M.S. Ikama

Aging, female sex, migration, elevated HDL-C, and inflammation are associated with prevalence of metabolic syndrome among African bank employees

Background The objective of this study was to compare four different criteria for diagnosing metabolic syndrome (MS) and to correlate sociodemographic data, liver enzymes, lipids, inflammation, and insulin resistance with MS definitions. Methods This cross-sectional study included a random number of 126 African bank employees from Brazzaville, Congo. Results The prevalence of MS varied according to the different definitions used: 4.8% under World Health Organization (WHO) criteria, 8.7% under the National Cholesterol Education Program Adult Treatment Panel III (NECP-ATPIII) criteria, 14.3% under the International Diabetes Federation (IDF) for Europe, and 15.9% by the IDF for Central Africa. According to the IDF, specific cutoff points for the erythrocyte sedimentation rate, ≥13 mm at first hour and ≥30 mm at second hour, defined MS for Central Africa. The best agreement was observed between the IDF for Europe and the IDF for Central Africa (Kappa = 0.938; P < 0.0001) criteria. The worst agreements were between the WHO and IDF for Central Africa (Kappa = 0.419; P < 0.0001) criteria and between the WHO and IDF for Europe (Kappa = 0.462; P < 0.0001) criteria. The NECP-ATPIII criteria did not agree with either the IDF for Europe or the IDF for Central Africa criteria. There was a significant relationship between female sex, aging, elevated liver enzymes, elevated phospholipids, high homeostasis model assessment of insulin resistance, and MS defined by the IDF for Central Africa. Conclusion The IDF definition of the MS modified for Central Africa provides higher prevalence estimates of MS than the estimates based on the NECP-ATPIII and IDF for Europe criteria. Liver enzymes, phospholipids, and homeostasis model assessment of insulin resistance should be included in clinical practice to stratify cardiovascular disease risk among Africans.

First thrombolysis in acute stroke with tenecteplase in Congo

Thrombolysis in acute ischemic stroke remains the only effective treatment. Alteplase or recombinant tissue Plasminogen Activator (rt-PA) is the only drug approved and widely used. The use of tenecteplase is still studied (1,2). In subSaharan Africa, many patients, although eligible for thrombolysis, do not benefit for many reasons including accessibility to medical imaging, the lack of stroke unit, and the cost of thrombolytic drug. We report the first Congolese case of intravenous thrombolysis, using tenecteplase.

0248: Echocardiographic profile of the Congolese hypertensive patients

Objectives to assess echocardiographic aspect of Congolese hypertensive patients, and to identify predictive factors of left ventricular hypertrophy (LVH). Material and Methods A transversal study was lead in Brazzaville from January 2011 to December 2013 (36 months). 1125 hypertensive patients under treatment underwent transthoracic echocardiography. The test was carried out either as part of an initial assessment of the hypertension disease or during the development of evocative symptom or complication. Patients’ sociodemographic data and echocardiographic parameters were collected and analyzed. Results There were 621 males (55.2%) and 504 females (44.8%), mean age 54.7±12 years. The main indication of the test were the hypertension initial evaluation in 792 cases (70.4%), dyspnea in 122 cases (10.8%), investigation of ischemic stroke in 101 cases (9%), cardiac failure and chest pain in respectively 58 and 52 cases. The mean duration of hypertension status was 5.3±4.7 years. Echocardiographic test was abnormal in 590 cases (52.4%) and showed hypertrophic cardiomyopathy in 510 cases (45.2%), dilated and hypertrophic cardiomyopathy in 46 cases (4.1%), dilated cardiomyopathy with systolic dys-function in 31 cases (2.8%), coronary artery disease in 4 cases (0.4%). LVH was concentric in 470 cases (84.6%), eccentric in 70 cases (12.6%), and in 16 cases (3%), it was a concentric left ventricular remodeling. The left ventricular’s systolic ejection fraction average was 70.5±9.3%, relaxation disorders in 480 cases (42.6%). Age, male gender, income, known duration of hypertension and treatment were predictive factors of LVH. Conclusions echocardiographic profile of the Congolese hypertensive is quite various, left ventricular hypertrophy is the most predominant abnormality. Efficient management on the hypertension will lead to reduce its morbidity and mortality.

0383: Clinical and echocardiographic profile of HIV-infected patients in cardiology department at the University Hospital of Brazzaville (Congo)

Aim To describe the clinical and echocardiographic aspects of HIV-infected patients. Method this descriptive and analytical study was conducted from 2008 to 2012 in the cardiology department at the University Hospital of Brazzaville. Results one hundred and thirteen patients were included, 75 women (66.4%). There were 46 (40.7%) known HIV patients, and 40 (35.4%) were on antiretroviral treatment. Heart failure was noted in 59 cases (52.2%) which 15 cases (13.3%) of pulmonary acute oedema. The mean ejection fraction was 54.8±16.2% (range: 17-80), and the ejection fraction was lowered in 39 cases (34.5%). Pulmonary hypertension was present in 8 cases (7.1%). The main pathologies were myocarditis (n=33; 29.2%), dilated cardiomyopathy (n=27; 23.9%), myopericarditis (n=20; 17.7%) and tuberculous pericarditis (n=30; 26.5%). The death was recorded in 16 cases. Average CD4 count, ejection fraction, left ventricle diameter and right ventricle diameter were lower in deceased patients, no statistical difference. Conclusion untreated HIV exhibit more cardiovascular complications. Mortality is due to several comorbidities. For limiting these complications, prevention and antiretroviral treatment actually poorly used, are required.

Prevalence of anaemia among patients with heart failure at the Brazzaville University Hospital.

Summary Background Heart failure (HF) is a frequent cause of hospitalisation in cardiology. Its prognosis depends on several risk factors, one of which is anaemia. Objectives We aimed to determine the prevalence of anaemia in patients with heart failure, and evaluate its impact on their prognosis. Methods This article describes a cross-sectional study with prospective collection of data, carried out from 1 January to 31 December 2010 in the Department of Cardiology at Brazzaville University Hospital, Congo. Patients admitted for heart failure were included. Anaemia was defined as a haemoglobin level < 12 g/dl for men and < 11 g/dl for women. Results In total, 130 men (47.8%) and 142 women (52.2%) were recruited, mean age 56.9 ± 16.5 years. The prevalence of anaemia was 42%. Average levels of haemoglobin were 9.4 ± 1.8 and 13.8 ± 4.9 g/dl for the anaemic (A) and non-anaemic (NA) patients, respectively (p = 0.0001). Two hundred and forty-nine patients (91.5%) were in NYHA functional class III–IV. Forty-seven patients (17.3%) were on oral anticoagulation and 15 (5.5%) were on aspirin. The average duration of hospital stay was 19.1 ± 16.7 days, without a significant difference between the A and NA groups (19.4 ± 12 vs 18.8 ± 13.8 days; p = 0.79, respectively). Total mortality rate was 17%, with a significant difference between the A and NA groups (26 vs 10%; p = 0.001). Conclusion This preliminary study showed a high prevalence of anaemia in patients with heart failure, and it had a negative effect on the prognosis.