|Year : 2021 | Volume
| Issue : 1 | Page : 1-5
Early practice with two-dimensional transthoracic echocardiography at the Ekiti State University Teaching Hospital. Ado Ekiti Nigeria
Oladapo Adedamola Adewuya1, Olatunji Olubukola Olaoye2, Opeyemi Ezekiel Ojo2, Oluwaseun Olusegun Areo3
1 Cardiology Units, Afe Babalola Multisystem Hospital, Ado Ekiti and Ekiti State University Teaching Hospital, Ado-Ekiti (EKSUTH), Nigeria
2 Cardiology Unit, Ekiti State University Teaching Hosp., Ado-Ekiti, Nigeria
3 Cardiology Units, Federal Teaching Hosp Ido-Ekiti; University Hospital Ayr, Scotland
|Date of Submission||16-Jun-2020|
|Date of Decision||07-Dec-2020|
|Date of Acceptance||02-Nov-2021|
|Date of Web Publication||11-Aug-2022|
Dr. Oladapo Adedamola Adewuya
Cardiology Unit, R-Jolad Multispecialist Hospital, 1 Akindele St, Gbagada Lagos
Source of Support: None, Conflict of Interest: None
Background: Transthoracic echocardiography (TTE) is an essential noninvasive heart study technique which has changed the practice of cardiology worldwide. The procedure began at the Ekiti State University Teaching Hospital on October 24, 2017, till date.
Objective: The objective of the study is to present our early practice with TTE in our location.
Materials and Methods: It is a descriptively analyzed retrospective data acquired on demographic parameters, indications for the procedure, echocardiographic parameters, and diagnoses. The procedure was performed using general electric ultrasound machine Logiq C5 premium equipped with 3.5–5.0MHz transducer.
Results: Three hundred and three procedures were done between October 24, 2017, and December 17, 2019 (2 years 2 months). There were 158 males and 145 females who were aged 52.8 ± 18.1and 56.6 ± 17.2 respectively. The mean age for all the subjects was 54.6 ± 17.8 years. Hypertension made up 168 (55.4%) and arrhythmia 25 (8.3%) of the indications for the procedure. The various diagnoses made include hypertensive heart disease (HHDx) (47.2%), cardiomyopathy (7.3%), valvular heart disease (rheumatic type) (5.9%), congestive cardiac failure (2.6%), pericardial disease (2.0%), left ventricular failure (1.7%), cor-pulmonale (1.7%), thyrotoxic heart disease (0.7%), ischemic heart disease, incomplete echo due to orthopnea, congenital heart disease (0.3%), and normal echo was recorded in (30%).
Conclusion: HHDx was the most common diagnosis in our study. Other diagnoses include dilated cardiomyopathy, valvular heart disease (rheumatic type), cor pulmonale, congestive cardiac failure with varied ejection fractions, and peripartum cardiomyopathies. Congenital heart disease was uncommon.
Keywords: Early practice, echocardiography, Ekiti State University Teaching Hospital Ado Ekiti
|How to cite this article:|
Adewuya OA, Olaoye OO, Ojo OE, Areo OO. Early practice with two-dimensional transthoracic echocardiography at the Ekiti State University Teaching Hospital. Ado Ekiti Nigeria. Nig J Cardiol 2021;18:1-5
|How to cite this URL:|
Adewuya OA, Olaoye OO, Ojo OE, Areo OO. Early practice with two-dimensional transthoracic echocardiography at the Ekiti State University Teaching Hospital. Ado Ekiti Nigeria. Nig J Cardiol [serial online] 2021 [cited 2022 Oct 6];18:1-5. Available from: https://www.nigjcardiol.org/text.asp?2021/18/1/1/353682
| Introduction|| |
Echocardiography is among the top ten greatest discoveries in cardiology of the 20th century. Edler and Heartz printed an article on its use in the initial period of 1950. In the latter part of the 1950s, Effer and Domanig identified left atrial masses during echocardiography. In Nigeria, echocardiography was used for the first time in 1976 as reported by Falase. At present, few centers mostly located in urban areas possess echocardiography machines. Patient's access to the procedure in Nigeria is still low due to the relatively high costs of the technique and dearth of highly specialized personnel for its operation. In the Ekiti State University Teaching Hospital (EKSUTH) Ado-Ekiti, Nigeria, the procedure commenced on October 24, 2017. The goal of this article is to report our early know-how with this technique.
| Materials and Methods|| |
This is a descriptive evaluation of a prospective data collection. The study was done in the laboratory for echocardiography of the Medicine department of EKSUTH between October 24, 2017, and December 17, 2019 (2 years 2 months).
Ekiti state has an estimated population of 2,737,186. EKSUTH is one of the three separate teaching hospitals in the state, the others being Afe Babalola Multisystem Hospital (ABMSH) Ado-Ekiti, and Federal Teaching Hospital Ido-Ekiti about 28 miles from Ado-Ekiti. EKSUTH renders sub-tertiary health care services and is a referral center for Ekiti and neighboring states.
The baseline demographic and clinical characteristics were acquired from the subjects. They are birth date, gender, age, weight, height, and indication for echocardiography.
Two-dimensional-guided M-mode echocardiography with the use of General Electric ultrasound machine Logiq C5 premium equipped with 3.5–5.0MHz transducer was carried out on every subject in the left lateral decubitus position. Echocardiographic axis views were parasternal long axis, short axis, two chamber, apical four chamber, five chamber, suprasternal, and rarely subcostal views. Dimensions and echocardiographic diagnoses were based on customary criteria.
Data analysis was performed with the Statistical Package for the Social Sciences (SPSS software version 20.0 Chicago, Illinois, USA). Categorical variables are expressed as proportions and continuous variables as mean ± standard deviation.
| Results|| |
In the 2 years 2 months, passé 303 echo studies were carried out.
[Table 1] displays the demographic and clinical characteristics of the 303 subjects.
There were 158 and 145 females who were aged 52.8 ± 18.1 and 56.6 ± 17.2, respectively. The mean age for all the subjects was 54.6 ± 17.8 years.
[Table 2] displays the indications for echocardiography. The foremost indications were hypertension 168 (55.4%) and arrhythmia 25 (8.3%). Other indications were congestive cardiac failure 19 (6.3%), chest pain and ischemic heart disease (IHDx) 10 (3.3%), stroke and congenital heart disease 5 (1.7%), syncope 4 (1.3%), peripartum cardiomyopathy 3 (1.0%), valvular heart disease, rheumatic or degenerative type) 3 (1.0%), hypertrophic obstructive cardiomyopathy 2 (0.7%). In 23 (7.6%) of the patients scheduled for echocardiography with request forms, the reason for the request was missing. [Table 3] shows the echocardiographic diagnoses. 143 (47.2%) had hypertensive heart disease (HHDx), cardiomyopathy 22 (7.2%), valvular heart disease-rheumatic type 18 (5.9%), congestive cardiac failure 8 (2.6%), left ventricular failure 5 (1.7%), thyrotoxic heart disease 2 (0.7%), and 91 (30%) patients had a normal study. A patient had incomplete echo findings secondary to worsening orthopnea.
Out of the congestive cardiac failure patients, 6 (2%) were with reduced ejection fraction, 2 (0.6%) had mid-range and preserved ejection fraction, respectively. Among the patients with cardiomyopathy, 20 (6.6%) were of the dilated type, while there was one case each of peripartum cardiomyopathy and endomyocardial fibroelastosis (0.3%). One case of IHDx was documented. For the five cases with cor pulmonale (1.7%), 2 were due to long-standing tuberculosis, 2 from obstructive sleep apnea with pulmonary hypertension, and the other 1 from an unknown cause.
[Figure 1], [Figure 2], [Figure 3], [Figure 4] represents echocardiograms of selected diagnoses documented.
|Figure 2: Concentric left ventricular hypertrophy-a feature of hypertensive heart disease|
Click here to view
| Discussion|| |
The most widely occurring echocardiography diagnosed heart disorder in our study of 303 patients is HHDX with a prevalence of 47.2%. This is similar to studies in a Nigerian south western private clinic by Ajayi et al. and a south eastern federal hospital by Uwarunuochi et al., at 39.9% and 39.2%, respectively. On the other hand, Kolo et al. in Ilorin reported a higher prevalence at 58% which is comparable to the prevalence of 56.7% described in Abeokuta by Ogah et al. A likely cause of these differences in prevalence may be uncommon utilization of appropriate use criteria in the country. Another possible reason for the disparity in the prevalence of echocardiographic diagnosis is ease of access to health-care services in the different regions of the country. One top obstacle to access to health care in some foreign settings is constrained financial resources, equivalent to individual poverty, and existing regionally variable high cost of echocardiography in Nigeria.
In the United States, the echo diagnostic prevalence range of valvular heart disease likely degenerative type is 2.5% of general population and increasing to 11.7%–13.3% in those aged 75 years and above, and the rheumatic type is the leading cause of morbidity and mortality in India, similarly, a study in South Africa reported a prevalence of 6.9%, which is close to our study prevalence of 5.9.%
Krueger et al. described clinically significant incidental valvular findings on chest computed tomography studies like Nakamura et al. in Japan reported incidental echocardiographic findings of a quadricuspid aortic valve. In our study, many times, the echo diagnosis of valvular heart disease was an incidental finding made while assessing the heart for another totally different pathology or indication as evidenced by a higher prevalence of valvular diagnosis of 5.9% against the indications at 1.0%. Several of our valvular disease patients were suspected to have past rheumatic infection since rheumatic valvular heart disease usually occurs 10–20 years after the original illness and majority of our patients were middle-aged adults.
As more cardiologists are been trained in Nigeria, there is increased ownership of personal portable and stationary echocardiography machines and several cardiologists are itinerant carrying out echocardiography in various remote clinics and hospitals wherever their specialized service is required. So the true prevalence of disease may not be captured as the data is far flung and many times inaccessible.
In our study in southwestern Nigeria, cardiomyopathy was detected by echocardiography in 7.3%. This is parallel to studies done by James et al. in the southern south that reported a prevalence of 6.6% dissimilar to the study carried out by Agomuoh et al. that reported a higher prevalence of 19.9% in the same region. A larger study in Ife, another southwestern Nigeria town reported a much lower prevalence of 1.7%, the reason for these disparities may be due to changing socioeconomic status affecting consequential dilated and peripartum cardiomyopathies. The premier world incidence of peripartum cardiomyopathy is suggested to exist in the North east of Nigeria and a similar study in the north western region reported an echocardiographic diagnosis as high as 32%.
A recent study in Madras India revealed a prevalence of 25.2% normal echocardiograms, similar to a prevalence of 22% in a Tanzanian study and both studies are of lower prevalence as compared to our study at 30%. In Ibadan Nigeria, echocardiographic report of normal studies was higher at 36.5% and the reason postulated by Aje et al. was repetitive health check examinations forming a large part of indications for echocardiograms that may lead to preponderance of normal echocardiograms.
In Ekiti State Nigeria, the advent of echocardiography in a major referral center where this study was conducted has improved care of heart disease immensely. Congenital heart disease, though uncommon, and valvular heart disease are now diagnosed with referrals to ABMSH about 5 miles away for definitive cardiac surgery. The limitation to cardiac echo practice and utilization is the deficiency of experienced and knowledgeable staff in the teaching hospital. In addition, a more up-to-date and advanced Echocardiographic machine needs to be installed to enhance the outcome of this potentially world-class university hospital. Furthermore, the dearth of a transesophageal echocardiogram limits the delineation of intricate and posteriorly located cardiac configurations.
| Conclusion|| |
Systemic hypertension and its complications were the largest indications; HHDx, in particular, was the most common echocardiographic diagnosis, followed by cardiomyopathy and valvular heart disease. Congenital heart disease was rare. Due to the profound worth of echocardiography, in our setting, directors of hospitals in Nigeria need to strive for employment and retention of staff with technical skills and seek to upgrade essential equipment such as the echocardiogram.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]