المؤلفون: Balieva I; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Groningen, Groningen, the Netherlands. Email: irinabalieva@gmail.com., Dzudie A; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Internal Medicine, Douala General Hospital, Douala, Cameroon; NIH Millennium Fogarty Chronic Disease Leadership Programme; Soweto Cardiovascular Research Heart Unit (SOCRU), Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa., Thienemann F; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Clinical Infectious Diseases Research Initiative, IDM, University of Cape Town; Integerafrica Research and Development, Cape Town; Wellcome Centre Infectious Diseases Research in Africa, Institue of Infectious Diseases and Molecular Medicine, Cape Town; and Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa., Mocumbi AO; Instituto Nacional de Saúde; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Karaye K; Department of Medicine, Bayero University, Kano, Nigeria., Sani MU; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Medicine, Bayero University, Kano, Nigeria., Ogah OS; Department of Medicine, University College Hospital, Ibadan; Ministry of Health, Umuahia, Nigeria., Voors AA; University of Groningen, Groningen, the Netherlands., Kengne AP; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Non-Communicable Diseases Unit, South African Medical Research Council, Cape Town, South Africa., Sliwa K; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Soweto Cardiovascular Research Heart Unit (SOCRU),Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.

المصدر: Cardiovascular journal of Africa [Cardiovasc J Afr] 2017 Nov/Dec 23; Vol. 28 (6), pp. 370-376. Date of Electronic Publication: 2017 Oct 11.

نوع المنشور: Journal Article; Multicenter Study

بيانات الدورية: Publisher: Clinics Cardive Pub Country of Publication: South Africa NLM ID: 101313864 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1680-0745 (Electronic) Linking ISSN: 10159657 NLM ISO Abbreviation: Cardiovasc J Afr Subsets: MEDLINE

مواضيع طبية MeSH: Electrocardiography* , Heart Rate*, Arrhythmias, Cardiac/*diagnosis , Arrhythmias, Cardiac/*epidemiology , Heart Conduction System/*physiopathology , Hypertension, Pulmonary/*diagnosis , Hypertension, Pulmonary/*epidemiology, Action Potentials ; Adult ; Africa/epidemiology ; Arrhythmias, Cardiac/physiopathology ; Arterial Pressure ; Biomechanical Phenomena ; Case-Control Studies ; Female ; Humans ; Hypertension, Pulmonary/physiopathology ; Male ; Middle Aged ; Myocardial Contraction ; Predictive Value of Tests ; Prevalence ; Pulmonary Artery/physiopathology ; Registries ; Ventricular Function, Right

مستخلص: Background: Pulmonary hypertension (PH) is prevalent in Africa and is still often diagnosed only at an advanced stage, therefore it is associated with poor quality of life and survival rates. In resource-limited settings, we assessed the diagnostic utility of standard 12-lead electrocardiograms (ECG) to detect abnormalities indicating PH.
Methods: Sixty-five patients diagnosed with PH were compared with 285 heart disease-free subjects. The prevalence and diagnostic performance of ECG features indicative of PH and right heart strain were calculated.
Results: Compared to the control group, all abnormalities were more frequent in the PH cohort where no patient had a completely normal ECG. The most prevalent (cases vs control) ECG abnormalities were: pathological Q wave in at least two contiguous peripheral leads (47.7 vs 6.7%), left ventricular hypertrophy (38.5 vs 9.8%) and p-pulmonale (36.9 vs 20.7%) (all p < 0.05). The sensitivity of ECG criteria for right heart strain ranged between 6.2 and 47.7%, while specificity ranged between 79.3 and 100%. Negative predictive value ranged between 81.5 and 88.9% and positive predictive value between 25 and 100%. Positive predictive value was lowest (25%) for right bundle branch block and QRS rightaxis deviation (≥ 100°), and highest (100%) for QRS axis ≥ +100° combined with R/S ratio in V1 ≥ 1 or R in V1 > 7 mm.
Conclusion: When present, signs of PH on ECG strongly indicated disease, but a normal ECG cannot rule out disease. ECG patterns focusing on the R and S amplitude in V1 and right-axis deviation had good specificity and negative predictive values for PH, and warrant further investigation with echocardiography.

المؤلفون: Thienemann F; Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa., Dzudie A; Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon., Mocumbi AO; Instituto Nacional de Saúde, and Universidade Eduardo Mondlane, Maputo, Mozambique., Blauwet L; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA., Sani MU; Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, PMB 3452 Kano, Nigeria., Karaye KM; Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria., Ogah OS; Division of Cardiology, Department of Medicine, University College Hospital Ibadan, Oyo State, Nigeria., Mbanze I; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Mbakwem A; Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria., Udo P; Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria., Tibazarwa K; Department of Cardiovascular Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania; Hatter Institute for Cardiovascular Research in Africa and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa., Damasceno A; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Keates AK; Mary MacKillop Institute for Health Research and NHMRC Centre for Research Excellence (CRE) to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia., Stewart S; Hatter Institute for Cardiovascular Research in Africa and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Mary MacKillop Institute for Health Research and NHMRC Centre for Research Excellence (CRE) to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia; Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa., Sliwa K; Hatter Institute for Cardiovascular Research in Africa and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: Karen.Sliwa-Hahnle@uct.ac.za.

المصدر: International journal of cardiology [Int J Cardiol] 2016 Oct 15; Vol. 221, pp. 205-11. Date of Electronic Publication: 2016 Jun 29.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8200291 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1874-1754 (Electronic) Linking ISSN: 01675273 NLM ISO Abbreviation: Int J Cardiol Subsets: MEDLINE

مواضيع طبية MeSH: Heart Defects, Congenital*/complications , Heart Defects, Congenital*/epidemiology , Hypertension, Pulmonary*/diagnosis , Hypertension, Pulmonary*/etiology , Hypertension, Pulmonary*/mortality , Hypertension, Pulmonary*/therapy, Adolescent ; Africa/epidemiology ; Child ; Familial Primary Pulmonary Hypertension/diagnosis ; Familial Primary Pulmonary Hypertension/epidemiology ; Humans ; Infant ; Kaplan-Meier Estimate ; Middle Aged ; Prognosis ; Prospective Studies ; Ventricular Function, Right/physiology

مستخلص: Background: Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce.
Methods: A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied.
Results: There were 209 adults (median age 48years [IQR 35, 64]) and 11 children (age range 1 to 17years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252m (IQR 120, 350) and median right ventricular systolic pressure 58mmHg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment (p=0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease.
Conclusions: These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes.
Trial Registration: ClinicalTrials.gov (NCT02265887).
(Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

المؤلفون: Thienemann F; Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa.; Integerafrica Research & Development, Cape Town, South Africa.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Dzudie A; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Douala General Hospital, Douala, Cameroon., Mocumbi AO; Instituto Nacional de Saúde, Maputo, Mozambique., Blauwet L; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA., Sani MU; Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Karaye KM; Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria., Ogah OS; Department of Medicine, University College Hospital Ibadan, Ibadan, Nigeria.; Ministry of Health, Umuahia, Nigeria., Mbanze I; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Mbakwem A; Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria., Udo P; Department of Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria., Tibazarwa K; Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa., Ibrahim AS; Alzaiem Alazhary University, Alshaab Teaching Hospital, Khartoum, Sudan., Burton R; Khayelitsha District Hospital, Khayelitsha, South Africa., Damasceno A; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Stewart S; Department of Preventative Cardiology, Baker Heart Research Institute, Melbourne, Australia., Sliwa K; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

المصدر: BMJ open [BMJ Open] 2014 Oct 14; Vol. 4 (10), pp. e005950. Date of Electronic Publication: 2014 Oct 14.

نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't

بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE

مواضيع طبية MeSH: Cohort Studies* , Hypertension, Pulmonary* , Registries* , Research Design*, Africa ; Humans ; Multicenter Studies as Topic ; Ventricular Dysfunction, Right

مستخلص: Introduction: Pulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy due to a narrowing of the pulmonary vasculature and consecutive right heart failure. Little is known about PH in Africa, but limited reports suggest that PH is more prevalent in Africa compared with developed countries due to the high prevalence of risk factors in the region.
Methods and Analysis: A multinational multicentre registry-type cohort study was established and tailored to resource-constraint settings to describe disease presentation, disease severity and aetiologies of PH, comorbidities, diagnostic and therapeutic management, and the natural course of PH in Africa. PH will be diagnosed by specialist cardiologists using echocardiography (right ventricular systolic pressure >35 mm Hg, absence of pulmonary stenosis and acute right heart failure), usually accompanied by shortness of breath, fatigue, peripheral oedema and other cardiovascular symptoms, ECG and chest X-ray changes in keeping with PH as per guidelines (European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines). Additional investigations such as a CT scan, a ventilation/perfusion scan or right heart catheterisation will be performed at the discretion of the treating physician. Functional tests include a 6 min walk test and the Karnofsky Performance Score. The WHO classification system for PH will be applied to describe the different aetiologies of PH. Several substudies have been implemented within the registry to investigate specific types of PH and their outcome at up to 24 months. Data will be analysed by an independent institution following a data analyse plan.
Ethics and Dissemination: All local ethics committees of the participating centres approved the protocol. The data will be disseminated through peer-reviewed journals at national and international conferences and public events at local care providers.
(Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

المؤلفون: Enakpene EO, Adebiyi AA, Ogah OS, Olaniyi JA, Aje A, Adeoye MA, Falase AO

المصدر: Acta cardiologica [Acta Cardiol] 2014 Oct; Vol. 69 (5), pp. 505-11.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Taylor & Francis Country of Publication: England NLM ID: 0370570 Publication Model: Print Cited Medium: Print ISSN: 0001-5385 (Print) Linking ISSN: 00015385 NLM ISO Abbreviation: Acta Cardiol Subsets: MEDLINE

مواضيع طبية MeSH: Echocardiography* , Pulmonary Wedge Pressure*, Anemia, Sickle Cell/*diagnostic imaging , Hypertension, Pulmonary/*diagnostic imaging, Anemia, Sickle Cell/epidemiology ; Case-Control Studies ; Cross-Sectional Studies ; Female ; Humans ; Hypertension, Pulmonary/epidemiology ; Male ; Nigeria/epidemiology ; Risk Factors ; Young Adult

مستخلص: Introduction: Pulmonary hypertension is emerging as one of the causes of morbidity and mortality in adults with sickle cell disease. The prevalence of pulmonary hypertension in Nigerian adults with sickle cell anaemia is unknown. We decided to estimate the pulmonary artery systolic and diastolic pressures in subjects with sickle cell anaemia seen at the University College Hospital, Ibadan, Nigeria, and to determine the frequency of pulmonary hypertension among them.
Methods: Ninety patients (38 males and 52 females) with sickle cell anaemia in steady state and comparable age- and sex-matched normal controls had a clinical evaluation and echocardiographic examination.
Results: The mean age of the subjects with sickle cell anaemia was 24.0 (9.00) years while the mean age for the control group was 24.0 (7.00) years. The frequency of pulmonary hypertension as assessed by a tricuspid regurgitant jet velocity of > 2.5 m/s in this study was 12.2%. Larger left ventricular dimensions and volumes, higher stroke volume and increased left ventricular mass indexed by body surface area were found to be associated with pulmonary hypertension. A multivariate analysis of the potential predictors of pulmonary hypertension in this study showed that male sex and lower packed cell volume (PCV) were independent predictors of pulmonary hypertension in patients with sickle cell anaemia.
Conclusion: We conclude that pulmonary artery systolic and diastolic pressures are higher in subjects with sickle cell disease than normal controls. Male sex and low PCV are independent determinants of pulmonary arterial pressure in subjects with sickle cell anaemia in Nigeria.