[Cardiovascular risk assessment among patients with hypertension based on SCORE2 and SCORE-OP algorithms in black Africans]. / Évaluation du risque cardiovasculaire chez les patients hypertendus selon le SCORE2 et le SCORE OP dans une population d'Afrique subsaharienne.

BACKGROUND: Hypertension is a major risk factor for cardiovascular events. The cardiovascular risk assessment is performed using specific algorithms, particularly SCORE2 and SCORE2-OP developed by the European Society of Cardiology. PATIENTS AND METHODS: Prospective cohort study from February 1, 2022, to July 31, 2022, enrolling 410 hypertensive patients. Epidemiological, paraclinical, therapeutic, and follow-up data were analyzed. Cardiovascular risk stratification of patients was performed using SCORE2 and SCORE2-OP algorithms. We compared the initial and 6-month cardiovascular risks. RESULTS: The mean age of the patients was 60.88 ± 12.35 years with a female predominance (sex ratio = 0.66). In addition to hypertension, dyslipidemia (45.4%) was the most frequently associated risk factor. A high proportion of patients were classified as high (48.6%) and very high (46.3%) cardiovascular risk, with a significant difference between men and women. Reassessment of cardiovascular risk after 6 months of treatment found significant differences compared with the initial cardiovascular risk (p < 0.001). The rate of patients at low to moderate cardiovascular risk (49.5%) increased substantially, whereas the proportion of patients at very high risk decreased (6.8%). CONCLUSION: Our study conducted at Abidjan Heart Institute in a young population of patients with hypertension revealed a severe cardiovascular risk profile. Almost half of the patients are classified at very high cardiovascular risk, based on the SCORE2 and SCORE2-OP. The widespread use of these new algorithms for risk stratification should lead to more aggressive management and prevention strategies for hypertension and associated risk factors.

[Prevalence and characteristics of erectile dysfunction in coronary patients in Abidjan Heart Institute of Côte d'ivoire]. / Prévalence et caractéristiques de la dysfonction érectile chez les patients coronariens à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

INTRODUCTION: Erectile dysfunction (ED) represents an independent and/or predictive risk factor for coronary heart disease according to many studies. The aim of our study is to determine the prevalence and risk factors associated with erectile dysfunction in coronary patients confirmed by coronary angiography. MATERIAL AND METHOD: We conducted a descriptive and analytical cross-sectional study. A total of 60 patients were included with proven atheromatous coronary lesions after coronary angiography. The study period was from June 1, 2020 to February 29, 2021. After assessment of erectile status based on the short version of the International Index of Erectile Function (IIEF-5). Measures of association were adjusted odds ratios and odd ratios with their confidence intervals. Multivariate analysis was conducted using logistic regression. Only patients with erectile insufficiency underwent penile pharmocodoppler. RESULTS: The mean age was 56 ± 8.4 years with extremes of 28 and 65 years. Erectile status was classified according to the IIEF-5 score as follows: severe ED (32%), moderate (13%), mild (15%) and normal erectile function (40%). The time to onset of ED was> 2 years in 69.4% of cases before the onset of coronary artery disease with a mean time of 2.37 years ± 1.29. In 20% of the cases, the patients were already on treatment before the erectile disorder, 65% undergoing treatment after the erectile disorder and 15% had no undergoing treatment. The main factors associated with ED were: high blood pressure (OR = 7; p = 0.0007), dyslipidemia (OR = 4.86; p = 0.004), diabetes (OR = 3.8; p = 0.02), obesity (OR = 4, 45; p = 0.02) as well as beta blockers (OR = 5.3; p = 0.004), calcium channel blockers (OR = 4.5; p = 0.004) and angiotensin-converting enzyme inhibitors (OR = 4.3; p = 0.008). The vascular cause clearly dominates (95%) of which 61% arterial mechanism, 17% mixed and 17% venous mechanism. The factor associated with a decrease PSVpi was the diabetes (OR = 28; p = 0.01). In multivariate analysis, no factor was statistically associated with ED or decrease in PSVpi. CONCLUSION: Isolated ED appears as an early marker of generalized endothelial dysfunction. Hence the advantage of systematic screening, especially in subjects at risk of cardiovascular disease.

[Evolution of epidemiology and management of acute coronary syndromes in Abidjan : A cross-sectional study of 1011 patients.] / Évolution de l'épidémiologie et de la prise en charge des syndromes coronariens aigus à Abidjan : étude transversale de 1011 patients.

BACKGROUND: To assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS). METHODS: Cross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS. RESULTS: One thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07). CONCLUSION: The burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.

[Practice of home blood pressure monitoring in a population of hypertensive patients in subsaharan Africa]. / Pratique de l'automesure tensionnelle dans une population d'hypertendus en Afrique subsharienne.

AIM: To investigate home blood pressure monitoring (HBPM) practice among treated hypertensive patients in a subsaharan Africa setting. PATIENTS AND METHODS: Cross-sectional observational study over a five-month period from April 30 to September 30, 2019. The survey was carried out among treated hypertensive patients aged at least 18-years-old, received in outpatient consultations department at the Abidjan Heart Institute during the study period. We assessed the rate of patients performing HBPM, and compared characteristics and rate of blood pressure control between patients according to the realization of HBPM. RESULTS: Three hundred hypertensive patients (mean age 59.2±12.0 years, sex ratio 1.4) were included. Of these, 68.3% reported to have information about HBPM. In 42.3% of cases, patients had an electronic blood pressure device at home, the majority of which were devices with arm cuffs (65.3%). The study showed that 40.3% of the patients had received education on hBPSM, most commonly provided by practitioners (71.9%). Among our population study, 36.3% performed HBPM, of whom only 13.8% according to the 3-day standardised protocol. In multivariate analysis, HBPM appeared to be an independent factor associated with better blood pressure control. CONCLUSION: HBPM is rarely used by patients with hypertension in our practice. Most of the patients do not receive education about HBPM and adequate training in order to perform it routinely.

[Assessment of peripheral artery disease in proven coronary patients in Abidjan Heart Institute of Côte d'Ivoire]. / Évaluation des lésions artérielles périphériques chez le coronarien avéré à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

BACKGROUND: Coronary artery disease is mainly due to atherosclerosis. The aim of this study was to evaluate the frequency of peripheral arterial disease in proven coronary artery disease and to determine the associated factors in our context. MATERIAL AND METHODS: We included in a cross-sectional descriptive and analytical study 224 patients with proven coronary artery disease confirmed on coronary angiography from March 1 to October 30, 2019. It took place in the external exploration department of the Abidjan Heart Institute. An ultrasonographic exploration of the supra-aortic trunks and arteries of the lower extremity with measurement of the ankle brachial index (ABI) was carried out. RESULTS: The mean age was 57.4±10.9 years (27-81years). There was a clear male predominance with a sex-ratio of 5. The prevalence of carotid artery disease was 56.4% of patients. The main factors associated with elevated Intima Media Thickness (IMT) and the presence of carotid plaques were male sex (OR=8.8; P=0.038), smoking (OR=2.5; P=0.049) and multi-truncular involvement (OR=3.2; P=0.014). In the lower extremities, there was a prevalence of peripheral arterial disease of 48.5%. The main factors associated with the decrease of ABI were age ≥50 years (OR=2.6; P=0.043), diabetes (OR=2.8; P=0.02), dyslipidemia (OR=3.8; P=0.001) and pluri-truncular involvement (OR=4.5; P<0.0001). CONCLUSION: The presence of significant coronary artery disease in our context is associated with a high prevalence of peripheral carotid artery and lower extremity artery disease. This is all the more so as we are male, over 50 years old, pluri-truncular with many cardiovascular risk factors.

[Assessment of Contraindications to Percutaneous Mitral Commissurotomy (PMC) in Abidjan Heart Institute, Côte d'Ivoire]. / Evaluation des contre-indications à la commissurotomie mitrale percutanée (CMP) à l'Institut de cardiologie d'Abidjan en Côte d'Ivoire.

Rheumatic mitral stenosis is still common in sub-Saharan Africa. The aim of this study was to evaluate the clinical and echocardiographic contraindications to the realization of percutaneous mitral commissurotomy (PMC) in Abidjan Heart Institute. We conducted a prospective, transversal and analytical study in the Exploration Unit from March 30, 2017 to March 30, 2018. Mitral stenosis was severe with an average anatomical surface area of 0.87cm2, an average gradient of 13.7 mmHg and an upstream repercussion (dilatation of the left atrium (78 ml/m2); moderate dilatation of the right atrium (22.3 cm2) and average pulmonary arterial hypertension (PAH) of 55 mmHg). The main clinical contraindications were a history of rest dyspnoea at 66.7%, permanent atrial fibrillation at 53.3 % and clinical manifestations of severe PAH in 40 %. Unfavourable anatomy (95.7 %) evaluated by scores of Wilkins, Cormier and especially Echoscore revisited; bicommissural fusion (95.7 %) and severe aortic valvulopathy (31.1%) were the main barriers in transthoracic echocardiography. In multivariate analysis after linear regression, valvular anatomy, as assessed by the various scores, was significantly related to low socioeconomic status (p=0.018), level of education (p=0.04), severity of mitral stenosis evaluated by the mean gradient (p=0.033) and the impact on the left atrium (p=0.015). Mitral stenosis presents several clinical and echocardiographic contraindications. Adverse anatomy is the main obstacle and is related to low socio-economic status, educational level and severity of stenosis.

La sténose rhumatismale mitrale est courante en Afrique subsaharienne. Le but de cette étude était d'évaluer les contre-indications cliniques et échocardiographiques de la commissurotomie mitrale percutanée (CMP) à l'Institut de cardiologie d'Abidjan. Nous avons mené une étude prospective, transversale et analytique dans l'unité d'exploration du 30 mars 2017 au 30 mars 2018. La sténose mitrale était sévère, avec une surface anatomique moyenne de 0,87 cm2, un gradient moyen de 13,7 mmHg et une répercussion en amont (dilatation) de l'oreillette gauche (78 ml/m2) ; dilatation modérée de l'oreillette droite (22,3 cm2) et hypertension artérielle pulmonaire moyenne (HAP) de 55 mmHg). Les principales contre-indications cliniques étaient des antécédents de dyspnée de repos à 66,7 %, de fibrillation auriculaire permanente à 53,3 % et de manifestations cliniques de HAP sévère à 40 %. L'anatomie défavorable évaluée par les scores de Wilkins, Cormier et surtout l'échoscore revisité ; la fusion bicommissurale (95,7 %) et la valvulopathie aortique sévère (31,1 %) étaient les principaux obstacles à l'échocardiographie transthoracique. Dans l'analyse multivariée après régression linéaire, l'anatomie valvulaire, évaluée par les différents scores, était significativement liée au faible statut socio-économique (p = 0,018), au niveau d'éducation (p = 0,04), à la gravité de la sténose mitrale évaluée par le gradient moyen (p = 0,033) et l'impact sur l'oreillette gauche (p = 0,015). La sténose mitrale présente plusieurs contre-indications cliniques et échocardiographiques. L'anatomie défavorable est le principal obstacle et est liée au faible statut socio-économique, au niveau d'éducation et à la gravité de la sténose.

[Pulmonary embolism and complete atrioventricular block]. / Embolie pulmonaire et bloc auriculoventriculaire complet.

Complete atrioventricular block is a rare complication of pulmonary embolism. We describe the case of a black African patient, aged 42 years, who presented to the emergency department of Abidjan Heart Institute for sudden onset dyspnea and hemoptysis. ECG revealed a third degree atrioventricular block. Computed tomographic angiography showed proximal pulmonary embolism of the right main pulmonary artery. To our knowledge, this is the first case of complete atrioventricular block in pulmonary embolism in Sub-Saharan Africa. In case of pulmonary embolism, clinical and electrocardiographic monitoring is necessary in order to identify this uncommon and potentially serious outcome.

[Percutaneous coronary intervention in the management of acute coronary syndromes in Ivory Coast: Challenges and outcomes]. / Angioplastie coronaire dans les syndromes coronariens aigus en Côte d'Ivoire : difficultés et résultats.

AIM: Assess the challenges and outcomes of percutaneous coronary intervention (PCI) in the management of ACS at Abidjan Heart Institute. PATIENTS AND METHODS: Prospective survey carried out from April, 1st, 2010 to April, 29th, 2016. Whole patients aged 18-year-old, admitted at Abidjan Heart Institute for ACS, and who underwent PCI were included in the Registre prospectif des actes de cardiologie interventionnelle de l'institut de cardiologie d'Abidjan (REPACI). Indications and outcomes of PCI were analyzed. RESULTS: Seven hundred and forty-nine patients were admitted for ACS, of which 165 underwent PCI. Ratio PCI/ACS was 0.22. Mean age was 55.6±9.8 years. Male were predominant (sex-ratio=12.7). Main clinical presentation was ST-elevation myocardial infarction (STEMI) in 75.1% of cases. One-vessel disease was predominant in STEMI (52.4%), and multi-vessel disease in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (51.2%). Most of patients (86.7%) underwent PCI with stent implantation. PCI was performed successfully in 97.0% of cases. Main non-fatal complications were hematoma (2.4%). In-hospital mortality-rate was 1.2%, and one-year mortality-rate was 1.6%. CONCLUSION: PCI is performed in Subsaharan Africa with safety, despite encountered difficulties in its implementation.

[Spontaneous coronary artery dissection: An exceptional cause of acute coronary syndrome]. / Dissection spontanée des artères coronaires : une cause rare de syndrome coronarien aigu.

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS) or sudden death, which typically affects young women. We reported two cases of black Africans patients, aged 56 and 52 years old, who presented to Abidjan Heart Institute for ACS. Coronary angiography showed spontaneous dissection of the right coronary artery in the first case, and dissection of the distal left anterior descending artery in the second. A conservative approach was preferred. Both patients received antiplatelet agents, beta-blockers, angiotensin converting enzyme inhibitors and statins, with a favorable in-hospital course. These cases highlight SCAD as a possible cause of ACS. Implementation of interventional cardiology in Sub-Saharan Africa will help identify this uncommon cause of ACS.

[Prevalence and characteristics of metabolic syndrome among hypertensive patients in Abidjan]. / Prévalence et caractéristiques du syndrome métabolique chez les hypertendus à Abidjan.

AIM: Assess prevalence of metabolic syndrome (MetS) in black Africans hypertensive patients. POPULATION: Prospective survey from 3rd November 2014 to 12th June 2015, at Abidjan Heart Institute. Study was carried out among patients aged 18 years old, admitted to external consultation. Oral consent was obtained. MetS was established based on the definitions of the NCEP-ATP III 2005 and the International Diabetes Federation (IDF). RESULTS: Over 1246 hypertensive patients, 404 were included in our study. The prevalence of MetS was 48.8% according to the criteria of the NCEP-ATP III 2005 and 51% according to the IDF. We noticed a female predominance (69% against 31%, P<0.001). Central obesity (49.5%) and low HDL-cholesterol (42.1%) were the factors defining the SM most predominant in our series. Low blood pressure control was higher in the presence of MetS (43.6%). The average number of antihypertensive prescribed drugs were significantly higher (2.2±0.8 against 2±0.8, P<0.001). MetS was significantly associated with obesity (BMI≥30kg/m(2) : 40.6% against 14%, P<0.001). Cardiovascular complications were observed in 54.8% of hypertensive patients in the presence of MetS. CONCLUSION: MetS is a reality in sub-Saharan Africa. Adequate preventive measures are needed to limit its progression.

[Coronary artery aneurysms probably due to Kawasaki's disease]. / Anévrismes coronaires chez un adulte jeune évocateurs d'une probable maladie de Kawasaki.

We report the case of a young adult admitted to the Abidjan Heart Institute for coronary angiography to explore unstable angina. Coronary angiography showed multiple aneurysms which suggested sequelae of misdiagnosed Kawasaki disease.

[Prevalence and characteristics of acute coronary syndromes in a sub-Saharan Africa population]. / Prévalence et caractéristiques des syndromes coronariens aigus dans une population d'Afrique subsaharienne.

AIM: To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population. PATIENTS AND METHODS: Prospective survey from January, 2010 to December, 2013, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for acute coronary syndrome (ACS). RESULTS: Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13.5%. Mean age was 55.4±11 years. Clinical presentation was predominantly ST-segment elevation myocardial infarction (STEMI) in 71.5% of subjects, non-ST-segment elevation acute coronary syndrome (NSTE-ACS) accounted for 28.5%. Two hundred and eighty patients (65.9%) were transferred by unsafe transportation. Among the 89 patients admitted within 12hours of the onset of symptoms, primary percutaneous coronary intervention was performed in 20 patients (22.5%), or 6.6% of STEMI as a whole. Twenty-five patients (8.2%) received fibrinolytic therapy with alteplase. In-hospital death rate was 10%. CONCLUSION: The prevalence of acute coronary syndromes is increasing in sub-Saharan Africa. Excessive delays of admission and limited technical facilities are the major difficulties of their management in our regions.

[Self-medication among black African hypertensive patients: Factors and consequences]. / Recours à l'automédication chez l'hypertendu noir africain : ses facteurs et ses conséquences.

INTRODUCTION: Self-medication practice is under-evaluated among black African hypertensive patients. AIM: To assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences. METHODS: Prospective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute. RESULTS: Mean age was 55.1. The patients had a self-medication use in 60.1% of cases. Medicinal plants and derived products were commonly involved. Self-medication use reasons were: influence of relatives (89.8%) and the fear of antihypertensive drugs adverses effects (54.9%). Multivariate analysis shows that factors of self-medication were age (56.6 years vs. 50.3 years, P<0.001), income less than 762 euros/month (88% vs. 75.4%; OR=2.73; 95% CI: 1.62-4.6; P<0,0001), obesity (70.4% vs. 35.6%; OR=1.24; 95% CI: 0.75-1.15; P=0.037), dyslipidemia (40.8% vs. 27.9%; OR=6.72; 95% CI: 0.57-2.13; P=0.043), antihypertensive association therapy (61.7% vs. 51.4%; OR=2.27; 95% CI: 0.25-0.97; P=0.037). Poor control of high blood pressure (HBP) was a consequence of self-medication (6.5% vs. 47.1%; OR=10.27; 95% CI: 4.65-56.4; P=0.034), repercussions of HBP on major organ (75% vs. 17.2%; OR=12.9; 95% CI: 8.5-19.6; P=0.0001). CONCLUSION: Self-medication is a common practice in African hypertensive patients. It has many consequences.

[Presumption of sleep apnea in a black African hypertensive population: Importance of the Epworth sleepiness scale in the diagnostic approach]. / Présomption d'apnées du sommeil dans une population d'hypertendus Noirs africains : intérêt de l'échelle de somnolence diurne d'Epworth dans l'approche diagnostique.

INTRODUCTION: Sleep apnea syndrome (SAS) is very little described in the hypertensive black African. PURPOSE: To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences. METHOD: This is a retrospective and prospective study with descriptive and analytical purpose that focused on 200 hypertensive outpatients of the Cardiology Institute of Abidjan. The primary endpoint studied was the SAS. The diagnostic approach of SAS was performed using the rating scale of Epworth daytime sleepiness. RESULTS: The prevalence of sleep apnea was 45%. The average age of sleep apnea carriers was 56.1 years, with a male predominance (60%). The determinant factors of sleep apnea syndrome were male gender (60% versus 40%, P=0.021), obesity (77.8% versus 62.7%, P<0.0001), diabetes (26.7% versus 15.5%, P=0.5) and dyslipidemia (54.4% versus 27.3%, P=0.0009). Life in urban areas, occupation and smoking were not correlated with SAS in our series. The control of hypertension was better in non-apneic patients compared to apneic patients (63.6% versus 38.9%, P=0.04). The visceral impact of hypertension in apneic patients was highly significant (77.8% versus 41.7%, P=0.014). Therapeutically, it was noted the preferential prescription of combination therapy in apneic patients compared to non-apneic patients (82.3% versus 74.4%).

Infarctus du myocarde a coronaires saines chez un sujet apres consommation de marijuana

"Introduction. Encore appele ""Cannabis""; la marijuana est la drogue illicite la plus consommee dans le monde avec des effets psychoactifs et medicinaux. Sa consommation peut avoir des consequences gravissimes. L'objectif de ce travail etait de rapporter un cas d'un homme de 32 ans; sans risque cardiovasculaire. Cas clinique et commentaire. Nous rapportons le cas d'un patient de 32 ans; sans facteur de risque cardiovasculaire; admis aux urgences de l'Institut de Cardiologie d'Abidjan pour une douleur thoracique infarctoide prolongee survenue cinq heures auparavant. L'interrogatoire retrouvait une prise de marijuana une heure avant le debut de la douleur. Les elements cliniques et l'electrocardiogramme avaient permis de retenir le diagnostic de syndrome coronarien aigu avec sus-decalage persistant du segment ST. Une revascularisation coronaire par thrombolyse a ete realisee; avec des suites simples. La coronarographie a retrouve des coronaires saines. L'hypothese retenue etait un spasme coronaire prolonge; du a la consommation de marijuana. Conclusion. Ce cas clinique doit attirer l'attention des praticiens et de la population sur les consequences cardiovasculaires possibles inherentes a la consommation de marijuana "

Infarctus du myocarde a coronaires saines chez un sujet jeune apres consommation de marijuana

"Introduction. Encore appele "" Cannabis ""; la marijuana est la drogue illicite la plus consommee dans le monde avec des effets psychoactifs et medicinaux. Sa consommation peut avoir des consequences gravissimes. L'objectif de ce travail etait de rapporter un cas d'un homme de 32 ans; sans risque cardiovasculaire.Cas clinique et commentaire. Nous rapportons le cas d'un patient de 32 ans; sans facteur de risque cardiovasculaire; admis aux urgences de l'Institut de Cardiologie d'Abidjan pour une douleur thoracique infarctoide prolongee survenue cinq heures auparavant. L'interrogatoire retrouvait une prise de marijuana une heure avant le debut de la douleur. Les elements cliniques et l'electrocardiogramme avaient permis de retenir le diagnostic de syndrome coronarien aigu avec sus-decalage persistant du segment ST. Une revascularisation coronaire par thrombolyse a ete realisee; avec des suites simples. La coronarographie a retrouve des coronaires saines. L'hypothese retenue etait un spasme coronaire prolonge; du a la consommation de marijuana. Conclusion. Ce cas clinique doit attirer l'attention des praticiens et de la population sur les consequences cardiovasculaires possibles inherentes a la consommation de marijuana."

[Transthoracic echocardiography in a heart institute in Abidjan (Ivory Coast): Indications and evaluation of the request appropriateness]. / Échocardiographie transthoracique dans un institut de cardiologie à Abidjan (Côte d'Ivoire) : motifs et évaluation de la pertinence des indications.

OBJECTIVES: The aim of this study was to clarify the clinical situations motivating indications of transthoracic echocardiography (TTE) in a cardiology institute in Côte d'Ivoire and to assess the appropriateness of indications. PATIENTS AND METHODS: This is a prospective and observational study conducted over a period of 6 months. The 1733 enrolled were classified according to the indications and their relevance defined by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Echocardiography and the American Heart Association (ACCF/ASE/AHA). RESULTS: In five cases (0.3%), indications were not listed in the document ACCF/ASE/AHA. The most common indication was the initial evaluation of hypertension (HTA) and suspicion of hypertensive heart disease (47.3%). All indications, the assessment in the context of hypertension represented 853 examinations (49.2%). Heart failure accounted for 5.3% of indications, but consisted of 302 applications (17.4%) when was associated hypertension with signs suggestive of heart failure. Requests were considered as appropriate in 95.3%, inappropriate in 3.2% and uncertain in 1.6%. In the group of inappropriate indications patients were significantly younger, and were examinations more often normal and less often absolutely abnormal. CONCLUSION: The profile of cardiovascular morbidity in our institution is dominated by the spectrum of hypertension and heart failure. Each indication must be balanced for the profitability of the ETT.

[Pulse pressure monitoring in hypertensive black Africans]. / Intérêt du suivi de la pression pulsée chez l'hypertendu noir Africain

AIM: A pulse pressure above 60 mmHg in hypertensive subjects is an independent cardiovascular risk factor. There are few data on pulse pressure in sub-Saharan Africa. The aim of this study was to describe the pulse pressure in black Africans with arterial hypertension. METHODS: A 10-year study was carried out on 640 hypertensive sub-Saharan African subjects at the outpatient department of the Abidjan Heart Institute. The primary endpoint was to determine the prevalence of a high pulse pressure, the correlation between pulse pressure and cardiovascular risk factors, the impact of pulse pressure on target organs, and the variation in pulse pressure while on treatment during follow up. Evaluations were made at the start of the study, and in the first, third, sixth and twelfth months of follow up. The mean age was 56.2 years and 56% were female. RESULTS: The prevalence of a high pulse pressure in our patients was 60% at the start of the study. The factors contributing to a high pulse pressure were age over 50 years (75.3 vs 24.7%, p < 0001), gender (60 vs 40%, p = 0.02), and diabetes (76.7 vs 23.3%, p = 0.0006). Smoking, obesity and dyslipidaemia were not related to an elevation in pulse pressure. The control of pulse pressure was poor during monitoring. Only 17.8% of patients had their pulse pressure lowered below 60 mmHg between the first and fifth consultations. A high pulse pressure was a predictor of future myocardial complications but few target organs were significantly affected. Dual therapy with a diuretic was more effective in controlling the pulse pressure, with a reduction rate of 22% during follow up (19.2 mmHg), against a rate reduction of 11% (8.4 mmHg) in patients without a dual diuretic. CONCLUSION: The prevalence of pulse pressure above 60 mmHg was higher in hypertensive black Africans. Their control was poor, but dual therapy with a diuretic was more effective. Myocardial consequences were significant.