Prognostic value of admission hyperglycaemia in black Africans with acute coronary syndromes: a cross-sectional study.

AIM: The aim of the study was to determine the relationship between acute hyperglycaemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). METHODS: From January 2002 to December 2017, 1 168 patients aged ≥ 18 years old, including 332 patients with diabetes (28.4%), consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l). Predictors for death were determined by multivariate logistic regression. RESULTS: The prevalence of admission hyperglycaemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycaemia (hazard ratio = 2.33; 1.44-3.77; p < 0.001), heart failure (HR = 2.22; 1.38-3.56; p = 0.001), reduced left ventricular ejection fraction (HR = 6.41; 3.72-11.03; p < 0.001, sustained ventricular tachycardia or ventricular fibrillation (HR = 3.43; 1.37-8.62; p = 0.008) and cardiogenic shock (HR = 8.82; 4.38-17.76; p < 0.001) were predictive factors associated with in-hospital death. In sub-group analysis according to the history of diabetes, hyperglycaemia at admission was a predictor for death only in patients without diabetes (HR = 3.12; 1.72-5.68; p < 0.001). CONCLUSIONS: In ACS patients and particularly those without a history of diabetes, admission acute hyperglycaemia was a potentially threatening condition. Appropriate management, follow up and screening for glucose metabolism disorders should be implemented in these patients.

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.

[Thromboembolic manifestations in 36 HIV-infected patients in West Africa]. / Manifestations thromboemboliques chez 36 patients Ouest Africains infectés par le VIH.

In HIV-infected patients thromboembolic disease is a complication linked to heightened risk. In Ivory Coast no study has been conducted on HIV-infected patients treated in HIV Services. The aim of our study is to describe HIV-associated thromboembolic manifestations in patients treated or untreated with antiretroviral drugs whose data were collected in the Infectious and Tropical Diseases Service (ITDS). We conducted a retrospective study by reviewing the medical records of HIV-infected patients hospitalized with deep vein thrombosis (DVT), arterial thrombosis and/or pulmonary embolism over the period January 2005-July 2015. Diagnosis was based on Doppler ultrasound of vessels and/or on thoracic angioscanner. Diagnostic, therapeutic and evolutionary features of thromboembolic manifestations in these patients were analyzed. The medical records of 36 patients, including 23 women (64%), with a sex-ratio M/F of 0.57 and an average age of 43±12 years were selected. Deep venous thrombosis (DVT) was found in 26 (72.2%) patients, pulmonary embolism (PE) in 9 (25%) patients and arterial thrombosis in 1 patient (2.8%). DVT was unilateral in 81% of cases and predominantly left-sided in 77% of cases. PE was unilateral and right-sided in 100% of cases while arterial thrombosis was bilateral in 2.7% of cases. In patients with DVT, the femoral vein (39%) and the popliteal vein (35%) were most commonly affected by thrombosis. PE involved the pulmonary arteries in 77.8% of cases while arterial thrombosis involved the left and right internal carotid. The majority of patients was under antiretroviral treatment (69%). The most commonly associated opportunistic infections included oral candidiasis (31%) and tuberculosis (33%). Nine patients died (25%). This study highlights high rates of DVT in HIV-infected patients. Other studies are necessary to better understand the role of HIV in the occurrence of thromboembolic disease.

Transoesophageal echocardiography (TEE) at the Institute of Cardiology in Abidjan: indications, results and diagnostic accuracy.

OBJECTIVE: The aim of the study was to define the indications for and results and diagnostic accuracy of transoesophageal echocardiography (TEE) in the Abidjan Cardiology Institute. METHODS: A retrospective analysis was carried out of 103 TEE reports from February 2007 to January 2011. The analysis focused on the clinical characteristics of the patients, quality of the prescribers, and indications and diagnostic accuracy (proportion of confirmed diagnoses, which is the ratio of 'anomaly found/number of examinations made for the indication'). RESULTS: There were 47 women (45.6%) and 56 men (54. 4%) in the study, with an average age of 37.9 ± 16.4 years. Prescribers were mostly cardiologists (n = 57; 55.4%). The indications were predominantly evaluation for atrial septal defect (ASD, 34.9%), investigation for thrombus due to rhythm disturbance before cardioversion (18.4%), aetiological evaluation of ischaemic stroke (13.5%), and assessment for mitral regurgitation (lesion assessment, mechanism and/or quantification, 9.7%). In the evaluation for an ASD, TEE was contributory in 17.3% and for thrombus, it was 21%. No embolic aetiology was found in the ischaemic strokes. Three examinations weredone during cardiac surgery to assess the mechanical valves or quality of mitral plasty. There were no incidents or accidents reported during those 103 examinations. CONCLUSION: Because of the high number of congenital heart disease cases discovered in adulthood involving arrhythmias and valvular heart disease, TEE is likely to become more important as a means of diagnosis, and should be used correctly so as to achieve optimal diagnostic advantage. TEE should be provided by specialists not cardiologists.

Hypertension management in an outpatient clinic at the Institute of Cardiology of Abidjan (Ivory Coast).

BACKGROUND: Elevated blood pressure is one of the most important modifiable risk factors for cardiovascular diseases. AIM: To evaluate blood pressure management in Côte d'Ivoire. METHODS: A retrospective study was conducted among 2575 hypertensive patients from the Institute of Cardiology of Abidjan, who were followed for at least 10 years, between January 2000 and December 2009. RESULTS: The patients' mean age ± standard deviation was 59.1 ± 12.5 years; 54.3% were women. At first presentation, hypertension was stage 1 in 21.7%, stage 2 in 32.3% and stage 3 in 46.0% of patients. According to the European guidelines' stratification of the cardiovascular risk-excess attributable to high blood pressure, 46.7% had a very high added risk, 37.8% had a high added risk and 14.9% had a low-to-moderate added risk. Pharmacological therapy was prescribed in 97.8% of patients; more than 66% were receiving at least two antihypertensive drugs, including fixed-dose combination drugs. The most common agents used were diuretics (59.7%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (59.6%). The most common agents for monotherapy were calcium antagonists. When two or more drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were most commonly used. Blood pressure control was achieved in 43.7% of cases. CONCLUSION: In our series, severe hypertension with high added risk or very high added risk was very common. Treatment--mostly diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers--required at least two antihypertensive drugs to meet the recommended blood pressure target.

Unusual giant right atrium in rheumatic mitral stenosis and tricuspid insufficiency.

Dilation and hypertrophy of the atria occur in patients with valvular heart disease especially in mitral regurgitation, mitral stenosis or tricuspid abnormalities. In sub-saharan Africa, rheumatic fever is still the leading cause of valvular heart disease. We report a case of an unusual giant right atrium in context of rheumatic stenosis and severe tricuspid regurgitation in a 58-year-old woman.