Cardiac Dimensions in Normal Pregnancy: A Prospective Study.

BACKGROUND: Pregnancy, a unique physiologic state, is associated with several changes in the various body systems. The cardiovascular system is one of the systems affected, with chronic volume overload being one of the characteristic changes experienced during pregnancy. Cardiovascular disease in pregnancy is the leading cause of non-obstetric maternal death worldwide. AIM: This study aims to determine and describe the changes in left and right ventricular and atrial sizes in systole and diastole in the course of normal pregnancy. METHODS AND MATERIALS: A cohort study was conducted among healthy pregnant women between the age of 18 and 40 who attended the antenatal clinic of Federal Medical Centre (FMC), Yenagoa, Bayelsa State. Fifty women were recruited during the first trimester (T1) of pregnancy and followed up until six weeks postpartum. Ethical approval was obtained from the Research Ethics Committee of Federal Medical Centre, Yenagoa, with approval number FMCY/REC/ECC/2019/JAN/150. Clinical evaluation, hematologic, biochemical, and anthropometric assessments, and two-dimensional M-mode and Doppler echocardiography were done for the participants in each trimester of pregnancy and at six weeks postpartum. The clinical and echocardiographic parameters were analyzed using Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: The mean trend of left ventricular posterior wall thickness in diastole (LVPWd) and left ventricular posterior wall thickness in systole (LVPWs) increased progressively from the first to third trimester (T3) (not statistically significant) but dropped toward initial values in postpartum to the level that was statistically significant for LVWPd alone when compared to baseline first trimester values. The left atrial diameter in systole (LADs) was largest in the third trimester, and the left atrial volume index (LAVI) and right ventricular basal diameter (RVD1) also showed a similar trend. The left ventricular internal diameter (LVID) in both systole and diastole increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). The right atrial diameter (RAD) and right atrial volume (RAV) also increased progressively from the first to the third trimesters, but the increase was only statistically significant between the third trimester (T3) and the first trimester (T1). CONCLUSION: Changes were noticed in the cardiac chamber sizes during pregnancy. However, this reversed back to levels similar to the first trimester during the postpartum period. To aid in the early detection and treatment of cardiovascular disorders in pregnancy, screening of apparently healthy pregnant women who later developed complaints is advised as cardiovascular changes could be significant during pregnancy.

Short-term rehospitalisation or death and determinants after admission for acute heart failure in a cohort of African patients in Port Harcourt, southern Nigeria.

BACKGROUND: Heart failure (HF) is a major health burden globally and contributes significantly to morbidity and mortality related to cardiovascular disease. The aim of this study was to determine the outcome, and factors determining these outcomes in patients admitted for acute HF and followed up for six months. METHOD: This was a hospital-based, prospective study. Subjects included consecutive patients with a confirmed diagnosis of acute HF admitted to the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) in Nigeria over one year. All had a full physical examination and relevant investigations, including echocardiography. Subjects were followed up for six months and reassessed for outcome/endpoint, which was rehospitalisation or death. Factors that predicted these outcomes were also determined. RESULTS: There were 160 subjects, 84 females and 76 males, age range 20 to 87 years, mean age 52.49 ± 13.89 years. Sixteen subjects (10.0%) were lost to follow up, 66 (41.3%) showed clinical improvement, 57 (35.6%) were rehospitalised, while 21 (13.1%) died. Determinants of rehospitalisation were New York Heart Association (NYHA) class, heart failure type, haemoglobin level at presentation and estimated glomerular filtration rate (eGFR). Determinants of mortality were NYHA class and haemoglobin level at presentation. CONCLUSION: Heart failure rehospitalisation and mortality rates of 35.6 and 13.1%, respectively, were high compared to developed countries.

Comparison of 3 risk estimators to guide initiation of statin therapy for primary prevention of cardiovascular disease.

BACKGROUND: Among high-risk individuals, statins are beneficial for primary prevention of cardiovascular disease (CVD). In Nigeria, currently, there are no CVD prevention guidelines, so the use of CVD risk estimation to guide statin therapy is left to the discretion of the physician. OBJECTIVE: The objective of the study was to compare 3 CVD risk estimation tools in the evaluation of patients presenting to a tertiary hospital in Nigeria. METHODS: Cross-sectional study involving 295 patients with any CVD risk factors but not taking statins. Traditional CVD risk factors were assessed with a standard questionnaire and laboratory evaluation. Ten-year CVD risk was estimated with American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ACC/AHA ASCVD) Risk Estimator (2013), Framingham Risk Score (Framingham Risk Score [FRS] 2008), and the World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction chart for Africa Region D. Kappa statistic was used to determine agreement among the estimators. RESULTS: The mean age was 48.4 ± 10.4 years; 60.7% were females. Risk factors for CVD were hypertension (56.3%), dyslipidemia (41.4%), diabetes (20%), obesity (28.5%), and cigarette smoking (4.4%). In all, 50.2%, 16.9%, and 15.2% were classified as high risk using the ACC/AHA ASCVD Risk Estimator, FRS 2008, and WHO/ISH risk chart, respectively. The agreement was moderate between FRS and WHO/ISH (Kappa 0.414, P < .001) and fair between ACC/AHA Estimator and WHO/ISH (Kappa 0.223, P < .001) and between ACC/AHA Estimator and FRS (Kappa 0.301, P < .001). CONCLUSIONS: The considerable variation in prediction of high risk using the 3 tools may lead to underutilization of evidence-based therapy. This underscores the dire need for the development of risk prediction tools derived from our own Nigerian population.

Left ventricular dysfunction in normotensive type II diabetic patients in Port Harcourt, Nigeria.

BACKGROUND: Diabetes mellitus (DM) is on the increase globally. Cardiovascular complications, such as left ventricular dysfunction is a major cause of death in patients with type II DM. Prior to the development of symptomatic heart failure, subclinical left ventricular dysfunction (systolic and diastolic) may exist for some time. AIM: The aim of the study was to determine the prevalence of left ventricular dysfunction in non-hypertensive type II DM patients. METHODS: A cross sectional study of left ventricular function in 90 normotensive type II diabetes mellitus patients using echocardiography was carried out. Healthy normotensive controls matched for age, sex, and body mass index were selected for comparison. Patients and controls who had hypertension (blood pressure of >140/90 mmHg), history of smoking, significant alcohol history, pregnancy, features of thyroid disease, or valvular heart disease were excluded. Left ventricular diastolic and systolic functions were assessed. RESULTS: Ninety patients, (39 males and 51 females) and 90 healthy controls (39 males and 51 females) were enrolled. Mean age of patients was 50.76 ± 9.13 years and 51.33 ± 7.84 years for controls. Mean body mass index was 26.88 ± 4.73 kg/m² in patients and 27.09 ± 4.04 kg/m² in controls. Mean ejection fraction was 62.4% ± 8.47% and 68.52% ± 7.94% in patients and controls, respectively (P < 0.001). Fourteen (15.56%) patients had ejection fraction less than 55% compared to four (4.44%) in controls (P < 0.001; odds ratio = 3.96). Impaired diastolic function was found in 65.6% of patients compared to 3.3% of controls (P < 0.001). Left ventricular mass index of >99 kg/m² in females and >115 kg/m² in males was considered abnormal. The left ventricular mass index was also higher in patients than in controls (95.17 ± 25.67 g/m² versus 85.40 ± 18.0 g/m²; P = 0.004). CONCLUSION: Normotensive diabetic patients have a high prevalence of left ventricular dysfunction even in the absence of cardiac symptoms.