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Resume Contexte Selon les recommandations actuelles, en presence d'une douleur thoracique suspecte, le diagnostic d'infarctus sans sus-decalage du segment ST (IDMST-) peut etre exclu en presence d'un resultat negatif de troponine cardiaque ultrasensible sur un prelevement unique realise au moins 6 heures apres le debut de la douleur. Le but de cette etude est d'evaluer une strategie d'exclusion de l'IDMST- base sur un taux plasmatique de Troponine I ultrasensible (TnIc-HS) inferieur a la limite de quantification, a partir d'un prelevement unique effectue entre 3 et 6 heures apres le debut de la douleur. Methodes Cette etude observationnelle retrospective a inclus 432 patients consecutifs vus aux Urgences pour douleurs thoraciques suspectes d'IDMST-, avec un dosage unique de TnIc-HS Resultats L’âge moyen etait de 48,5 ± 5,6 ans et 51 % etaient des hommes. La probabilite pre-test d'IDMST- etait faible (70 %) ou intermediaire (21 %). Sur les 419 patients suivis (13 perdus de vue, 3 %) il n'y a eu ni deces ni evenement cardiovasculaire ; 38 patients (9,2 %) ont ete hospitalises dans le 1er mois, aucun pour raison cardiaque. Conclusions Les resultats de cette etude confirment la validite d'une strategie d'exclusion de l'IDMST- aux urgences, basee sur un prelevement unique de troponine cardiaque effectue 3 a 6 heures apres le debut de la douleur thoracique.

Guidelines recommend to consider excluding non-ST-segment elevation myocardial infarction (NSTEMI) when high-sensitivity cardiac troponin is below the limit of quantification and a single blood sample is taken6 h after the onset of chest pain. The aim of our study was to assess such exclusion when a single blood sample was taken 3-6 h after the onset of permanent chest pain.This observational study included consecutive patients admitted into the emergency room of our hospital with chest pain and suspected NSTEMI, with non-contributive electrocardiograms and a single high-sensitivity cardiac troponin I (hs-cTnI) blood sample taken 3-6 h after the onset of chest pain and hs-cTnI4 ng/l (Abbott Diagnostic). Clinical follow-up was undertaken 1 month after admission.The mean age of the 432 patients was 48.5 ± 5.6 years and 51% were male. Based on a clinical algorithm, the pre-test probability of NSTEMI was low in 70%, and intermediate in 21% of patients. Among 419 patients with available 1-month follow-up data, there were no myocardial infarctions or deaths. Thirty-eight patients (9%) were admitted into hospital but none for cardiac reasons.Our results suggest that exclusion of NSTEMI in patients with a non-contributive electrocardiogram and a single "negative" troponin test in a blood sample taken 3-6 h after the onset of symptoms is valid.

INTRODUCTION The aim of this work was to describe the epidemiological, clinical, and therapeutic characteristics of acute coronary syndromes (ACS) in the cardiology department of Lome Campus University Hospital in Togo. METHODOLOGY We conducted a prospective study that consistently included patients hospitalized from 2014 to 2017 for ACS, based on clinical, electrocardiographic, and laboratory findings. RESULTS Of 1914 patients admitted to the department during the study period, 67 were admitted for ACS, for a 3.5% prevalence. The (M/F) sex ratio was 1.91. Patients' mean age was 60 ± 12 years. The clinical presentation was an ST elevation myocardial infarction (STEMI) in 71.6% of cases, and non-STEMI in 28.4% of cases, including 18.1% non-Q-wave infarction and 10.3% unstable angina. The mean time to admission after the onset of symptoms was 81.9 ± 124.6 hours. Patients were transported to the hospital by a private vehicle in 82.1% of cases. Thrombolysis was performed for 14.6% of patients (7/48 patients with ACS STEMI), with a success rate of 85.7% (n=6). In-hospital mortality was 10.5% (7/67). This mortality was significantly associated with the interval from onset of symptoms to admission and with the Killip stage. CONCLUSION Acute coronary syndromes are increasingly common in Togo. They are characterized by a relatively young age and a long delay until admission. Improving the management of these conditions in our countries requires effective primary prevention.

A large thrombus burden is not uncommon in primary percutaneous coronary intervention, and is associated with more frequent complications. The role of intracoronary thrombolysis and glycoprotein IIb/IIIa inhibitors in the management of a large thrombus burden is discussed. The use of thromboaspiration must follow a particular logic and used with rigorous manipulations; the capacities of the protective filters are often exceeded. Stents dedicated to thrombus management can be used. Interest and limits of these stents are developed. Direct stenting should be encouraged, and delayed stenting probably considered for the most important thrombotic burden despite "negative" results in studies.

Resume Introduction La presence de plaque carotidienne est un facteur predictif du risque vasculaire individuel. L’echographie est une technique de reference mais son application en pratique courante reste difficile du fait de l’absence de standardisation et de la variabilite inter-operateur. Nous presentons l’echelle TIMMA, une technique de mesure de l’atherome carotidien. Notre objectif etait d’evaluer la capacite pour des medecins neurovasculaires d’etre concordant avec l’evaluation d’un expert en echographie vasculaire. Materiel et methodes L’echelle TIMMA est l’acronyme des cinq classes de surcharge atheromateuse : tres importante, importante, moderee, minime et absente. Le regroupement des deux premieres classes definit le groupe « atherome significatif ». L’echelle a ete evaluee chez 38 patients (76 carotides) souffrant d’accident vasculaire ischemique ou d’accident ischemique transitoire, par cinq operateurs competents en echo-Doppler des carotides : un neurologue vasculaire (NV) forme a TIMMA (40 heures de formation), trois NV informes du mode de mesure (1 heure d’information) et un medecin vasculaire specialise (MVa), examinateur de reference. Nous avons evalue la concordance entre les NV et le MVa, a classer les patients dans le groupe atherome significatif ou non puis dans les 5 classes TIMMA. Resultats L’evaluation de l’echelle avec regroupement en deux groupes montrait une concordance du NV informe avec le MVa sur 76 carotides de 86 % (kappa a 0,7) et du NV forme avec le MVa sur 58 carotides de 90 % (kappa a 0,8) ; les valeurs predictives positive et negative de faire le diagnostic d’un atherome significatif etaient respectivement de 100 % et 81 % pour le NV informe, et de 100 % et 80 % pour le NV forme. L’evaluation de l’echelle sur cinq classes montrait une comparabilite du NV informe avec le MVa de 46 % (kappa a 0,3) et avec le NV forme de 75 % (kappa a 0,7). Conclusion TIMMA permet au neurovasculaire competent en echo-Doppler carotidien de reconnaitre, de facon reproductible, les sujets avec un atherome carotidien significatif. L’interet de cette echelle a determiner le risque cardiovasculaire des patients devra etre evalue sur une large cohorte.

to analyze patient-related factors that may influence adherence in patients with heart failure in an African cardiology department.This prospective observational study took place in the in-patient department of the Abidjan cardiology institute and enrolled consecutive patients hospitalized for decompensated heart failure from January to November 2014. The inclusion criteria were chronic heart failure in patients older than 18 years, developing for at least 6 months and treated by medication. The revised heart failure compliance questionnaire was used.The study included 121 patients. Overall adherence was poor in 88.4% of patients. Multiple linear regression analyses showed that use of traditional medicine was associated with poor adherence for the following 3 components: keeping follow-up appointments, medication intake, and sodium limitations. Overall adherence increased with the number of hospitalizations (OR = 1.69, 95% CI 1.13-2.53; p = 0.01). This increase persisted after adjustment for age, sex, educational level, marital status, medical insurance coverage and the use of alternative medicines (traditional and Chinese) (OR = 1.70; CI 1.12-2.28; p = 0.01).Adherence among black Africans with heart failure remains poor, influenced too much by traditional medicine. Therapeutic education is essential to improve patients’ knowledge about their disease and its treatment.

A 30-year-old woman consulted for a predominantly right-sided global heart failure chart that had been evolving for about 3 months. Its antecedents include a concept of poorly treated pleuropulmonary tuberculosis at the age of 8 years. Lateral chest X-ray, transthoracic echocardiography and thoracic CT showed ventricular ring calcification with mid-ventricular compression with apical ballooning. The diagnosis of chronic mid-ventricular constrictive pericarditis of tuberculosis etiology was retained. The patient was put on diuretic treatment and the immediate evolution is favorable with a regression of the signs of congestion. Surgical decortication has been indicated.

High-risk pulmonary embolism (PE) accounts for 5% of total acute PE and is a life-threatening emergency requiring immediate therapeutic management by fibrinolysis. The objective of this work is to describe the experience of thrombolysis in high-risk PE in a cardiology department in Togo.This is an analytical and descriptive study carried out in the cardiology department of the Campus teaching hospital of Lomé over a period of 5 years (August 2012 to July 2017) concerning patients hospitalized for high-risk mortality PE and having undergone streptokinase thrombolysis.Twenty-eight of the 102 PE were at high risk of mortality (27.5%). They were 9 men and 19 women with an average age of 61.9±14.1 years. The mean systolic blood pressure was 65mmHg and 50% of the patients were placed on dobutamine. Thrombolysis was performed in 22 of the 28 patients (78.6%). Eighteen patients had a short protocol and 4 a long protocol. The mortality rate was 32.1% or 13.6% in the thrombolysis PE versus 100% in the non-thrombolysis PE (P=0.01). Causes of death in thrombolysis were persistent shock (2 cases) at the end of thrombolysis and sudden death occurred 1 month after hospitalization. The average hospital stay was 18.8 days.The high-risk PE remains today a pathology burdened with heavy mortality. Thrombolysis remains the first treatment to reduce this mortality.

A large thrombus burden is not uncommon in primary percutaneous coronary intervention, and is associated with more frequent complications. The role of intracoronary thrombolysis and glycoprotein IIb/IIIa inhibitors in the management of a large thrombus burden is discussed. The use of thromboaspiration must follow a particular logic and used with rigorous manipulations; the capacities of the protective filters are often exceeded. Stents dedicated to thrombus management can be used. Interest and limits of these stents are developed. Direct stenting should be encouraged, and delayed stenting probably considered for the most important thrombotic burden despite "negative" results in studies.

Carotid atherosclerosis is a powerful predictive factor of vascular risk at the individual patient level. Ultrasonography is a reference technique for the evaluation of this condition. However, its use in common practice remains difficult due to a lack of standardization and inter-operator variability. We present a new and simple technique for the assessment of carotid atherosclerosis; and evaluate the ability of vascular neurologists to obtain results consistent with those of an expert in vascular ultrasound.The TIMMA scale is an acronym for the five classes of carotid atherosclerosis in French, VIMMA in English: very important, important, moderate, minimal and absent. Combined, the first two classes make up the group "significant atheroma" and the last three classes make up the group "no significant atheroma". This scale was evaluated in 38 patients (76 carotid arteries) suffering from ischemic stroke or transient ischemic attack by five operators who are competent in carotid echocardiography: one TIMMA-trained (40 hours of training) vascular neurologist physician (VNP), three VNPs informed on the measurement method (1 hour of information) and one specialized vascular physician (SVP) who was considered to be the reference examiner. We evaluated the concordance between the VNPs and the SVP in classifying patients, firstly into the significant or not atheroma group and, secondly, into the five TIMMA classes.The evaluation of the two-group clustering scale found a concordance between the informed VNPs and the SVP on 76 carotid arteries of 86% (kappa=0.7) and between the trained VNP and the SVP on 58 carotid arteries of 90% (kappa=0.8). The positive and negative predictive values for significant atheroma diagnosis were 100% and 81%, respectively, for the informed VNPs, and 100% and 80% for the trained VNP. The evaluation of the Five-Class Scale showed a concordance between the informed VNPs and the SVP of 46% (kappa=0.3), and between the trained VNP and the SVP of 74% (kappa=0.7).TIMMA allows VNPs who are competent in carotid ultrasonography to reproducibly identify subjects with significant carotid atheroma. The contribution of this scale to the determination of cardiovascular risk should be evaluated.

Background To determine the frequency of cardiovascular diseases, their risk factors as well as their evolution in two cardiology departments of Lome. Methods This cross-sectional study was carried out among patients attending two cardiology departments of Lome, from June 2004 to May 2009, who had a diagnosis of cardiovascular disease. Results A total of 7959 patients were included. Female gender predominated. The mean age was of 49.5 ± 17.2 years. The number of admissions increased from 958 in 2004 to 2399 in 2009. Arterial hypertension (62.7%) and ischemic heart diseases (10.6%) were the most frequent diagnoses. Among patients with a diagnosis of heart failure, the etiology was not recorded for 12.2%. Overweight and dyslipidemia were significantly more frequent in women (P Conclusion Admissions for cardiovascular diseases increased from 2004 to 2009. This epidemiological transition may be related to poor awareness of cardiovascular disease among the low-income population and the financial burden of health care.

Nous avons realise une etude afin d’evaluer les connaissances et les pratiques en matiere de prevention de la MTEV en milieu medical a Lome, au Togo. Le risque de survenue d’une MTEV lors d’une hospitalisation est relativement connu des medecins a Lome. La plupart se basent sur les facteurs de risque pour poser l’indication d’une thromboprophylaxie, et une minorite ont cite les affections medicales aigues parmi ces indications.

Les societes savantes proposent des algorithmes pour guider le choix de la technique de revascularisation des STEMI < 12 H : ils doivent etre adaptes au niveau regional. L'objectif de notre etude etait d'estimer le taux d'adequation entre pratiques et recommandations dans notre reseau et d'identifier les facteurs associes au suivi des celles-ci. Il s'agissait d'une etude observationnelle, a partir du registre du RESURCOR, prospectif des STEMI < 12H, dans 3 departements des Alpes du Nord. Ont ete analyses 2620 patients pris en charge entre le 01/01/2009 et le 31/12/2012. Le type de revascularisation etait en accord avec les recommandations pour 60% des patients. Apres analyse multivariee, les facteurs associes au suivi des recommandations etaient un âge de 65 ans ou plus, une prise en charge en Haute-Savoie, une TAS initiale inferieure a 100 mmHg. Les pratiques etaient moins souvent conformes aux recommandations en presence d'un choc cardiogenique, d'un Pacemaker ou BBG a l'ECG, d'une prise en charge hors reseau. Une interaction significative impliquait filiere et delai douleur-prise en charge : les recommandations etaient plus suivies pour un delai douleur-prise en charge inferieur a 3 heures lors d'une admission aux urgences et superieur a 3 heures lors de prise en charge par SMUR. La population caracterisee par les facteurs associes a l'absence de suivi des recommandations correspond aux patients pour lesquels il faudra etre vigilant dans le RESURCOR lors du choix du type de reperfusion.

International guidelines have recommendations for selecting the type of reperfusion (fibrinolysis or angioplasty) in the setting of ST-segment elevation myocardial infarction (STEMI), and suggest that emergency-care networks adapt these recommendations according to the local environment.To assess the proportions of STEMI patients treated with fibrinolysis or angioplasty in accordance with regional guidelines.Observational study based on a permanent registry of patients with STEMI of12h duration in an emergency network in the French North Alps (Isère, Savoie, Haute-Savoie) from January 2009 to December 2012.The registry included 2620 patients. Reperfusion was given in 2425/2620 (93%) of patients. Reperfusion type was in accordance with recommendations in 1567/2620 (60%) patients. Guideline-recommended fibrinolysis and angioplasty were performed in 47% (656/1385) and 79% (911/1149) respectively, of patients. In multivariable analysis, variables independently associated with guideline-recommended reperfusion were: an age65 years (OR 1.60; 95%CI 1.33-1.90), being managed in Haute-Savoie versus Isère or Savoie (OR 1.38; 95%CI 1.12-1.71), an arterial tension100mmHg (OR 1.73; 95%CI 1.27-2.35), a cardiogenic shock (OR 0.50; 95%CI 0.30-0.84), a pacemaker or left bundle branch block (OR 0.49; 95%CI 0.28-0.88), and an initial management outside the network (followed by treatment in an interventional centre in the network) (OR 0.62; 95%CI 0.40-0.94). Patients initially treated by mobile intensive care units were more often reperfused in accordance with recommendations when admitted3 (versus ≥ 3) h following symptom onset (adjusted OR 2.05; 95% CI 1.61-2.59), while those initially treated by in-hospital emergency units were less often reperfused in accordance with recommendation when treated3h following symptom onset (adjusted OR 0.67; 95% CI 0.46-0.97). In-hospital major adverse cardiac events (9.1% vs. 8.5%) and in-hospital mortality (6.4% vs. 5.1%) were not significantly different between patients reperfused in accordance with (versus not) recommendations.Forty percent of patients with STEMI were not reperfused with fibrinolysis or angioplasty in accordance with regional guidelines. Characterization of this population should allow us to improve guideline adherence.

The prevalence of hypertension in the Sub-Saharan Africa region is increasing as a manifestation of the epidemiological transition, and this fact will oblige these countries to mobilize significant resources. World Bank estimates cheaper to prevent cardiovascular disease than to treat people once these diseases are established suggesting the need to know the prevalence of hypertension in order to allow prevention programs in our population. However, data in Togolese populations are rare. The purpose of the present study was to determine the prevalence of high blood pressure and its risk factors in Lomé.We performed a cross-sectional survey among 2002 unselected respondents of the municipality of Lomé in May 2011. A questionnaire has been filled about family history of hypertension, habits and practices that affect hypertension on behalf of each respondent and anthropometric data and blood pressure has been measured.The prevalence of high blood pressure was 36.7% (34.6% of male vs. 38.4% of female, OR=0.85; 95%CI=0.7-1.02; P=0.08); 42.4% of the hypertensive respondents have been diagnosed at the screening. Blood pressure was positively correlated to the age (SBP: r=+0.46; P=0.001; DBP: r=+0.36; P0.001), the body mass index (SBP: r=+0.7; P0.001; DBP: r=+0.89; P0.001) and waist circumference (SBP: r=+0.28; P0.001; DBP: r=+0.3; P0.001). There was a significant relationship between arterial hypertension and obesity (OR=1.65; 95%CI=1.47-1.84; P=0.003), salt consumption (OR=1.4; 95%CI=1.13-1.72; P0.001) and oral contraception (OR=2.1; 95%CI=1.29-3.43; P=0.002).There was a high prevalence and low awareness of arterial hypertension in the municipality of Lomé with a female prevalence. This affection was correlated to age, salt consumption and obesity. This study raises the need for accentuating the prevention in our poor populations which are unable to face adverse outcomes which can occur.

To determine the frequency of cardiovascular diseases, their risk factors as well as their evolution in two cardiology departments of Lomé.This cross-sectional study was carried out among patients attending two cardiology departments of Lomé, from June 2004 to May 2009, who had a diagnosis of cardiovascular disease.A total of 7959 patients were included. Female gender predominated. The mean age was of 49.5 ± 17.2 years. The number of admissions increased from 958 in 2004 to 2399 in 2009. Arterial hypertension (62.7%) and ischemic heart diseases (10.6%) were the most frequent diagnoses. Among patients with a diagnosis of heart failure, the etiology was not recorded for 12.2%. Overweight and dyslipidemia were significantly more frequent in women (P0.001), while smoking and physical inactivity were significantly more frequent in men (P0.001). During the period, there was a moderate rise of the prevalence of overweight, dyslipidemia, and physical inactivity, whereas the prevalence of diabetes and smoking remained almost unchanged.Admissions for cardiovascular diseases increased from 2004 to 2009. This epidemiological transition may be related to poor awareness of cardiovascular disease among the low-income population and the financial burden of health care.

The incidence and prevalence rates of the heart failure in the world approach epidemic proportions. The evaluation of the follow-up of the treatment of heart failure can allow the setting up of strategies to reduce the frequency of decompensations and improve the quality of life of these patients.To estimate the compliance to treatment and factors liable to influence it in Togolese patients suffering from heart failure.This study was carried out from January 1st, 2008 to June 30th, 2009 in the department of cardiology of the university teaching hospital Campus in Lomé and included prospectively, patients with chronic heart failure hospitalized for acute decompensation and of which the heart failure was diagnosed and treated for at least 3 months. Questionnaires were filled to estimate the compliance to medication, to diet, as well as knowledge of the patients on their disease and their relationship with their doctor and their family.In the 103 patients included, we noticed no good compliance to medication; there were 74.7% of bad compliance to medication, 47.3% of good compliance to diet; 62.1% of patients had enough knowledge on their disease, 29.1% considered that their doctor did not grant them enough time; 57.3% estimated to have no necessary support of their family. Bad compliance to treatment was correlated to the existence or not of a health care insurance (OR=115.5; 95% CI=21.51-620.08; P0.0001); this difference persisted after adjusting for age, sex and monthly income (OR=99.65; 95% CI=18.87-587.21; P=0.001). Bad compliance was not associated with monthly income (OR=0.93; 95% CI=0.37-2.28; P=0.944); it was neither influenced by traditional therapy (OR=1.58 95% CI=0.64-3.91; P=0.43), nor recovery prayers (OR=1.6; 95% CI=0.62-4.13; P=0.45), nor frequency of tablets intake (≥3 intake day), OR=0.169; 95% CI=0.05-0.49; P=0.43.The compliance to medication in Togolese heart failure patients was very low and essentially correlated to the absence of health care insurance.

The purpose of this report was to describe epidemiologic, clinical, and paraclinical aspects and to identify etiologic factors associated with lower extremity venous thrombosis in Lome, Togo.

Le coeur pulmonaire chronique (CPC) est l’une des causes d’insuffisance cardiaque droite. Il faut cependant le considerer comme une affection pneumologique car ses causes sont de ce ressort avec, au premier rang, les insuffisances respiratoires chroniques obstructives. Nos objectifs etaient d’etudier les aspects epidemiologiques, cliniques et paracliniques des CPC a la clinique cardiologique du CHU Campus de Lome. Patients et methode: Il s’agit d’une etude retrospective menee sur 4 ans, du 1er juin 2004 au 31 mai 2008 et portant sur 35 cas de coeur pulmonaire chronique. Resultats : La prevalence du coeur pulmonaire chronique etait de 0,61%. Il y avait une predominance feminine avec un sex-ratio de 0,75. L’âge moyen etait de 58,6± 17,03 ans avec des extremes de 22 et 90 ans. Les signes d’appels cliniques etaient domines par la dyspnee (88,6%), la toux (34,3%), les oedemes des membres inferieurs (45,7%), la condensation pulmonaire (40%), la tachycardie (34,3%) et la turgescence des veines jugulaires (25,7%). Les signes echocardiographiques etaient essentiellement domines par la dilatation du ventricule droit et l’hypertension arterielle pulmonaire (100%), la dilatation de l’oreillette droite (88,6%), le septum paradoxal (17,1%) et la dilatation de l’artere pulmonaire (11,4%). Les principales etiologies et facteurs de risque associes etaient : l’obesite (34,3%), l’asthme (28,6%), la bronchite chronique (20,0%), le tabac (8,6%) et la tuberculose (14,3%). Conclusion : Le CPC est relativement peu frequent dans notre milieu. La lutte contre l’obesite et le tabagisme, un suivi regulier des BPCO et un traitement precoce et correct de la tuberculose devraient permettre de minimiser cette affection. Mots cles : Coeur pulmonaire chronique, epidemiologie, diagnostic. The chronic cor pulmonale is one cause of right cardiac failure. It should however be regarded as a pneumologic affection because its causes are of this spring with, with the first rank, the obstructive chronic respiratory insufficiencies. Our objectives were to study the epidemiologic, clinical and paraclinic aspects of the chronic cor pulmonale to the cardiologic private clinic of the Campus university hospital of Lome. Patients and method: It is about a retrospective study undertaken over 4 years, of June 1, 2004 to May 31, 2008 and bearing on 35 cases of chronic cor pulmonale. Results: The prevalence of the chronic cor pulmonale was of 0.61%. There was a female prevalence with a sex-ratio of 0.75. The Middle Age was of 58.6±17.03% years with extremes of 22 and 90 years. The clinical signs of calls were dominated by dyspnoea (88.5%), cough (34.3%), the oedemas of the lower extremities (45.71%), pulmonary condensation (40%), tachycardia (34.29%), turgescence of the jugular veins (25.71%). The echocardiography signs were primarily dominated by the dilation of the right ventricle and pulmonary arterial hypertension (100%), the dilation of the right auricle (88.5%), paradoxical septum (17.1%), the dilation of the pulmonary artery (11.4%). The principal etiologists and associated risk factors were: obesity (34.3%), asthma (28.6%), chronic bronchitis (20.0%), tobacco (8.6%), tuberculosis (14.3%). Conclusion: The chronic cor pulmonale is relatively not very frequent in our medium. The fight against obesity and the nicotinism, a regular follow-up of the BPCO and an early and correct treatment of tuberculosis should make it possible to minimize this affection. Key words: Chronic cor pulmonale, epidemiology, diagnosis.

But : Souligner l’apport de l’echocardiographie transthoracique dans le diagnostic des thrombus intracardiaques et les myxomes, et le probleme lie a leur prise en charge au Togo. Materiel et methode : il s’agi d’une etude retrospective sur une periode de 6ans allant de janvier 2001 a decembre 2006 et effectuee a la clinique cardiologique du CHU-Campus. Etaient inclus dans notre etude les patients ayant beneficies d’une echocardiographie montrant la presence d’un thrombus ou myxome. Resultat : sur 2129 patients, 10 thrombus chez 8 patients et 2 myxomes chez 2 patients ont ete diagnostiques. Cinq thrombus etaient dans le ventricule gauche, 4 dans l’oreillette gauche, et 1 dans l’oreillette droite. Un myxome etait dans l’oreillette gauche et l’autre dans le ventricule gauche. Le tableau d’insuffisance cardiaque etait la circonstance de decouverte dans 9 cas. Il y avait 1 cas de decouverte fortuite pour un myxome. Les etiologies dans le cas de la thrombose etaient : 5 cas de cardiomyopathie dilatee, 1 cas de retrecissement mitral, 1 cas de cardiomyopathie ischemique et 1 cas de coeur pulmonaire chronique. L’anticoagulation a ete instituee dans tous les cas de thrombose. Le malade porteur du myxome du ventricule gauche a beneficie de l’exerese chirurgicale et l’autre patient est mort 1an apres dans un tableau de defaillance cardiaque global par manque de traitement chirurgical. Conclusion : le diagnostic des thrombus intracardiaques et de myxome est base sur l’echocardiographie. Cependant la prise en charge des cas chirurgicaux pose un probleme dans notre pays ou il n’existe pas encore de chirurgie cardiaque. Mots cles : Thrombus, myxome, echocardiographie transthoracique, anticogulation, chirurgie cardiaque. Object: to show the contribution of the transthoracic echocardiography in the diagnosis of the intracardiac thrombosis and myxoma, and the problem involved in their assumption of responsibility. Materiel and method: it was about a study retrospective on period of 6 years energy from January 2001 to December 2006 and carried out with the cardiologic clinic of the CHU-Campus. Were included in our study the patients having profited from an echocardiography showing the presence of an intracardiac mass. Result: on 2129 patients, 10 thrombi among 8 patients and 2 myxoma among 2 patients were diagnosed. Five thrombi were in the left ventricle, 4 in the left auricle, and 1 in the right auricle. One myxoma was in the left auricle and the other in the left ventricle. The cardiac table of insufficiency was the circumstance of discovered in 9 cases. There was 1 case of fortuitous discovery for a myxoma. The causes in the case of thrombosis were: 5 cases of dilated cardiomyopathy, 1 case of mitral stenosis, 1 case of ischemic cardiomyopathy and 1 case of chronic pulmonary heart. The anticoagulation was instituted in all the cases of thrombosis. One case of myxoma profited from the surgical treatment and the other patient died 1year afterwards in a table of cardiac deficiency total for lack of surgerycal treatment. Conclusion: The diagnosis of the intracardiac masses is based on the two-dimensional transthoracic echocardiography in our countries without of the transoesophageal echocardiography. However the assumption of responsibility of the surgical cases poses a serious problem in our countries in the process of development which do not lay out of cardiac surgery. Key words : Thrombosis, myxoma, transthoracic echocardiography, anticoagulation, cardiac surgery

Objectifs : Analyser les resultats a cours et moyen termes, identifier les problemes de prise en charge de l’hypertendu et proposer des mesures de prevention. Methode : Il s’est agi d’une etude prospective longitudinale effectuee dans l’unite de cardiologie de l’hopital secondaire de Be du 1er octobre au 30 septembre 2006. Ont ete inclus dans cette etude les malades hypertendus selon les nouvelles normes (JNCVII). Le traitement des donnees a ete informatise. Resultat : Notre etude nous avait permis de recenser 147 patients hypertendus sur 164 enregistres soit une prevalence de 89,63%. La prevalence en fonction du sexe donnait une predominance feminine avec un sex-ratio de 0,27. Les cephalees (65,39%), les palpitations (55,78%), les douleurs thoraciques (53,06%) ont ete les principaux motifs de consultation. L’alcoolisme (34%), la prise de cafe (29,9%) et l’obesite (29,3% etaient les facteurs de risques predominants ; 36,7% des patients etaient de pere hypertendu et 31,3% de mere hypertendue. 73,5% de nos patients etaient au stade 2 de la classification JNCVII, 72,8% avaient une pression pulsee superieure a 60 mmHg. Les patients obeses representaient de 36,7% et 38,1% avaient un surpoids. Tous les patients etaient mis sous regime demi-sale et 74,82% sous regime amaigrissant. Les medicaments essentiellement utilises ont ete les diuretiques (83,67%), les inhibiteurs de l’enzyme de conversion (75,51%), les beta bloquants (55,10%), les inhibiteurs calciques (37,41%), les antihypertenseurs centraux (9,52%). Le taux de participation etait de 93,88% a trois mois et de 63,27% a six mois. Les principales complications ont ete : cardiaques (49,5%), oculaires (12,9%), neurologiques (9,7%) et renales (6,5%). L’evolution etait favorable chez 39,9% des patients. Nous avions note 2,15% de deces. Conclusion : L’HTA est un reel probleme de sante publique au Togo. Le respect des mesures hygienodietetiques et la prise reguliere des medicaments antihypertenseurs pourraient reduire ce taux de letalite qui demeure eleve. Mais la prevention demeure l’arme la plus efficace. Mots cles : Hypertension arterielle, prise en charge, Togo. Objective: To analyse the results at short and long terms. To identify the problems of the take over of the hypertensive patients and to propose preventive measures. Methods: Il is about a retrospective study done in the cariological unit at (Hospital Secondaire Be). From 1st October 2006 to 30th September 2006; have been included in this study the hypertensive patients according to the new gages (JNCVII). The treatment of the out come is delta processed. Results: Our study have permitted us to gather 147 hypertensive patients on 164 registered or a prevalence of 89.63%. The prevalence in function of sex gave female predominance with a sex ratio of 0.27. The headache (65.39%), palpitation (55.78%) chest pains (53.06%) have been the principal reasons of consultation. The alcoholism (34%) the use of coffee (29.9%) and obesity (29.3%) were the predominance risk of factories, 36.7% of the patients were of a hypertensive fathers and 31,3% of hypertensive mothers. 73.5% of our patients were in 2 stage as classified by the JNCVII, 72.8% were having pulse pressure wore than 60 mmgh. The patients with obesity were representing 36.7% and 38.1% were having over weight. All the patients were on low salted diet and 74.82% on the essential medicines used have been the diuretics (83.67%), the inhibitors of conversion enzyme (75.51%), the beta - bloquants (55.10%), the central antihypertensive 9.52%. The level of participation were of 93.88% at 3 months and of 63.27% at six months. The principal complications have been cardiac (49.5%), sight (12.9%) neurological (9.7%) and renal (6.5%). The evolution was favourable with 39.9% of the patients. We have noted 2.15% of death. Conclussion: the arterial hypertensive is a real public health problem in Togo. The prevention is still the more efficient means. The obedience of the hygieno dietetic measures and the regular use of the antihypertensive drugs may reduce this level of letality which is still higt. Key words: Hypertensive, take over, Togo.

High blood pressure is a public health problem for which the assumption of responsibility remains especially difficult in older subjects. Generally, it is associated with other cardiovascular risk factors. The objective of this study is to determine the prevalence of high blood pressure in older subjects in a particular environment and to evaluate the cardiovascular risk among these patients.This is a longitudinal exploratory study undertaken on 1485 hypertensive subjects of 50 years of age or older, selected from 1999 patients received in three health professional training centers of the community of Lomé, between June 1, 2004 and June 30, 2007. Information had been collected using a card of investigation. Classifications of high blood pressure were those of the JVCVII and the European Society of Cardiology. The data analysis had been made by computer tools.The prevalence high blood pressure was of 74.29%. We had noted a female prevalence (63.8%) with a sex ratio of 0,57 and one middle age of 62.08±9.3 years. Dyspnea (45.9%), chest pains (16.2%) and palpitations (13.2%) were the principal found symptoms. The various listed risk factors were: dyslipidemia (58.1%), obesity (36.12%), alcoholism (16.7%) and diabetes (10.6%). The complications were cardiac (87.81%), ocular (79.8%), renal (19.86%), neurological (4.92%) and arterial (0.99%). The cardiovascular risk was very high at 58.05% of the patients. The mortality rate was of 1.9%.High blood pressure is the most frequent cardiovascular risk factor in our country from 50 years of age. Assumption of responsibility for it is by information, education of the population and requires the mobilization of all the social components.

According to the WHO, cardiovascular disease such as arterial hypertension and ischemic heart disease will be the main non-communicable diseases in developing countries in the next decades. In Togo, there is no statistic on this disease on this day. Our objectives were to study the epidemiological aspects and to describe the risk factors of this affection in our surroundings. It is about a multicentric transverse study from June 1st, 2004 to May 31, 2007, in 3 sanitary formations of the city of Lomé.The frequency of ischemic heart disease was 11, 46%. There was a feminine predominance with a sex-ratio of 0.71. The average age of the patients was about 55.3 +/- 13.4 years with extremes of 18 and 95 years. The cardiovascular risk factors were: dyslipidaemia (76.9%), hypertension (75.3%), left ventricular hypertrophy (72.8%), abdominal obesity (71.1%), hyperuricemia (50.5%), hyperglycemia (41.9%) of which overt diabetes (29%) and smoking (3%). There was a feminine predominance at the hypertensive and the obese. The women accumulated more modifiable risk factors than the men. The middle risk indication was of 2.34 +/- 0.9 at the men and 2.55 +/- 0.8 at the women. The different clinical forms were: stable angina (71.2%), unstable angina (1.7%) and myocardial infarction (5.2%); silent ischemia represented 21.9%. The antero-septal territory was the more reached in case of myocardial infarction and the antero-lateral territory in case of ischemia.A sanitary politic centered on the eviction of the risk factors should help to reduce the prevalence of this affection for a long time in our surroundings.

We report an observation of a double left thrombosis intraventriculaire and atrium at a subject 45 years. The diagnosis was made by the transthoracic two-dimensional echocardiography which showed a dilated cardiomyopathy and two bulky thrombi in the left ventricle and atrium. As the chirurgical treatment is not accessible, we use the medical treatment: anticoagulant treatment associated on the low salt diet, with diuretic and the inhibitors of the enzyme of conversion, the evolution was favourable without embolic accident.

Background Elderly patients with acute ST-elevation myocardial infarction (STEMI) remain undertreated. Purpose To evaluate the management of elderly STEMI patients treated in a formal regional network of care. Methods This prospective analysis, based on data from the ongoing RESURCOR coronary emergency network, involved 6169 patients presenting with an acute STEMI between 2002 and 2011 in the north French Alps. Patients were divided into age groups: Results Lack of reperfusion therapy increased with age ( Table 1 ). The rate of fibrinolysis was higher than that for PPCI in younger patients whereas the situation was reversed in elderly patients. In patients who had PPCI, use of bivalirudin increased and GPI decreased with age, system delays were similar. Conclusion These regional French data indicate that elderly STEMI patients receive appropriate management with timely delivered PPCI and bivalirudin; however, a substantial proportion are still undertreated.

Purpose: In the setting of primary percutaneous coronary intervention (PPCI), we hypothesized that a 24-48 hour delayed strategy of stenting after successful thrombus aspiration and establishment of Thrombolysis In Myocardial Infarction (TIMI) 3 flow with optimal antithrombotic therapy may decrease the risk of microvascular obstruction as assessed by cardiac magnetic resonance imaging (CMRI). Methods: MIMI is a randomized, multicentre, prospective, open-label study with blindly assessed primary endpoints. Patients were included if the pre-procedural flow of the culprit artery was TIMI 0 or 1, thrombus aspiration restored a TIMI 3 flow, and the patients were eligible for stent implantation. Patients were randomized to either immediate stenting or 24-48 hours intentional deferred stenting. Patients were treated with heparin, clopidogrel/prasugrel and glycoprotein IIb/IIIa inhibitors. The primary endpoint is the extent of microvascular obstruction, as assessed by CMRI, and expressed as the ratio of microvascular obstruction to left ventricular mass (Clinicaltrial.gov registration [NCT01360242][1]). Results: Of 160 patients included between June 2011 and December 2012 in 19 coronary interventional centres, 83 were randomized to the immediate stenting group and 77 to the intentional deferred stenting group. A total of 144 patients had a CMRI. None of the patients in the "deferred intentional stenting" group presented an infarct related artery reocclusion between thrombus aspiration and second procedure. Most (98%) of the patients in the "immediate stenting" group and 87% of those in the "deferred intentional stenting" group underwent a stent implantation (no definitive data). Results will be presented at the ESC congress 2013. Conclusions: In the setting of PPCI, the MIMI study is the first randomized study comparing the effects of immediate versus delayed stenting after TIMI 3 flow restoration on microvascular obstruction by CMRI. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01360242&atom=%2Fehj%2F34%2Fsuppl_1%2F1773.atom