Left ventricular hypertrophy and insulin resistance in adults from an urban community in The Gambia: cross-sectional study.

To determine the association between left ventricular hypertrophy and insulin resistance in Gambians.Cross-sectional study.Outpatient clinics of Royal Victoria Teaching Hospital and Medical Research Council Laboratories in Banjul.Three hundred and sixteen consecutive patients were enrolled from outpatient clinics. The data of 275 participants (89 males) were included in the analysis with a mean (± standard deviation) age of 53.7 (±11.9) years.A questionnaire was filled and anthropometric measurements were taken. 2-D guided M-mode echocardiography, standard 12-1ead electrocardiogram, fasting insulin and the oral glucose tolerance test were performed.The Penn formula was used to determine the left ventricular mass index, 125 g/m2 in males and 110 g/m2 in females as the cut-off for left ventricular hypertrophy. Using the fasting insulin and fasting glucose levels, the insulin resistance was estimated by the homeostatic model assessment formula. Logistic regression analysis was used to determine the association between left ventricular hypertrophy and insulin resistance.The mean Penn left ventricular mass index was 119.5 (±54.3) and the prevalence of Penn left ventricular mass index left ventricular hypertrophy was 41%. The mean fasting glucose was 5.6 (±2.5) mmol/l, fasting insulin was 6.39 (±5.49) μU/ml and insulin resistance was 1.58 (±1.45). There was no association between Penn left ventricular mass index left ventricular hypertrophy and log of insulin resistance in univariate (OR = 0.98, 95% CI = 0.80-1.19, p = 0.819) and multivariate logistic regression (OR = 0.93, 95% CI = 0.76-1.15, p = 0.516) analysis.No association was found in this study between left ventricular hypertrophy and insulin resistance in Gambians and this does not support the suggestion that insulin is an independent determinant of left ventricular hypertrophy in hypertensives

Undiagnosed sub-valvular aortic stenosis with an associated Ventricular Septal Defect (VSD) presenting late in a multi-parous woman

Abstract Background Sub-valvular aortic stenosis is a rare disorder that has a prevalence of 6.5% of all adult congenital heart diseases. The hemodynamic changes that occur in pregnancy with the resultant increase in cardiac output may not well be tolerated by a pregnant woman with sub-valvular aortic stenosis. Case presentation We report the case of a 34-year-old para 7 (6 alive + 1 dead) who has been experiencing intermittent episodes of easy fatigability on moderate exertion since childhood and had survived 6 prior pregnancies. During her last pregnancy, she started experiencing chest pain, palpitations, dyspnea, orthopnea, and pre-syncope at 36 weeks and had a caesarean section at 37 weeks on account of fetal distress. The post-delivery cardiac evaluation showed severe sub-valvular Aortic stenosis and a ventricular septal defect. Conclusion Sub-valvular Aortic stenosis may progress slowly in adults and may be tolerated during pregnancy. Despite the rare presentation and contraindication of pregnancy in such a patient, she extraordinarily survived the pregnancy with a healthy baby. Routine cardiovascular assessment during prenatal, ante-natal and post-natal care is highly advocated particularly so in resource-poor settings

The clinical characteristics of participants by sex.

<p>t  =  Two sample t test with equal variance.</p><p>P  =  Statistical significance of difference.</p><p>n  =  Number.</p><p>SD  =  Standard deviation.</p><p>BMI  =  Body Mass Index BMI ≥ 30 (kg/m²)  =  General obesity.</p><p>WHR  =  Waist hip ratio  =  Central obesity.</p><p>SBP  =  Systolic Blood Pressure.</p><p>DBP  =  Diastolic Blood Pressure.</p

Univariate analysis of variables with log of Insulin Resistance as the outcome variable.

<p>P  =  Statistical test of significance of association.</p><p>CI  =  Confidence Interval.</p><p>R  =  Regression Coefficient.</p><p>BMI  =  Body Mass Index BMI≥30 (kg/m²)  =  General obesity.</p><p>WHR  =  Waist hip ratio  =  Central obesity.</p><p>SBP  =  Systolic Blood Pressure.</p><p>DBP  =  Diastolic Blood Pressure.</p><p>HIGH WHR  =  WHR>0.9 for males and >0.8 for females.</p

Univariate analysis of variables with PVLMILVH as the outcome variable.

<p>P  =  Statistical test of significance of association.</p><p>CI  =  Confidence Interval.</p><p>OR  =  Odds Ratio.</p><p>BMI  =  Body Mass Index BMI≥30 (kg/m²)  =  General obesity.</p><p>WHR  =  Waist hip ratio  =  Central obesity.</p><p>SBP  =  Systolic Blood Pressure.</p><p>DBP  =  Diastolic Blood Pressure.</p><p>HIGH WHR  =  WHR>0.9 for males and >0.8 for females.</p

Multivariate analysis of variables with PVLMILVH as the outcome variable and log of Insulin Resistance as the explanatory variable.

<p>P  =  Statistical test of significance of association.</p><p>CI  =  Confidence Interval.</p><p>R  =  Regression Coefficient.</p><p>BMI  =  Body Mass Index BMI≥30 (kg/m²)  =  General obesity.</p><p>WHR  =  Waist hip ratio  =  Central obesity.</p><p>HIGH WHR  =  WHR>0.9 for males and >0.8 for females.</p

The biochemical characteristics of participants by sex.

<p>t  =  Two sample t test with equal variance.</p><p>P  =  statistical significance of difference.</p><p>n  =  Number.</p><p>SD  =  Standard deviation.</p

The echocardiographic characteristics of participants by sex.

<p>t  =  Two sample t test with equal variance.</p><p>χ ²  =  Pearson chi squared test.</p><p>P  =  statistical significance of difference.</p><p>n  =  Number.</p><p>SD  =  Standard deviation.</p><p>* Number.</p