Coronary angiographic findings in dilated cardiomyopathy in a sub-Saharan African population.

AIM: To describe the coronary angiographic aspects observed in patients with dilated cardiomyopathies (DCM) in a sub-Saharan African country in order to improve their management. METHODS: This was a cross-sectional study conducted from 1 January 2010 to 31 March 2016. All patients aged 18 years and older, presenting with DCM and admitted to Abidjan Heart Institute, who underwent coronary angiography were included. One hundred and eight patients were selected. We analysed and compared the coronary angiographic features observed. RESULTS: The median age of our patients was 52 years (46-61). There was a male predominance (sex ratio = 3). Hypertension (53.7%) was the major cardiovascular risk factor found. Coronary angiography was abnormal in 37 patients (34.3%). Twenty-three patients (21.3%) had obstructive coronary artery disease (CAD). Patients with CAD were older than those with normal coronary arteries, but with no statistically significant difference (p = 0.06). Hypertension (p < 0.001) and diabetes (p = 0.0003) were statistically significantly more commonly reported in patients with CAD. CONCLUSIONS: Ischaemic heart disease is likely to be underdiagnosed in sub-Saharan Africa. A coronary angiographic assessment of patients receiving treatment for DCM, especially in the presence of cardiovascular risk factors, should help optimise their management and improve prognosis.

Coronary artery disease in black African patients with diabetes: Insights from an Ivorian cardiac catheterization centre.

BACKGROUND: Coronary angiography data are scarce for black patients with diabetes. AIM: To assess coronary angiography findings in patients with diabetes at the Abidjan Heart Institute. METHODS: This observational cross-sectional survey was conducted between 1 April 2010 and 31 December 2014. All patients admitted for known or suspected coronary artery disease who underwent coronary angiography were included in the Registre Prospectif des Actes de Cardiologie Interventionnelle de l'Institut de Cardiologie d'Abidjan. We analysed and compared coronary angiographical findings in patients with and without diabetes. RESULTS: Eighty patients with diabetes were compared with 353 patients without diabetes. Patients with diabetes were significantly older (58.7±8.9 vs 52.1±11.5 years; P<0.001). Hypertension and hypertriglyceridaemia were significantly associated with diabetes (P<0.001 and P=0.04, respectively). A higher proportion of patients with diabetes had an abnormal coronary angiogram (85.0% vs 67.7%; P=0.002). Coronary artery disease in patients with diabetes was predominantly characterized by multivessel disease (P<0.001). Cardiovascular risk factors associated with diabetes influenced the severity of coronary lesions. A SYNTAX score≥33 was found in a higher proportion of patients with diabetes (12.5% vs 7.1%). In the multivariable logistic regression, after adjustment, age>60 years (hazard ratio 2.53, 95% confidence interval 1.59-4.04; P<0.001) and diabetes (hazard ratio 2.12, 95% confidence interval 1.26-3.57; P=0.004) were associated with multivessel coronary artery disease. CONCLUSIONS: In our study, diabetes emerged as a risk factor for multivessel coronary artery disease. Future studies should help to define the long-term prognosis of these patients, and to assess the benefits of myocardial revascularization procedures.

Embolisation des fibromyomes utérins (EFU): premières expériences en Côte d'Ivoire à propos de 81 patientes

Objectifs. Rapporter les résultats des premières procédures d'embolisation des fibromyomes (EFU) utérins en Côte d'Ivoire et en préciser les particularités africaines Matériels et méthodes. Etude prospective à visée descriptive réalisée sur unepériode de 25 mois, portant sur des patientes, non ménopausées, présentant un utérus fibromateux symptomatique et n'ayant pas de grossesse et d'infection pelvienne.Elles ont été retenues à l'issue d'une concertation collégiale entre les médecins radiologue interventionnel, gynécologue et anesthésiste.Résultats. L'âge moyen des patientes était de 40,5 ans et 28,3% d'entre elles étaient dans la période de pré-ménopause. Les motifs de consultation étaient dominés par les saignements anormaux avec 89,41% qui disparaissaient dans 92% des cas en post-EFU. Le volume utérin moyen et la taille des myomes dominants étaient respectivement de 849,5 cm3 et 67,7cm passant à 584 cm3 et 45,4cm soit un taux de réduction de 31,3% et 33% après l'embolisation. Le nombre moyen de fibromes était de 12 avec une dévascularisation quasi-totale après l'EFU. Les myomes étaient à 89% intra muraux et de volume très important. L'endométriose représentait la lésion associée majoritaire avec 31% des cas. Le cathétérisme était bilatéral dans 92,6% des cas. Les suites post-EFU étaient marquées par des complications mineures à type de troubles digestifs et aménorrhée définitive dans 4,93% des cas.Conclusion. L'embolisation des artères utérines pour les fibromyomes symptomatiques est une méthode efficace, dont le taux de réussite est de 92,59% dans notre étude, comparable au taux préconisé par la SIR