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Güner A, Topel Ç, Cansever AT, Güner EG, Tüfekcioğlu O, Ertürk M, Güler GB. Where is the right ventricle? Accurate diagnosis with cardiovascular multimodality imaging. Echocardiography 2020; 37:456-461. [DOI: 10.1111/echo.14606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ahmet Güner
- Department of Cardiology Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey
| | - Çağdaş Topel
- Department of Radiology Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey
| | - Aysel Türkvatan Cansever
- Department of Radiology Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey
| | - Ezgi Gültekin Güner
- Department of Cardiology Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey
| | - Omaç Tüfekcioğlu
- Department of Cardiology University Health Sciences Ankara City Hospital Ankara Turkey
| | - Mehmet Ertürk
- Department of Cardiology Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey
| | - Gamze Babür Güler
- Department of Cardiology Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey
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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Glob Heart 2020; 15:15. [PMID: 32489788 PMCID: PMC7218780 DOI: 10.5334/gh.403] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
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de Carvalho FP, Azevedo CF. Comprehensive Assessment of Endomyocardial Fibrosis with Cardiac MRI: Morphology, Function, and Tissue Characterization. Radiographics 2020; 40:336-353. [PMID: 32004118 DOI: 10.1148/rg.2020190148] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endomyocardial fibrosis (EMF) affects approximately 12 million persons worldwide and is an important cause of restrictive cardiomyopathy in the developing world, with the highest prevalence reported in sub-Saharan Africa, South Asia, and South America. EMF is characterized by apical filling with fibrotic tissue of one or both ventricles, often associated with thrombus, calcification, and atrioventricular valve regurgitation, leading to typical symptoms of restrictive heart failure. Transthoracic echocardiography (TTE) is the first-line modality for assessment of EMF, basically owing to its widespread availability. However, in recent years cardiac MRI has emerged as a powerful tool for assessment of cardiac morphology and function, with higher accuracy than TTE, along with the unique advantage of being able to provide comprehensive noninvasive tissue characterization. Delayed enhancement (DE) imaging is the cornerstone of cardiac MRI tissue characterization and allows accurate identification of myocardial fibrosis, conveying valuable additional diagnostic and prognostic information. The typical DE pattern in EMF, described as the "double V" sign, consists of a three-layered pattern of normal myocardium, thickened enhanced endomyocardium, and overlying thrombus at the apex of the affected ventricle; it has excellent correlation with histopathologic findings and plays an important role in differentiating EMF from other cardiomyopathies. Conversely, fibrous tissue deposition quantified using DE imaging, when indexed to body surface area, has been shown to be a strong independent predictor of mortality. The aim of this review is to summarize state-of-the-art applications of cardiac MRI for diagnostic and prognostic assessment of patients with suspected or confirmed EMF. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Filipe Penna de Carvalho
- From Diagnósticos da America (DASA), Rio de Janeiro, Brazil (F.P.d.C., C.F.A.); Americas Serviços Médicos, Rio de Janeiro, Brazil (F.P.d.C.); and Division of Cardiology, Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Room 1E63, DUMC 3934, Durham, NC 27710 (C.F.A.)
| | - Clerio Francisco Azevedo
- From Diagnósticos da America (DASA), Rio de Janeiro, Brazil (F.P.d.C., C.F.A.); Americas Serviços Médicos, Rio de Janeiro, Brazil (F.P.d.C.); and Division of Cardiology, Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Room 1E63, DUMC 3934, Durham, NC 27710 (C.F.A.)
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Wagner G, Haumer M, Poelzl G, Wiedemann D, Kliegel A, Ullrich R, Gartlehner G, Zuckermann A, Müller L, Mayr H, Moertl D. A case report of a 40-year-old woman with endomyocardial fibrosis in a non-tropical area: from initial presentation to high urgent heart transplantation. BMC Cardiovasc Disord 2019; 19:302. [PMID: 31881943 PMCID: PMC6933894 DOI: 10.1186/s12872-019-1243-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 10/31/2019] [Indexed: 11/17/2022] Open
Abstract
Background Endomyocardial fibrosis (EMF) represents the most common cause of restrictive cardiomyopathy worldwide. Despite a high prevalence in tropical regions, it occasionally occurs in patients who have never visited these areas. While researches have proposed various possible triggers for EMF, etiology and pathogenesis remain largely unknown. Diagnosis is based on patient history, heart failure symptoms, and echocardiographic signs of restrictive ventricular filling, atrioventricular valve regurgitation and frequently apical thrombus. Following is a case report of an Austrian patient with EMF who eventually had to undergo a heart transplant. This case report strives to promote awareness for this in non-tropical areas uncommon but nevertheless detrimental disease. Case presentation A 40-year-old woman was presented at our emergency department with chest pain and fever up to 38.1° Celsius. Plasma troponin-T levels and inflammatory markers were slightly elevated, but the echocardiogram was without pathological findings. The patient was hospitalized on the suspicion of acute myocarditis and discharged soon after improvement. Eight months later, she was presented again with chest pain and symptoms of heart failure. The echocardiogram showed normal systolic left ventricular (LV) function with LV wall thickening and severe restrictive mitral regurgitation as well as aortic and tricuspid regurgitation. Coronary angiogram was normal but right heart catheterization showed pulmonary hypertension due to left heart disease. Further diagnostic workup with cardiac magnetic resonance imaging revealed subendocardial late enhancement and apical thrombus formation in the left ventricle compatible with the diagnosis of EMF. A comprehensive diagnostic workup showed no evidence of infection, systemic immunologic or hematological disease, in particular hypereosinophilic syndrome. After a multidisciplinary consideration of several therapeutic options, the patient was listed for heart transplantation. On the waiting list, she deteriorated rapidly due to progressive heart failure and finally underwent a heart transplantation. Histological examination confirmed the diagnosis of EMF. Six years after her heart transplantation, the patient was presented in an excellent clinical condition. Conclusions Even in non-tropical regions, the diagnosis of EMF should always be considered in restrictive cardiomyopathy. Knowledge of the distinct phenotype of EMF facilitates diagnosis, but comprehensive workup and therapeutic management remain challenging and require a multidisciplinary approach.
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Affiliation(s)
- Gernot Wagner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Dr. Karl Dorrek Strasse 30, 3500, Krems, Austria
| | - Markus Haumer
- Department of Internal Medicine 2, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Gerhard Poelzl
- Department of Internal Medicine III, Clinical Division of Cardiology & Angiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andreas Kliegel
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunantplatz 1, 3100, St. Poelten, Austria.,Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Propst-Fuehrer-Strasse 4, 3100, St. Poelten, Austria
| | - Robert Ullrich
- Clinical Institute of Pathology, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Danube University Krems, Dr. Karl Dorrek Strasse 30, 3500, Krems, Austria.,RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ludwig Müller
- Department of Cardiac Surgery, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Harald Mayr
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunantplatz 1, 3100, St. Poelten, Austria.,Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Propst-Fuehrer-Strasse 4, 3100, St. Poelten, Austria
| | - Deddo Moertl
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunantplatz 1, 3100, St. Poelten, Austria. .,Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Propst-Fuehrer-Strasse 4, 3100, St. Poelten, Austria.
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Negri F, Fabris E, Masè M, Vitrella G, Minà C, Turrisi M, Liotta R, Gentile G, Pilato M, Sinagra G, Clemenza F. Endomyocardial fibrosis of the right ventricle: A case report of successful surgery. J Card Surg 2019; 35:460-463. [PMID: 31778572 DOI: 10.1111/jocs.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The case we report, shows a successful treatment of right ventricle endomyocardial fibrosis. MATERIALS AND METHODS Surgical therapy by endocardial decortication seems to be beneficial for many patients with advanced disease who are in functional-therapeutic class III or IV. The operative mortality rate is high, but successful surgery has a clear benefit on symptoms and seems to favourably affect survival as well.
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Affiliation(s)
- Francesco Negri
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Enrico Fabris
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Marco Masè
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Postgraduate School in Cardiovascular Disease, University of Trieste, Italy
| | - Giancarlo Vitrella
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Chiara Minà
- IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Marco Turrisi
- IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Rosa Liotta
- IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Giovanni Gentile
- IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Michele Pilato
- IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Cardiomyopathy Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Postgraduate School in Cardiovascular Disease, University of Trieste, Italy
| | - Francesco Clemenza
- IRCCS-ISMETT Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
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Abstract
PURPOSE OF REVIEW This review aims at highlighting the need to better understand the pathogenesis and natural history of endomyocardial fibrosis when set against its changing endemicity and disease burden, improvements in diagnosis, and new options for clinical management. RECENT FINDINGS Progress in imaging diagnostic techniques and availability of new targets for drug and surgical treatment of heart failure are contributing to earlier diagnosis and may lead to improvement in patient survival. Endomyocardial fibrosis was first described in Uganda by Davies more than 70 years ago (1948). Despite its poor prognosis, the etiology of this neglected tropical restrictive cardiomyopathy still remains enigmatic nowadays. Our review reflects on the journey of scientific discovery and construction of the current guiding concepts on this mysterious and fascinating condition, bringing to light the contemporary knowledge acquired over these years. Here we describe novel tools for diagnosis, give an overview of the improvement in clinical management, and finally, suggest research themes that can help improve patient outcomes focusing (whenever possible) on novel players coming into action.
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Affiliation(s)
- Ana Olga Mocumbi
- Division of Non-Communicable Diseases, Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique. .,Instituto Nacional de Saúde, Marracuene, Mozambique.
| | | | - Paulo Correia-de-Sá
- Centro de Investigação Farmacológica e Inovação Medicamentosa, Porto, Portugal.,Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Magdi Yacoub
- Imperial College London, London, UK.,Aswan Heart Centre, Aswan, Egypt
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Abstract
Due to an increase in global mobility, international travel and migration, tropical diseases are more frequently observed in Germany. Some tropical diseases can also affect the heart, cause cardiac symptoms and may require inclusion in differential diagnostic work-ups. The most important tropical diseases with cardiac involvement are Chagas' disease and echinococcosis. Other tropical diseases such as schistosomiasis, tropical endomyocardial fibrosis or sleeping sickness can affect the heart. The suspicion of a tropical disease as the cause of cardiac symptoms is based on the patient history of travel, migration and social setting. This CME article describes the diagnostic and therapeutic approach to tropical parasitic diseases with cardiac involvement.
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García-Granja PE, Pombo-Otero J, Barriales-Villa R. Isolated right ventricle endomyocardial fibrosis. An increasingly frequent disease in Spain. Med Clin (Barc) 2019; 153:219-220. [PMID: 30146360 DOI: 10.1016/j.medcli.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Pablo Elpidio García-Granja
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Jorge Pombo-Otero
- Servicio de Anatomía Patológica, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, España
| | - Roberto Barriales-Villa
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, España
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Marangou J, Beaton A, Aliku TO, Nunes MCP, Kangaharan N, Reményi B. Echocardiography in Indigenous Populations and Resource Poor Settings. Heart Lung Circ 2019; 28:1427-1435. [DOI: 10.1016/j.hlc.2019.05.176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/25/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023]
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Chaudhry M, Ashwath ML. Isolated Right-Sided Endomyocardial Fibroelastosis Resulting in Sudden Cardiac Death. JACC Case Rep 2019; 1:184-187. [PMID: 34316781 PMCID: PMC8301532 DOI: 10.1016/j.jaccas.2019.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022]
Abstract
Restrictive cardiomyopathy, atrial fibrillation, and cardiac thrombi have been reported with endomyocardial fibroelastosis. This case report examines a unique case of focal endomyocardial fibroelastosis localized to the right ventricle that resulted in sudden cardiac death in an otherwise healthy 21-year-old adult and discusses cardiac magnetic resonance imaging findings in this disease. (Level of Difficulty: Beginner.)
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Namuyonga J, Lwabi PS, Omagino J, Yacoub M, Mocumbi AO. Feasibility of south-south collaboration in Africa: the Uganda-Mozambique perspective. Cardiovasc J Afr 2019; 29:262-263. [PMID: 30204223 PMCID: PMC6421556 DOI: 10.5830/cvja-2018-030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | - Magdi Yacoub
- Imperial College of London, UK; Aswan Heart Centre, Cairo, Egypt
| | - Ana Olga Mocumbi
- Mozambique Institute of Health Education and Research (MIHER); Instituto Nacional de Saúde; Universidade Eduardo Mondlane, Maputo, Mozambique
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Seferović PM, Polovina M, Bauersachs J, Arad M, Gal TB, Lund LH, Felix SB, Arbustini E, Caforio AL, Farmakis D, Filippatos GS, Gialafos E, Kanjuh V, Krljanac G, Limongelli G, Linhart A, Lyon AR, Maksimović R, Miličić D, Milinković I, Noutsias M, Oto A, Oto Ö, Pavlović SU, Piepoli MF, Ristić AD, Rosano GM, Seggewiss H, Ašanin M, Seferović JP, Ruschitzka F, Čelutkiene J, Jaarsma T, Mueller C, Moura B, Hill L, Volterrani M, Lopatin Y, Metra M, Backs J, Mullens W, Chioncel O, Boer RA, Anker S, Rapezzi C, Coats AJ, Tschöpe C. Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:553-576. [DOI: 10.1002/ejhf.1461] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Petar M. Seferović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Marija Polovina
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Johann Bauersachs
- Department of Cardiology and AngiologyMedical School Hannover Hannover Germany
| | - Michael Arad
- Cardiomyopathy Clinic and Heart Failure Institute, Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tuvia Ben Gal
- Department of CardiologyRabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Lars H. Lund
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo Pavia Italy
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiological, Thoracic and Vascular SciencesUniversity of Padua Padua Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Gerasimos S. Filippatos
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Elias Gialafos
- Second Department of CardiologyHeart Failure and Preventive Cardiology Section, Henry Dunant Hospital Athens Greece
| | | | - Gordana Krljanac
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe Limongelli
- Department of Cardiothoracic Sciences, Università della Campania ‘Luigi VanvitellI’Monaldi Hospital, AORN Colli, Centro di Ricerca Cardiovascolare, Ospedale Monaldi, AORN Colli, Naples, Italy, and UCL Institute of Cardiovascular Science London UK
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular MedicineGeneral University Hospital, Charles University in Prague Prague Czech Republic
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London UK
| | - Ružica Maksimović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia Belgrade Serbia
| | - Davor Miličić
- Department of Cardiovascular DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Michel Noutsias
- Mid‐German Heart Center, Department of Internal Medicine III, Division of CardiologyAngiology and Intensive Medical Care, University Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Ali Oto
- Department of CardiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Öztekin Oto
- Department of Cardiovascular SurgeryDokuz Eylül University Faculty of Medicine İzmir Turkey
| | - Siniša U. Pavlović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Pacemaker Center, Clinical Center of Serbia Belgrade Serbia
| | | | - Arsen D. Ristić
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe M.C. Rosano
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele Pisana Rome Italy
| | - Hubert Seggewiss
- Medizinische Klinik, Kardiologie & Internistische Intensivmedizin, Klinikum Würzburg‐Mitte Würzburg Germany
| | - Milika Ašanin
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Jelena P. Seferović
- Cardiovascular DivisionBrigham and Women's Hospital, Harvard Medical School Boston MA USA
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center Serbia and Faculty of MedicineUniversity of Belgrade Belgrade Serbia
| | - Frank Ruschitzka
- Department of CardiologyUniversity Heart Center Zürich Switzerland
| | - Jelena Čelutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius University Vilnius Lithuania
- State Research Institute Centre for Innovative Medicine Vilnius Lithuania
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health ScienceLinköping University Linköping Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology DepartmentCentro Hospitalar São João Porto Portugal
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Belfast UK
| | | | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd Volgograd Russia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Johannes Backs
- Department of Molecular Cardiology and EpigeneticsUniversity of Heidelberg Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim Heidelberg Germany
| | - Wilfried Mullens
- BIOMED ‐ Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt University Diepenbeek Belgium
- Department of CardiologyZiekenhuis Oost‐Limburg Genk Belgium
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucharest Romania
- Emergency Institute for Cardiovascular Diseases, ‘Prof. C. C. Iliescu’ Bucharest Romania
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Stefan Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT) Berlin Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Charité Berlin Germany
| | - Claudio Rapezzi
- Cardiology, Department of ExperimentalDiagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna Bologna Italy
| | - Andrew J.S. Coats
- Monash University, Australia, and University of Warwick Coventry UK
- Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy, and St George's University of London London UK
| | - Carsten Tschöpe
- Berlin‐Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) Berlin, Department of CardiologyCampus Virchow Klinikum, Charite ‐ Universitaetsmedizin Berlin Berlin Germany
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Landge K, Ojha V, Ganga K, Kaushik P, Sharma P, Jagia P, Arava S, Chetan P, Gulati G, Ray R, Seth S. Endomyocardial fibrosis regression. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2019. [DOI: 10.4103/jpcs.jpcs_7_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raphael DM, Roos L, Myovela V, Mchomvu E, Namamba J, Kilindimo S, Gingo W, Hatz C, Paris DH, Weisser M, Kobza R, Rohacek M. Heart diseases and echocardiography in rural Tanzania: Occurrence, characteristics, and etiologies of underappreciated cardiac pathologies. PLoS One 2018; 13:e0208931. [PMID: 30586432 PMCID: PMC6306243 DOI: 10.1371/journal.pone.0208931] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Little is known about heart diseases and their treatment in rural sub-Saharan Africa. This study aimed to describe the occurrence, characteristics, and etiologies of heart diseases, and the medication taken before and prescribed after echocardiography in a rural referral Hospital in Tanzania. METHODS This prospective descriptive cohort study included all adults and children referred for echocardiography. Clinical and echocardiographic data were collated for analysis. RESULTS From December 2015 to October 2017, a total of 1'243 echocardiograms were performed. A total of 815 adults and 59 children ≤15 years had abnormal echocardiographic findings; in adults 537/815 (66%) had hypertension, with 230/537(43%) on antihypertensive drugs, and 506/815 (62%) were not on regular cardiac medication; 346/815 (42%) had severe eccentric or concentric left ventricular hypertrophy, and 182/815 (22%) had severe systolic heart failure. Only 44% demonstrated normal left ventricular systolic function. The most frequent heart diseases were hypertensive heart disease (41%), valvular heart disease (18%), coronary heart disease (18%), peripartum cardiomyopathy (7%), and other non-hypertensive dilated cardiomyopathies (6%) in adults, and congenital heart disease (34%) in children. Following echocardiography, 802/815 (98%) adults and 40/59 (68%) children had an indication for cardiac medication, 70/815 (9%) and 2/59 (3%) for oral anticoagulation, and 35/815 (4%) and 23/59 (39%) for cardiac surgery, respectively. CONCLUSION Hypertension is the leading etiology of heart diseases in rural Tanzania. Most patients present with advanced stages of heart disease, and the majority are not treated before echocardiography. There is an urgent need for increased awareness, expertise and infrastructure to detect and treat hypertension and heart failure in rural Africa.
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Affiliation(s)
| | | | - Victor Myovela
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Elisante Mchomvu
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Jabir Namamba
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Said Kilindimo
- Emergency Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Winfrid Gingo
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
| | - Christoph Hatz
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Daniel H. Paris
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Maja Weisser
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Division of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Richard Kobza
- Division of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Martin Rohacek
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- * E-mail:
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Endomyocardial fibrosis and myocardial infarction leading to diastolic and systolic dysfunction requiring transplantation. Cardiovasc Pathol 2018; 38:21-24. [PMID: 30419478 DOI: 10.1016/j.carpath.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/20/2022] Open
Abstract
Endomyocardial fibrosis (EMF) is an endemic disease in tropical areas, characterized by restrictive physiology due to endocardial fibrous thickening of the ventricular chambers. We report the case of a 25-year-old man of African origin who presented with end-stage heart failure due to both diastolic and systolic dysfunction and extensive endocavitary thrombosis as proven by echocardiography and cardiac magnetic resonance. EMF diagnosis was confirmed by endomyocardial biopsy and the patient had eventually cardiac transplantation. The explanted heart revealed, besides features consistent with EMF, transmural post- myocardial infarction scarring, in the absence of significant coronary artery disease, most probably thromboembolic in origin.
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Bhasin D, Gupta SK, Arava S, Kothari SS. Eosinophilia to endomyocardial fibrosis: Documentation of a case. Ann Pediatr Cardiol 2018; 11:207-210. [PMID: 29922022 PMCID: PMC5963239 DOI: 10.4103/apc.apc_143_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endomyocardial fibrosis (EMF) is an important cause of restrictive cardiomyopathy in tropical countries. The etiopathogenesis of EMF remains obscure. The role of eosinophilia in the etiopathogenesis of EMF has been debated extensively, but remains unproven. Accordingly, we present a case wherein a patient with documented eosinophilia and heart failure at the age of three-and-a-half years presented with endomyocardial fibrosis at the age of nine years. Such documentation is important to highlight the central role of eosinophils in the pathogenesis of EMF.
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Affiliation(s)
- Dinkar Bhasin
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Conte L, Fejzo M, Rossi A, Zuin M, Roncon L. Endomyocardial Fibrosis: A Rare Case of Diastolic Heart Failure in a European Caucasian Elderly Woman. Heart Lung Circ 2018; 27:e31-e33. [DOI: 10.1016/j.hlc.2017.06.732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
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Curry C, Zuhlke L, Mocumbi A, Kennedy N. Acquired heart disease in low-income and middle-income countries. Arch Dis Child 2018; 103:73-77. [PMID: 28838969 DOI: 10.1136/archdischild-2016-312521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/05/2017] [Accepted: 08/13/2017] [Indexed: 11/04/2022]
Abstract
The burden of illness associated with acquired cardiac disease in children in low-income and middle-income countries (LMIC) is significant and may be equivalent to that of congenital heart disease. Rheumatic heart disease, endomyocardial fibrosis, cardiomyopathy (including HIV cardiomyopathy) and tuberculosis are the most important causes. All are associated with poverty with the neediest children having the least access to care. The associated mortality and morbidity is high. There is an urgent need to improve cardiac care in LMIC, particularly in sub-Saharan Africa and parts of Southeast Asia where the burden is highest.
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Affiliation(s)
- Chris Curry
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liesl Zuhlke
- Cardiology, University of Cape Town, Cape Town, South Africa
| | - Ana Mocumbi
- Cardiology, University Eduardo Mondlane, Maputo, Mozambique
| | - Neil Kennedy
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
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Affiliation(s)
- Paulo Sampaio Gutierrez
- University of São Paulo, Hospital das Clínicas da Faculdade de Medicina, Heart Institute (InCor), Laboratory of Pathology. São Paulo, SP, Brazil
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Abstract
The nonischemic cardiomyopathies are a diverse group of cardiac disorders that frequently cause heart failure and death and are now recognized with increasing frequency. There has been substantial progress in the clinical recognition and understanding of the natural history of these conditions. Well-established and new techniques of cardiac imaging are also helpful in this regard. Basic scientists are elucidating the pathogenesis and pathobiology of individual cardiomyopathies. In this compendium, some of the most important advances in this field are reviewed. Scientific opportunities to enhance further collaborative research to accelerate progress are identified.
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Affiliation(s)
- Eugene Braunwald
- From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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Nunes MCP, Guimarães Júnior MH, Diamantino AC, Gelape CL, Ferrari TCA. Cardiac manifestations of parasitic diseases. Heart 2017; 103:651-658. [PMID: 28285268 DOI: 10.1136/heartjnl-2016-309870] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 02/06/2023] Open
Abstract
The heart may be affected directly or indirectly by a variety of protozoa and helminths. This involvement may manifest in different ways, but the syndromes resulting from impairment of the myocardium and pericardium are the most frequent. The myocardium may be invaded by parasites that trigger local inflammatory response with subsequent myocarditis or cardiomyopathy, as occurs in Chagas disease, African trypanosomiasis, toxoplasmosis, trichinellosis and infection with free-living amoebae. In amoebiasis and echinococcosis, the pericardium is the structure most frequently involved with consequent pericardial effusion, acute pericarditis, cardiac tamponade or constrictive pericarditis. Chronic hypereosinophilia due to helminth infections, especially filarial infections, has been associated with the development of tropical endomyocardial fibrosis, a severe form of restrictive cardiomyopathy. Schistosomiasis-associated lung vasculature involvement may cause pulmonary hypertension (PH) and cor pulmonale Tropical pulmonary eosinophilia, which is characterised by progressive interstitial fibrosis and restrictive lung disease, may lead to PH and its consequences may occur in the course of filarial infections. Intracardiac rupture of an Echinococcus cyst can cause membrane or secondary cysts embolisation to the lungs or organs supplied by the systemic circulation. Although unusual causes of cardiac disease outside the endemic areas, heart involvement by parasites should be considered in the differential diagnosis especially of myocardial and/or pericardial diseases of unknown aetiology in both immunocompetent and immunocompromised individuals. In this review, we updated and summarised the current knowledge on the major heart diseases caused by protozoan and metazoan parasites, which either involve the heart directly or otherwise influence the heart adversely.
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Affiliation(s)
- Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Adriana Costa Diamantino
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Claudio Leo Gelape
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Carranza-Rodríguez C, San-Román-Sánchez D, Marrero-Santiago H, Hernández-Cabrera M, Gil-Guillén C, Pisos-Álamo E, Jaén-Sánchez N, Pérez-Arellano JL. Endomyocardial involvement in asymptomatic sub-Saharan immigrants with helminth-related eosinophilia. PLoS Negl Trop Dis 2017; 11:e0005403. [PMID: 28234952 PMCID: PMC5342272 DOI: 10.1371/journal.pntd.0005403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/08/2017] [Accepted: 02/12/2017] [Indexed: 02/06/2023] Open
Abstract
Background Among immigrants of sub-Saharan origin, parasitic infection is the leading cause of eosinophilia, which is generally interpreted as a defense mechanism. A side effect of the inflammatory mediators released by eosinophils is damage to host organs, especially the heart. The main objectives of this study were to i) assess cardiac involvement in asymptomatic sub-Saharan immigrants with eosinophilia, ii) relate the presence of lesions with the degree of eosinophilia, and iii) study the relationship between cardiac involvement and the type of causative parasite. Methodology/Principle findings In total, the study included 50 black immigrants (37 patients and 13 controls) from sub-Saharan Africa. In all subjects, heart structure and function were evaluated in a blinded manner using Sonos 5500 echocardiographic equipment. The findings were classified and described according to established criteria. The diagnostic criteria for helminthosis were those reported in the literature. Serum eosinophil-derived neurotoxin levels were measured using enzyme-linked immunosorbent assay. A significant association was found between the presence of eosinophilia and structural alterations (mitral valve thickening). However, the lack of an association between the degree of eosinophilia and heart valve disease and the absence of valve involvement in some patients with eosinophilia suggest the role of other factors in the appearance of endocardial lesions. There was also no association between the type of helminth and valve involvement. Conclusions We, therefore, suggest that transthoracic echocardiography be performed in every sub-Saharan individual with eosinophilia in order to rule out early heart valve lesions. Endomyocardial fibrosis is characterized by fibrosis of the apical endocardium of the right ventricle, left ventricle, or both. Epidemiological studies of endomyocardial fibrosis indicate a predominance in tropical regions, with young people and men being affected predominantly. Little is known about the natural history and pathogenic factors of this condition. One of the most important factors is the presence of eosinophilia, which is mainly related to helminth infections. The aim of the study was to evaluate cardiac involvement in patients with absolute eosinophilia. We performed an echocardiographic study in asymptomatic sub-Saharan immigrants with eosinophilia and compared them with a group of control patients from the same region and of the same age. Our results suggest that eosinophilia associated with helminth infection (regardless of the causative microorganism) contributes to the asymptomatic phases of endomyocardial involvement. Treatment of these infections is simple, effective, and economical. Therefore, we suggest that all immigrant patients with eosinophilia undergo etiologic study and causal treatment as well as transthoracic echocardiography in order to rule out early damage.
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Affiliation(s)
- Cristina Carranza-Rodríguez
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- * E-mail:
| | - Daniel San-Román-Sánchez
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Cardiology Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Héctor Marrero-Santiago
- Cardiology Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Michele Hernández-Cabrera
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Carlos Gil-Guillén
- Cardiology Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Elena Pisos-Álamo
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Nieves Jaén-Sánchez
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - José-Luis Pérez-Arellano
- Department of Medical and Surgery Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Infectious Diseases and Tropical Medicine Division, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
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Ammirati E, Sirico D, Brevetti L, Scudiero L, Artioli D, Pedrotti P, Frigerio M. The key clues to reach the diagnosis of Loeffler endomyocardial fibrosis associated with eosinophilic granulomatosis with polyangiitis. J Cardiovasc Med (Hagerstown) 2017; 18:831-832. [PMID: 28072629 DOI: 10.2459/jcm.0000000000000496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Enrico Ammirati
- a'De Gasperis' Cardio Center bRadiology Department Niguarda Hospital, Milan, Italy
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Grimaldi A, Mocumbi AO, Narayanan K, Marijon E. Response by Grimaldi et al to Letter Regarding Article, "Tropical Endomyocardial Fibrosis: Natural History, Challenges, and Perspectives". Circulation 2016; 134:e463. [PMID: 27881500 DOI: 10.1161/circulationaha.116.024943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antonio Grimaldi
- From the Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy (A.G.); St. Raphael of St. Francis-Nsambya Hospital, Kampala, Uganda (A.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A,-O.M.); Paris Cardiovascular Research Center, INSERM U970, France (K.N., E.M.); Maxcure Hospitals, Hyderabad, India (K.N.) Paris Descartes University, France (E.M.); and European Georges Pompidou Hospital, Cardiology Department, Paris, France (E.M.)
| | - Ana-Olga Mocumbi
- From the Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy (A.G.); St. Raphael of St. Francis-Nsambya Hospital, Kampala, Uganda (A.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A,-O.M.); Paris Cardiovascular Research Center, INSERM U970, France (K.N., E.M.); Maxcure Hospitals, Hyderabad, India (K.N.) Paris Descartes University, France (E.M.); and European Georges Pompidou Hospital, Cardiology Department, Paris, France (E.M.)
| | - Kumar Narayanan
- From the Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy (A.G.); St. Raphael of St. Francis-Nsambya Hospital, Kampala, Uganda (A.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A,-O.M.); Paris Cardiovascular Research Center, INSERM U970, France (K.N., E.M.); Maxcure Hospitals, Hyderabad, India (K.N.) Paris Descartes University, France (E.M.); and European Georges Pompidou Hospital, Cardiology Department, Paris, France (E.M.)
| | - Eloi Marijon
- From the Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy (A.G.); St. Raphael of St. Francis-Nsambya Hospital, Kampala, Uganda (A.G.); Instituto Nacional de Saúde, Maputo, Mozambique (A,-O.M.); Paris Cardiovascular Research Center, INSERM U970, France (K.N., E.M.); Maxcure Hospitals, Hyderabad, India (K.N.) Paris Descartes University, France (E.M.); and European Georges Pompidou Hospital, Cardiology Department, Paris, France (E.M.)
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Yangni-Angate KH, Meneas C, Diby F, Diomande M, Adoubi A, Tanauh Y. Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire. Cardiovasc Diagn Ther 2016; 6:S44-S63. [PMID: 27904843 DOI: 10.21037/cdt.2016.10.06] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.
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Affiliation(s)
- Koffi Herve Yangni-Angate
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Christophe Meneas
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Florent Diby
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Manga Diomande
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire
| | - Anicet Adoubi
- Department of Cardiovascular and Thoracic Surgery, Bouake Teaching Hospital, Bouake, Côte d'Ivoire;; Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
| | - Yves Tanauh
- Department of Thoracic Surgery, Institute of Cardiology of Abidjan, Abidjan, Côte d'Ivoire
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