Epidemiology of Cardiovascular Mortality in Patients under 60 Years Old in a Cardiology Department in West Africa, Dakar-Senegal

Background: Our study aimed to examine cardiovascular mortality within the working-age population, exploring epidemiological, clinical, and paraclinical features, complications, and identifying etiological factors linked to mortality. Methods: We conducted a descriptive and analytical retrospective study from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar, we reviewed all the medical records of patients from 15 to 60 years old who died while admitted in the cardiology department. Data collected were socioeconomic status, clinical history, type of cardiovascular disaese, length of hospitalization, circumstances and timing of death. The data were analyzed with R. Studio version 2022.12.0 + 353 and Excel 2019, with a P-value Results: The study included 73 patients, indicating a specific mortality rate of 8.8% and a proportional mortality of 39%. Predominantly male (sex ratio 1.2), the average age was 44. Key cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). The leading cause for consultation was dyspnea (72.6%). Notable findings included a majority of patients presenting with general condition deterioration (90%) and cardiovascular collapse upon admission (23.3%). Physical exam revealed signs of heart failure in 63%. Echocardiography showed left ventricular ejection fraction impairment (81%) and pulmonary hypertension (78%). Immediate causes of death were primarily cardiogenic shock (45.2%) and septic shock (37%). The analytical study indicates that the data most closely associated with mortality were age, socio-economic level, ischemic heart disease (p = 0.034), rheumatic valvulopathies, pulmonary embolism (p = 0.034), hypertension (HTA) (p = 0.009), smoking (p = 0.011), diabetes (p = 0.011), dyslipidemias, prolonged bedrest (p = 0.001), morbid obesity (p = 0.001), and COVID-19 infection (p = 0.017). Conclusion: The prevalence of ischemic heart diseases, pulmonary embolisms, and valvulopathies in premature mortality statistics underscores the need for enhanced cardiovascular prevention efforts.

Screening of Myocardial Cardiotoxicity Induced by Anticancer Chemotherapy and the Importance of Global Longitudinal Strain

Introduction: The improvement of survival in patients with cancer and the expansion of therapeutic options have led to the emergence of a new profile of cardiotoxicity, specifically associated with antimitotic agents. Our study aimed to assess the incidence of chemotherapy-induced myocardial toxicity in patients with cancer. Patients and Methods: We conducted a looking-forward longitudinal cohort study including all patients admitted to the Cardiology departments of Aristide le Dantec Hospital and Dalal Jamm National Hospital Centre for apre-chemotherapy check-up. The included patients did not undergo any pre-existing cardiopathy. Results: Over a period of two years ranging from January 2019 to December 2021, a total of 37 patients were included in the study. Notably, there was a female predominance (92%) with an average age of 49.7 years ± 13.69. Breast cancer accounted for 70% of the neoplasms. Laboratory findings revealed moderate anemia in 19 patients (51%). At inclusion, the left ventricle (LV) was of normal size (LV diastole at 44.46 ± 4.97 mm). The systolic function of the left ventricle was normal in all patients, with an average ejection fraction (EF) of 63.1% ± 5.80 and a mean global longitudinal strain (GLS) of −20.4% ± 2.58. The most commonly used agents were anthracyclines. During follow-up, 3 patients (8.1%) developed clinical symptoms of left heart failure, and LV dysfunction on echocardiography was observed in 5 (13.5%) patients, with a significant decrease in EF Conclusion: The incidence of cardiac toxicity is not negligible, hence the importance of early screening. Strain imaging is an essential tool that should be performed as part of the assessment before chemotherapy and re-evaluated during treatment.

Comparative Study of Acute Coronary Syndrome with Persistent ST-Segment Elevation (STEMI) between Diabetics and Non-Diabetics in Dakar, Senegal

Introduction: This study aimed to compare the frequency of diabetic and non-diabetic patients admitted for ST-elevation myocardial infarction (STEMI), assess their epidemiological, clinical, and paraclinical profiles, and evaluate their therapeutic strategies and outcomes. Methodology: A descriptive, analytical, comparative study with prospective and retrospective data collection was conducted from April 1, 2020, to March 31, 2021. Diabetic and non-diabetic patients with STEMI admitted to a cardiology department were included. STEMI diagnosis was based on clinical and electrocardiographic criteria showing persistent ST-segment elevation in at least two leads. All patients included in the study signed a written, informed consent form. Data analysis was performed using SPSS, with a p-value ≤ 0.05 considered statistically significant. Results: STEMI prevalence was 15.27%, with 37.11% of patients being diabetic and 62.89% non-diabetic. Diabetic patients had a mean age of 59.2 ± 10.9 years, while non-diabetics averaged 58 ± 13.4 years. Diabetics were predominantly female (72.2%), whereas non-diabetics were mainly male (83.6%). Smoking was less frequent among diabetics (25% vs. 47.54%), but hypertension, obesity, and sedentary lifestyle were more common. Diabetics had an average of 3.5 ± 1.1 risk factors compared to 2.6 ± 1.2 in non-diabetics. Admission delay was longer for diabetics (34.8 ± 51.6 hours vs. 23.3 ± 52.3 hours). Chest pain was the main symptom in both groups. Electrocardiograms showed that anterior and inferior infarctions were most frequent. Triple vessel disease and severe complications, such as cardiogenic shock, were more common in diabetics, who also had higher mortality (5.56% vs. 3.28%). Conclusion: Diabetic STEMI patients represent a high-risk group with distinct clinical features, longer admission delays, and a greater accumulation of cardiovascular risk factors, emphasizing the need for targeted interventions.

Results of the First 10 Cases of Coronary Bypass Surgery in Senegal

This is a review of the first 10 coronary artery bypass surgeries performed by the local team. The mean age was 62 years old [45 - 74]. The patients were predominantly male, with a M/F ratio of 4:1. Cardiovascular risk factors were mainly myocardial infarction (MI) (60%), hypertension (50%), obesity (40%) and diabetes (30%), with at least two risk factors per patient. Angina was the main symptom (80%). The average time from presentation to surgery was 8 months. The mean Euroscore 2 was 2.92 ± 1.65 [1.33 - 6.60]. Coronary angiography revealed an average of 2 lesions per patient, with 3-vessel involvement in 70% of cases: the Interventricular artery (IVA) (100%), the right coronary artery (90%) and the circumflex artery (70%). On echocardiography, the mean Left ventricular ejection fraction (LVEF) was 59% [33% - 76%]. All patients underwent median sternotomy with bypass grafting. The average duration of the cardiopulmonary bypass was 150 min [46 - 275 min];that of aortic clamping, 120 min [43 - 232 min]. The grafts used were internal thoracic artery (ITA) in 100% of cases (80% on the left and 20% on the right), and the great saphenous vein (GSV) in 60% of cases (50% on the left and 10 on the right). Double bypass was performed in 60% of cases, single bypass in 30% and triple bypass in 10%. The bypasses were performed on the IVA (100%), the middle lateral of the circumflex (30%) and the bisector (20%). The average time to extubation was 11 hours and the length of stay in the intensive care unit was 7 days [03 - 17 days]. One patient had a reoperation on Day 0 post-op. The average hospital stay was 13 days [06 - 27 days]. Complications occurred in nine of the patients (90%), with a predominance of infectious and neurological complications. Overall operative mortality was 3%, all in intensive care.

Profile of Cardiovascular Diseases of Diabetics Admitted in Fann and Dantec Cardiology Departments

Introduction: Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in type 2 diabetes (T2D). The objective of this study was to describe the profile of cardiovascular diseases of diabetics admitted at the cardiology departments of Aristide Le Dantec and Fann hospitals. Patients and Methods: This was a retrospective, descriptive and analytical study conducted on January 1st and December 31st, 2020 at the Dantec and Fann cardiology departments in Dakar. We studied epidemiological, diagnostic, therapeutic and evolutionary data. The data 7 was analyzed with STATA 14 software. Results: Of the 1483 patients hospitalized in both cardiology departments, one hundred and thirty-three (133) were diabetic, the hospital frequency was 9.01%. The average age was 62.3 ± 11.2 years. The sex ratio (M/F) was 0.8. Almost half (47.4%) of patients had a duration of diabetes greater than 10 years. Cardiovascular risk factors were dominated by physical inactivity (84.2%), menopause (81.9%) and hypertension (64.7%). Heart failure was the most common clinical manifestation with 45.1%. The prevalence of acute coronary artery disease in our study was 37.59%, followed by lower limbs peripheral arterial disease (9.7%) and stroke (3%). Concerning the treatment, 119 patients were on anti-diabetic treatment. Most patients were on aspirin (79%), cholesterol-lowering drugs (78.95%) and ACE inhibitor (77.44%). Percutaneous coronary intervention was performed in 19 patients. 12.03% of patients diabetics died during hospitalization. Conclusion: Cardiovascular events are common during type 2 diabetes. Their management is important to avoid complications that can be fatal.

Mortality of Children with Mechanical Valve Prostheses at the CUOMO Cardio-Pediatric Center of University National Hospital of Fann (Dakar)

Introduction: Mechanical valve replacement in pediatric age is a dreaded but sometimes inevitable surgery. The purpose of this study was to determine the mortality of children with mechanical valve prostheses in the short, medium and long term. Patients and Methods: This was a retrospective and descriptive study conducted at the CUOMO cardio-pediatric center at Teaching National Hospital of Fann between January 1st, 2017 and December 31st, 2021. We included, children whose age is less than or equal to 16 years of age and who have benefited from a mechanical valve replacement and with a follow-up period of more than 6 months post-operative in the CUOMO cardio-pediatric center. Patients whose age at the time of surgery was over 16 years were excluded;patients who have benefited from bioprosthesis or valvular plastic surgery alone;as well as patients for whom a follow-up of more than 6 months was not found. Statistical analyses were carried out using the SPSS (Statistical Package for Social Science) software version 18 to calculate averages and percentages. Results: We included 85 patients. The average age was 12.84 ± 2.52 years. The male gender predominated with a sex ratio of 1.65. Dyspnea was found in 96.47% of children. Pure mitral regurgitation was the most common valve disease found in 67.06%. Rheumatic etiology was noted in 87.06% of cases. Mono valve replacement was performed in 84.71% of patients and double valve replacement in 15.3% of cases. Major mechanical complications were reported in 8 patients including 5 severe aortic mismatch cases. Hemorrhagic complications were observed in 4 patients requiring surgery. Hemodynamic complications were dominated by right ventricle dysfunction in 14 patients. Supraventricular rhythm disorders were present in 11 patients and one case of ventricular tachycardia. We found six cases of infectious endocarditis. Eight deaths were recorded with a mortality rate of 5.88%. Significant predictors of mortality were stage IV dyspnea of NYHA and preoperative overall heart failure. Conclusion: Our study showed good results in terms of short-, medium- and long-term mortality. Complications related to mechanical valve prostheses are not negligible, hence a rigorous lifetime monitoring after surgery.

Cardiac Rehabilitation in the Elderly

Introduction: The purpose of cardiac rehabilitation is to improve the effects of aging and maintain a good quality of life for older individuals. This study aims to assess how cardiac rehabilitation affects the autonomy and quality of life of older adults. Patients and Method: This was a longitudinal, descriptive and comparative before-and-after cardiovascular rehabilitation study conducted over a two-year period from January 2019 to December 2021. This study was conducted at four cardiac rehabilitation units in Dakar: the Aristide Le Dantec Hospital (HALD), National Dalal Jamm Hospital, and the General Idrissa Pouye Hospital (HOGIP). We compared the degree of autonomy, dependence and quality of life of subjects aged over 65 before and after the cardiac rehabilitation program using the Katz index, the Lowton index and the SF12 quality-of-life questionnaire. Results: Over a two-year period, a total of 345 patients had benefited from a complete cardiovascular rehabilitation program in the four cardiovascular rehabilitation units in Dakar, and 86 patients, or 24.92% of the population, were at least 65 years old. The patients were predominantly male (sex ratio M/F = 4.73). The mean age was 70.35 ± 4.55 years for men and 69.27 ± 4.59 years for women. The main pathology motivating cardiac rehabilitation was ischemic heart disease, which was found in 73 patients (84.88%). Initial assessment revealed exertional dyspnea in 35 patients (40.69%), followed by residual exertional angina in 21 patients (4.41%). Mean functional capacity increased from 5.81 ± 2.38 Mets in pre-cardiac rehabilitation to 8.68 ± 2.28 Mets in post-cardiac rehabilitation (p < 0.001). The mean distance covered in the 6-minute walk test increased from 330.42 ± 170.50 m in pre-cardiac rehabilitation to 524 ± 98.54 m in post-cardiac rehabilitation (p = 0.119). The Lowton dependency index in pre-cardiac rehabilitation was 44.18% versus 36.04% in post-cardiac rehabilitation (p = 0.0156). The mental quality of life score was 42.15 ± 10.27 in pre-cardiac rehabilitation versus 52.94 ± 10.86 in post-cardiac rehabilitation (p Conclusion: This study demonstrates the effectiveness of the cardiac rehabilitation program in elderly subjects. In fact, this well-managed, well-structured and well-supervised program enables this population to regain their autonomy, improve their quality of life and functional capacities, and consequently their prognosis.

ST-Elevation Myocardial Infarction (STEMI) in Diabetics Patients in Four Dakar Cardiology Departments

Introduction: Diabetes is an independent risk factor for coronary heart disease worldwide. But few data exist in our developing countries. The objective of this study was to study the particularities of STEMI in diabetic patients in Dakar. Methodology: It was a retrospective, multicenter and descriptive study, carried out over a period of 12 months from 19 September 2019 to 19 September 2020 in four cardiology centers in Dakar. Included was any diabetic patient admitted for STEMI. Data analysis was done with the SPSS (Statistical Package for Sciences Socials) software. Results: A total of 87 diabetic patients were included, for a prevalence of 29.7%. The average age of patients was 60 years. The predominance was male with a sex ratio of 1.1. Diabetes was mostly type 2 (99%) and most patients were on oral antidiabetics (56%). Glycemic imbalance was noted in 24.1% of patients. The associated cardiovascular risk factors were hypertension (51%), dyslipidemia (51%) and physical inactivity (41.4%). Chest pain was typical in 76% of cases. The average time between onset of pain and first medical contact was 47 hours. The electrocardiogram had reached mainly the anterior (25%) and inferior (27%) territories with necrosis Q waves in 37.9% of cases. The coronary angiography was done for 63 patients and found one hundred and twenty-three significant lesions distributed in three-vessel (48%), single-vessel (33%) and two-vessel (14%) disease. Percutaneous coronary intervention (PCI) was performed in 37 patients (42.2%) and thrombolysis in 7 patients. The evolution was favourable in most cases (82%). The reported complications were: 4 cardiogenic shocks, 3 rhythm disorders, 2 conduction disorders and 2 strokes. Four patients had died during hospitalization, for a hospital mortality of 4.59%. Conclusion: STEMI in diabetics are diagnosed with considerable delay in Dakar. The coronary involvement is severe. Their support under optimal. Improving management requires a multidisciplinary approach involving the diabetologist, emergency physician and cardiologist.

Asymptomatic Mitral Regurgitation Caused by an Isolated Mitral Leaflet Cleft in a Young Adult: A Case Report

We report the case of an 18-year-old young man without previous medical history, who was referred for evaluation of an asymptomatic cardiac murmur. Physical examination found holosystolic 4-5/6 apical murmur with normal ECG. Bidimensionnal (2D) echocardiography revealed severe mitral regurgitation with thin mitral leaflets. Three dimensional (3D) Echocardiography done for better assessment of mitral valve regurgitation mechanism revealed an isolated mitral leaflet cleft, without signs of endocarditis or traumatic lesion. Regarding the absence of symptoms and excellent maximal exercise tolerance at stress echocardiography, a repair surgery wasn’t offered. Isolated mitral leaflet cleft is a rare congenital anomaly, in adults, the cleft may be an incidental finding that remains asymptomatic for years when the leak is well tolerated. 2D combined with 3D echocardiography is key for diagnosis and surgery guidance.

Acute Coronary Syndromes in Elderly: Multicentric Study about 76 Cases in 3 Cardiology Departments in Dakar

Background: Acute coronary syndromes (ACS) in the elderly are often a problem in their diagnosis and treatment, explaining a high mortality. Our study aimed to evaluate diagnostic, therapeutic and evolutive aspects in 3 cardiology departments of Dakar. Patients and Methods: We conducted a multicentric, retrospective and descriptive study during 2 years from January 1, 2017 to December 31, 2018. All patients older than 75 years admitted for acute coronary syndromes were included. The diagnosis was based on clinical signs with typical electrocardiographic changes and troponin assays. Results: Seventy and six patients (76) were enrolled. The prevalence of ACS in the elderly was 2.5% of all hospitalized patients and 21.8% of all ACS. The average age was 78.76 years. The sex ratio male/female was 1.71. The cardiovascular risk factors were essentially physical inactivity (97%) and hypertension (6.84%). Angina pain was the master symptom, but the pain was atypical in the most cases (52.63%). The second sign was dyspnea (46.05%). The average admission time for patients with STEMI (ST-segment elevation myocardial infarction) was 27 hours. Among these patients, 67% had a STEMI, 24% had NSTEMI (non-ST segment elevation myocardial infarction) and 9% had an unstable angina. Four patients had a thrombolysis with an average time of 5.75 hours. The thrombolysis was not successful for all patients. Eighteen (18) patients had a percutaneous coronary intervention (PCI), but only two had a primary PCI. DES (drug-eluting-stents) were the most used stents (55.5%). Eighty and nine (89%) of PCI were successful. Complications were essentially hemodynamic and rhythmic (26.6%). In-hospital mortality was 14.47%;n = 11. Conclusion: Our study revealed a delay in diagnosis and management of ACS in the elderly. Reperfusion therapy was less practiced in our context and the prognosis was poorer with a high mortality.