Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy

Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients.Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH.Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test.Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003).Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor

Left ventricular function in Nigerian diabetics with or without hypertension

Objectives: This study evaluated left ventricular function, using echocardiographic methods, in Nigerian diabetics with additional aim of assessing the effect of coexisting hypertension. Design: A descriptive cross sectional studySetting: Hospital based studySubjects: Ninety five subjects aged 30-60 years comprising 31 hypertensive diabetics, 30 normotensive diabetics, and 34 age- and sex- matched non diabetic non hypertensive subjects as control.Main Outcome measures: All subjects had transthoracic 2D/Mmode and Doppler flow echocardiography performed to determine left ventricular systolic and diastolic functions.Results: Age and sex of the subjects were comparable. Duration of diabetics for hypertensive diabetics and normotensive diabetics were 36.78 ±31.26 months and 36.12 ± 47.50 months respectively. Mean fasting blood glucose was significantly higher in the normotensive diabetics (8.94 ± 2.13 mmol/L) than hypertensive diabetics (6.04 ± 2.01 mmol/L); p=0.038. There was stepwise reduction in Left Ventricular Ejection Fraction(LVEF) from normal controls (71.77 ± 8.26 %) to normotensive diabetics (65.34 ± 9.75 %) and hypertensive diabetics (64.29 ±10.99 %); p= 0.005. The diabetic subjects had impaired LV diastolic function, as shown by their significantly longer Isovolumic relaxation time (IVRT) and deceleration time and lower transmitral E: A ratio compared with controls. No statistically significant difference existed in these indices of LV diastolic function between the normotensive and hypertensive diabetics, thoughhypertensive diabetics had higher LVMI than the normotensive diabetics.Conclusion: Left ventricular function is impaired in diabetics. This may be independent of coexisting hypertension, though presence of hypertension appears to worsen it.Key words: diabetes, echocardiography, left ventricular function

Two dimensional and Doppler echocardiographic evaluation of patients presenting at Obafemi Awolowo University Teaching Hospitals Complex Ile Ife Nigeria a prospective study of 2501 subjects

Rasaaq Ayodele Adebayo,1 Patience Olayinka Akinwusi,2 Michael Olabode Balogun,1 Anthony Olubunmi Akintomide,1 Victor Oladeji Adeyeye,1 Olugbenga Olusola Abiodun,1 Luqman Adeleke Bisiriyu,3 Suraj Adefabi Ogunyemi,1 Ebenezer Adekunle Ajayi,4 Olufemi Eyitayo Ajayi,1 Adebayo Tolulope Oyedeji5 1Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, 2Cardiology Unit, Department of Medicine, Osun State University, Osogbo, Osun State, 3Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, 4Cardiology Unit, Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, 5Cardiology Unit, Department of Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria Background: Echocardiography remains a key noninvasive cardiac investigative tool in the management of patients, especially in a developing economy like Nigeria. In this study, we investigated the indications for transthoracic echocardiography and spectrum of cardiac disease found in patients referred to our cardiac unit for echocardiography. Methods: A prospective two-dimensional, pulsed, continuous, and color-flow Doppler echocardiographic evaluation was done using the transthoracic approach in 2501 patients over an eight-year period. Univariate data analysis was performed for mean age, gender, clinical indications, and diagnoses. Results: The subject age range was less than 12 months to 97 years (mean 52.39 years). There were 1352 (54.06%) males and 1149 (45.94%) females. The most common indication for echocardiography was hypertension (52.1%) followed by congestive cardiac failure (13.9%). Others were for screening (6.1%), arrhythmias (5%), cerebrovascular disease (5%), chest pain (3.3%), chronic kidney disease (3.2%), congenital heart disease (2.6%), cardiomyopathy (1.8%), rheumatic heart disease (1.7%), diabetes mellitus (1.3%), thyrocardiac disease (1.2%), ischemic heart disease (1.2%), and pericardial disease (1.1%). The echocardiographic diagnosis was hypertensive heart disease in 59.4% of subjects and normal in 14.1%. Other echocardiographic diagnoses included rheumatic heart disease (3.1%), congenital heart disease (2.1%), cardiomyopathy (1.7%), pericardial disease (1.1%), and ischemic heart disease (0.1%). Conclusion: Hypertension and its cardiac complications is the most common echocardiographic indication and diagnosis at our unit. Keywords: echocardiography, cardiac diseases, prospective, indications, diagnosis, Nigeri

Prevalence, predictors, and outcomes of cardiorenal syndrome in children with dilated cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry

BACKGROUND: The association of cardiorenal syndrome (CRS) with mortality in children with dilated cardiomyopathy (DCM) is unknown. METHODS: With a modified Schwartz formula, we estimated glomerular filtration rates (eGFR) for children ≥1 year old with DCM enrolled in the Pediatric Cardiomyopathy Registry at the time of DCM diagnosis and annually thereafter, and defined CRS as an eGFR <90 mL/min/1.73 m(2). Children with and without CRS were compared on survival and serum creatinine concentrations (SCr). The association between eGFR and echocardiographic measures was assessed with linear mixed-effects regression models. RESULTS: Of 285 eligible children with DCM diagnosed at ≥1 year of age, 93 were evaluable. CRS was identified in 57 (61.3%). Mean (SD) eGFR was 62.0 (22.6) mL/min/1.73 m(2) for children with CRS and 108.0 (14.0) for those without (P<0.001); median SCr concentrations were 0.9 and 0.5 mg/dL, respectively (P<0.001). The mortality hazard ratio of children with CRS vs. no CRS was 2.4 (95% CI: 0.8-7.4). eGFR was positively correlated with measures of left ventricular function and negatively correlated with age. CONCLUSIONS: CRS in children newly diagnosed with DCM may be associated with higher 5-year mortality. Children with DCM, especially those with impaired left ventricular function, should be monitored for renal disease

A Systematic Review and Meta-Analysis of Fecal Contamination and Inadequate Treatment of Packaged Water

<div><p>Background</p><p>Packaged water products provide an increasingly important source of water for consumption. However, recent studies raise concerns over their safety.</p><p>Objectives</p><p>To assess the microbial safety of packaged water, examine differences between regions, country incomes, packaged water types, and compare packaged water with other water sources.</p><p>Methods</p><p>We performed a systematic review and meta-analysis. Articles published in English, French, Portuguese, Spanish and Turkish, with no date restrictions were identified from online databases and two previous reviews. Studies published before April 2014 that assessed packaged water for the presence of <i>Escherichia coli</i>, thermotolerant or total coliforms were included provided they tested at least ten samples or brands.</p><p>Results</p><p>A total of 170 studies were included in the review. The majority of studies did not detect fecal indicator bacteria in packaged water (78/141). Compared to packaged water from upper-middle and high-income countries, packaged water from low and lower-middle-income countries was 4.6 (95% CI: 2.6–8.1) and 13.6 (95% CI: 6.9–26.7) times more likely to contain fecal indicator bacteria and total coliforms, respectively. Compared to all other packaged water types, water from small bottles was less likely to be contaminated with fecal indicator bacteria (OR = 0.32, 95%CI: 0.17–0.58) and total coliforms (OR = 0.10, 95%CI: 0.05, 0.22). Packaged water was less likely to contain fecal indicator bacteria (OR = 0.35, 95%CI: 0.20, 0.62) compared to other water sources used for consumption.</p><p>Conclusions</p><p>Policymakers and regulators should recognize the potential benefits of packaged water in providing safer water for consumption at and away from home, especially for those who are otherwise unlikely to gain access to a reliable, safe water supply in the near future. To improve the quality of packaged water products they should be integrated into regulatory and monitoring frameworks.</p></div