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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 120-121

Heart failure in Black Africans under 45 years old


Department of Cardiology, Teaching University Hospital of Brazzaville; Department of Doctorals Studies, Faculty of Health Sciences, Marien Ngouabi University of Brazzaville, Brazzaville, Congo

Date of Submission19-Feb-2019
Date of Acceptance18-May-2019
Date of Web Publication11-Nov-2019

Correspondence Address:
Dr. Bertrand F Ellenga-Mbolla
BP 13400, Brazzaville
Congo
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njc.njc_3_19

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How to cite this article:
Ellenga-Mbolla BF, Motsambo D, Ngamami SM, Kaky SGK. Heart failure in Black Africans under 45 years old. Nig J Cardiol 2019;16:120-1

How to cite this URL:
Ellenga-Mbolla BF, Motsambo D, Ngamami SM, Kaky SGK. Heart failure in Black Africans under 45 years old. Nig J Cardiol [serial online] 2019 [cited 2019 Dec 11];16:120-1. Available from: http://www.nigjcardiol.org/text.asp?2019/16/2/120/270688



Sir,

Heart failure (HF) is currently, most commonly associated with ischemic heart disease in the high-income countries.[1],[2] In Africa, hypertension and rheumatic heart disease (RHD) are the most common causes.[1],[2],[3] Further, HF most often affects young patients, unlike in high-income countries.[1],[2] Their overall management is difficult because of the limitations of access to cardiac surgery, and the low income of people living in sub-Saharan Africa.[3],[4]

The aim of this study was to enumerate the main causes of HF in the young patient.

This cross-sectional study was conducted from April 2014 to June 2015, in the Department of Cardiology at the Teaching University Hospital of Brazzaville (the Republic of the Congo). We had included patients admitted for HF, patients whose diagnosis was based on the Framingham criteria, and patients under 45 years old. In all patients, the following examinations were performed: biological analysis, electrocardiography, chest X-ray, and cardiac ultrasonography. Parameters analyzed were clinical, paraclinical, and diagnostic.

In total, 95 patients were included, of which 64 were female (67%). The frequency was 15% of HF. The mean age was 34 ± 6 years (range 18–44). The history of HF was n = 28, 29.5%. Of these, 15 were poor adherence to treatment and 13 were average adherence to treatment. On examination, HF was global (n = 63, 66.3%), acute pulmonary edema due to left ventricular failure (n = 26, 27.4%), and rightsided HF (n = 6). On cardiac ultrasound, the average left ventricular ejection failure (%) was 39.6 ± 16 (range 18–76). The main causes of HF are reported in [Table 1]. The rheumatic valvular heart diseases were mitral regurgitation (n = 8), mitral stenosis (n = 5), aortic regurgitation (n = 4), and mitral disease (n = 1). The decompensation factors for HF were the salt diet consumption (n = 22), discontinuation of treatment (n = 17), influenza (n = 8), and atrial fibrillation (n = 4). Comorbidities are also recorded in [Table 1].
Table 1: Etiologies and comorbidities of heart failure

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The etiologies of HF in young adults remain dominated by hypertension. Indeed, hypertension affects young patients, and complications are early due to late discovery and limitations of access to care.[3] Peripartum cardiomyopathy remains the obvious cause in young women. This pathology is more common in Black women, and their prognosis is poor.[3],[4],[5] This disease is linked to disadvantaged areas.[5] RHD remains prevalent in Africa, although its prevalence is steadily declining.[2],[3] These valvulopathies are often of poor prognosis, because of the limits of access to cardiac surgery. An important cause of HF is dilated cardiomyopathy (DCM), which occurs in young patients without risk factors or HIV infection, and in good health.[3],[4] Etiological research in idiopathic DCM remains limited, due to limitations of access to coronary angiography, in many Sub-Saharan African countries. In addition, the place of ischemic heart disease is increasing because the epidemiological transition in this world area.[2] Ogah and Falase reported the intricacy of several factors in the occurrence of DCM in Africa.[4] In view of these aspects, the prevention of communicable and noncommunicable diseases must remain active in low-income populations, to limit the occurrence of complications.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Khatibzadeh S, Farzadfar F, Oliver J, Ezzati M, Moran A. Worldwide risk factors for heart failure: A systematic review and pooled analysis. Int J Cardiol 2013;168:1186-94.  Back to cited text no. 1
    
2.
Dokainish H, Teo K, Zhu J, Roy A, AlHabib KF, ElSayed A, et al. Heart failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol 2016;204:133-41.  Back to cited text no. 2
    
3.
Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, et al. The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries. Arch Intern Med 2012;172:1386-94.  Back to cited text no. 3
    
4.
Ogah OS, Falase AO. Cardiomyopathies in sub-saharan africa : hypertensive heart disease (cardiomyopathy), peripartum cardiomyopathy, and HIV-associated cardiomyopathy. In: Cardiomyopathies-Types and Treatment. IntechOpen 2017. DOI: 10.5772/67023.  Back to cited text no. 4
    
5.
Sliwa K, Mebazaa A, Hilfiker-Kleiner D, Petrie MC, Maggioni AP, Laroche C, et al. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational research programme in conjunction with the heart failure association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail 2017;19:1131-41.  Back to cited text no. 5
    



 
 
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