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Olowoyo P, Dzudie A, Okekunle AP, Obiako R, Mocumbi A, Beheiry H, Parati G, Lackland DT, Sarfo FS, Odili A, Adeoye AM, Wahab K, Agyemang C, Campbell N, Kengne AP, Whelton PK, Pellicori P, Ebenezer AA, Adebayo O, Olalusi O, Jegede A, Uvere E, Adebajo O, Awuah B, Moran A, Williams B, Guzik TJ, Kokuro C, Bukachi F, Ogah OS, Delles C, Maffia P, Akinyemi R, Barango P, Ojji D, Owolabi M. ACHIEVE conference proceedings: implementing action plans to reduce and control hypertension burden in Africa. J Hum Hypertens 2024; 38:193-199. [PMID: 38424209 DOI: 10.1038/s41371-024-00903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
The prevalence of hypertension, the commonest risk factor for preventable disability and premature deaths, is rapidly increasing in Africa. The African Control of Hypertension through Innovative Epidemiology, and a Vibrant Ecosystem [ACHIEVE] conference was convened to discuss and initiate the co-implementation of the strategic solutions to tame this burden toward achieving a target of 80% for awareness, treatment, and control by the year 2030. Experts, including the academia, policymakers, patients, the WHO, and representatives of various hypertension and cardiology societies generated a 12-item communique for implementation by the stakeholders of the ACHIEVE ecosystem at the continental, national, sub-national, and local (primary) healthcare levels.
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Affiliation(s)
- Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Anastase Dzudie
- Departments of Internal Medicine and Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Akinkunmi Paul Okekunle
- College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
- Seoul National University, 08826, Seoul, Republic of Korea
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University Teaching Hospital Zaria, Zaria, Nigeria
| | - Ana Mocumbi
- Departamento de Medicina, Universidade, Eduardo Mondlane, Maputo, Mozambique
| | - Hind Beheiry
- Physiology Department, Faculty of Medicine, International University of Africa (IUA), Khartoum, Sudan
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, Univeristy of Milano-Bicocca, Milan, Italy
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Fred S Sarfo
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Odili
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
| | | | - Kolawole Wahab
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Norman Campbell
- Departments of Medicine, Physiology, and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Andre Pascal Kengne
- South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Pierpaolo Pellicori
- School of Cardiovascular & Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Oladimeji Adebayo
- Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladotun Olalusi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ayodele Jegede
- Department of Sociology, University of Ibadan, Ibadan, Nigeria
| | - Ezinne Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | | - Tomasz J Guzik
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Department of Internal and Agricultural Medicine and Omicron Medical Genomics Laboratory, Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Collins Kokuro
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fred Bukachi
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Department of Medical Physiology, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Okechukwu S Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/ University College Hospital, Ibadan, Nigeria
| | - Christian Delles
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pasquale Maffia
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda
- Centre for Cardiovascular Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
- School of Infection & Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rufus Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria
| | - Prebo Barango
- WHO African Regional Office, DRC, Brazzaville, Democratic Republic of the Congo
| | - Dike Ojji
- Department of Medicine, University of Abuja, FCT, Abuja, Nigeria
- Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University College Hospital, Ibadan, Nigeria.
- Co-Lead, Africa-Europe Cluster of Research Excellence (CoRE) in Non-Communicable Diseases & Multimorbidity, African Research Universities Alliance ARUA & The Guild, Arua, Uganda.
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, University College Hospital Ibadan, Ibadan, Nigeria.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
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Kamotho C, Bukachi F. Telemedicine is an effective way to manage cardiovascular disease in rural Kenya and to achieve universal healthcare. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Africa faces a growing burden of communicable and non-communicable diseases (NCDs). Innovative health tech companies are on the rise in Africa, but to be truly effective they need to cover the patient journey and to involve key stakeholders in the health ecosystem.
Purpose
To prove that Digital Health could enable rural folk to consult a doctor conveniently, to control NCDs and to access affordable, quality drugs, all part of Universal Healthcare.
Methods
This was a longitudinal, interventional, comparative study based at a community hospital in Murang'a County. The centre lacks doctors but the local paramedics and nurses carried out initial assessments. Doctors and specialists in Kiambu County were consulted online using the Daktari Africa telemedicine platform, which has regulatory approval and received various awards. Blood pressure and sugar levels were recorded on individual patient profiles.
Results
121 consultations were made between January and October 2019: 81 were online (the “Cases”), and 40 were interviewed there who had been seen in the usual way by the local staff (the “Controls”). Of the 81 case consultations, 72 were unique patients, seven were seen twice online, and two were seen three times. Of the Cases 60 (83.3%) were female and 12 (16.6%) were male. The average age was 63 years. 44 (61.1%) were hypertensive and 8 (11.1%) were diabetic. Among the Controls, 27 (67.5%) were female and 13 (32.5%)male. Average age was 54 years. 15 (37.5%) were hypertensive and 10 (25%) diabetic. Between the Cases and the Controls, the p-values of the differences in gender and age were 0.125 and 0.054 respectively, meaning that they were essentially homogeneous. For hypertension, among the Cases the average initial BP was 145/85 mmHg, the average final BP (in a subsequent check) was 143/89 mmHg. The average drop in BP in the Case group was 15.17/8.83 mmHg. In the Control group the average initial BP was 150/91 mmHg, the average final was 147/92 mmHg. The average drop in BP was 3.4/-0.4 mmHg. The difference in drop in BP between the two groups of patients was significant for the systolic BP (p-value = 0.048), but not for the diastolic (p-value = 0.534). While all diabetic Cases were recommended to have HbA1c tests, only 2 (2.5%) managed to. None (0%) of the Controls had HbA1c. (The local laboratories are limited.) The consulting doctors held two live, educative webinars on diabetes for the local paramedics using the same telemedicine platform. And a partnership was entered into with a Kenyan drug manufacturer to ensure access to quality but affordable medication.
Conclusions
Telemedicine is acceptable in rural African populations. Daktari Africa was effective in improving systolic blood pressure control, and was able to organize educative sessions for the local staff. Quality, affordable medication was made available to patients. These are steps towards universal healthcare.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer Global Medical Grants
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Affiliation(s)
| | - F Bukachi
- University of Nairobi, Medical Physiology, Nairobi, Kenya
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Ndede K, Ogolla E, Otieno F, Bukachi F. PO235 Types of Electrocardiographic Abnormalities and Their Determinants Among Ambulatory Type 2 Diabetics at a Tertiary Hospital In Kenya. Glob Heart 2018. [DOI: 10.1016/j.gheart.2018.09.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Dzudie A, Ojji D, Damasceno A, Sani MU, Kramoh E, Kacou JB, Anisiuba B, Ogola E, Awad M, Nel G, Otieno H, Toure AI, Kane A, Kengne AP, Ngwasiri C, Ba H, Kingue S, Mipinda B, Mbolla BE, Weldehana A, Bukachi F, Gitura B, Kitio B, Rayner B, Shutte AE, Mocumbi AO, Mayosi B, Jose A, Sandeep B, Weber M, Delles C, Cappuccio F, Gamra H, Prabhakaran D, Poulter N, Subhani S. Development of the certificate course in the management of hypertension in Africa (CCMH-Africa): proceedings of the first continental faculty meeting, Nairobi, Kenya, 25-26 February 2018. Cardiovasc J Afr 2018; 29:331-334. [PMID: 30395142 DOI: 10.5830/cvja-2018-055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In response to the call by the World Health Organisation to reduce premature deaths from non-communicable diseases by 25% by the year 2025 (25×25), the Pan-African Society of Cardiology (PASCAR), in partnership with several organisations, including the World Heart Federation, have developed an urgent 10-point action plan to improve detection, treatment and control of hypertension in Africa. Priority six of this action plan is to promote a task-shifting/task-sharing approach in the management of hypertension. AIM This capacity-building initiative aims to enhance the knowledge, skills and core competences of primary healthcare physicians in the management of hypertension and related complications. METHODS In a collaborative approach with the International Society of Hypertension, the British and Irish Hypertension Society, the Public Health Foundation of India and the Centre for Chronic Disease Control, the PASCAR hypertension taskforce held a continental faculty meeting in Kenya on 25 and 26 February 2018 to review and discuss a process of effective contextualisation and implementation of the Indian hypertension management course on the African continent. RESULTS A tailored African course in terms of evidence-based learning, up-to-date curriculum and on-the-job training was developed with a robust monitoring and evaluation strategy. The course will be offered on a modular basis with a judicious mix of case studies, group discussions and contact sessions, with great flexibility to accommodate participants' queries. CONCLUSIONS Hypertension affects millions of people in Africa and if left untreated is a major cause of heart disease, kidney disease and stroke. CCMH-Africa will train in the next 10 years, 25 000 certified general physicians and 50 000 nurses, capable of adequately managing uncomplicated hypertension, thereby freeing the few available specialists to focus on severe or complicated cases.
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Affiliation(s)
- Anastase Dzudie
- Department of Physiology, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon; Clinical Research Education Networking and Consultancy, and Cardiology Unit, Douala General Hospital, Douala, Cameroon; Hatter Institute for Cardiovascular Research, University of Cape Town, South Africa.
| | - Dike Ojji
- Department of Medicine, Faculty of Health Sciences, University of Abuja; Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Mahmoud U Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Euloge Kramoh
- Institut cardiologique d'Abidjan, Abidjan, Cote d'Ivoire
| | | | - Benedict Anisiuba
- Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Mohamed Awad
- Division of Cardiology, University of Khartoum, Khartoum, Sudan
| | - George Nel
- Pan-African Society of Cardiology (PASCAR), Cape Town, South Africa
| | - Harun Otieno
- Section of Cardiology, Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Ali Ibrahim Toure
- Cardiovascular Department, Faculty of Medical Sciences, University Teaching Hospital, Niamey, Niger
| | - Abdoul Kane
- Service de cardiologie, Hôpital Général de Grand Yolf, Dakar, Senegal
| | - Andre Pascal Kengne
- Clinical Research Education Networking and Consultancy, and Cardiology Unit, Douala General Hospital, Douala, Cameroon; Medical Research Council, Cape Town, South Africa
| | - Calypse Ngwasiri
- Clinical Research Education Networking and Consultancy, and Cardiology Unit, Douala General Hospital, Douala, Cameroon
| | - Hamadou Ba
- Department of Physiology, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Samuel Kingue
- Department of Physiology, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Bruno Mipinda
- Centre Hospitalier et Universitaire de Libreville, Libreville, Gabon
| | | | - Amha Weldehana
- Addis Ababa University Medical School, Addis Ababa, Ethiopia
| | | | | | | | - Brian Rayner
- University of Cape Town, Cape Town, South Africa
| | - Aletta E Shutte
- Hypertension in Africa Research Team (HART); MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ana Olga Mocumbi
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Arun Jose
- Public Health Foundation of India, New Delhi, India
| | | | - Michael Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York, USA
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | | | | | | | - Neil Poulter
- International Centre for Circulatory Health, Imperial College, London, UK
| | - Saad Subhani
- Division of Cardiology, University of Khartoum, Khartoum, Sudan
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Kimani S, Sinei K, Bukachi F, Tshala-Katumbay D, Maitai C. Memory deficits associated with sublethal cyanide poisoning relative to cyanate toxicity in rodents. Metab Brain Dis 2014; 29:105-12. [PMID: 24293006 PMCID: PMC3944471 DOI: 10.1007/s11011-013-9459-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/21/2013] [Indexed: 01/17/2023]
Abstract
Food (cassava) linamarin is metabolized into neurotoxicants cyanide and cyanate, metabolites of which we sought to elucidate the differential toxicity effects on memory. Young 6-8 weeks old male rats were treated intraperitoneally with either 2.5 mg/kg body weight (bw) cyanide (NaCN), or 50 mg/kg bw cyanate (NaOCN), or 1 μl/g bw saline, daily for 6 weeks. Short-term and long-term memories were assessed using a radial arm maze (RAM) testing paradigm. Toxic exposures had an influence on short-term working memory with fewer correct arm entries (F(2, 19) = 4.57 p < 0.05), higher working memory errors (WME) (F(2, 19) = 5.09, p < 0.05) and longer RAM navigation time (F(2, 19) = 3.91, p < 0.05) for NaOCN relative to NaCN and saline treatments. The long-term working memory was significantly impaired by cyanide with fewer correct arm entries (F(2, 19) = 7.45, p < 0.01) and increased working memory errors (F(2, 19) = 9.35 p < 0.05) in NaCN relative to NaOCN or vehicle treated animals. Reference memory was not affected by either cyanide or cyanate. Our study findings provide an experimental evidence for the biological plausibility that cassava cyanogens may induce cognition deficits. Differential patterns of memory deficits may reflect the differences in toxicity mechanisms of NaOCN relative to NaCN. Cognition deficits associated with cassava cyanogenesis may reflect a dual toxicity effect of cyanide and cyanate.
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Affiliation(s)
- S Kimani
- Department of Pharmacology and Pharmacognosy & School of Nursing Sciences, University of Nairobi, Kenyatta National Hospital, P.O. Box 19676, Nairobi, Kenya,
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Kimani S, Moterroso V, Lasarev M, Kipruto S, Bukachi F, Maitai C, David L, Tshala-Katumbay D. Carbamoylation correlates of cyanate neuropathy and cyanide poisoning: relevance to the biomarkers of cassava cyanogenesis and motor system toxicity. Springerplus 2013; 2:647. [PMID: 24349951 PMCID: PMC3862856 DOI: 10.1186/2193-1801-2-647] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/25/2013] [Indexed: 12/01/2022]
Abstract
We sought to elucidate the protein carbamoylation patterns associated with cyanate neuropathy relative to cyanide poisoning. We hypothesized that under a diet deficient in sulfur amino acids (SAA), the carbamoylation pattern associated with cyanide poisoning is similar to that of cyanate neuropathy. Male rats (6–8 weeks old) were fed a diet with all amino acids (AAA) or 75%-deficiency in SAA and treated with 2.5 mg/kg/body weight (bw) NaCN, or 50 mg/kg/bw NaOCN, or 1 μl/g/bw saline, for up to 6 weeks. Albumin and spinal cord proteins were analyzed using liquid chromatography mass spectrometry (LC-MS/MS). Only NaOCN induced motor deficits with significant levels of carbamoylation. At Day 14, we found a diet-treatment interaction effect on albumin carbamoylation (p = 0.07). At Day 28, no effect was attributed to diet (p = 0.71). Mean number of NaCN-carbamoylated sites on albumin was 47.4% higher relative to vehicle (95% CI:16.7-86.4%). Only NaOCN carbamoylated spinal cord proteins, prominently, under SAA-restricted diet. Proteins targets included myelin basic and proteolipid proteins, neurofilament light and glial fibrillary acidic proteins, and 2', 3' cyclic-nucleotide 3'-phosphodiesterase. Under SAA deficiency, chronic but not acute cyanide toxicity may share biomarkers and pathogenetic similarities with cyanate neuropathy. Prevention of carbamoylation may protect against the neuropathic effects of cyanate.
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Affiliation(s)
- Samuel Kimani
- Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, 19676 Kenya ; School of Nursing Sciences, University of Nairobi, Nairobi, 19676 Kenya
| | - Victor Moterroso
- Department of Comparative Medicine, Oregon Health & Science University (OHSU), Portland, OR 97239 USA
| | - Mike Lasarev
- Center for Research on Occupational & Environmental Toxicology, OHSU, Portland, OR 97239 USA
| | - Sinei Kipruto
- Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, 19676 Kenya
| | - Fred Bukachi
- Department of Medical Physiology, University of Nairobi, Nairobi, 30197 Kenya
| | - Charles Maitai
- Department of Pharmacology and Pharmacognosy, University of Nairobi, Nairobi, 19676 Kenya
| | - Larry David
- Biochemistry and Molecular Biology & Proteomics Shared Resource, OHSU, Portland, OR 97239 USA
| | - Desire Tshala-Katumbay
- Center for Research on Occupational & Environmental Toxicology, OHSU, Portland, OR 97239 USA ; Department of Neurology, OHSU, Portland, OR 97239 USA ; Center for Research on Occupational and Environmental Toxicology & Department of Neurology, Oregon Health & Science University, 3181 Sam Jackson Park Road, Mail code L606, Portland, OR 97239 USA
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Bukachi F, Waldenström A, Mörner S, Lindqvist P, Henein MY, Kazzam E. Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects: Umea General Population Heart Study. Eur J Echocardiogr 2008; 9:522-9. [PMID: 18490308 DOI: 10.1093/ejechocard/jen124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Peak left ventricular (LV) relaxation normally precedes peak filling (E), which supports the hypothesis that LV suction contributes to early-diastolic filling. The significance of similar temporal discordance in late diastole has previously not been studied. We describe the time relationships between mitral annular motion and LV filling in early and late diastole and examine the effect of normal ageing on these time intervals. METHODS AND RESULTS A total of 128 healthy subjects aged 25-88 years were studied. Transmitral and pulmonary venous flow reversals (Ar) were recorded by Doppler echocardiography. Mitral annular diastolic displacement-early (E(m)) and late (A(m))-were recorded by Doppler tissue imaging. With reference to electrocardiographic R and P-waves, the following measurements were made: R to peak E-wave (R-E) and E(m) (R-E(m)); onset P to peak A-wave (P-pA), A(m) (P-pA(m)), and Ar (P-pAr). The differences between [(R-E) and (R-E(m))] for early-diastolic temporal discordance (EDTD) and [(P-A) and (P-A(m))] for late-diastolic temporal discordance (LDTD) were calculated. Isovolumic relaxation time (IVRT) was also measured. Early-diastolic temporal discordance was approximately 26 ms in all age groups. Late-diastolic temporal discordance, however, was inversely related to age (r = -0.35, P < 0.001) and IVRT (r = -0.34, P < 0.001) and therefore decreased in the elderly vs. young (13 +/- 10 vs. 23 +/- 10 ms; P < 0.001). In multivariate analysis, age failed to predict LDTD in the presence of IVRT. A, A(m), and Ar were simultaneous at onset, and peak A(m) coincided with peak Ar in all age groups (r = 0.97, P < 0.001). No significant differences were noted in the RR intervals. CONCLUSIONS Sequential prolongation of IVRT with ageing reduces LDTD, thus converging the peaks of A(m), A, and Ar (atrial mechanical alignment)-a potential novel method to identify subjects at increased dependency on atrial contraction for late-diastolic filling.
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Affiliation(s)
- F Bukachi
- Department of Medical Physiology, College of Health Sciences, Nairobi, Kenya
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Bukachi F, Kazzam E, Mörner S, Lindqvist P, Henein MY, Waldenström A. RETRACTED: Age dependency in the timing of mitral annular motion in relation to ventricular filling in healthy subjects - A pulsed and tissue Doppler study. Eur J Echocardiogr 2005:S1525-2167(05)00078-8. [PMID: 15996522 DOI: 10.1016/j.euje.2005.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 05/12/2005] [Indexed: 10/25/2022]
Abstract
This article has been retracted consistent with Elsevier Policy on Article Withdrawal. Please see .The Publisher apologizes for any inconvenience this may cause.
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Affiliation(s)
- F Bukachi
- Department of Public Health and Clinical Medicine, Medicine, University Hospital Umeå, S-901 85 Umeå, Sweden
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Bukachi F, Waldenström A, Mörner S, Lindqvist P, Henein MY, Kazzam E. Pulmonary venous flow reversal and its relationship to atrial mechanical function in normal subjects ? Ume� General Population Heart Study. European Journal of Echocardiography 2005; 6:107-16. [PMID: 15760687 DOI: 10.1016/j.euje.2004.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Revised: 07/27/2004] [Accepted: 07/27/2004] [Indexed: 11/28/2022]
Abstract
AIMS Although pulmonary venous flow reversal (Ar) is useful in the evaluation of left ventricular (LV) diastolic function, it is often difficult to study with transthoracic echocardiography (TTE). We determined the relationship between Ar and left atrial (LA) mechanical function and sought to define surrogate measurements for Ar. METHODS AND RESULTS A total of 130 healthy subjects, mean age 54.3+/-18.3 years, 62 women, were studied and classified into three groups: [young (Y), 25-44 years; n=44], [middle-age (M), 45-64 years; n=43] and [elderly (E), > or =65 years; n=43]. Pulmonary venous flow and LV inflow studies were performed by TTE and LV basal free-wall motion was studied by Doppler tissue imaging (DTI). All images were acquired with a superimposed electrocardiogram. RR interval was similar in all groups while LA dimension and PR interval were increased in Group E vs. Y (P<0.001). LA contraction (A(m)) on DTI, transmitral A-wave (A) and Ar were simultaneous and started 84ms after onset of P wave and this interval increased with age (P=0.02). Similarly, the time intervals from the same landmark to peak A(m), A, and Ar were prolonged with age (all, P<0.001). Despite this prolongation, peak A(m) coincided with peak Ar in every age group (r=0.97, P<0.001) and Ar acceleration and deceleration times were consistently equal. CONCLUSION The timing of A(m) obtained by DTI can be used to accurately estimate corresponding measurements of Ar recorded by TTE in subjects without cardiac disease.
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Affiliation(s)
- F Bukachi
- Department of Public Health and Clinical Medicine, Medicine, University Hospital Umeå, S-901 85 Umeå, Sweden.
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Abstract
OBJECTIVE To assess the clinical outcome of successful percutaneous transluminal coronary angioplasty (PTCA) in patients with poor ventricular function. METHODS Analysis of angiographic, echocardiographic and clinical records of patients with severe LV dysfunction who underwent PTCA from January 1, 1995 to December 31, 1997 was undertaken. Forty-one patients aged 63+/-10 years, 36 men, all with significant coronary artery disease and impaired LV function (fractional shortening, FS<or=20%) were identified. Patients' data before and after angioplasty were analyzed. RESULTS Post PTCA: angiographic success was 95.2%. Major complications occurred in 19.5% and hospital mortality was 2.7%. At 6 months after PTCA:LV fractional shortening (FS) increased from 15.9+/-3.4% to 19.6+/-6.6%, P=0.02 and consequently cardiac output from 4.28+/-0.98 to 5.34+/-1.77 l/min, P<0.01. Change in at least one class of angina and cardiac functional status was observed in 46% of patients, P<0.001, and this was maintained to the end of the year. After 12 months follow-up: restenosis occurred in 10.8%; mortality was 5.4%; event-free and actuarial survivals were 62.3% and 91.9%, respectively. CONCLUSIONS In patients with severe LV dysfunction, continued symptomatic improvement can be achieved with successful coronary angioplasty. This is associated with significant recovery of LV systolic function and cardiac output. In order to minimize procedure-related complications, careful patient selection should be considered.
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Affiliation(s)
- F Bukachi
- The Department of Cardiology, Royal Brompton Hospital, Sydney Street, Imperial College, London University, UK
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Bukachi F, Henein MY, Underwood SR. Predicting the outcome of revascularization in ischaemic left ventricular dysfunction. Eur Heart J 2000; 21:1290-2. [PMID: 10952819 DOI: 10.1053/euhj.2000.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Affiliation(s)
- B Lown
- Lown Cardiovascular Center, Brookline, MA 02146, USA.
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