Left ventricular mass and systolic function in African diabetic patients: association with microalbuminuria

OBJECTIVE

To assess echocardiographic evidence of cardiomyopathy and its association with microalbuminuria in type 2 normotensive non-proteinuric diabetic patients.

MATERIAL AND METHODS

Forty consecutive normotensive non-proteinuric type 2 diabetic patients were studied. Body mass index, blood pressure, urinary albumin excretion, ECG at rest and after exercise, left ventricular mass, and shortening fraction using two-dimensional and M-mode echocardiography were measured in every patient.

RESULTS

Among the 40 patients studied, 17 (42.5%) presented with microalbuminuria, 16 (40.0%) with left ventricular hypertrophy, 22 (55.0%) with systolic dysfunction and 3 (7.5%) with ECG changes compatible with cardiac ischaemia. No significant difference existed between normoalbuminuric and microalbuminuric patients for age, known duration of diabetes, body mass index, systolic and diastolic blood pressure. Ventricular mass correlated to urinary albumin excretion rate (r=0.34; p=0.04) and shortening fraction to diastolic blood pressure (r = - 0.40; p=0.01).

CONCLUSION

Left ventricular structure and function might be altered in African type 2 diabetic patients in the absence of hypertension, and microalbuminuria may be an early biochemical marker of these abnormalities.

[Diastolic function of the left ventricle in a North-African patient with homozygous sickle-cell anemia]

AIM

The aim of this study was to investigate left ventricular diastolic function in a group of homozygous Black African patients with sickle-cell disease via echocardiography-Doppler, and to describe the possible hemodynamic implications of these findings.

PATIENTS AND METHODS

Fifty patients with sickle-cell anemia from two hematology departments in Yaoundé volunteered to participate in the study, carried out between May-October 1995. The presence of any other associated pathology (cardiovascular disorder, acute drepanocytic anemia, pregnancy) was excluded following a clinical, hematological and echocardiographic examination. A sex- and age-matched control group consisting of 50 healthy subjects was selected after the same examination criteria had been met. Mitral flow recorded by pulsed Doppler was measured, and the amplitudes of the E and A waves of the proto- and telediastolic flow, the E/A ratio, the decrease over time (DT) for the E wave, and the left ventricular isovolumetric relaxation time were also calculated. The limits of the confidence interval for the mean DT of the control group were used as the criterion to determine the following in the patient population: i) relaxation disorder profile, with DT > 154 ms; ii) restrictive disorder profile, with DT < 137 ms.

RESULTS

The dimensions of the cardiac cavities and the left ventricular mass were higher in the patient population; 34 cases of left auricular dilatation (68%) and 33 cases of left ventricular dilatation 8 66%) were observed. In only two patients was a systolic dysfunction noted. The amplitudes of the mitral flow E and A waves were increased, and the DT was longer in the sickle-cell group. Forty patients (80%) had abnormal diastolic function, with a marked predominance of the 'relaxation disorder' profile (60%). The restrictive disorder profile was only observed in ten sickle-cell patients (20%), while ten others displayed a normal profile (20%). The means of the various clinical and echocardiographic parameters of the three categories of sickle-cell patients (based on their diastolic profile, i.e., normal, relaxation disorder, restrictive disorder) were compared. The clinical parameters could be superimposed in the 3 categories. The dimensions of the left auricle and the telesystolic diameter of the left ventricle were significantly larger in the restrictive disorder category. The latter category appeared to be more symptomatic, and included the two isolated cases of systolic dysfunction.

CONCLUSION

Left ventricular diastolic dysfunction is commonly encountered in sickle-cell cases in the Cameroon. The restrictive disorder profile is less frequently observed, but appears to be more harmful at the hemodynamic level. The present results suggest that the study of diastolic function in patients with sickle-cell anemia could help identify hemodynamically at-risk subjects who require more specific cardiovascular care, even before a noticeable alteration in systolic function has taken place.

Microalbuminuria and retinopathy in a diabetic population of Cameroon

Microalbuminuria and retinopathy was studied in a non-proteinuric diabetic population of Cameroon. Patients were enrolled on a consecutive basis in two referral hospitals in Yaoundé. Retinopathy was evaluated by direct ophthalmoscopy and biomicroscopy, and controlled by mydriatic fundus photography. Detection of microalbuminuria was carried out on an overnight urine sample using Micral II test (Boehringer Mannheim). Anthropometric and blood pressure measurements were done using validated methods. In 64 non-proteinuric diabetic patients (9 IDDM and 55 NIDDM) aged 19-70 years with known duration of diabetes of 1-23 years, the prevalence of retinopathy was 37.5%. Microalbuminuria was detected in 53.1% of patients. Microalbuminuria correlated with duration of diabetes, and blood pressure, retinopathy was positively correlated with age, and blood pressure. Retinopathy was not significantly associated with the known duration of diabetes. Retinopathy was found to be independently associated with microalbuminuria (P < 0.001) and microalbuminuria appeared to be a sensitive marker of retinopathy. The prevalence of retinopathy and microalbuminuria in this population was high. Microalbuminuria and non-proliferative retinopathy are independently associated, and are both associated with increased blood pressure levels in the study population. As shown in previous studies microalbuminuria may also be a sensitive marker of early diabetic retinopathy in African diabetic patients.

[Screening of hepatocellular carcinoma in the middle of a high risk population in Cameroon]

We undertook a prospective study of cancerous lesions of the liver in 163 patients (136 males and 27 females) considered to be on high risk. These patients were, healthy carriers of HBs Antigen (n = 70), had chronic hepatitis (n = 45) or cirrhosis (n = 48). The screening was done from two main tests: liver ultrasound and blood alphafoetoprotein. Amongst the 163 patients, malignancy was diagnosed in 29 (22 males and 7 females) giving a prevalence of 17.8 percent: 9 cancers were diagnosed in the group with chronic hepatitis (20 percent), 20 in the group with cirrhosis (41.6 percent) and none in the group of healthy carriers. These results show that in Cameroun, cirrhosis is the most frequent abnormality associated with development of hepatocarcinoma. Thus the strategy against liver cancer should be oriented towards two main objectives; vaccination of children after eliminating healthy carriers and a regular follow-up of patients at risk.

[Chronic pancreatitis in Cameroon. Analysis of etiological and clinical aspects]

In a collection of 3,571 patient's files admitted in the University Teaching Hospital and the Yaounde General Hospital, we studied 27 patients suspected of chronic pancreatitis. 20 patients with calcified chronic pancreatitis benefited from a detailed history, physical examination and a complete paraclinical work-up. From the data collected, chronic alcoholism seemed to have been the main aetiology. Industrial beer from barley alone and/or associated with other traditional liquors was most consumed. The majority of patients were heavy alcoholics and daily consumption varied from 75 to 124 g of pure alcohol. The natural history of the disease and physical examination were identical to that observed in the western countries. Associated pathology was observed in 10% of the patients. This included peptic ulcer disease, cirrhosis and bile stones. Complications included diabetics, obstructive jaundice, and malabsorption syndrome. As a conclusion, chronic pancreatitis is a pathology whose prevalence seems to be progressing constantly.