiography is a useful technique for detecting left ventricular diastolic dysfunction in HIV infected patients with clinically unsuspected cardiac lesions. Systolic function was normal despite the presence of such cardiac abnormalities.

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.

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.

Hematocrit and stroke in black Africans under tropical climate and meteorological influence.

OBJECTIVES: To assess the relationship between hematocrit and risk of fatal and non-fatal stroke in conjunction with meteorological variations. DESIGN: Prospective study of a series of Africans living in Kinshasa, Congo, followed up for 5 years. SUBJECTS: A total of 1,032 unselected patients consecutively admitted to hospitals for acute stroke. Main outcome measures. Fatal and non-fatal ischemic or hemorrhagic strokes. The association of hematocrit with stroke morbidity and mortality and meteorological variables were evaluated by simple or multiple linear regression and logistic regression. RESULTS: Patients were aged 53.7 +/- 12.1 years. Hematocrit was mostly correlated with mean ambient air temperature (r = 0.124; p < 0.001) and atmospheric pressure at 6 a.m GMT (r = 0.157; p < 0.001). Patients with hematocrit > 40% presented the highest levels of systolic blood pressure, fibrinogen, body temperature, resting heart rate, duration of coma and incidence of all stroke types and ischemic stroke (p < 0.001). Hematocrit > 40% was associated with stroke mortality (Odds ratio, 6.2, 4.5-8.6; p < 0.001). The risk of stroke mortality was multiplied by 21, 18.3 and 4.2 in conditions of a mean ambient air temperature > 28 degrees C, atmospheric pressure 975-977 mm Hg and body temperature > 37 degrees C respectively. CONCLUSIONS: Our study suggests that higher hematocrit is associated with an increased risk of stroke morbidity and mortality, particularly ischemic stroke at noon. This risk is probably mediated by increased susceptibility of African older hypertensive subjects to meteorological variations.