|Year : 2015 | Volume
| Issue : 1 | Page : 13-17
Initial experience with echocardiography at the federal medical centre, Umuahia, Nigeria
Kelechukwu Uwanuruochi1, Eme Offia1, Ogba J Ukpabi1, Abali Chuku2, Okechukwu S Ogah3
1 Department of Medicine, Federal Medical Centre, Umuahia, Nigeria
2 Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria
3 Department of Medicine, Division of Cardiology, University College Hospital, Queen Elizabeth Road, Ibadan, Oyo, Nigeria
|Date of Web Publication||5-Jan-2015|
Department of Medicine, Federal Medical Centre, Umuahia, PMB 7001
Source of Support: None, Conflict of Interest: None
Background: Echocardiography is an important non-invasive cardiac procedure which has revolutionalized the practice of cardiology globally. The procedure commenced at the Federal Medical Centre, Umuahia, Nigeria on 19 th November 2012.
Objective: The aim of this report is to present our initial experience with the procedure in our center.
Materials and Methods: This is essentially a descriptive study. Data was prospectively obtained on demographic parameters, indications for the procedure and the main echocardiographic diagnoses. The procedure was performed using Vivid I echocardiograph (Vivid, General Electric Inc. USA) equipped with 2.5-5.0 MHz transducer.
Results: Three hundred and nine procedures were carried out between November 19, 2012 and September 20, 2013. There were 163 males and 146 females who were aged 53.9 ± 23.0 and 46.0 ± 23.0 respectively. The mean age for all the subjects was 51.5 ± 22.0 years. Hypertensive heart disease and congestive cardiac failure comprised 28.7% and 26.3% respectively of the indications for the procedure. The various diagnoses made include: Hypertensive heart disease 121 (39.2%), valvular heart disease 30 (9.7%), pericardial disease 24 (7.8%), cor-pulmonale17 (5.5%), cardiomyopathy 14 (4.5%), congenital heart disease no (3.2%), ischaemic heart disease no (1.0%) and aortic aneurysm no (0.3%). Normal echo was recorded in 89 (28.8).
Conclusion: Hypertensive heart disease was the most common diagnoses in our study. Other diagnoses include valvular heart disease, pericardial disease, corpulmonale and cardiomyopathies. Ischaemic heart disease was uncommon.
Keywords: Echocardiography, federal medical centre Umuahia, initial experience
|How to cite this article:|
Uwanuruochi K, Offia E, Ukpabi OJ, Chuku A, Ogah OS. Initial experience with echocardiography at the federal medical centre, Umuahia, Nigeria. Nig J Cardiol 2015;12:13-7
|How to cite this URL:|
Uwanuruochi K, Offia E, Ukpabi OJ, Chuku A, Ogah OS. Initial experience with echocardiography at the federal medical centre, Umuahia, Nigeria. Nig J Cardiol [serial online] 2015 [cited 2021 Dec 4];12:13-7. Available from: https://www.nigjcardiol.org/text.asp?2015/12/1/13/148480
| Introduction|| |
In the early 1950s Hertz and Edler  first published on the use of ultrasound to assess cardiac disease. Echocardiography is now an established procedure for cardiac evaluation. It was first used inNigeria in 1976.  Over the years many centers have acquired this facility. ,,,, At the Federal Medical Centre Umuahia, Nigeria, echocardiography commenced on 19 th November 2012. The aim of this paper is to report our initial experience with this procedure.
| Materials and methods|| |
This is descriptive analyses of a prospectively collected data. The study was carried out at the Echocardiography laboratory of Cardiology Unit, Department of Medicine, Federal Medical Centre, Umuahia, Nigeria between November 19, 2012 and September 20, 2013. Federal Medical Centre, Umuahia is a tertiary health care institution in the capital city of Abia State, Nigeria. It was founded on 24 th march, 1956. This institution is 327-bedded with 58 medical beds.
Baseline clinical and demographic characteristics were obtained from the subjects. These included: Date of birth, age, gender and indication for echocardiography, weight, height, pulse rate and blood pressure.
Two-dimensional guided M-mode echocardiography with the use of commercially available echo-machine Vivid-1 (General Electric Inc.) and a 2.5-5.0 MHz linear array transducer was performed on each subject in the partial decubitus position. Echocardiographic examination was performed in the parasternal long axis, short axis, two chamber, apical four chamber, five chamber and occasionally in the subcostal and suprasternal views. Measurements and echocardiographic diagnoses were based on standard criteria.
Data management and analysis were performed with SPSS software version 15.0. (SPSS, Inc. Chicago Illinois). Continuous variables were expressed as mean ± standard deviation while categorical variables are expressed as proportions.
| Results|| |
During the 10 months period 319 echocardiograms were performed. 10 were excluded from the analysis due to incomplete data or repeated procedure. [Table 1] shows the clinical and demographic characteristics of the subjects of the 309 subjects. There were 163 males and 146 females who were aged 53.9 ± 23.0 and 46.0 ± 23.0 respectively. The mean age for all the subjects was 51.5 ± 22 years.
[Table 2] shows the indications for referral for echocardiography. The major indications were hypertension or hypertensive heart disease 72 (28.7%) and cardiac failure 66 (26.3%). Other fairly infrequent indications include ischaemic heart disease 11 (4.4%), suspected cardiomyopathy 11 (4.4%), palpitations 10 (4.0%), abnormal electrocardiogram 10 (4.0%), pericardial effusion 7 (2.8%), valvular heart disease 7 (2.8%), cardiomegaly on chest radiograph 7 (2.8%), corpulmonale 6 (2.4%), medical fitness assessment 6 (2.4%) and congenital heart disease 5 (2.0%). In 58 (18.8%) of subjects who came with echocardiography request forms, the physician had not written out the reason for the request.
One hundred and twenty-one subjects (39.2%) had hypertensive heart disease. valvular heart disease 30 (9.7%), cardiomyopathies 14 (4.5%), pericardial diseases 24 (7.8%), corpulmonale 17 (5.5%), were the other diagnoses. Eighty-nine (28.8%) subjects had normal study [Table 3].
Of the valvular diseases, 14 were degenerative, 14, rheumatic in origin while both flail mitral valve and mitral valve prolapse affected one subject each. Among the patients with cardiomyopathy, most were dilated (12), 2 restrictive (endomyocardial fibrosis), while 1 had hypertrophic cardiomyopathy. One case of amyloid heart disease was documented. For the patients with pericardial diseases, 22 were effusive, 1 each had constrictive, and effusive-constrictive pericarditis.
[Figure 1],[Figure 2],[Figure 3] and [Figure 4] are echocardiograms of some of the diagnoses documented. [Figure 5] shows the Spectrum of echocardiographic diagnosed heart diseases (excluding individuals with normal study).
|Figure 1: Dilated cardiomyopathy with minimal contractility of ventricular wall|
Click here to view
|Figure 2: Rheumatic mitral valve disease with thickened and shrunken posterior leaflet|
Click here to view
|Figure 3: Regurgitant jet and systolic pressure gradient in patient with mixed aortic valve Disease|
Click here to view
|Figure 4: Flow across the inter-atrial septum in patient with atrial septal defect|
Click here to view
|Figure 5: Spectrum of echocardiographic diagnosed heart diseases (excluding individuals with normal study)|
Click here to view
| Discussion|| |
Hypertensive heart disease is the most common heart disease in this study. It was the diagnosis in 39.2%. High prevalence have also been reported by Ogah et al.,  and Kolo et al.,  56.7% and 58.8% respectively. One factor that contributes to these varying prevalences is that some physicians request echocardiography as a basic work-up in hypertension, while others do not. 
The prevalence of hypertensive heart disease in our study is much higher than that reported in 2003 (Enugu) by S.O.Ike,  17.3%. In the period Ike covered (1991-2001), echocardiography was less accessible and affordable, and was less requested as a basic work-up in management of uncomplicated hypertension. This explanation is also supported by the higher prevalence (53%) reported in 2012 by James et al.,  compared to 34.0% from the same hospital by Agomuoh et al.,  in 2000.
Out of all the patients 28.8% had normal echocardiogram. This compares to 31.2% reported by Ogah et al.,  (2008), and 30.5% by Agomuo et al.,  (2000). Our value for normal echocardiograms differ from that reported by S O Ike  (2003), 10.9%, because of the national cardiothoracic surgery center at Enugu. Cases referred to the cardiac surgery center are more often patients with structural defects and so less likely to have normal echocardiogram. Kolo et al.,  (2009) from Ilorin also reported a lower frequency of normal echocardiogram, 11.5%. The reason for the difference is that their echocardiography service serves about five states, is therefore less accessible, expectedly doctors will restrict the request to cases where it is vital to decision making and course of management.
With echocardiograms being much more accessible and hence affordable as in our center, its utility as a screening tool comes into place, and physicians may depend on it to help them screen out doubtful cases of structural heart disease. On this note, the higher figures of normal echocardiograms we report would not necessarily be judged improper. This explanation is supported by the low frequency of normal echocardiograms in S O Ike's study; carried out at a time, 1991-2001, when echocardiography at Enugu served all the neighboring states. 
Compared to our report, Aje from Ibadan (2008) reports an even higher percentage of normal echocardiogram (36.5%). The explanation is because pre-chemotherapy (8.2%) as well as routine medical fitness exam (6.4%) formed a significant percentage of referrals in their study. 
Cardiomyopathy was detected in only 4.5% of our patients. The explanation may be that infections are the major etiology in Nigeria, and with improved standard of living, resultant dilated cardiomyopathy is on the decline. This is supported when we observe that in Port-Harcourt Agomuo et al.,  found a prevalence of 19.9% in the year 2000, but by 2012 James O O et al.,  found 6% prevalence. In 2003 Ike S O recorded 9.5% prevalence in Enugu  but in 2008 Ogah et al., reported 3% in Abeokuta.  The prevalence is still relatively high in Calabar-9.7% (Ansa et al., 2013).  This may not be unconnected with high incidence in that area of the Loaloa parasitic infestations associated with Calabar swellings and cardiomyopathy.  In Kano, dilated cardiomyopathy was the second most common heart disease, comprising 16.8% of patients.  The North-East of Nigeria has been suggested to have the highest world incidence of peripartal cardiomyopathy, a form of dilated cardiomyopathy.  Peripartal heart disease has also been reported to be a major component of heart disease in the Nigerian Savanna. 
Majority of our patients with echocardiographic valvular diseases were degenerative in origin. This is understandable since the majority of the subjects were adults.
Echocardiography has improved cardiac medicine in our centre, especially with regard to diagnosis of structural abnormalities. Some of our limitations include the non-availability of transesophageal echocardiography, and as such posterior cardiac structures cannot be more precisely studied. The lack of contrast echocardiography studies also implies we could not reliably exclude such conditions as the presence of intracardiac shunts. We also do not perform stress echocardiography which helps to exclude ischaemic heart disease.
Our study suggests that adequate control of hypertension should remain a clinical priority. Also centres should pursue competence in full utilization of echocardiography, including stress echocardiography as well as endeavour to purchase machines that have full options. Subsequent studies should also indicate percentage of patients who are in heart failure.
| Conclusion|| |
Our study shows that hypertensive heart disease, valvular heart disease, pericardial diseases cardiomyopathy, and cor-pulmonale are the most frequent causes of heart disease in Umuahia, South-Eastern Nigeria.
| Acknowledgements|| |
We are also grateful to the nurses in the Echo room of our center for their cordial assistance.
| References|| |
Krishnamoorthy VK, Sengupta PP, Gentile F, Khandheria BK. History of echocardiography and its future applications in medicine. Crit Care Med 2007;35 Suppl 8:S309-13.
Falase AO. Echocardiography: It′s relevance in the Nigerian setting. Nig Med J 1976;237.
Ike SO. Echocardiography in Nigeria: Experience from University of Nigeria Teaching Hospital (UNTH) Enugu. West Afr J Radiol 2005;1:43-53.
Agomuoh DI, Akpa MR, Alasia DD. Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003. Niger J Med 2006;15:132-6.
Ogah SO, Adegbite GD, Akinyemi RO, Adesina JO, Alabi AA, Udofia OI, et al
. Spectrum of heart diseases in a new cardiac service in Nigeria: An echocardiographic study of 1441 subjects in Abeokuta. BMC Res Notes 2008;1:98.
Ukoh VA. Spectrum of heart diseases in adult Nigerians: An echocardiographic study. Nig J Cardiol 2005;2:24-7.
Kolo PM, Omotoso AB, Adeoye PO, Fasae AJ, Adamu UG, Afolabi J, et al
. Echocardiography at the University of Ilorin teaching hospital, Nigeria: A three years audit. Res J Med Sci 2009;3:141-5.
American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, et al.
Douglas PS, Garcia MJ, Haines DE, Lai WW, Manning WJ, Patel AR, et al
. A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Society of Echocardiography, American Heart Association, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance Endorsed by the American College of Chest Physicians. J Am Coll Cardiol 2011;57:1126-66.
James OO, Efosa JD, Romokeme AM, Zuobemi A, Sotonye DM. Dominance of hypertensive heart disease in a tertiary hospital in southern Nigeria: An echocardiographic study. Ethn Dis 2012;22:136-9.
Aje A, Adebiyi AA, Oladapo OO, Ogah OS, Dada A, Ojji DB, et al
. Audit of echocardiographic services at the university college hospital Ibadan. Niger J Med 2009;18:32-4.
Ansa VO, Odigwe CO, Agbulu RO, Odudu-Umoh I, Uhegbu V, Ekripko U. The clinical utility of echocardiography as a cardiological diagnostic tool in poor resource settings. Niger J Clin Pract 2013;16:82-5.
Klion AD, Massougbodji A, Sadeler BC, Ottesen EA, Nutman TB. Loiasis in endemic and nonendemic populations: Immunologically mediated differences in clinical presentation. J Infect Dis 1991;163:1318-25.
Sani MU, Karaye KM, Ibrahim DA. Cardiac morbidity in subjects referred for echocardiographic assessment at a tertiary medical institution in the Nigerian savanna zone. Afr J Med Med Sci 2007;36:141-7.
Fillmore SJ, Parry EH. The evolution of peripartal heart failure in Zaria, Nigeria. Some etiologic factors. Circulation 1977;56:1058-61.
Ladipo GO, Froude JR, Parry EH. Pattern of heart disease in adults of the Nigerian Savanna: A prospective clinical study. Afr J Med Med Sci 1977;6:185-92.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]