Influence of systolic blood pressure on outcomes in Nigerians with peripartum cardiomyopathy.

Background: The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP). Patients and Methods: PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90-99, 100-109, 110-119, 120-129, 130-139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling. Results: Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90-99 mmHg, 24.7% had 100-109 mmHg, 24.7% had 110-119 mmHg, 18.5% had 120-129 mmHg, 7.5% had 130-139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90-99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49-10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91-0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or ß-receptor blockers had an HR of 1.71 (95% CI 0.93-3.16, P = 0.085). However, SBP was not associated with LV function recovery. Conclusion: In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.

Relevance of Rheumatic Valvular Heart Disease in the Aetiology of Heart Failure in Contemporary Times.

BACKGROUND: Rheumatic valvular heart disease (RVHD) is one of the foremost causes of heart failure (HF) in our population, particularly among young adults, but a decline in the prevalence of RVHD has been observed. The effect of this decline on the relevance of RVHD among other causes of HF is not established in our setting. OBJECTIVE: To determine whether RVHD is still a leading cause of HF in our population or not. METHODS: This was a retrospective study of HF patients hospitalized between August 2018 and June 2020. The demographic features, blood pressure, aetiology of HF and ejection fraction were retrieved from the unit's HF register. Data were presented as frequencies and medians. Associations were tested as appropriate. RESULTS: RVHD accounted for 78 (35.5%) of HF, with a median age of 47 years. The young and middle- aged subgroups were 10(12.8%) and 48(61.6%), respectively. The affected valves were all regurgitant and 68 (77.2%) had definite RVHD. Isolated mitral valve, combined mitral and aortic valves were affected in 40 (51.3%) and 22 (28.2%), respectively. The median systolic blood pressure and ejection fraction were 110mmHg and 26% respectively. RVHD was associated with HF with reduced ejection fraction. (P value < 0.001). CONCLUSION: RVHD remains one of the leading causes of HF (35.5%) among adults in our population. Young adults are now in the minority and most patients present late in the course of the disease. Valve surgery should be made readily accessible. Primary and secondary prevention of acute rheumatic fever should be reinforced.

CONTEXTE: La cardiopathie valvulaire rhumatismale (RVHD) est l'une des principales causes d'arrete cardiaque (IC) dans notre population, en particulier chez les jeunes adultes, mais une baisse de la prévalence du RVHD a été observée. L'effet de ceci le déclin de la pertinence de la RVHD parmi les autres causes d'IC est pas établi dans notre environnement. OBJECTIF: Déterminer si ou non la RVHD est toujours un cause de l'IC dans notre population. MÉTHODES: Il s'agissait d'une étude rétrospective de patients atteints d'IC hospitalisé entre août 2018 et juin 2020. Le caractéristiques démographiques, tension artérielle, étiologie de l'IC et les fractions d'éjection ont été extraites du registre HF de l'unité. Les données ont été présentées sous forme de fréquences et de médianes. Les associations ont été testés le cas échéant. RÉSULTATS: Le RVHD représentait 78 (35,5%) de l'IC, avec une médiane âge de 47 ans. Les sous-groupes jeunes et d'âge moyen étaient 10 (12,8%) et 48 (61,6%), respectivement. Les valves affectées étaient tous régurgitants et 68 (77,2%) avaient un RVHD défini. La valve mitrale isolée, les valves mitrale et aortique combinées étaient touchés dans 40 (51,3%) et 22 (28,2%), respectivement. Le la pression artérielle systolique médiane et la fraction d'éjection étaient 110 mmHg et 26% respectivement. Le RVHD était associé à HF avec fraction d'éjection réduite. (Valeur P <0,001). CONCLUSION: Le RVHD reste l'une des principales causes de HF (35,5%) chez les adultes de notre population. Les jeunes adultes sont maintenant dans la minorité et la plupart des patients se présentent tard dans le cours de la maladie. La chirurgie valvulaire doit être rendue facilement accessible. Prévention primaire et secondaire de la fièvre rhumatismale aiguë devrait être renforcée. Mots clés: Arrete cardiaque, étiologie, cœur valvulaire rhumatismal maladie.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

Obesity Indices and Peripheral Artery Disease Measured by Ankle Brachial Index in Nigerian Out-Patients.

BACKGROUND: Peripheral artery disease (PAD), an important component of the cardiovascular triad, has been linked with obesity as one of the risk factors for its development. The risk posed by obesity however varies depending on the indices measured. METHODS: We compared the relationship of measures of central and visceral obesity (waist circumference (WC) and waist-hip ratio (WHR) versus that of general obesity (body mass index (BMI) in the development of PAD among Nigerians with hypertension and/or diabetes mellitus. PAD was diagnosed when Ankle Brachial Index (ABI) was <0.9 in either limb. RESULTS: A total of 541 patients (194 males and 347 females) were studied with a mean age of 58.4(±0.46)years. The mean BMI, WC and WHR were 27.8 (±0.222)kg/m2, 96.8 (±0.515)cm and 0.941 (±0.003) respectively. Although the mean BMI, WC and WHR were higher in patients with PAD than those without PAD, the difference was only statistically significant for WC and WHR (p=0.003 and p=0.016) but not BMI (p=0.151). However, the difference in mean BMI was statistically significant in patients <60 years (p=0.015) but not in those >60 years (p=0.953). CONCLUSION: This study has shown that in Nigerian Africans measures of central and visceral obesity were more related to the development of PAD than BMI which is a measure of general obesity and that this lack of significance is probably due to the fact that PAD occurred more in older people as there was a significant relationship with PAD in people younger than 60 years old.

Lower extremity peripheral artery disease: prevalence and risk factors among adult Nigerians with diabetes mellitus.

BACKGROUND: Diabetes mellitus is an important risk factor for development of atherosclerosis. Lower extremity peripheral artery disease (LEAD) which is mainly due to atherosclerosis has been associated with not only increased risk of lower limb amputation but also increased risk of morbidity and mortality from major cardiovascular events such as stroke and myocardial infarction. Information on the prevalence of peripheral vascular disease is scanty in Nigeria. OBJECTIVE: The aim of this study was to determine the prevalence of LEAD and risk factors associated with its development in adult Nigerians with type 2 diabetes mellitus. METHODS: The study was cross-sectional. Patients were consecutively enrolled in the study between August 2009 and May 2010 from the Consultant out-patient department, University of Benin Teaching Hospital, Benin-City, Nigeria. LEAD was assessed in all the patients using Ankle Brachial Index <0.9 in either leg. The Edinburgh Claudication Questionnaire was used to determine if patient had symptomatic disease or not. RESULTS: Three hundred and eighty eight diabetic patients were enrolled in the study out of which 244 (62.9%) were females. The study showed that the prevalence of LEAD was 35.6% when diagnosed using Doppler ABI <0.9 in either leg. The ratio of symptomatic to asymptomatic disease was 1: 7.6. Advancing age, duration of diabetes and concomitant hypertension were important risk factors significantly associated with the disease. CONCLUSION: LEAD is not uncommon among type 2 diabetes patients in Nigeria and the majority were asymptomatic. Advancing age, duration of diabetes and concomitant hypertension were important risk factors identified.

Determination of lower extremity peripheral artery disease: the role for automated Oscillometric measurement of ankle brachial index in Nigerians.

AIMS AND OBJECTIVES: To determine the prevalence of LEAD and compare the accuracy of ABI obtained by automated oscillometric method with Doppler ultrasonography. PATIENTS AND METHODS: This study compared the accuracy of ABI obtained by automated oscillometric method versus that by Doppler among 153 hypertensive patients aged 18 years and above, attending the hypertension clinic of the University of Benin Teaching Hospital, Benin-City. RESULTS: Of the 153 patients studied, 64 (41.8%) and 48 (31.4%) had ABI <0.9 using hand held Doppler ultrasound and automated oscillometric method respectively, while 39 (25.5%) had LEAD detected by both methods. Assuming the gold standard for diagnosis of LEAD was by Doppler ABI < 0.9, ABI obtained by automated oscillometric method had a sensitivity, specificity, positive and negative likelihood ratios of 60.9%, 89.9%, 6.03 and 0.43 respectively while the area under the receiver operating characteristic curve was 0.787. There was good and positive correlation between ABI obtained by automated oscillometric method and Doppler ultrasound with a Pearson's correlation coefficient of 0.73 and 0.74 for left and right lower limbs respectively (p<0.001) CONCLUSION: ABI obtained using automated oscillometric method is a good alternative to Doppler ultrasonography when screening for LEAD.