ABSTRACT
BACKGROUND: There is evidence that cardiac pacemakers improve symptoms and quality of life in patients with severe bradycardia. Globally, the number of pacemaker implantations is on the rise. However, the associated high-cost limits pacemaker's accessibility in low resource settings. This study aimed to investigate access to pacemakers and the long-term outcome of patients requiring a pacemaker. METHOD: We conducted a cohort study in 03 health care structures in Cameroon. Participants aged at least 18 years with indication for a permanent pacemaker between January 2010 and May 2016 were included. Clinical profile, electrocardiography, pacemaker implantation parameters were recorded. Long-term survival was studied by event-free analysis using the Kaplan-Meier method. RESULTS: In total, 147 participants (mean age 67.7±13.7 years, female 58.5%) were included. Fatigue (78.7%), dyspnoea (77.2%), dizziness (47.1%) and palpitations (40.4%) were the main symptoms while syncope was present in 35.7% of patients. The main indication for cardiac pacemaker was atrioventricular block (85.3%). Forty (27.2%) could not be implanted with 34 (85%) of participants highlighting cost of intervention as main reason. VVIR was the main mode of stimulation (70.5%). Of 125 patients in which follow-up was ascertained, 17(13.5%) died after a median survival time of 2.8 years post diagnosis [IQR: 1.8-4.2]. The survival curve was better in participants with a pacemaker with a Hazard ratio of 2.7 [CI: 1.0-7.3, P=0.045]. CONCLUSION: Our patients with severe heart blocks presented late and more than a quarter did not have access to pacemaker but its implantation multiplied the survival rate by 2.7 times at approximately 3 years post diagnosis. Improving early detection of heart blocks and access to cardiac pacing to reduce mortality shall be a key future priority.
Subject(s)
Bradycardia/therapy , Cardiac Pacing, Artificial/statistics & numerical data , Adolescent , Adult , Aged , Atrioventricular Block/mortality , Atrioventricular Block/therapy , Bradycardia/mortality , Cameroon/epidemiology , Cardiac Pacing, Artificial/mortality , Child , Electrocardiography , Female , Health Services Accessibility , Humans , Male , Middle Aged , Prognosis , Quality of Life , Registries , Retrospective Studies , Sick Sinus Syndrome/therapy , Symptom Assessment , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: High level of androgens found in congenital adrenal hyperplasia (CAH) seems to have a deleterious effect on heart function. We therefore evaluate cardiac function of children with CAH in comparison with a healthy group. METHODS: We carried out a case-control study in the single endocrinology unit of the Mother and Child Center of Chantal Biya's Foundation. Cases were matched for age and genotypic sex to 2 healthy controls. We analyzed the ejection fraction (LVEF), fractional shortening and left ventricular mass; output and cardiac index; E and A waves velocities, E/A ratio and the mitral deceleration time and diameter of the left atrium; tricuspid annular plane systolic excursion and pulmonary artery systolic pressure were also measured. RESULTS: We included 19 patients with a median age of 6.26 ± 3.75 years and 38 controls stackable distribution. The left ventricular mass of cases was greater than that of controls. A case of reversible cardiomyopathy on hormone replacement therapy was found. For the cases, the average ejection fraction was 71.95 ± 7.88%; the average fractional shortening was 40.67 ± 7.02%. All these values ââwere higher than those of controls, although the difference was not statistically significant. Diastolic left ventricular function was more impaired among the cases. Right ventricular function was similar in both groups. These abnormalities were highly correlated to the late age at diagnosis and duration of treatment. CONCLUSION: This study shows an altered cardiac function in CAH compared to healthy control and highlights importance of an early diagnosis of cases, a tight control of androgens levels and a regular monitoring of cardiac function.
Subject(s)
Adrenal Hyperplasia, Congenital/physiopathology , Heart/physiopathology , Adolescent , Cameroon , Case-Control Studies , Child , Child, Preschool , Female , Heart Function Tests , Humans , Infant , MaleABSTRACT
INTRODUCTION. L'artériopathie oblitérante des membres inférieurs (AOMI) évolue chez près de 70% des malades de manière asymptomatique. Le but de notre étude était de décrire les aspects épidémiologiques, cliniques et diagnostiques de l'AOMI chez un groupe de patients consultant à l'Hôpital Général de Yaoundé. METHODOLOGIE. Il s'agit d'une étude transversale, descriptive qui s'est déroulée d'Octobre 2012 à Avril 2013 dans l'unité de Cardiologie de l'Hôpital général de Yaoundé. Nous avons recruté 42 sujets ayant au moins un facteur de risque cardiovasculaire majeur. Pour chaque sujet, nous avons collecté des données cliniques, anthropométriques. Puis nous avons mesuré l'Indice des pressions systoliques(IPS) et l'épaisseur intima média (EIM) fémorale. RESULTATS. La moyenne d'âge des sujets était de 54,3 ± 10,3 ans avec un sex-ratio (H/F) de 3,2. Une AOMI (IPS < 0,90) a été retrouvée chez 16,7% des sujets, tandis que 7,1% avaient un IPS > 1,30. L'EIM fémorale moyenne était de 0,82 ± 0,19 mm et 26,2% des sujets avaient une EIM augmentée (> 1 mm). CONCLUSION. L'AOMI asymptomatique est fréquente chez les patients présentant plusieurs facteurs de risque cardiovasculaire à Yaoundé
