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Ogah O, Adebiyi A, Aje A, Adeoye A, Oladapo O, Adeyanju T, Orimolade O, Eze C, Babatunde A, Okeke M. GENDER DIFFERENCES IN THE CLINICAL PROFILE AND SOCIODEMOGRAPHIC CHARACTERISTICS OF DILATED CARDIOMYOPATHY IN IBADAN, NIGERIA. Ann Ib Postgrad Med 2022; 20:6-13. [PMID: 37006654 PMCID: PMC10061665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Background Cardiomyopathies contribute about 18.2-40.2% (average- 21.4%) to the global burden of heart failure of which dilated cardiomyopathy (DCM) is a major cause. DCM is the second commonest cause of heart failure in Ibadan. The gender differences in the clinical profile has not been described in our setting. Objective In this study, we set out to describe the gender differences in the pattern and presentation of DCM at the University College Hospital, Ibadan, Nigeria. Methods This was an analysis of a prospectively collected data over a period of 5 years (August 1, 2016 to July 31, 2021). Results A total of 117 subjects, 88 males (75.3%) and 29 females (24.8%) aged 50.30 ± 14.7 years (range, 17 to 86 years). Males had significantly achieved a higher educational level than females (p = 0.004). Males were more likely to be employed and had more monthly income compared to females. Males were significantly more likely to use alcohol and smoke cigarette (p = 0.0001 and 0.001 respectively). Females were more likely to be in NYHA class III/IV. There was no statistically significant difference in the relationship between any medication and gender of participants (p > 0.05). Conclusions DCM is a disease of young and middle-aged adults in our population. The commonest age group was 20-39 years and there was male preponderance. There were some gender differences in the clinical profile of the disease in our environment.
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Affiliation(s)
- O.S. Ogah
- Department of Medicine, University of Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan
| | - A. Adebiyi
- Department of Medicine, University of Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan
| | - A. Aje
- Department of Medicine, University College Hospital, Ibadan
| | - A.M. Adeoye
- Department of Medicine, University of Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan
| | - O.O. Oladapo
- Department of Medicine, University of Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan
| | - T.A. Adeyanju
- Department of Medicine, University College Hospital, Ibadan
| | - O.A. Orimolade
- Department of Medicine, University College Hospital, Ibadan
| | - C.D. Eze
- Department of Medicine, University College Hospital, Ibadan
| | - A.O. Babatunde
- Clinical Student, College of Medicine, University of Ibadan, Ibadan
| | - M.F. Okeke
- Clinical Student, College of Medicine, University of Ibadan, Ibadan
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Gtif I, Bouzid F, Charfeddine S, Abid L, Kharrat N. Heart failure disease: An African perspective. Arch Cardiovasc Dis 2021; 114:680-690. [PMID: 34563468 DOI: 10.1016/j.acvd.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.
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Affiliation(s)
- Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia.
| | - Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
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Adeoye AM, Ovbiagele B, Akinyemi JO, Ogah OS, Akinyemi R, Gebregziabher M, Wahab K, Fakunle AG, Akintunde A, Adebayo O, Aje A, Tiwari HK, Arnett D, Agyekum F, Appiah LT, Amusa G, Olunuga TO, Onoja A, Sarfo FS, Akpalu A, Jenkins C, Lackland D, Owolabi L, Komolafe M, Faniyan MM, Arulogun O, Obiako R, Owolabi M. Echocardiographic Abnormalities and Determinants of 1-Month Outcome of Stroke Among West Africans in the SIREN Study. J Am Heart Assoc 2019; 8:e010814. [PMID: 31142178 PMCID: PMC6585359 DOI: 10.1161/jaha.118.010814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1‐month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1‐month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2±14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1‐month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1‐month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association.
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Affiliation(s)
- Abiodun M Adeoye
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- 2 Department of Neurology University of California San Francisco CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mayowa Owolabi
- 1 Center for Genomic and Precision Medicine University of Ibadan Ibadan Nigeria
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Prakaschandra RD, Naidoo DP. The Association of Epicardial Adipose Tissue and the Metabolic Syndrome in Community Participants in South Africa. J Cardiovasc Echogr 2018; 28:160-165. [PMID: 30306019 PMCID: PMC6172886 DOI: 10.4103/jcecho.jcecho_71_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: We sought to determine the association of echocardiographically derived epicardial adipose tissue (EAT) thickness, which is a component of visceral adipose tissue, with the metabolic syndrome (MetS) in a cohort of randomly selected community participants. Methods: South African-Asian Indians aged 15–64 years were recruited over a 2-year period after informed consent was obtained. All participants who had complete measurements done for biochemistry and echocardiography (using established criteria), were dichotomized into the MetS or non-MetS groups defined according to the harmonized criteria. Results: Of the 953 (232 men and 721 women) participants recruited, 47.1% (448) were classified with the MetS. These participants had larger waist circumference and body mass index (P < 0.001), with larger LA volumes and diameter, thicker ventricular walls, higher left ventricular mass, relative wall thickness, and EAT (P < 0.001). There was a corresponding increase in EAT thickness with increasing number of MetS risk factors at the transition from 0 MetS factors to 1 (95% confidence interval [CI] −0.8; −0.2) and from 2 to 3 MetS factors (95% CI −0.9; −0.4). The AUC of the receiver operator curve was highest for triglycerides (0.845), followed by fasting plasma glucose (0.795) and then EAT (0.789). An EAT value of <3.6 mm predicted the presence of the MetS with a 78% sensitivity and 70% specificity. Using backward stepwise logistic regression, the most significant independent determinants of the MetS after adjusting for age, gender, and type 2 diabetes mellitus, was fasting plasma glucose (odds ratio [OR] = 1.2), triglycerides (OR = 7.1), and EAT (OR = 2.3). Conclusion: Although EAT is associated with the MetS, and can identify individuals at increased cardiometabolic risk, it has a limited additional role compared to current risk markers.
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Affiliation(s)
- Rosaley D Prakaschandra
- Department of Biomedical and Clinical Technology, Durban University of Technology, Durban, South Africa
| | - Datshana P Naidoo
- Department of Cardiology, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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5
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Ogbemudia EJ, Sadoh WE. An assessment of the clinical utility of echocardiography criteria in a Tertiary Health Center. Niger Med J 2016; 56:268-71. [PMID: 26759512 PMCID: PMC4697215 DOI: 10.4103/0300-1652.169706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: The rising prevalence of cardiovascular diseases in the population has increased the demand for cardiovascular imaging procedures (specifically echocardiography) in our center. Aim: To determine the percentage of appropriate indications for echocardiography. Materials and Methods: This was a prospective study conducted over a period of 1 year in the Department of Medicine of a Tertiary Health Care Center. The clinical diagnoses by the referring clinician and the indications (specific reasons for the study) for the echocardiography were consecutively recorded. The age and gender of the patients were also recorded. The indications were given a score of one to nine according to the revised appropriate use criteria of the American College of Cardiology Foundation and the American Society of Echocardiography (ASE). These indications were then classified into appropriate, inappropriate or uncertain based on the score. (1-3)-inappropriate use, (4-6) were derived. Results: There were 25 indications, 16 (64%) were appropriate, 6 (24%) were inappropriate and three (12%) were rated as uncertain. Conclusion: Sixty-four percent of the indications for echocardiography are appropriate for the procedure. This implies that the criteria for echocardiography are yet to be fully implemented resulting in overutilization of the procedure.
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Affiliation(s)
- Ehimwenma J Ogbemudia
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Wilson E Sadoh
- Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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6
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Ojji DB, Opie LH, Lecour S, Lacerda L, Adeyemi OM, Sliwa K. The proposed role of plasma NT pro-brain natriuretic peptide in assessing cardiac remodelling in hypertensive African subjects. Cardiovasc J Afr 2015; 25:233-8. [PMID: 25629540 PMCID: PMC4241593 DOI: 10.5830/cvja-2014-050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/18/2014] [Indexed: 01/19/2023] Open
Abstract
AIM Although plasma NT-proBNP differentiates hypertension (HT) with or without left ventricular hypertrophy (LVH) from hypertensive heart failure (HHF), most of the published data are based on studies in Western populations. Also, most previous studies did not consider left ventricular (LV) diastolic function and right ventricular (RV) function. We therefore examined the relation between NT-proBNP on LV and RV remodelling in an African hypertensive cohort. METHODS Subjects were subdivided into three groups after echocardiography: hypertensives without LVH (HT) (n = 83); hypertensives with LVH (HT + LVH) (n = 50); and those with hypertensive heart failure (HHF) (n = 77). RESULTS Subjects with HHF had significantly higher NT-proBNP levels compared to the HT + LVH group (p < 0.0002). NT-proBNP correlated positively with right atrial area, an indirect measure of RV function. CONCLUSIONS NT-proBNP is proposed as a useful biomarker in differentiating hypertension with or without LVH from hypertensive heart failure in black hypertensive subjects.
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Affiliation(s)
- Dike B Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja; Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Lionel H Opie
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Lydia Lacerda
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Olusoji M Adeyemi
- Department of Medical Laboratory Sciences, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa ; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand
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7
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Ogah OS, Sliwa K, Akinyemi JO, Falase AO, Stewart S. Hypertensive heart failure in Nigerian Africans: insights from the Abeokuta Heart Failure Registry. J Clin Hypertens (Greenwich) 2015; 17:263-72. [PMID: 25688932 PMCID: PMC8031496 DOI: 10.1111/jch.12496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
Data from the Abeokuta Heart Failure Registry were used to determine the clinical characteristics, mode of treatment, and short- and medium-term outcomes of patients with hypertensive heart failure. A total of 320 patients were consecutively studied, comprising 184 men (57.5%) and 136 women (42.5%) aged 58.4±12.4 and 60.6±14.5 years, respectively. Most patients (80%) presented with New York Heart Association functional class III or IV and around one third (35%) had preserved systolic function. Median hospital stay was 9 days (interquartile range 5-21) while intra-hospital mortality was 3.4%. The 30-day, 90-day, and 180-day mortality rates were 0.9% (95% confidence interval, -0.2 to 3.5), 3.5% (95% confidence interval, -1.7 to 7.3), and 11.7% (95% confidence interval, -7.8 to 17.5), respectively. In a multiple logistic regression analysis, only serum creatinine was an independent predictor of mortality at 180 days (adjusted odds ratio, 1.76; 95% confidence interval, -1.17 to 2.64). Hypertension is the most common etiological risk factor for heart failure in Nigeria. Most patients present in the fourth decade of life with severe heart failure and secondary valvular dysfunction and significant in-hospital mortality.
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Affiliation(s)
- Okechukwu S. Ogah
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
- Department of MedicineFaculty of Health SciencesHatter Institute for Cardiovascular Research in Africa & IIDMMUniversity of Cape TownCape TownSouth Africa
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical StatisticsCollege of MedicineUniversity of IbadanIbadanNigeria
| | - Ayodele O. Falase
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
| | - Simon Stewart
- Mary MacKillop Institute for Health Research/NHMRC CRE to Reduce Inequality in Heart DiseaseAustralian Catholic UniversityMelbourneVictoriaAustralia
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Tognon AP, Foppa M, Luft VC, Chambless LE, Lotufo P, El Aouar LMM, Fernandes LP, Duncan BB. Reproducibility of left ventricular mass by echocardiogram in the ELSA-Brasil. Arq Bras Cardiol 2014; 104:104-11. [PMID: 25424165 PMCID: PMC4375653 DOI: 10.5935/abc.20140183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/25/2014] [Indexed: 01/19/2023] Open
Abstract
Background Echocardiography, though non-invasive and having relatively low-cost, presents
issues of variability which can limit its use in epidemiological studies. Objective To evaluate left ventricular mass reproducibility when assessed at acquisition
(online) compared to when assessed at a reading center after electronic
transmission (offline) and also when assessed by different readers at the reading
center. Methods Echocardiographers from the 6 ELSA-Brasil study investigation centers measured the
left ventricular mass online during the acquisition from 124 studies before
transmitting to the reading center, where studies were read according to the study
protocol. Half of these studies were blindly read by a second reader in the
reading center. Results From the 124 echocardiograms, 5 (4%) were considered not measurable. Among the
remaining 119, 72 (61%) were women, mean age was 50.2 ± 7.0 years and 2 had
structural myocardial abnormalities. Images were considered to be optimal/ good by
the reading center for 110 (92.4%) cases. No significant difference existed
between online and offline measurements (1,29 g, CI 95% −3.60-6.19), and the
intraclass correlation coefficient between them was 0.79 (CI 95% 0.71-0.85). For
images read by two readers, the intraclass correlation coefficient was 0.86 (CI
95% 0.78-0.91). Conclusion There were no significant drifts between online and offline left ventricular mass
measurements, and reproducibility was similar to that described in previous
studies. Central quantitative assessment of echocardiographic studies in reading
centers, as performed in the ELSA-Brasil study, is feasible and useful in clinical
and epidemiological studies performed in our setting.
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Affiliation(s)
- Alexandre Pereira Tognon
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Murilo Foppa
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vivian Cristine Luft
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Paulo Lotufo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Bruce Bartholow Duncan
- Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Armstrong AC, Ricketts EP, Cox C, Adler P, Arynchyn A, Liu K, Stengel E, Sidney S, Lewis CE, Schreiner PJ, Shikany JM, Keck K, Merlo J, Gidding SS, Lima JAC. Quality Control and Reproducibility in M-Mode, Two-Dimensional, and Speckle Tracking Echocardiography Acquisition and Analysis: The CARDIA Study, Year 25 Examination Experience. Echocardiography 2014; 32:1233-40. [PMID: 25382818 DOI: 10.1111/echo.12832] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Few large studies describe quality control procedures and reproducibility findings in cardiovascular ultrasound, particularly in novel techniques such as speckle tracking echocardiography (STE). We evaluate the echocardiography assessment performance in the Coronary Artery Risk Development in Young Adults (CARDIA) study Year 25 (Y25) examination (2010-2011) and report findings from a quality control and reproducibility program conducted to assess Field Center image acquisition and reading center (RC) accuracy. METHODS The CARDIA Y25 examination had 3475 echocardiograms performed in 4 US Field Centers and analyzed in a RC, assessing standard echocardiography (LA dimension, aortic root, LV mass, LV end-diastolic volume [LVEDV], ejection fraction [LVEF]), and STE (two- and four-chamber longitudinal, circumferential, and radial strains). Reproducibility was assessed using intraclass correlation coefficients (ICC), coefficients of variation (CV), and Bland-Altman plots. RESULTS For standard echocardiography reproducibility, LV mass and LVEDV consistently had CV above 10% and aortic root below 6%. Intra-sonographer aortic root and LV mass had the most robust values of ICC in standard echocardiography. For STE, the number of properly tracking segments was above 80% in short-axis and four-chamber and 58% in two-chamber views. Longitudinal strain parameters were the most robust and radial strain showed the highest variation. Comparing Field Centers with echocardiography RC STE readings, mean differences ranged from 0.4% to 4.1% and ICC from 0.37 to 0.66, with robust results for longitudinal strains. CONCLUSION Echocardiography image acquisition and reading processes in the CARDIA study were highly reproducible, including robust results for STE analysis. Consistent quality control may increase the reliability of echocardiography measurements in large cohort studies.
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Affiliation(s)
- Anderson C Armstrong
- Johns Hopkins University, Baltimore, Maryland.,University of Sao Francisco Valley, Petrolina, Brazil.,Bahiana School of Medicine and Public Health, Salvador, Brazil
| | | | | | - Paul Adler
- Johns Hopkins University, Baltimore, Maryland
| | | | - Kiang Liu
- Northwestern University, Chicago, Illinois
| | | | - Stephen Sidney
- Kaiser Permanente Division of Research, Oakland, California
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | - Jamie Merlo
- Johns Hopkins University, Baltimore, Maryland
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Durodola A, Ajani AA, Sliwa K. Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: data from the Abeokuta Heart Failure Registry. Cardiovasc J Afr 2014; 25:217-23. [PMID: 25210973 PMCID: PMC4241595 DOI: 10.5830/cvja-2014-040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/01/2014] [Indexed: 01/20/2023] Open
Abstract
Background Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa’s most populous country, Nigeria. We examined the six-month outcomes (including case fatalities) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria. Methods The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%). Results There were a number of differences according to the subject’s gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also having greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7–11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once. Conclusions The characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Gali D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
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11
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Ajani AA, Adesina JO, Durodola A, Sliwa K. Contemporary profile of acute heart failure in Southern Nigeria: data from the Abeokuta Heart Failure Clinical Registry. JACC-HEART FAILURE 2014; 2:250-9. [PMID: 24952692 DOI: 10.1016/j.jchf.2013.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to determine the contemporary profile, clinical characteristics, and intrahospital outcomes of acute heart failure (AHF) in an African urban community. BACKGROUND There are limited data on the current burden and characteristics of AHF in Nigerian Africans. METHODS Comprehensive and detailed clinical and sociodemographic data were prospectively collected from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population about 1 million) over a 2-year period. RESULTS The mean age was 56.6 ± 15.3 years (57.3 ± 13.4 years for men, 55.7 ± 17.1 years for women), and 204 patients (45.1%) were women. Overall, 415 subjects (91.8%) presented with de novo AHF. The most common risk factor for heart failure was hypertension (pre-existing in 64.3% of patients). Type 2 diabetes mellitus was present in 41 patients (10.0%). Hypertensive heart failure was the most common etiological cause of heart failure, responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%), and ischemic heart disease were less common (0.4%) causes. The majority of subjects (71.2%) presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9 ± 9.0%), with valvular dysfunction and abnormal left ventricular geometry frequently documented. The mean duration of hospital stay was 11.4 ± 9.1 days, and intrahospital mortality was 3.8%. CONCLUSIONS Compared with those in high-income countries, patients presenting with AHF in Abeokuta, Nigeria, are relatively younger and still of working age. It is also more common in men and associated with severe symptoms because of late presentation. Intrahospital mortality is similar to that in other parts of the world.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gail D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Julius O Adesina
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hatter Institute for Cardiovascular Research in Africa & IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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12
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Oyedeji AT, Akintunde AA, Owojori OO, Peter JO. Spectrum of Echocardiographic Abnormalities among 168 Consecutive Referrals to an Urban Private Hospital in South-Western Nigeria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:35-8. [PMID: 24701123 PMCID: PMC3972076 DOI: 10.4137/cmc.s14320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 02/18/2014] [Accepted: 02/25/2014] [Indexed: 11/20/2022]
Abstract
Trans-thoracic echocardiography (TTE) is an important non-invasive cardiac examination that provides structural and functional information. It is useful in the diagnosis of cardiac diseases and often guides the management and follow-up of patients with cardiovascular diseases (CVD). The study aimed to present an audit of the echocardiograms performed in an urban private hospital over a two-year period in order to define the pattern of cardiac diseases in our center. Echocardiogram reports of 168 consecutive patients performed between May 2011 and April 2013 at an organized private sector hospital in Lagos, south-west Nigeria were reviewed. Studies were performed with a Toshiba Nemio XG ultrasound machine. The data obtained were analyzed for mean age, sex, clinical indications, and echocardiographic diagnosis in the study subjects. A total of 168 echocardiography reports were examined, comprising of 92 males (54.8%) and 76 females (45.2%). The age range of the subjects was 10-76 years (mean 42.5 ± 12.1 years). The commonest indication for echocardiography was systemic hypertension and hypertension related causes (38.1%), followed by abnormal resting electrocardiogram (14.9%). Routine annual medical screening was the next most common indication, representing 13.1% of the indications for echocardiography. The other indications are as presented in Table 1. The echocardiogram was normal in 64.3% of the subjects. The commonest abnormality detected was hypertensive heart disease (HHD); accounting for 9.6% of the subjects studied. Isolated atrial enlargement (left, right, or bi-atrial) was the next most common abnormality accounting for 6% of the echocardiographic diagnosis. Pulmonary hypertension was the next most common diagnosis accounting for 4.8% of our findings. The other echocardiographic diagnoses are as listed in Table 2. Hypertension represents the commonest indication for echocardiography. Normal echocardiogram was the commonest echocardiographic finding while HHD was the commonest echocardiographic abnormality. The prevalence of ischemic heart disease by echocardiography was 2.4%. There was no case of rheumatic heart disease (RHD). The prevalence of hypertrophic cardiomyopathy (HCM) was 1.2%. Ease of access to echocardiography may influence the findings in an echocardiographic audit and policy makers should incorporate appropriateness criteria into their guidelines for reimbursement.
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Affiliation(s)
- Adebayo T. Oyedeji
- Department of Medicine, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
| | | | | | - Johnson O. Peter
- Department of Medicine, Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria
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13
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Ojji DB, Opie LH, Lecour S, Lacerda L, Adeyemi O, Sliwa K. Relationship Between Left Ventricular Geometry and Soluble ST2 in a Cohort of Hypertensive Patients. J Clin Hypertens (Greenwich) 2013; 15:899-904. [DOI: 10.1111/jch.12205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 08/08/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Dike B. Ojji
- Cardiology Unit; Department of Medicine; University of Abuja Teaching Hospital; Gwagwalada Abuja Nigeria
- Department of Medicine; Faculty of Health Sciences; Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; Cape Town South Africa
| | - Lionel H. Opie
- Department of Medicine; Faculty of Health Sciences; Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; Cape Town South Africa
| | - Sandrine Lecour
- Department of Medicine; Faculty of Health Sciences; Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; Cape Town South Africa
| | - Lydia Lacerda
- Department of Medicine; Faculty of Health Sciences; Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; Cape Town South Africa
| | - Olusoji Adeyemi
- Department of Medical Laboratory Sciences; University of Abuja Teaching Hospital; Gwagwalada Abuja Nigeria
| | - Karen Sliwa
- Department of Medicine; Faculty of Health Sciences; Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; Cape Town South Africa
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14
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Adebayo RA, Akinwusi PO, Balogun MO, Akintomide AO, Adeyeye VO, Abiodun OO, Bisiriyu LA, Ogunyemi SA, Ajayi EA, Ajayi OE, Oyedeji AT. Two-dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria: a prospective study of 2501 subjects. Int J Gen Med 2013; 6:541-4. [PMID: 23861593 PMCID: PMC3704451 DOI: 10.2147/ijgm.s43614] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. Methods A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. Results The subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%). Conclusion Hypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit.
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Affiliation(s)
- Rasaaq Ayodele Adebayo
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State
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15
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Ogah OS, Akinyemi RO, Adegbite GD, Udofia OI, Udoh SB, Adesina JO, Ojo OS, Alabi AA, Majekodunmi T, Osinfade JK, Ogundipe RF, Falase AO. Prevalence of asymptomatic left ventricular systolic dysfunction in hypertensive Nigerians: echocardiographic study of 832 subjects. Cardiovasc J Afr 2011; 22:297-302. [PMID: 22159315 PMCID: PMC3721806 DOI: 10.5830/cvja-2010-063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 08/16/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We sought to determine the prevalence of echocardiographically determined left ventricular systolic dysfunction in asymptomatic hypertensive subjects seen in Abeokuta, Nigeria. METHODS Echocardiography was performed in 832 consecutive hypertensive subjects referred for cardiac evaluation over a three-year period. RESULTS Data were obtained in 832 subjects (50.1% women) aged 56.0 ± 12.7 years (men 56.9 ± 13.3 years, women 55.0 ± 12.0 years, range 15-88). The prevalence of left ventricular systolic dysfunction (LVSD) was 18.1% in the study population (mild LVSD = 9.6%, moderate LVSD = 3.7% and severe LVSD = 4.8%). In a multivariate analysis, male gender, body mass index and LV mass were the predictors of LVSD. CONCLUSION Significant numbers of hypertensive subjects in this study had varying degrees of left ventricular systolic dysfunction. Early introduction of disease-modifying drugs in these patients, such as angiotensin converting enzyme inhibitors or angiotensin receptor blockers may retard or prevent the progression to overt heart failure.
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Affiliation(s)
- O S Ogah
- Department of Medicine, Federal Medical Centre, Idi-Aba, Abeokuta, Ogun State, Nigeria
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16
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Ogah OS, Adegbite GD, Akinyemi RO, Adesina JO, Alabi AA, Udofia OI, Ogundipe RF, Osinfade JKL. Spectrum of heart diseases in a new cardiac service in Nigeria: an echocardiographic study of 1441 subjects in Abeokuta. BMC Res Notes 2008; 1:98. [PMID: 18957102 PMCID: PMC2585576 DOI: 10.1186/1756-0500-1-98] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 10/28/2008] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Echocardiography is a non-invasive, relatively cheap and useful imaging technique for the evaluation of cardiac diseases. The procedure has reliable levels of accuracy. Echocardiography commenced at the Federal medical centre Abeokuta on September 9, 2005.The aim of this study is to report our experience with the procedure, and to define the clinical cases seen in our setting. METHODS This is a retrospective analysis of a prospectively collected data. Echocardiography was performed using Aloka SSD 1,100 echocardiograph equipped with 2.5-5.0 MHz transducer RESULTS During the period of 18 months under review (September 2005-February 2007), 1629 procedures were performed. The reports of 188 echocardiograms were excluded due to poor echo-window, repeated procedure or incomplete report. 1441 reports were reviewed for demographic parameter, indications for the procedure and the main echocardiographic diagnoses.The mean age of the 1441 individuals studied was 54 +/- 14.3 years (15-90). There were 744 men and 697 women. Eight hundred and seventeen subjects (56.7%) had hypertensive heart disease, 53 subjects (3.7%) had rheumatic heart disease while 44(3.0%) had dilated cardiomyopathy. Pericardial diseases, cor-pulmonale, ischaemic heart disease, congenital heart diseases, diabetic heart disease, thyroid heart disease, sickle cell cardiopathy were present in 26(1.8%), 23(1.6%), 9(0.6%), 6(0.4%), 6(0.4%), 6(0.4%), 1(0.1%), and 1(0.1%) respectively. Four hundred and forty nine (31.2%) subjects had normal study. CONCLUSION Hypertensive heart disease was found to be the most prevalent cardiac condition in this study. The relatively frequent diagnoses of rheumatic heart disease, cardiomyopathies and pericardial diseases reflect the impact of infections and infestations on the cardiovascular health of adult Nigerians.We suggest that prevention and treatment of cardiac diseases in our setting should among other things focus on blood pressure control and early treatment of infections causing heart diseases.
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Affiliation(s)
- Okechukwu S Ogah
- Department of Medicine, Federal medical centre, Idi-Aba, Abeokuta, Ogun State, Nigeria.
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