Friedrich Thienemann1, Anastase Dzudie2, Ana O Mocumbi3, Lori Blauwet4, Mahmoud U Sani5, Kamilu M Karaye6, Okechukwu S Ogah7, Irina Mbanze8, Amam Mbakwem9, Patience Udo10, Kemi Tibazarwa11, Albertino Damasceno8, Ashley K Keates12, Simon Stewart13, Karen Sliwa14. 1. Institute of Infectious Diseases and Molecular Medicine and Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa. 2. Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon. 3. Instituto Nacional de Saúde, and Universidade Eduardo Mondlane, Maputo, Mozambique. 4. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA. 5. Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, PMB 3452 Kano, Nigeria. 6. Department of Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria. 7. Division of Cardiology, Department of Medicine, University College Hospital Ibadan, Oyo State, Nigeria. 8. Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique. 9. Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria. 10. Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria. 11. Department of Cardiovascular Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania; Hatter Institute for Cardiovascular Research in Africa and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 12. Mary MacKillop Institute for Health Research and NHMRC Centre for Research Excellence (CRE) to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia. 13. Hatter Institute for Cardiovascular Research in Africa and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Mary MacKillop Institute for Health Research and NHMRC Centre for Research Excellence (CRE) to Reduce Inequality in Heart Disease, Australian Catholic University, Melbourne, Australia; Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa. 14. Hatter Institute for Cardiovascular Research in Africa and Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: Karen.Sliwa-Hahnle@uct.ac.za.
Abstract
BACKGROUND: Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. METHODS: A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. RESULTS: There were 209 adults (median age 48years [IQR 35, 64]) and 11 children (age range 1 to 17years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252m (IQR 120, 350) and median right ventricular systolic pressure 58mmHg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment (p=0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. CONCLUSIONS: These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02265887).
BACKGROUND: Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. METHODS: A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. RESULTS: There were 209 adults (median age 48years [IQR 35, 64]) and 11 children (age range 1 to 17years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252m (IQR 120, 350) and median right ventricular systolic pressure 58mmHg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment (p=0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. CONCLUSIONS: These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02265887).
Authors: Anastase Dzudie; Bonaventure Suiru Dzekem; Dike B Ojji; Andre Pascal Kengne; Ana Olga Mocumbi; Karen Sliwa; Friedrich Thienemann Journal: Cardiovasc Diagn Ther Date: 2020-04
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Authors: Brandy E Wade; Kristi M Porter; Sharilyn Almodovar; Justin M Smith; Robert A Lopez-Astacio; Kaiser Bijli; Bum-Yong Kang; Sushma K Cribbs; David M Guidot; Deborah Molehin; Bryan K McNair; Laura Pumarejo-Gomez; Jaritza Perez Hernandez; Ethan A Salazar; Edgar G Martinez; Laurence Huang; Cari F Kessing; Edu B Suarez-Martinez; Kevin Pruitt; Priscilla Y Hsue; William R Tyor; Sonia C Flores; Roy L Sutliff Journal: Sci Rep Date: 2020-07-16 Impact factor: 4.379