[Severe ventricular arrhythmias in a patient with dilated cardiomyopathy and automated implantable defibrillator (AID)]. / Orage rythmique chez un patient porteur d'une cardiomyopathie dilatée et un défibrillateur automatique implantable (DAI).

Severe ventricular arrhythmias are frequent during heart failure; they are a life-threatening condition due to the increased risk of sudden death. Efficient management remains limited in sub-Saharan Africa because of the limited or unavailable medical resources as automated implantable defibrillator (AID). We report the case of a 56-year old patient with non ischemic dilated cardiomyopathy with very low left ventricular ejection fraction (LVEF)who underwent AID implantation for primary prevention of sudden cardiac death due to ventricular arrhythmias in 2012. Maintenance therapy combined diuretic, angiotensin-converting enzyme (ACE) inhibitor and anti-vitamin K. In the month of November 2014 the patient had iterative episodes requiring the delivery of electric shocks by the AID, without the sensation of palpitations suggestive of episodes of arrhythmias. Clinical examination is a poor screening test, especially for heart failure. AID detected multiple episodes of tachycardia and ventricular fibrillation justifying antitachycardia pacing (ATP) therapy or the delivery of electric shocks of 15J. The patient was treated with amiodarone and beta blocker. Evolution was favorable at 3-months follow-up. The patients had resumed normal activities, without experiencing new episodes requiring the delivery of electric shocks. This study emphasizes the essential role of anti-arrhythmic drug therapy for severe ventricular arrhythmias, even in the presence of AID.

Prevalence of anaemia among patients with heart failure at the Brazzaville University Hospital.

BACKGROUND: Heart failure (HF) is a frequent cause of ospitalisation in cardiology. Its prognosis depends on several risk factors, one of which is anaemia. OBJECTIVES: We aimed to determine the prevalence of anaemia in patients with heart failure, and evaluate its impact on their prognosis. METHODS: This article describes a cross-sectional study with prospective collection of data, carried out from 1 January to 31 December 2010 in the Department of Cardiology at Brazzaville University Hospital, Congo. Patients admitted for heart failure were included. Anaemia was defined as a haemoglobin level < 12 g/dl for men and < 11 g/dl for women. RESULTS: In total, 130 men (47.8%) and 142 women (52.2%) were recruited, mean age 56.9 ± 16.5 years. The prevalence of anaemia was 42%. Average levels of haemoglobin were 9.4 ± 1.8 and 13.8 ± 4.9 g/dl for the anaemic (A) and non-anaemic (NA) patients, respectively (p = 0.0001). Two hundred and forty-nine patients (91.5%) were in NYHA functional class III-IV. Forty-seven patients (17.3%) were on oral anticoagulation and 15 (5.5%) were on aspirin. The average duration of hospital stay was 19.1 ± 16.7 days, without a significant difference between the A and NA groups (19.4 ± 12 vs 18.8 ± 13.8 days; p = 0.79, respectively). Total mortality rate was 17%, with a significant difference between the A and NA groups (26 vs 10%; p = 0.001). CONCLUSION: This preliminary study showed a high prevalence of anaemia in patients with heart failure, and it had a negative effect on the prognosis.

Aging, female sex, migration, elevated HDL-C, and inflammation are associated with prevalence of metabolic syndrome among African bank employees.

BACKGROUND: The objective of this study was to compare four different criteria for diagnosing metabolic syndrome (MS) and to correlate sociodemographic data, liver enzymes, lipids, inflammation, and insulin resistance with MS definitions. METHODS: This cross-sectional study included a random number of 126 African bank employees from Brazzaville, Congo. RESULTS: THE PREVALENCE OF MS VARIED ACCORDING TO THE DIFFERENT DEFINITIONS USED: 4.8% under World Health Organization (WHO) criteria, 8.7% under the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) criteria, 14.3% under the International Diabetes Federation (IDF) for Europe, and 15.9% by the IDF for Central Africa. According to the IDF, specific cutoff points for the erythrocyte sedimentation rate, ≥13 mm at first hour and ≥30 mm at second hour, defined MS for Central Africa. The best agreement was observed between the IDF for Europe and the IDF for Central Africa (Kappa = 0.938; P < 0.0001) criteria. The worst agreements were between the WHO and IDF for Central Africa (Kappa = 0.419; P < 0.0001) criteria and between the WHO and IDF for Europe (Kappa = 0.462; P < 0.0001) criteria. The NECP-ATPIII criteria did not agree with either the IDF for Europe or the IDF for Central Africa criteria. There was a significant relationship between female sex, aging, elevated liver enzymes, elevated phospholipids, high homeostasis model assessment of insulin resistance, and MS defined by the IDF for Central Africa. CONCLUSION: The IDF definition of the MS modified for Central Africa provides higher prevalence estimates of MS than the estimates based on the NECP-ATPIII and IDF for Europe criteria. Liver enzymes, phospholipids, and homeostasis model assessment of insulin resistance should be included in clinical practice to stratify cardiovascular disease risk among Africans.