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Ce travail se propose une contribution au processus de photodégradation des pesticides dans l’environnement. L’étude a porté sur le profénofos issus des eaux de rinçage des pulvérisateurs.et avait pour objectif d’identifier les photoproduits de sa dégradation. L’étude a concerné quatre aspects : la photolyse directe, l’influence de la source lumineuse, de la nature de l’eau et les photoproduits de dégradation. Les expériences de la photolyse ont été réalisées sous deux lampes à vapeur de mercure basse pression : l’une monochromatique à λ = 253,7 nm et l’autre polychromatique à λ ≥ 285 nm. L’identification des photoproduits a été faite par Chromatographie liquide haute pression couplée à une spectrométrie de masse de type Agilent 5972. Les résultats ont montré que le profénofos est dégradable sous les deux lampes monochromatique et polychromatique assimilable aux irradiations solaires. Toutefois, la réaction de photolyse du profénofos a été plus lente avec la lampe polychromatique. Les résultats ont aussi montré que la cinétique de dégradation du profenofos a été plus faible dans l'eau naturelle comparativement à l’eau pure. Les résultats ont permis également de mettre en évidence la formation de six produits de dégradation P1, P2, P3, P4, P5 et P6 qui ont été identifiés. Englsih title: Identification of photoproducts of degradation of profenofos contained in sprayer rinsing waters This work proposes a contribution to the process of photodegradation of pesticides in the environment. The study focused on profenofos from sprayer rinsing water and aimed to identify the photoproducts of its degradation. The study concerned four aspects : direct photolysis, the influence of the light source, the nature of the water and the photoproducts of degradation. The photolysis experiments were carried out under two low-pressure mercury vapor lamps : one monochromatic at λ = 253.7 nm and the other polychromatic at λ ≥ 285 nm. The identification of the photoproducts was made by high pressure liquid chromatography coupled with Agilent 5972 type mass spectrometry. The results showed that profenofos is degradable under both monochromatic and polychromatic lamps comparable to solar irradiation. However, the photolysis reaction of profenofos was slower with the polychromatic lamp. The results also showed that the degradation kinetics of profenofos was lower in natural water compared to pure water. The results also made it possible to high light the formation of six degradation products P1, P2, P3, P4, P5 and P6 which were identified.&nbsp

Introduction: Despite the advances of interventional catheterization, surgery remains the treatment of choice for some coronary lesions. Objective: To report the indications and results of surgical revascularization of the myocardium at the Abidjan Heart Institute. Patient and Methods: This is a retrospective study of patients with coronary insufficiency who underwent surgical myocardial revascularization between March 2014 and May 2020 in the Cardiovascular Surgery Department of the Abidjan Heart Institute. There were 17 patients, 11 of whom were men (64.7%) and 6 women (35.3%), The mean age of the patients was 57.5 years ± 8.8. All patients were symptomatic with disabling angina in class III of the Canadian Cardiac Society (CCS). This sym- ptomatology had been evolving on average for 5 years and 6 patients had a history of acute coronary syndrome, 2 of whom had undergone prior angioplasty. Coronary angiography revealed mono-truncated (17.6%), bi-truncated (23.5%) and tri-truncated (58.8%) lesions. Results: The patients were operated under cardiopulmonary bypass (CPB) 15 cases (88.2%) and off pump in 2 cases (11.8%). They underwent a single bypass in 23.5% of cases, a double bypass in 47.1% of cases and a triple bypass in 29.4% of cases. We observed 3 cases of complications (17.6%), namely transient acute renal failure, mediastinitis and postoperative bleeding. The operative and hospital mortality was nil. After a mean follow-up of 3 ± 1.8 years, all patients were asymptomatic with a negative stress test at last check-up. Conclusion: Our experience has allowed us to demonstrate the safe performance of surgical myocardial revascularization in our patients with satisfactory and encouraging results.

AIM To describe the coronary angiographic aspects observed in patients with dilated cardiomyopathies (DCM) in a sub-Saharan African country in order to improve their management. METHODS This was a cross-sectional study conducted from 1 January 2010 to 31 March 2016. All patients aged 18 years and older, presenting with DCM and admitted to Abidjan Heart Institute, who underwent coronary angiography were included. One hundred and eight patients were selected. We analysed and compared the coronary angiographic features observed. RESULTS The median age of our patients was 52 years (46-61). There was a male predominance (sex ratio = 3). Hypertension (53.7%) was the major cardiovascular risk factor found. Coronary angiography was abnormal in 37 patients (34.3%). Twenty-three patients (21.3%) had obstructive coronary artery disease (CAD). Patients with CAD were older than those with normal coronary arteries, but with no statistically significant difference (p = 0.06). Hypertension (p < 0.001) and diabetes (p = 0.0003) were statistically significantly more commonly reported in patients with CAD. CONCLUSIONS Ischaemic heart disease is likely to be underdiagnosed in sub-Saharan Africa. A coronary angiographic assessment of patients receiving treatment for DCM, especially in the presence of cardiovascular risk factors, should help optimise their management and improve prognosis.

Coronary angiography data are scarce for black patients with diabetes.To assess coronary angiography findings in patients with diabetes at the Abidjan Heart Institute.This observational cross-sectional survey was conducted between 1 April 2010 and 31 December 2014. All patients admitted for known or suspected coronary artery disease who underwent coronary angiography were included in the Registre Prospectif des Actes de Cardiologie Interventionnelle de l'Institut de Cardiologie d'Abidjan. We analysed and compared coronary angiographical findings in patients with and without diabetes.Eighty patients with diabetes were compared with 353 patients without diabetes. Patients with diabetes were significantly older (58.7±8.9 vs 52.1±11.5 years; P0.001). Hypertension and hypertriglyceridaemia were significantly associated with diabetes (P0.001 and P=0.04, respectively). A higher proportion of patients with diabetes had an abnormal coronary angiogram (85.0% vs 67.7%; P=0.002). Coronary artery disease in patients with diabetes was predominantly characterized by multivessel disease (P0.001). Cardiovascular risk factors associated with diabetes influenced the severity of coronary lesions. A SYNTAX score≥33 was found in a higher proportion of patients with diabetes (12.5% vs 7.1%). In the multivariable logistic regression, after adjustment, age60 years (hazard ratio 2.53, 95% confidence interval 1.59-4.04; P0.001) and diabetes (hazard ratio 2.12, 95% confidence interval 1.26-3.57; P=0.004) were associated with multivessel coronary artery disease.In our study, diabetes emerged as a risk factor for multivessel coronary artery disease. Future studies should help to define the long-term prognosis of these patients, and to assess the benefits of myocardial revascularization procedures.

Background Major in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute. Methods Prospective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. Results Of the 260 patients followed up on a median period of 39 months [28–68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment. Conclusions STEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.

BackgroundThe impact of COVID-19 sanitary measures on the time trends in infectious and chronic disease consultations in Sub-Saharan Africa remains unknown.MethodsWe conducted a cohort study on all emergency medical consultations over a five-year period, January 2016 to July 2020, from SOS Medecins in Dakar, Senegal. The consultation records provided basic demographic information such as age, ethnicity (Senegalese v. Caucasian), and sex as well as the principal diagnosis using an ICD-10 classification (‘infectious, ‘chronic’, and ‘other’). Firstly, we investigated how the pattern in emergency consultation differed from March to July 2020 compared to previous years. Secondly, we examined any potential racial/ethnic disparities in COVID-19 consultation.FindingsData on emergency medical consultations were obtained from 53,583 patients of all ethnic origins. The mean age of patients was 37.0 ± 25.2 and 30.3 ± 21.7 in 2016-2019 and 45.5 ± 24.7 and 39·5 ± 23.3 in 2020 for Senegalese and Caucasians. The type of consultations between the months of January and July were similar from 2016 and 2019; however, in 2020, there was a drop among the numbers of infectious disease consultations, particularly from April to May 2020 when sanitary measures for COVID-19 were applied (average of 366.5 and 358.25 in 2016-1019 and 133 and 125 in 2020). The prevalence of chronic conditions remained steady during the same period (average of 381 and 394.75 in 2016-2019 and 373 and 367 in 2020). In a multivariate analysis after adjusting to age and sex, infectious disease consultations were significantly more likely to occur in 2016-2019 compared to 2020 (OR for 2016= 2.39, 2017= 2.74, 2018= 2.39, 2019= 2.01). Furthermore, the trend in the number of infectious and chronic consultations were similar among Senegalese and Caucasian groups, indicating no disparities among those seeking treatment.InterpretationDuring the implementation of COVID-19 sanitary measures, infectious disease rates dropped as chronic disease rates stayed stagnant in Dakar. Furthermore, no racial/ethnic disparities were observed among the infectious and chronic consultations.Key PointsQuestionHow has the application of COVID-19 sanitary measures affected emergency medical consultations from March to July 2020 compared to previous years?FindingThe rates of infectious diseases decreased as rates of chronic diseases stayed stagnant with the application of sanitary measures. Among the infectious and chronic disease consultations, no racial/ethnic disparities were observed.MeaningUnderstanding the effects of the sanitary measures against COVID-19 in Sub-Saharan Africa has helped emphasize the possibility of limiting the spread of other infectious diseases in this part of the world where they are still highly prevalent and the efficiency of controlling the spread of the virus while avoiding racial/ethnic disparities.

ObjectivesThe incidence of cardiovascular diseases is increasing and there is a growing need to provide access to quality cardio drugs in Africa. In the SEVEN study, we analysed 1530 cardiovascular drug samples randomly collected from 10 African countries. By that time, of the seven drugs products analysed, only those containing amlodipine and captopril had very low assay values with active substance contents that could be less than 75% of those expected. In this article we investigate complementary aspects of the amlodipine and captopril samples so to explain the previously observed low assays for these two drugs.DesignPost hoc analysis of the captopril and amlodipine drugs samples and their packages collected in the context of the SEVEN study.Setting10 countries were concerned: Benin, Burkina Faso, Congo, Democratic Republic of the Congo, Guinea, Côte d’Ivoire, Mauritania, Niger, Senegal and Togo.ParticipantsLocal scientists and hospital practitioners collected the drug samples in the 10 African countries.Outcome measuresThe drug amount and the relative amounts of drug impurities, as well as the main compounds of the drugs packaging, were analysed.ResultsIdentification of the blister packaging of the samples led to separate both amlodipine and captopril drug samples in two groups. Mann Whitney’s bilateral test showed a significant difference (pConclusionBased on these results, particular attention should be paid to the materials and types of packaging used in order to minimise the lack of control over the exposures and drug circuits present in these different countries.

International audience

Many predicted a heavy toll of the COVID-19 pandemic on Africa. Its weakened health systems were harbingers of a terrible outcome. However, local expertise gathered from previous outbreaks and centralized public-health infrastructure with a clear action plan, in addition to a favorable demographic structure and climate, have put many countries in the continent in good standing to face this epidemic head on.

Background Implementation of primary percutaneous coronary intervention (PCI) in sub-Saharan Africa remains a challenging issue. The aim of this study was to report the results of primary PCI and outcomes in the catheterisation laboratory of the Abidjan Heart Institute. Methods Between April 2010 and March 2019, all patients aged 18 years presenting to the Abidjan Heart Institute for ST-segment elevation myocardial infarction (STEMI) over the study period and who underwent primary PCI were included. We considered primary PCI when it was performed within 48 hours of the onset of symptoms. Baseline data, PCI characteristics and outcomes were analysed. Results Among a total of 780 patients hospitalised for STEMI, 471 were admitted within 48 hours of the onset of symptoms. One-hundred and sixty six patients underwent primary PCI, with a ratio of primary PCI/STEMI of up to 21.3%. One hundred and six patients (63.9%) were admitted within 12 hours of the onset of symptoms. The femoral approach was the most commonly used (78.3%). Primary PCI was performed with stent implantation in 84.3% of patients. Drug-eluting stents (DES) were used in 42.1% of patients. In most cases, angiographic success was observed (157/166, 94.6%). Non-fatal complications were mainly haematomas (3.6%). Peri-procedural mortality rate was 1.2%. Conclusions Primary PCI can be performed safely in some small-volume centres in sub-Saharan Africa. Healthcare policies and regional networks must be encouraged in order to improve management of STEMI patients.

Objective Hypertension results in more deaths than any other risk factor and has been on the rise in sub-Saharan Africa over the past few decades. Generic drugs have helped improve accessibility and affordability of antihypertensive therapy in developing countries. However, assessment of quality standards of these products is important. We performed a quality assessment of five commonly used antihypertensive generic drugs in 10 sub-Saharan African countries and studied the impact of price on quality. Methods Drug samples were prospectively collected using standardized methods between 2012 and 2014. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Quality was defined based on the percentage ratio of measured to expected dosage of active ingredient. Results A total of 1185 samples were assessed, of which 70.0% were generic (n = 830). Among the generic drugs, the percentage of poor-quality drugs was 24.3% (n = 202/830). The percentage ratio of measured to expected dosage of active ingredient ranged from 49.2 to 111.3%; the majority (81.7%) of the poor-quality samples had insufficient quantity of the active ingredient. Moreover, poor quality was not associated with purchase price of the drug. Conclusion In this study from 10 sub-Saharan African countries, nearly one-quarter of the available generic antihypertensive drugs were found to be of poor quality. Concerted measures to improve the quality of antihypertensive drugs could lead to major improvements in hypertension control with attendant reduction of its deleterious consequences in low-income and middle-income countries.

Objectif Decrire les variations anatomiques des arteres coronaires en coronarographie. Materiel et methode Etude retrospective a visee descriptive realisee au service d’hemodynamique de l’Institut de Cardiologie d’Abidjan a partir des images de coronarographie de 195 sujets. Le critere de selection etait l’absence de pathologies acquises decelables a la coronarographie. Resultats Il y avait une dominance droite chez 74,87 % des sujets, une dominance gauche chez 14,36 % et une distribution equilibree chez 10,77 %. 87,69 % des sujets avaient deux (02) arteres coronaires parmi lesquels 3 sujets avaient une coronaire droite s’inserant dans le sinus aortique gauche ; 2,56 % avaient une coronaire unique (01) ; 8,71 % avaient trois (03) arteres coronaires et 1,03 % des sujets avaient quatre (04) arteres coronaires. Ces deux dernieres configurations consistent en une absence de tronc coronaire gauche. La longueur moyenne du tronc de l’artere coronaire gauche (TCG) etait de 10,23 mm. Il donnait deux (02) branches dans 57,44 % des cas ; trois (03) branches dans 35,9 % des cas et quatre (04) branches dans 6,67 % des cas. Au moins une branche destinee au nœud sinusal (ANS) chez 97,95 % des sujets. 78,97 % des sujets presentaient une seule ANS et 18,97 % en presentaient deux. Ces arteres naissaient a du segment I de l’artere coronaire droite et de l’artere circonflexe. Conclusion Ce travail confirme la grande variabilite anatomique des arteres coronaires. Il fournit une longueur moyenne du tronc coronaire gauche applicable au sujet d’Afrique Occidentale ce qui a un interet au cours du traitement de la pathologie ischemique coronarienne.

International audience

AIM: The aim of the study was to determine the relationship between acute hyperglycaemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). METHODS: From January 2002 to December 2017, 1 168 patients aged ≥ 18 years old, including 332 patients with diabetes (28.4%), consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycaemia at admission (> 140 mg/dl; 7.8 mmol/l). Predictors for death were determined by multivariate logistic regression. RESULTS: The prevalence of admission hyperglycaemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycaemia (hazard ratio = 2.33; 1.44–3.77; p < 0.001), heart failure (HR = 2.22; 1.38–3.56; p = 0.001), reduced left ventricular ejection fraction (HR = 6.41; 3.72–11.03; p < 0.001, sustained ventricular tachycardia or ventricular fibrillation (HR = 3.43; 1.37–8.62; p = 0.008) and cardiogenic shock (HR = 8.82; 4.38–17.76; p > 0.001) were predictive factors associated with in-hospital death. In sub-group analysis according to the history of diabetes, hyperglycaemia at admission was a predictor for death only in patients without diabetes (HR = 3.12; 1.72–5.68; p < 0.001). CONCLUSION: Conclusion: In ACS patients and particularly those without a history of diabetes, admission acute hyperglycaemia was a potentially threatening condition. Appropriate management, follow up and screening for glucose metabolism disorders should be implemented in these patients.

Introduction: les syndromes coronariens aigus (SCA) sont en progression en Afrique sub-saharienne. Les donnees angio-coronarographiques sont rares. L'objectif de cette etude etait d'analyser les lesions coronaires observees dans les syndromes coronariens aigus (SCA) a Abidjan. Methodes: etude transversale, du 1er janvier 2010 au 31er decembre 2014. Tous les patients admis pour SCA et ayant beneficie d'une coronarographie a l'Institut de cardiologie d'Abidjan pendant la periode d'etude ont ete inclus. Deux cent cinquante-six patients ont ete selectionnes. Nous avons analyse et compare les lesions coronaires chez les patients ayant presente un SCA avec sus decalage persistant du segment ST (SCA ST+) et ceux ayant presente SCA sans sus decalage du segment ST (SCA ST-). Resultats: l'âge moyen des patients etait de 53,2 ± 10,8 ans. Il existait une predominance masculine avec un sex-ratio de 6,1. Le taux de coronarographies anormales etait significativement plus eleve dans les SCA ST+ (95,4% et 64,2% respectivement, p < 0,001). Trois cent quatre lesions coronaires ont ete observees dans les SCA ST+ contre 43 dans les SCA ST-. Les lesions stenosantes etaient majoritairement monotronculaires (45,3%) dans les SCA ST+ et bi ou tri tronculaires dans les SCA ST- (68,0%). Les lesions de type B1 etaient plus frequentes dans les SCA ST- (62,8% versus 36,5%, p = 0,002). Les lesions les plus complexes de type C etaient plus frequentes dans les SCA ST+ (17,8%), sans difference significative. La majorite des patients avait un score SYNTAX inferieur a 22 quel que soit le type de SCA (87,4% dans les SCA ST+ et 90,1% dans les SCA ST-). Conclusion: les lesions coronaires dans les SCA sont majoritairement monotronculaires dans les SCA ST+ et plus diffuses dans les SCA ST- mais avec une proportion plus importante de coronaires angiographiquement normales. La prise en charge de ces lesions releve dans la majorite des cas de l'angioplastie coronaire.

Background Multi-vessel coronary artery disease (CAD) is recognized as a predictive factor of death in CAD. The aim was to assess the prevalence and predictive factors of multivessel CAD in a catheterization laboratory in Cote d’Ivoire. Methods Over a period of 8 years (April 2010 and January, 2018), we conducted a cross-sectional study in the catheterization laboratory of Abidjan Heart Institute. We enrolled one thousand and nineteen patients (1019) who underwent coronary angiography in the Registre Prospectif des Actes de Cardiologie Interventionnelle de l’Institut de Cardiologie d’Abidjan (REPACI). We analyzed and compared data in patients with and without multivessel CAD. Predictive factors were determined by multivariate logistic regression. Results Prevalence of multi-vessel CAD was 29.7% (302 patients). Means age was 58 yo with male predominance (87.7%). Main risk factors were hypertension (66.4%), diabetes (34.2%), dyslipidemia (33.9%). Left ventricle systolic dysfunction was reported in 28.9% of patients. Left anterior descending artery was involved in 90.4% of cases. After multivariate logistic regression, age > 50 yo (HR = 1.9; P = 0.02), diabetes (OR = 1.7; P = 0.01), previous percutaneous intervention (PCI) (OR = 2.53; P = 0.0001), chronic renal failure (OR = 4.99; P = 0.01), and type B2/C lesions (OR = 2.12; P = 0.001) were independant predictive factors of multi-vessel CAD. Among the 302 patients with multi-vessel CAD, 81 patients (27%) were eligible for coronary artery bypass graft surgery (CABG) but it was performed in 11 patients only. Conclusion Multivessel CAD is frequent in our context. Management of these patients in Subsaharan Africa needs heart teams with trained interventional cardiologists and cardiac surgeons, and equipped healthcare facilities.

Aim To determine the relationship between acute hyperglycemia and in-hospital mortality in black Africans with acute coronary syndromes (ACS). Methods From January 2002 to December 2017, 1168 patients aged ≥ 18 years-old including 332 patients with diabetes (28.4%) consecutively presented to the intensive care unit of the Abidjan Heart Institute for ACS. Baseline data and outcomes were compared in patients with and without hyperglycemia at admission (> 140 mg/dl). Predictors for death were determined by multivariate logistic regression. Results The prevalence of admission hyperglycemia was 40.6%. It was higher in patients with diabetes (55.3%). In multivariate logistic regression, acute hyperglycemia (HR = 2.33 [1.44–3.77]; P Conclusion In ACS patients and particularly without history of diabetes, admission acute hyperglycemia is a potential threatening condition. Appropriate management, follow-up and screening for glucose metabolism disorders should be implemented in these patients.

Background Data on extracoronary atherosclerotic disease in patients with known coronary heart disease (CAD) are scarce in our pratice. Purpose Our study aimed to assess the prevalence of carotid atherosclerosis and peripheral artery disease and predictors for extracoronary artery disease in the presence of CAD. Material and methods From March 1 to October 30, 2018, we conducted a cross-sectional study carried out among 112 patients with confirmed CAD who underwent coronary angiography in the catheterization laboratory of Abidjan Heart Institute. Ultrasound exploration of supra-aortic vessels and lower limbs arteries, and ankle brachial index (ABI) test were performed. Results The mean age was 57.4 ± 10.9 years old. There was a male predominance (sex ratio = 5). Increased intima media thickness (IMT) was reported in 55.4% of patients. Carotid plaques were observed in about 30% of cases. Smoking (HR = 3.6, P = 0.013) and multivessel CAD (HR = 2.2, P = 0.048) were the main factors associated with increased IMT. Predictive factors for increased IMT and the presence of carotid plaques were male sex (OR = 8.8, P = 0.038), smoking (OR = 2.5, P = 0.049), and multivessel CAD (HR = 3.2, P = 0.014). Concerning lower limbs arteries, 19.8% of patients had at least one plaque in common femoral arteries. Decreased ABI was reported in 48.5% of patients. The main factors associated with decreased ABI were age ≥ 50 years old (HR = 2.6, P = 0.043), diabetes (HR = 2.8, P = 0.02), dyslipidemia (HR = 3.8, P = 0.001) and multi-vessel CAD (HR = 4.5, P Conclusion Coronary artery disease is associated with increased IMT, carotid plaque, and decreased ABI, especially in patients with multivessel CAD. Systematic assessment of extracoronary artery disease should help improve the management of these high-risk patients.

Background: Several studies conducted in America or Europe have described major cardiac remodeling and diastolic dysfunction in patients with sickle cell disease (SCD). We aimed at assessing cardiac involvement in SCD in sub-Saharan Africa where SCD is the most prevalent. Methods: In Cameroon, Mali and Senegal, SCD patients and healthy controls of the CADRE study underwent transthoracic echocardiography if aged ≥10 years. The comparison of clinical and echocardiographic features between patients and controls, and the associations between echocardiographic features and the vascular complications of SCD were assessed. Results: 612 SCD patients (483 SS or Sβ0, 99 SC, and 19 Sβ+) and 149 controls were included. The prevalence of dyspnea and congestive heart failure was low and did not differ significantly between patients and controls. While left ventricular ejection fraction did not differ between controls and patients, left and right cardiac chambers were homogeneously more dilated and hypertrophic in patients compared to controls and systemic vascular resistances were lower (p < 0.001 for all comparisons). Three hundred and forty nine SCD patients had extra-cardiac organ damages (stroke, leg ulcer, priapism, microalbuminuria or osteonecrosis). Increased left ventricular mass index, cardiac dilatation, cardiac output, and decreased systemic vascular resistances were associated with a history of at least one SCD-related organ damage after adjustment for confounders. Conclusions: Cardiac dilatation, cardiac output, left ventricular hypertrophy, and systemic vascular resistance are associated with extracardiac SCD complications in patients from sub-Saharan Africa despite a low prevalence of clinical heart failure. The prognostic value of cardiac subclinical involvement in SCD patients deserves further studies.

BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and salt-restriction diet are the cornerstone of effective hypertension control. PURPOSE: We therefore, assessed adherence to medication and salt restriction in 12 sub-Saharan countries and studied their relationship with blood pressure (BP) control among hypertensive patients. MATERIAL AND METHODS: We conducted a cross-sectional survey in urban clinics of 12 sub-Saharan countries (Benin, Democratic Republic of Congo, Guinea, Mozambique, Niger, Togo, Cameroon, Congo (Brazzaville), Gabon, Côte d’Ivoire, Mauritania, Senegal). Data collected on demographics, treatment and standardised BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP

Systemic hypertension is a rapidly growing epidemic in Africa. The role of socioeconomic status on blood pressure control has not been well studied in this part of the world. We, therefore, aimed to quantify the association of socioeconomic status both at the individual and at the country level with blood pressure control in Sub-Saharan Africa. We conducted a cross-sectional survey in urban clinics of 12 countries, both low income and middle income, in Sub-Saharan Africa. Standardized blood pressure measures were made among the hypertensive patients attending the clinics. Blood pressure control was defined as blood pressure P for trend, P for trend, 0.03) and not in middle-income countries ( P for trend, 0.26). In low-income countries, the odds of uncontrolled hypertension increased 1.37-fold (odds ratio, 1.37 [0.99–1.90]) and 1.88-fold (odds ratio, 1.88 [1.10–3.21]) in patients with middle and low individual wealth as compared with high individual wealth. Similarly, the grade of hypertension increased progressively with decreasing level of individual patient wealth ( P for trend

Introduction les syndromes coronariens aigus (SCA) sont en progression en Afrique sub-saharienne. Les données angio-coronarographiques sont rares. L'objectif de cette étude était d'analyser les lésions coronaires observées dans les syndromes coronariens aigus (SCA) à Abidjan. Méthodes étude transversale, du 1er janvier 2010 au 31 décembre 2014. Tous les patients admis pour SCA et ayant bénéficié d'une coronarographie à l'Institut de cardiologie d'Abidjan pendant la période d'étude ont été inclus. Deux cent cinquante-six patients ont été sélectionnés. Nous avons analysé et comparé les lésions coronaires chez les patients ayant présenté un SCA avec sus décalage persistant du segment ST (SCA ST+) et ceux ayant présenté SCA sans sus décalage du segment ST (SCA ST-). Résultats l'âge moyen des patients était de 53,2 ± 10,8 ans. Il existait une prédominance masculine avec un sex-ratio de 6,1. Le taux de coronarographies anormales était significativement plus élevé dans les SCA ST+ (95,4% et 64,2% respectivement, p < 0,001). Trois cent quatre lésions coronaires ont été observées dans les SCA ST+ contre 43 dans les SCA ST- . Les lésions sténosantes étaient majoritairement monotronculaires (45,3%) dans les SCA ST+ et bi ou tri tronculaires dans les SCA ST- (68,0%). Les lésions de type B1 étaient plus fréquentes dans les SCA ST- (62,8% versus 36,5%, p = 0,002). Les lésions les plus complexes de type C étaient plus fréquentes dans les SCA ST+ (17,8%), sans différence significative. La majorité des patients avait un score SYNTAX inférieur à 22 quel que soit le type de SCA (87,4% dans les SCA ST+ et 90,1% dans les SCA ST-). Conclusion les lésions coronaires dans les SCA sont majoritairement monotronculaires dans les SCA ST+ et plus diffuses dans les SCA ST- mais avec une proportion plus importante de coronaires angiographiquement normales. La prise en charge de ces lésions relève dans la majorité des cas de l'angioplastie coronaire.

Background The growing menace of poor quality and falsified drugs constitutes a major hazard, compromising healthcare and patient outcomes. Efforts to assess drug standards worldwide have almost exclusively focused on anti-microbial drugs; with no study to date on cardiovascular drugs. Our study aims to assess quality of seven routinely used cardiovascular medications (anticoagulants, antihypertensives and statins) in ten Sub-Saharan African countries. Methods Drugs were prospectively collected using standardized methods between 2012 and 2014 from licensed (random pharmacies) and unlicensed (street-markets) places of sale in Africa. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Three quality categories were defined based on the ratio of the measured to the expected dosage of the active ingredient: A (good quality): 95% to 105%, B (low quality): 85 to 94.99% or 105.01 to 115%, C (very low quality): 115%. Results All expected medicines (n=3468 samples) were collected in Benin, Burkina-Faso, Congo-Brazzaville, the Democratic Republic of Congo, Guinea, Cote d'Ivoire, Mauritania, Niger, Togo and Senegal. Out of the 1530 samples randomly tested, poor quality (types B and C) was identified in 249 (16.3%) samples. The prevalence of poor quality was significantly increased in certain specific drugs (amlodipine 29% and captopril 26%), in generic versions (23%) and in drugs produced in Asia (35%). The proportion of poor quality reached 50% when drugs produced in Asia were sold in street-markets. Conclusion In this first study assessing the quality of cardiovascular drugs in Africa, we found a significant proportion of poor quality drugs. This requires continued monitoring strategies.

The hyperhemolysis paradigm that describes overlapping "hyperhemolytic-endothelial dysfunction" and "high hemoglobin-hyperviscous" subphenotypes of sickle cell disease (SCD) patients is based on North American studies. We performed a transversal study nested in the CADRE cohort to analyze the association between steady-state hemolysis and vascular complications of SCD among sub-Saharan African patients. In Mali, Cameroon, and Ivory Coast, 2407 SCD patients (1751 SS or sickle β-zero-thalassemia [Sβ0], 495 SC, and 161 sickle β+-thalassemia [Sβ+]), aged 3 years old and over, were included at steady state. Relative hemolytic intensity was estimated from a composite index derived from principal component analysis, which included bilirubin levels or clinical icterus, and lactate dehydrogenase levels. We assessed vascular complications (elevated tricuspid regurgitant jet velocity [TRV], microalbuminuria, leg ulcers, priapism, stroke, and osteonecrosis) by clinical examination, laboratory tests, and echocardiography. After adjustment for age, sex, country, and SCD phenotype, a low hemoglobin level was significantly associated with TRV and microalbuminuria in the whole population and with leg ulcers in SS-Sβ0 adults. A high hemolysis index was associated with microalbuminuria in the whole population and with elevated TRV, microalbuminuria, and leg ulcers in SS-Sβ0 adults, but these associations were no longer significant after adjustment for hemoglobin level. In conclusion, severe anemia at steady state in SCD patients living in West and Central Africa is associated with elevated TRV, microalbuminuria, and leg ulcers, but these vascular complications are not independently associated with indirect markers of increased hemolysis. Other mechanisms leading to anemia, including malnutrition and infectious diseases, may also play a role in the development of SCD vasculopathy.

Chronic kidney disease is one of the leading causes of mortality in patients with sickle cell disease. However, it has been almost exclusively studied in patients with the SS phenotype and in high-income countries, despite more than 80% of patients living in Africa. We looked for the determinants of glomerulopathy in a multinational cohort of patients with sickle cell disease of different phenotypes in sub-Saharan Africa.In the CADRE cohort, we prospectively included patients 3 years and older with sickle cell disease of all haemoglobin phenotypes in Cameroon, Côte d'Ivoire, Mali, and Senegal. All individuals were assessed at steady state. The main outcome of interest was albuminuria defined as a urine albumin-to-creatinine ratio of greater than 30 mg/g. We investigated the clinical and biological determinants (including haemolysis markers) of albuminuria in two main phenotype groups (SS and Sβ(0); SC and Sβ(+)) with further stratification by age and country.The study is ongoing because of follow-up. 2582 patients with sickle cell disease were included (1776 SS, 136 Sβ(0), 511 SC, and 159 Sβ(+)). 644 patients with the SS and Sβ(0) phenotypes (33·7%, 95% CI 31·6-35·8) and 110 with the SC and Sβ(+) phenotypes (16·4%, 13·6-19·2) had albuminuria. In the SS and Sβ(0) group, albuminuria was detected in 144 (27%) of 527 children younger than 10 years and its frequency increased with age (29 [48%] of 60 patients aged40 years). Multivariable analysis showed that albuminuria was associated with age (odds ratio 1·43, 95% CI 1·20-1·71; p0·0001), female sex (1·35, 1·02-1·82; p=0·045), low haemoglobin (0·79, 0·66-0·93; p=0·006), high lactate dehydrogenase concentrations (1·33, 1·14-1·58; p=0·0009), and, using Côte d'Ivoire as the reference, Mali (2·49, 1·64-3·79; p=0·042) and Cameroon (1·59, 1·01-2·51; p=0·0007) in patients with the SS and Sβ(0) phenotypes. The magnitude of the association of albuminuria with haemoglobin and lactate dehydrogenase concentrations increased with age. In the SC and Sβ(+) patients, only low haemoglobin (0·69, 0·48-0·97; p=0·029), high blood pressure (1·63, 1·17-2·27; p=0·0017), and Mali (3·75, 1·75-8·04; p0·0001) were associated with albuminuria.Hyperhaemolysis is associated with albuminuria, with an age-dependent effect, in the SS and Sβ(0) phenotypes only, suggesting a different pathological mechanism for glomerular disease in the patients with SC and Sβ(+) phenotypes. However, both phenotypes are associated with a high prevalence of albuminuria in childhood. Therefore, screening for albuminuria is advised in African children with sickle cell disease to detect early renal damage.Paris Cité Sorbonne University (GrEX project) and Cardiology and Development.

Resume La cardioversion electrique externe est efficace dans le traitement des arythmies. Peu de travaux lui ont ete consacres a Abidjan. Ce travail avait pour objectif de faire le bilan de 10 ans de pratique. Methode Mille trois cent quatrevingt-onze dossiers d’arythmies ont ete retrospectivement analyses. Resultats Cent deux patients ont ete choques ; 181 chocs delivres avec une energie moyenne de 262,1 Joules (J). La procedure a ete efficace chez 84 patients (82,3 %). Elle a echoue chez 18 patients (17,7 %). Huit complications graves ont ete enregistrees comprenant 1 dysfonction sinusale, 1 œdeme aigu du poumon, 1 metrorragie, 2 accidents vasculaires cerebraux et 1 embolie pulmonaire. Deux deces ont ete releves ; l’un pour tachycardie ventriculaire postoperatoire, l’autre pour tachycardie ventriculaire sur insuffisance cardiaque terminale. Conclusion Le choc electrique externe est efficace et sur. Les complications sont le plus souvent le fait des conditions cliniques plutot que de la procedure.

Background— Cardiogenic unilateral pulmonary edema (UPE) is a rare entity, frequently leading to initial misdiagnosis. We sought to assess the prevalence of UPE and to determine its impact on prognosis compared with bilateral pulmonary edema. Methods and Results— We studied the characteristics and outcomes of patients admitted to our institution for cardiogenic pulmonary edema during an 8-year period. The study population included 869 consecutive patients. The prevalence of UPE was 2.1%: 16 right-sided UPE (89%) and 2 left-sided UPE (11%). In patients with UPE, blood pressure was significantly lower ( P ≤0.01), whereas noninvasive or invasive ventilation and catecholamines were used more frequently ( P =0.0004 and P P P P =0.003, respectively). In-hospital mortality was 9%: 39% for UPE versus 8% for bilateral pulmonary edema (odds ratio, 6.9; 95% confidence interval, 2.6 to 18; P P =0.021 for model A; and adjusted odds ratio, 6.8; 95% confidence interval, 1.1 to 41; P =0.037 for model B). Conclusions— Unilateral pulmonary edema represented 2.1% of cardiogenic pulmonary edema in our study, usually appeared as an opacity involving the right lung, and was always associated with severe mitral regurgitation. Unilateral pulmonary edema is related to an independent increased risk of mortality and should be promptly recognized to avoid delays in treatment.

Data on prevalence and severity of arterial hypertension in the African general population are scare. We aimed to estimate the burden of severe hypertension among adults in the general population in Ivory Coast, using rigorous methods for blood pressure measurement. Data were collected in August

Summary Background Several patterns of Tako-Tsubo cardiomyopathy (TTC) have been described recently. Aims To assess the prevalence and characteristics of an apical-sparing variant of TTC. Methods This study included consecutive patients admitted to our catheterization laboratory for suspected acute coronary syndrome (ACS). All patients underwent coronary and left ventricular angiography systematically if no significant coronary lesions were found. Results Among 2893 patients with a suspected ACS, 38 had confirmed TTC. Nine patients presented with the apical-sparing variant, resulting in a 24% prevalence in our TTC population. At admission, mean left ventricular ejection fraction (LVEF) was significantly higher in patients with apical-sparing TTC (45 ± 4% vs 35 ± 7%, p = 0.01). Patients with classic TTC were significantly older (74 ± 10 years vs 63 ± 14 years, p = 0.01) and had a significantly higher mean heart rate and New York Heart Association functional class ( p = 0.04 and p = 0.002, respectively). Surgical or disease-related stress was found more frequently among patients with the apical-sparing variant ( p = 0.02). At day 7, mean LVEF was significantly higher in patients with apical-sparing TTC (55 ± 6% vs 48 ± 6%, p = 0.04). At 1-month and 1-year follow-up, no significant difference in LVEF was observed between the two patterns of TTC ( p = 0.60 and p = 0.46, respectively). Conclusions The apical-sparing variant of TTC is not rare and differs in several ways from the classic pattern of TTC. Physicians should be aware of and recognize this partial pattern of TTC.

Background Acute coronary syndromes (ACS) are emerging in developing countries, particularly in sub-Saharan Africa. Purpose Assess prevalence, characteristics and management of acute coronary syndromes in Ivory Coast. Methods Cross sectional study from January, 2002 to December, 2016, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for ACS. Results One thousand and eleven (1011) patients were enrolled in this study. Prevalence of ACS was 14.9% (1011/6784). Mean age was 55.0 ± 11.4 years. Main cardiovascular risk factor was hypertension (57.8%). Mean delay between symptom onset and admission to Abidjan heart institute was 35.0 ± 37.8 hours. Clinical presentation was predominantly ST-segment elevation myocardial infarction (STEMI) in 74.5% of subjects. Seven hundred and five patients (69.5%) were transferred by unsafe transportation. Among the 214 patients admitted for STEMI within 12 hours of the onset of symptoms, primary percutaneous coronary intervention was performed in 42 patients (19.6%), or 5.5% of STEMI as a whole. Seventy-eight patients (10.3%) received fibrinolytic therapy. In-hospital death rate was 8.9%. Conclusion The prevalence of acute coronary syndromes is increasing in sub-Saharan Africa. Management remains challenging in our regions, because of excessive delays of admission and limited technical facilities.

Background: Although a blood genetic disease, sickle cell disease (SCD) leads to a chronic vasculopathy with multiple organ involvement. We assessed arterial stiffness in SCD patients and looked for associations between arterial stiffness and SCD-related vascular complications. Methods: The CADRE (Coeur Artères et Drepanocytose, ie, Heart Arteries and Sickle Cell Disease) study prospectively recruited pediatric and adult SCD patients and healthy controls in Cameroon, Ivory Coast, Gabon, Mali, and Senegal. Patients underwent clinical examination, routine laboratory tests (complete blood count, serum creatinine level), urine albumin/creatinine ratio measure, and a measure of carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AI) at a steady state. The clinical and biological correlates of cf-PWV and AI were investigated by using a multivariable multilevel linear regression analysis with individuals nested in families further nested in countries. Results: Included were 3627 patients with SCD and 943 controls. Mean cf-PWV was lower in SCD patients (7.5±2.0 m/s) than in controls (9.1±2.4 m/s, P 0 than in SC-Sβ + phenotypes. AI, corrected for heart rate, increased more rapidly with age in SCD patients and was higher in SCD than in control adults. cf-PWV and AI were independently associated with age, sex, height, heart rate, mean blood pressure, hemoglobin level, country, and hemoglobin phenotype. After adjustment for these correlates, cf-PWV and AI were associated with the glomerular filtration rate and osteonecrosis. AI was also associated with stroke, pulmonary hypertension, and priapism, and cf-PWV was associated with microalbuminuria. Conclusions: PWV and AI are deeply modified in SCD patients in comparison with healthy controls. These changes are independently associated with a lower blood pressure and a higher heart rate but also with the hemoglobin phenotype. Moreover, PWV and AI are associated with several SCD clinical complications. Their prognostic value will be assessed at follow-up of the patients.

Summary Background Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. Aim To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. Methods The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. Results The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. Conclusion Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.