Institute Of Cardiologie Dabidjan

Abidjan, Ivory Coast

Institute Of Cardiologie Dabidjan

Abidjan, Ivory Coast

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PubMed | hopital Bichat, CHU de Brazzaville, hopital de Bamako, CHU de Dijon and 14 more.
Type: Journal Article | Journal: Archives of cardiovascular diseases | Year: 2016

Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge.To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations.The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities.The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories.Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.


PubMed | CHU de Bamako, CHU Ignace Deen, Hopitaux Universitaires Of Paris Seine Saint Denis, Institute Of Cardiologie Dabidjan and 5 more.
Type: Journal Article | Journal: Archives of cardiovascular diseases | Year: 2016

There are few African data available on rheumatic heart disease (RHD).To provide data on the clinical characteristics and treatment of patients with RHD hospitalized in sub-Saharan Africa.The VALVAFRIC study is a multicentre hospital-based retrospective registry of patients with RHD hospitalized in African cardiology departments from 2004 to 2008.Among 3441 patients with at least one mild RHD lesion seen on echocardiography in 5 years in 12 cardiology departments from seven countries, 1385 had severe lesions (502 men; 803 women; mean age 29.315.6 years). The ratio of severe to any RHD valvular lesion was higher in countries with the lowest gross domestic product (GDP). Mitral valve regurgitation was seen in 52.8% of cases, aortic regurgitation in 32.1%, mitral stenosis in 13.4% and aortic stenosis in 1.8%. Combined valvular lesions were observed in 13% of cases. Heart failure was present in 40% of patients. Major left ventricular dilatation was observed in 13.6% of patients, ectasic left atrial dilatation in 13.8%, dilatation of the right cardiac chambers in 19.8% and pulmonary hypertension in 28.7%. Patients with no formal schooling (41.5%) were older and had a higher New York Heart Association (NYHA) class and a lower ejection fraction (EF). Among patients aged<20 years (mean age 14.53.8 years), those who were schooled had a lower NYHA class (2.860.92 vs 3.420.93; P<0.01) and a higher EF (60.311.7 vs. 54.812.8; P<0.05) than those who were not. RHD-related delays or school failures were affected by NYHA class, EF and the number of children in the household. Although 1200 of 1334 patients required valve repair or replacement, only 27 had surgery. In-hospital outcomes included death (16%), heart failure (62%), arrhythmias (22%), endocarditis (4%) and thromboembolic events (4%). Subsequently, 176 patients were readmitted (13.6%).Patients with RHD hospitalized in sub-Saharan Africa are young, socially disadvantaged, with a high mortality rate and extremely low access to surgery. Poverty, as quantified by GDP and educational level, affects RHD-related severity, NYHA class and left ventricular dysfunction.


Anzouan-Kacou J.-B.,Institute Of Cardiologie Dabidjan | N'cho-Mottoh M.-P.,Institute Of Cardiologie Dabidjan | Balayssac-Siransy E.,Laboratoire Of Physiologie Et Dexplorations Fonctionnelles
Medecine Nucleaire | Year: 2012

Objective: To assess the prevalence of different types of cardiac dyssynchrony by pulsed Doppler ultrasound and Doppler tissue in patients with narrow QRS with or without left ventricular systolic dysfunction. Methodology: Prospective, cross-sectional survey at the Institute of Cardiology of Abidjan, from January to April 2012, in subjects with narrow QRS. Group 1: patients with dilated cardiomyopathy with severe left ventricular dysfunction (left ventricular end diastolic diameter greater than 60mm and/or 30mm/m 2 and ejection fraction less than 35% NYHA stage IV). Group 2: normal subjects with normal echocardiography. All patients underwent an evaluation including tissue Doppler search for different types of dyssynchrony (atrioventricular, interventricular and left intraventricular). Results: Patients in group 1 were significantly older (51.5. ±. 15.8 vs. 35.8. ±. 7.8, P=. 0.03), with larger left ventricular diameters and significantly higher pulmonary systolic pressure. The prevalence of different types of dyssynchrony in group 1 were: atrioventricular dyssynchrony 43.7%, interventricular dyssynchrony 37.5%, left ventricular dyssynchrony 65.6%. Group 2: atrioventricular dyssynchrony 0%, interventricular dyssynchrony 0%, left ventricular dyssynchrony 35%. Conclusion: A large proportion of patients with left ventricular systolic dysfunction and narrow QRS have cardiac dyssynchrony and left ventricular dyssynchrony can be found in healthy patients. This raises the problem of the specificity of Doppler ultrasound criteria using cardiac tissue Doppler to assess cardiac dyssynchrony. © 2012 Elsevier Masson SAS.


PubMed | Institute Of Cardiologie Dabidjan
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2016

To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population.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).Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13.5%. Mean age was 55.411 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%.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.


PubMed | Institute Of Cardiologie Dabidjan
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2015

Sleep apnea syndrome (SAS) is very little described in the hypertensive black African.To screen sleep apnea syndrome using the rating scale of Epworth daytime sleepiness, and to investigate the determinant factors and to infer therapeutic consequences.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.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%).


PubMed | Institute Of Cardiologie Dabidjan and Medecine hospitalisation
Type: Journal Article | Journal: Medecine et sante tropicales | Year: 2016

to analyze patient-related factors that may influence adherence in patients with heart failure in an African cardiology department.This prospective observational study took place in the in-patient department of the Abidjan cardiology institute and enrolled consecutive patients hospitalized for decompensated heart failure from January to November 2014. The inclusion criteria were chronic heart failure in patients older than 18 years, developing for at least 6 months and treated by medication. The revised heart failure compliance questionnaire was used.The study included 121 patients. Overall adherence was poor in 88.4% of patients. Multiple linear regression analyses showed that use of traditional medicine was associated with poor adherence for the following 3 components: keeping follow-up appointments, medication intake, and sodium limitations. Overall adherence increased with the number of hospitalizations (OR = 1.69, 95% CI 1.13-2.53; p = 0.01). This increase persisted after adjustment for age, sex, educational level, marital status, medical insurance coverage and the use of alternative medicines (traditional and Chinese) (OR = 1.70; CI 1.12-2.28; p = 0.01).Adherence among black Africans with heart failure remains poor, influenced too much by traditional medicine. Therapeutic education is essential to improve patients knowledge about their disease and its treatment.


PubMed | Center Hospitalier University Of Cocody and Institute Of Cardiologie Dabidjan
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2016

Assess prevalence of metabolic syndrome (MetS) in black Africans hypertensive patients.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).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 (2.20.8 against 20.8, P<0.001). MetS was significantly associated with obesity (BMI30kg/m(2): 40.6% against 14%, P<0.001). Cardiovascular complications were observed in 54.8% of hypertensive patients in the presence of MetS.MetS is a reality in sub-Saharan Africa. Adequate preventive measures are needed to limit its progression.


PubMed | Center Hospitalier Intercommunal Of Compiegne, Institute Of Cardiologie Dabidjan, Center Hospitalier Of Gonesse and Service de cardiologie
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2016

Coronary artery disease (CAD) occurs later in life in women when compared to men (10years later). The FAST-MI study has shown that the profile of women with CAD has changed in the past 15years, they are younger, more obese, and usually smokers. Whatever the age at which CAD occurs in women, the prognosis tends to be worse than in men, despite a higher frequency of acute coronary syndrome (ACS) with angiographically normal coronary arteries in women. In women without significant lesion at coronary angiography, the WISE study has shown abnormalities of the coronary vasomotricy. Despite its beneficial effect on morbidity and mortality, cardiac rehabilitation is underused particularly in women. Indeed, several factors do not encourage a woman to follow a cardiac rehabilitation program, even after an ACS. These factors may be cultural, domestic, familial, orthopedic, or even the fear of exercising. Therefore, physicians have to be particularly convincing in women, in order to have them participating in rehabilitation programs. Physical capacity is lower in women when compared to men. However, the weaker the physical capacity, the better the benefit of cardiac rehabilitation. Physical endurance training continuously or in interval, associated to muscle strengthening can improve the physical capacity in women. Vascular risk factors correction is also an important step for the management of women with CAD. Therapeutic education and several available workshops help women to better understand their disease and to improve their self-management when they return home. Anxiety, depression, and sexual dysfunction frequently deteriorate the quality of life of our patients. Therefore, psychological management is also essential in our departments.


PubMed | Institute Of Cardiologie Dabidjan
Type: Journal Article | Journal: Journal des maladies vasculaires | Year: 2016

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.


PubMed | Institute Of Cardiologie Dabidjan
Type: Journal Article | Journal: Annales de cardiologie et d'angeiologie | Year: 2015

Self-medication practice is under-evaluated among black African hypertensive patients.To assess the level of self-medication among black African hypertensive patients and to determine the factors favoring this practice and their consequences.Prospective study during a 3-month period including 612 hypertensive patients followed in Abidjan cardiology institute.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).Self-medication is a common practice in African hypertensive patients. It has many consequences.

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