Prevalence and Predictors of Atrial Fibrillation and its Embolic Complications in Patients with Rheumatic Heart Disease at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Abstract Background: Atrial fibrillation is one of the complications of rheumatic heart disease, with substantial morbidity and mortality. The prevalence and predictors of atrial fibrillation and its thrombo-embolic complications in Ethiopian patients with rheumatic heart disease are unknown. The objective of this study was to determine the prevalence and predictors of atrial fibrillation and its thromboembolic complications. Methods: A retrospective chart review of 500 patients with rheumatic heart disease at the adult cardiology clinic of Tikur Anbessa Specialized Hospital was carried out from 01 January to 31 June 2016. Data were entered into a pre-tested questionnaire and were analyzed using SPSS version 23. Results: Records of 500 patients (72% female) with electrocardiographic recordings and echocardiographic reports were available for analysis. Atrial fibrillation was found in 234 (46.8%) of the patients. Predictors of atrial fibrillation were found to be: age ≥50 years (p=0.01), left atrial size ≥45mm (p=0.01), the presence of mitral stenosis (p<0.01) and the presence of tricuspid regurgitation (p=0.01). Cardioembolic events were reported in 67 (9.2%) patients, and the presence of atrial fibrillation (p=0.02) and sub-therapeutic anticoagulation status (p<0.01) were significant predictors of cardioembolic events. Conclusions and recommendations: The study reveals a high prevalence of atrial fibrillation and cardioembolic events in Ethiopian patients with rheumatic heart disease. Hence, active screening of atrial fibrillation and optimal anticoagulation are recommended

Coronary Endothelial Dysfunction; Obesity and the Metabolic Syndrome

Objective : To define the impact of the metabolic syndrome (MetS) and obesity on coronary vascular function; with the hypothesis that subjects with MetS will have endothelial dysfunction. Background : Obesity or the metabolic syndrome is associated with a higher risk of diabetes and coronary artery disease (CAD). Endothelial dysfunction is a common causal pathway in the initiation and progression of CAD. Methods : A total of 418 patients (165 obese; 239 MetS) with and without angiographic evidence of CAD underwent coronary vascular function testing by measuring coronary blood flow (CBF) velocity in response to intracoronary infusion of acetylcholine (ACH) and sodium nitroprusside (SNP) and coronary flow reserve with adenosine. Results : Endothelium-dependent microvascular vasodilation correlated with body mass index (BMI) (r = -0.12; p = 0.02); with ACH responses significantly lower in overweight; obese and MetS subjects (p = 0.003). The number of MetS components correlated with the response to ACH in both the coronary microcirculation and the epicardial coronary arteries; and with impaired coronary microcirculatory responses to adenosine. No significant correlation was observed with SNP. In multivariable analysis; beyond age; only the total number of MetS components; and not BMI; emerged as an independent predictor of impaired microvascular response to ACH (CBF: ? = -0.18; p 0.001). Low-grade inflammation (C-reactive protein) was higher in patients with MetS; but was not associated with coronary vascular function. Conclusions : We demonstrate that the clustering of MetS components is an important and independent determinant of coronary endothelial dysfunction in subjects with and without CAD