Cardiomyopathie du péripartum: aspects cliniques, thérapeutiques et évolutifs à propos de 24 cas / Clinical features, management and outcome of peri-partum cardiomyopathy: a study of 24 patients

Introduction. La fréquence, la présentation et le devenir de cardiomyopathie du peripartum (CMPP) varient considérablement dans le monde. Au Niger, les données sont inexistantes d'où le but de notre étude qui était de préciser les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la cardiomyopathie du peripartum (CMPP). Méthodologie. Il s'agit d'une étude rétrospective concernant les patientes hospitalisées pour CMPPau pôle de Cardiologie de l'Hôpital National de Niamey du 01/01/2019 au 31/12/2019. Les facteurs de risque et les aspects épidémiologiques, cliniques, paracliniques, diagnostiques, thérapeutiques et évolutifs ont été étudiés. Résultats. La prévalence hospitalière de la CMPP était de 3,83%. L'âge moyen était de 27,4 ans (extrêmes de 16 et 45 ans). La multiparité a été rapportée chez 79 % des patientes contre 21% qui étaient primipares. La dyspnée était le signe le signe fonctionnel rapporté chez toutes les patientes. Les anomalies échocardiographiques les plus fréquentes étaient l'HVG (75%) et L'HAG (45,83%). L'hypocinésie était diffuse dans 100% des cas. L'altération de la fraction d'éjection du ventricule du ventricule gauche (FEVG) était moyenne dans 50%. Toutes les patientes ont ont eu comme traitement des bétabloquants, des diurétiques et des IEC. L'évolution a été favorable dans 87,5 % des cas. Les principaux facteurs pronostiques péjoratifs étaient la multiparité (79%) une fraction d'éjection du ventricule inférieure à (FEVG)

Introduction. The frequency, presentation and outcome of peripartum cardiomyopathy (PCM) vary considerably throughout the world. In Niger, data are non-existent, hence the aim of our study, which was to clarify the epidemiological, diagnostic, therapeutic and evolutionary aspects of peripartum cardiomyopathy (PPCM). Methodology. This is a retrospective study concerning patients hospitalized for CMPPat the Cardiology pole of the National Hospital of Niamey from 01/01/2019 to 31/12/2019. Risk factors and epidemiological, clinical, paraclinical, diagnostic, therapeutic and evolutionary aspects were studied. Results. The hospital prevalence of CMPP was 3.83%. The mean age was 27.4 years (extremes 16 and 45 years). Multiparity was reported in 79% of patients versus 21% who were primiparous. Dyspnea was the functional sign reported in all patients. The most frequent echocardiographic abnormalities were LVH (75%) and GAH (45.83%). Hypokinesia was diffuse in 100% of cases. Impaired left ventricular ejection fraction (LVEF) was moderate in 50%. All patients were treated with beta-blockers, diuretics and ACE inhibitors. Progression was favorable in 87.5% of cases. The main pejorative prognostic factors were multiparity (79%) lower ventricular ejection fraction (LVEF)

Manifestations cardiovasculaires au cours de l'infection à VIH à Libreville: étude comparative de patients séropositifs et séronégatifs / Cardiovascular Manifestations during HIV infection in Libreville: Comparative study of seropositive and seronegative patients

Introduction. Le spectre des atteintes cardiovasculaires au cours de l'infection à VIH a été modifi é par la trithérapie antirétrovirale. L'objectif de ce travail était de décrire le profi l des manifestations cardiovasculaires chez les patients vivants avec le VIH en le comparant à celui de patients séronégatifs. Méthodes. Il s'est agi d'une étude cas-témoins des dossiers de patients respectivement séropositifs et séronégatifs hospitalisés pour une pathologie cardiovasculaire au service de cardiologie du Centre Hospitalier Universitaire de Libreville de janvier 2015 à décembre 2018. L'analyse statistique a été réalisée à l'aide du logiciel Statview 5.0. Lestests de Chi-2 de Pearson ou Exact de Ficher ont été utilisés pour la comparaison des proportions. Résultats. L'étude a porté sur sur l'analyse de 82 et 150 dossiers de patients respectivement séropositifs et séronégatifs. Un âge inférieur à 50 ans était retrouvé chez 70,7% des séropositifs et 43,3% des séronégatifs (p<0,01). Le taux de CD4 moyen des séropositifs était de 189±170/mm3 et 45,1% d'entre eux étaient sous trithérapie antiretrovirale.La cardiomyopathie dilatée était l'atteinte cardiaque la plus fréquente chez les séropositifs (42,7%) et chez les séronégatifs (52,7%) (p=0,14). La maladie thromboembolique veineuse était relevée chez 7(8,5%) séropositifs et 14 (8,8%) séronégatifs (p=0,93). Une péricardite était diagnostiquée chez 25,6% des séropositifs avec une étiologie tuberculeuse dans 85,7% des cas. Les pathologies vasculaires athéromateuses étaient plus fréquentes chez les séronégatifs (23,1%) comparés aux séropositifs (6,1%) (p<0,01). La mortalité des séropositifs était principalement due aux péricardites (71,4%). Conclusion. les manifestations cardiovasculaires liées à l'immunodépression persistent chez les personnes vivant avec le VIH à Libreville. Un dépistage précoce de ces atteintes permettrait de réduire la mortalité.

Introduction. The spectrum of cardiovascular damage during HIV infection has been modified by triple antiretroviral therapy. The objective of this study was to describe the profile of cardiovascular manifestations in patients living with HIV by comparing it to the one of seronegative patients. Methods. This was a case-control study which focused on the files of patients hospitalized for a cardiovascular pathology in the cardiology department of the Center Hospitalier Universitaire de Libreville from january 2015 to december. 2018. Results. In total, there was on the analysis of the files of 82 seropositive patients and 150 seronegative patients. The age found was less than 50 years old in 70.7% of seropositives and 43.3% of seronegatives (p <0.01). The mean CD4 count in seropositives was 189 ± 170 /mm3 and 45.1% of them were on triple antiretroviral therapy. Dilated cardiomyopathy was the most common cardiac disease in HIVpositive (42.7%) and HIV-negative (52.7%) (p = 0.14). Venous thromboembolic disease was noted in 7 (8.5%) seropositives and 14 (8.8%) seronegatives (p=0.93).Pericarditis was diagnosed in 25.6% of seropositives patients with a tuberculous etiology in 85.7% of cases. Atheromatous vascular pathologies were more frequent in seronegative (23.1%) compared to seropositive (6.1%) (p <0.01). Mortality among seropositive was mainly due to pericarditis (71.4%)

Profil de la cardiomyopathie du péripartum au Centre Hospitalier Universitaire de Libreville

La cardiomyopathie du péripartum (CMP-PP) est une cause rare d'insuffisance cardiaque (IC) de la femme en période d'activité génitale. L'objectif de cette étude était d'en déterminer les profils cliniques de la maladie chez des parturientes au Gabon. Il s'est agi d'une analyse rétrospective réalisée de janvier 2012 à janvier 2016 au Centre Hospitalier Universitaire de Libreville. Une CMP-PP a été diagnostiquée chez 27 patientes avec un âge moyen de 27,1 ± 5,5 ans. L'IC était globale dans 59,2 % des cas et survenait chez 92,6 % des patientes dans le post-partum. La dyspnée était le symptôme initial dans 100 % des cas, d'installation progressive chez 9 (33.3 %) patientes, avec un délai moyen d'apparition de 29,4 ± 35 jours. La plupart des patientes étaient des multipares (74,1 %), avaient un niveau socio-économique faible (48,1 %) et avaient une pré-éclampsie (48,1 %). Un diamètre télédiastolique moyen du ventricule gauche supérieur à 60 mm était retrouvé chez 17 (62,9 %) patientes et une fraction d'éjection ventriculaire gauche inférieure à 30 % chez 14 (51,8 %) d'entre elles. A Libreville, la CMP-PP affecte des patientes jeunes et les lésions initiales sont sévères

Childhood Acquired Heart Diseases in Jos; North Central Nigeria

The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country; and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period; including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84?4.5 years) and comprised 80 (45.7) males and 95 (54.3) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0) children; followed by dilated cardiomyopathy (33 cases; 18.9) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1); pericardial disease in 15 (8.6); infective endocarditis in 8 (4.6) and aortic aneurysms in 2 (1.1) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology; with RHD remaining the most frequent; particularly in older children. Community-based screening and multicenter collaborative studies will help to better describe the pattern of AHD in our country. More vigorous pursuit of the Millennium development goals will contribute to reducing the burden of childhood acquired heart diseases in the country

The Contribution of South Africans to the Subject of Dilated Cardiomyopathy

Background : Dilated cardiomyopathy (DCM) is a heart muscle disease that is endemic in Africa. Over the past 50 years; South African investigators have made significant contributions to scientific elucidation of the condition. The objective of this review was to summarise their research on the subject of DCM. Methods and results : We searched PubMed for articles originating from South Africa and focusing on DCM or the related condition; peripartum cardiomyopathy (PCM). Reference lists and prominent South African researchers on DCM were also consulted. The prevalence of DCM is comparable in magnitude to that of other endemic heart conditions such as hypertension and rheumatic heart disease; although by comparison; DCM may cause disproportionate morbidity from heart failure. In the African context; malnutrition; excessive alcohol intake; prior myocarditis and genetic make-up have been proposed as aetiologies; and some or all of these factors may play an interrelated role in individual disease expression. The pathogenesis of DCM is partially due to the mechanical effects of fibrosis; and the immune response to myocardial damage likely affects disease progression. Small trials of pentoxifylline plus conventional therapy have demonstrated a trend towards reduced mortality from heart failure. Conclusions : Despite half a century of noteworthy research; the pathogenic mechanisms of DCM are still incompletely understood. South Africans have; however; played and should continue to play a critical role in advancing research on DCM

From Bowditch to Beta-Blockers : Evolution of the Understanding of the Importance of Heart Rate and Myocardial Energetics in Cardiomyopathy

During the past three decades; every aspect of cardiomyopathy has undergone dramatic change. When examining the literature on the physiological aspects of the failing heart; one immediately recognises that South Africa has made a contribution : Brink; Bester and Lochner evaluated the possible therapeutic aspects of the Bowditch phenomenon and myocardial energetics in cardiomyopathy almost four decades ago; at a time when the condition even had another name; myocardiopathy

Neglected Cardiomyopathies in Africa

"Cardiomyopathies are forms of disease in which the heart muscle is structurally and functionally abnormal in the absence of coronary artery disease; hypertension; valve disease and congenital heart disease sufficient to explain he observed myocardial abnormality. They constitute the greatest challenge of all the cardiovascular diseases in Africa; due to the difficulties in diagnosing and managing them; related to the lack of access to specialised investigations or effective interventions in most endemic areas. In this continent; in addition to the ""usual"" forms of cardiomyopathy; there is an increased incidence of specific forms of muscle heart disease like Endomyocardial Fibrosis and Peripartum Cardiomyopathy which; despite affecting thousands of people; have been largely neglected. Their etiology remains unknown; the mechanisms involved are not fully nderstood; and although some improvement in management has been witnessed in recent years much still need to be done to improve the outcome. The current knowledge on epidemiology; determinants; thophysiology; diagnosis and management of Endomyocardial Fibrosis and Peripartum Cardiomyopathy is reviewed in this article; which also presents the ongoing efforts for better understanding of their pathogenesis and the recent improvements in their management."

Thrombus intracardiaque avec ischemie aigue et thrombophlebite des membres inferieurs lors d'une cardiomyopathie du peripartum

La cardiomyopathie du peripartum est une cardiomyopathie dilatee survenant dans le dernier trimestre de la grossesse ou dans les cinq ou six mois suivants l'accouchement. Elle est caracterisee par une dysfonction ventriculaire gauche diagnostiquee a l'echocardiographie bidimensionnelle (fraction d'ejection 45); sans aucune autre etiologie de la defaillance cardiaque. Nous rapportons dans cette etude un cas associant un thrombus intracardiaque; une ishemie aigue du membre inferieur et une thrombophlebite

The a2CDel322-325 Adrenergic Receptor Polymorphism is not Associated with Heart Failure due to Idiopathic Dilated Cardiomyopathy in Black Africans : Cardiovascular Topics

Background : A four-amino acid deletion was identified within the a2C-adrenergic receptor (a2CDel322-325) that; when homozygous; increases the risk of heart failure in African-Americans nearly six-fold. We hypothesised that homozygosity for the a2CDel322-325 polymorphism may be a risk factor for heart failure due to idiopathic dilated cardiomyopathy (DCM) in black South Africans. Methods: The a2CDel322-325 polymorphism was genotyped in 37 patients with heart failure and 34 controls; all of black African ancestry. Genotyping was performed by a size-fractionation assay. Results: The patients studied ranged in age from 21 to 79 years with a mean age of 50 years; and 62were male. No significant difference was observed in homozygosity for the a2CDel322-325 polymorphism or in allele and genotype frequencies between patients and controls. The frequency of the allele containing the deletion was 0.54 in cases and 0.53 in controls. The genotype frequencies in the patients were consistent with those of the controls (p = 0.56). Conclusions: Homozygosity for the a2CDel322-325 polymorphism is not associated with an increased risk for heart failure due to idiopathic DCM in black South Africans

Takotsubo Cardiomyopathy : an Acute and Reversible Cardiomyopathy Mimicking Acute Myocardial Infarction

Takotsubo cardiomyopathy is an acute; reversible form of left ventricular dysfunction precipitated by emotional or physical stress. The condition is important to recognise as it mimics acute myocardial infarction and acute coronary syndrome. Most patients are female and postmenopausal. Presenting symptoms include severe chest pain; acute dyspnoea; hypotension or even cardiogenic shock. The ECG changes are suggestive of an acute coronary syndrome with T-wave inversion with / without ST elevation; most often in the precordial leads. The syndrome is characterised by a sudden onset of transient extensive akinesia of the left ventricle; often involving all three major coronary artery territories; in the absence of significant coronary artery stenosis. The wall motion typically involves the apex of the left ventricle with hyperkinesis of the base of the heart. Variant forms have recently been described where the wall motion abnormality involves the mid-ventricular wall with hyperkinesis of the base and apex; or the base of the heart with hyperkinesis of the apex. Characteristically; there is only a limited release of cardiac enzymes disproportionate to the extent of regional wall motion abnormality. Transient right ventricular dysfunction may occur and is associated with more complications; longer hospitalisation and worse left ventricular systolic dysfunction. Serial echocardiography is useful to document improvement in cardiac function. The pathogenesis is unclear. Transient mid-cavity obstruction has been invoked with subsequent myocardial stunning in the akinetic segments. Treatment is supportive. The most effective long-term management remains to be defined. Although the prognosis is good with recovery of ventricular function at about three weeks; some patients have died. The syndrome may recur

Beta1- and ? 2c-Adrenoreceptor Variants as Predictors of Clinical Aspects of Dilated Cardiomyopathy in People of African Ancestry : Cardiovascular Topics

Background : Although the Beta1-adrenoreceptor (AR) Gly389Arg and ?2c-AR Del322-325 gene variants are associated with the response to Beta-AR-blocker therapy; whether this effect is associated with the risk for heart failure; or the severity or progression of heart failure is uncertain. Aims : To assess the relationship between Gly389Arg and Del322-325 variants and the presence; severity and progression of idiopathic dilated cardiomyopathy (IDC) in 403 black South African patients. Methods : Genotypes were identified using a restriction fragment length olymorphism-based technique and automated sequencing. Left ventricular ejection fraction (LVEF) and dimensions were determined at baseline and in 132 patients after six months of standard medical therapy excluding Beta- AR-blockers (not indicated as standard care at the time of completing this study). Results : All patients and controls genotyped for the ?2c-AR variant were homozygous for the Del322-325 (risk) allele. The Gly389Arg polymorphism was not associated with IDC (control n = 429) (Arg389 allele homozygosity : odds ratio = 1.03; confidence limits = 0.78-1.35); nor did it predict LVEF and cavity dimensions either before or after therapy. Conclusion : in patients homozygous for the risk allele of the ?2c-AR variant; the Beta1-AR variant neither increased the risk for IDC nor predicted its severity or progression in patients not receiving Beta-AR-blockers

Unique Features of Non-Compaction of the Ventricular Myocardium in Arab and African patients : Cardiovascular Topics

Non-compaction of the ventricular myocardium (NCVM) is an under-diagnosed cardiomyopathy. Patients diagnosed with NCVM at the King Abdulaziz Cardiac Centre; Riyadh; KSA from January 2000 to July 2004 and at the Sudan Heart Centre from August 2004 to July 2007 were included. Fifty-two patients with NCVM were identified (22 per 10 000 echocardiograms). Patients were divided into three groups; namely; group 1 : isolated NCVM (21 patients); group 2 : NCVM associated with congenital heart disease (CHD) (26 patients); and group 3 : NCVM associated with mitral regurgitation (MR) (seven patients). Group 1 included 14 females and four males. Five patients (27) had a positive family history with a lethal outcome in five other siblings; 14 patients (76) presented with myocardial dysfunction and two had left ventricle thrombus. Group 2 included CHD; the most common pathologies were ventricular septal defects (VSD); pulmonary and tricuspid atresia and hypoplastic left heart syndrome. Sixteen patients (61) had myocardial dysfunction; seven had surgical repair / palliation; and four (80) developed serious post-operative complications. Group 3 included seven patients with MR associated with deformity of the anterior mitral leaflet and malcoaptation. Myocardial function was preserved in all patients with this pathology. In four patients of the whole cohort there was clinical as well as echocardiographic improvement. In two patients; left ventricular hypertrophy was noted. There were significantly more females in the group with isolated NCVM than in the group with associated CHD (p = 0.03; odds ratio = 4.2; 95CI = 0.529-16.1). We presented the largest series of NCVM in our area and found it to be not as rare as was thought; with females being more affected. Spontaneous improvement and left ventricular hypertrophy were unique features; and mitral valve deformity leading to MR was an established association

The G-308A Polymorphism of the TNF-? Gene Does not Predict Changes in Cardiac Function in Response to Medical Therapy for Idiopathic Dilated Cardiomyopathy

The G-308A polymorphism of the tumour necrosis factor-? (TNF-?) gene; a variant that influences TNF-? transcription; may contribute to non-ischaemic dilated cardiomyopathy. To evaluate whether TNF-? genotyping may assist in identifying a subset of patients who could potentially benefit from immunomodulatory therapy; we assessed the relationship between the G-308A polymorphism of the TNF-? gene and changes in left ventricular (LV) chamber dimensions and systolic function in patients with idiopathic dilated cardiomyopathy (IDC) before and six months after diuretic; digoxin and angiotensin-converting enzyme inhibitor (ACEI) therapy. In 331 patients with IDC and 349 controls; the TNF-2 (A) allele (odds ratio = 1.509; 95CI = 1.130-2.015; p 0.01) and the TNF-12/22 (AG/GG) genotype (odds ratio CI = 1.159-2.266; p 0.01) were associated with IDC. However; in 122 patients with IDC; the TNF-? genotype was not associated with plasma TNF-? concentrations. In 133 patients with IDC; the TNF-? genotype failed to predict either the severity of pump dysfunction and cardiac dilatation at baseline; or changes in pump function and cardiac dimensions after six months of medical treatment. We conclude therefore that although the TNF-? gene G-308A polymorphism may contribute to the development of IDC; it does not influence pump function or adverse cardiac remodelling in patients with IDC. Genotyping for this variant is therefore unlikely to assist in identifying patients with heart failure who may be particularly susceptible to novel immunomodulatory therapeutic strategies

Inhospital cardiovascular morbidity and mortality in the department of internal medicine at CHU Kigali (Rwanda)

Cardiovascular diseases (CVD) formerly considered as developed countries pandemic, are becoming nowadays increasingly ubiquitous in developing countries, where in addition to a steady increase in different risk factors, there is substantial inaccessibility to health care. However, data about the burden of CVD is lacking in many sub-Saharan African countries, and their morbimortality characteristics have been poorly described. Authors carried out a descriptive and retrospective study over a 12-month period, to describe the inhospital morbidity and mortality of CVD in the Department of Internal Medicine at University Teaching Hospital in Kigali City. Data were collected from 226 CVD cases (91 males and 135 females). The patients' age ranged from 26 to 94 years (mean age of 47.17 ± 16.04). The 226 CVD cases account for the 8.2% of hospitalized patients. Hypertension was the principal cause of death (43.1% of deaths) and the predominant cause of patients' admission (42.9%), followed by cardiomyopathies (11.9%) and valvular heart diseases (11.5%). The association between a CVD and HIV/AIDS infection was observed in 23.9% of the total patients, but no causality relationship was investigated. Isolated heart failure takes the first place (33.6%) among the cardiovascular complications, followed by stroke (14.2%) and isolated renal failure (7.5%). Findings of this study confirm the importance of CVD in CHU Kigali, not only by their inhospital frequency but also- and especially by their lethality rate and their complications associated. This study stresses also a real need of CVD community survey in Rwanda