Dyslipidemia and cardiovascular diseases: Science or fairy tale Basil Nwaneri Okeahialam Nigerian Journal of Cardiology 2019 16(1):1-4

Echocardiographic findings in Nigerian patients with stroke Jamila Ado Ya'u, Kamilu Musa Karaye, BN Okeahialam Nigerian Journal of Cardiology 2019 16(1):5-10 Stroke is the third leading cause of death in several industrial countries and cardio-embolism accounts for 15&#8211;30&#37; of ischaemic strokes. Studies investigating associations between echocardiographic parameters and stroke mechanisms are limited. This study therefore aimed at assessing echocardiographic parameters and left ventricular (LV) functions in stroke patients in comparison with apparent healthy controls. This was a case-control study conducted at Aminu Kano Teaching Hospital Kano, Nigeria. 100 stroke subjects were consecutively recruited and compared with 100 age and sex matched controls. Echocardiographic parameters studied include LV and Left atrial (LA) dimensions, LV hypertrophy (LVH), LV systolic and diastolic dysfunctions, regional wall motion abnormalities (RWMA), intracardiac thrombus, and valvular diseases using transthoracic echocardiography. The mean age of cases and controls was 56.4 &#177; 15.8years and 54.5 &#177; 15.4 years (P &#61; 0.39), and M:F ratio was 1.1:1 among both cases and controls (P &#61; 0.887). LVH was the most prevalent echocardiographic finding; found in 62&#37; and 21&#37; (P<0.01) of the cases and controls, respectively. Concentric LVH was found in 42&#37; of the cases and 13&#37; of controls, eccentric LVH in 23&#37; of cases and 9&#37; of the controls, while concentric remodeling was found in 5&#37; of cases and 2&#37; of controls (P &#60; 0.001, 0.002 and 0.272 respectively). LV systolic dysfunction was found in 10&#37; of the cases and 3&#37; of the controls (P &#61; 0.044), LV diastolic dysfunction in 48&#37; of the cases and 18&#37; of the controls (P &#60; 0.001), while combined systolic and diastolic dysfunction was found in 12&#37; of cases and 4&#37; of the controls respectively (P &#61; 0.038). Regional wall motion abnormality, Increased LA size, Aortic valve sclerosis and rheumatic valvular heart disease were commoner amongst cases than controls. Echocardiographic abnormalities were common among stroke patients and their presence could influence clinical decisions and outcomes. This study therefore supports echocardiographic evaluation of stroke patients.

Relationship between CD4 cell count and left ventricular dimension and function in treatment-naïve human immunodeficiency virus-infected patients Alaba Philip Adebola, Akindeji A Akinbo, Folashade A Daniel Nigerian Journal of Cardiology 2019 16(1):11-17 Introduction: Echo studies have documented obvious changes in the left ventricular (LV) dimension and function of human immunodeficiency virus (HIV)-infected patients. Previous studies had suggested that patients with very low CD4 cell counts (&#8804;200/&#956;l) were more likely to be at risk of cardiac complications. The aim of the present study was to evaluate and correlate the LV dimension and function of treatment-na&#239;ve HIV-positive patients with their CD4 cell count. Methodology: A total of 100 consenting treatment-na&#239;ve HIV-infected patients and fifty healthy controls were recruited for this study. The data were analyzed using the Statistical Package for the Social Science version 20.0. The data were subjected to appropriate statistical tests. The statistically significant P value was set at 0.05. Results: Fifty-eight HIV-infected patients had CD4 cell count of &#62;200/&#956;l, whereas 42 had CD4 cell count of &#8804;200/&#956;l. A higher proportion of treatment-na&#239;ve HIV-infected patients had larger LV dimension compared to their healthy seronegative counterparts (P &#61; 0.01). The HIV-infected patients were more likely to have asymptomatic systolic and diastolic dysfunctions compared to the healthy seronegative adults (P &#61; 0.01). Thirty-three HIV patients had LV systolic dysfunction consisting of 26 (61.9&#37;) with CD4 cell count &#60;200/&#956;l and 7 (12.1&#37;) with CD4 cell count &#62;200/&#956;l. Thirty-four of the patients had LV diastolic dysfunction consisting of 20 (47.6&#37;) with CD4 cell count &#60;200/&#956;l and 14 (24.1&#37;) with CD4 cell count &#62;200/&#956;l. The LV cavity diameter and LV mass index did not show any significant correlation with CD4 cell count ([r] &#61; &#8722;0.018; P &#61; 0.863 and [r] &#61;0.012; P &#61; 0.902, respectively). LV systolic function showed significant positive correlation with CD4 cell count, (r &#61; 0.384; P &#61; 0.001). Conclusion: Treatment-na&#239;ve HIV-infected patients had larger LV dimension and were more likely to have LV systolic and diastolic dysfunction compared to HIV-negative healthy individuals. Some of these findings were more prevalent in HIV-infected patients with very low CD4 cell count of &#8804;200/&#956;l.

Pattern and appropriateness of antihypertensive prescriptions among hospitalized hypertensives in Nigeria Adeseye A Akintunde, Kamilu M Karaye, Daniel Olusegun-Joseph, SA Balarabe, Oladimeji G Opadijo Nigerian Journal of Cardiology 2019 16(1):18-24 Introduction: Prescribers&#39; compliance to relevant guidelines may be a reflection of the depth of thoroughness in therapy, awareness, and a pointer to pitfalls in reducing cardiovascular mortality. This study was aimed to study the pattern and appropriateness of antihypertensive prescriptions among hospitalized patients with hypertensive disorders in Nigeria. Materials and Methods: This was a retrospective study. All medical admissions over a 1-year from January 1 to December 31, 2013, were reviewed from three teaching hospitals across Nigeria. Two hundred and eighty-eight hospitalized hypertensive patients were identified with complete records. The pattern of drugs prescription and their compliance with the Joint National Commission VII criteria was determined. Results: The mean age was 57.6 &#177; 15.7 years. Associated comorbid conditions include heart failure, transient ischemic attack, and type 2 diabetes mellitus. Commonly prescribed drugs include angiotensin-converting enzyme inhibitors (ACE-I), diuretics, calcium channel blockers (CCBs), and angiotensin receptor blockers. The proportions of participants using these drugs were 57.3&#37;, 34.0&#37;, 26.4&#37;, and 12.5&#37;, respectively. Fifty-one (20.73&#37;) were on a single medication, 108 (43.9&#37;) were on two medication classes while 87 (35.37&#37;) were on drugs from at least three classes of antihypertensive pharmacotherapy. Combination therapy is frequent among hospitalized hypertensive patients in this study. The common pattern of two-drug combination among study participants included ACE-I and diuretics. The most common three-drug combinations included ACE-I, CCBs, and diuretics. Conclusion: Majority of study participants were on combination therapy and had multiple comorbid cardiovascular risk factors, target organ damage, and complications. Antihypertensive prescriptions across three tertiary centers in Nigeria appear to follow relevant clinical guidelines with minimal differences across the centers.

Serum chemerin as a predictor of left ventricle hypertrophy in patients with coronary artery disease Noha Hasssanin Hanboly, Yasser Sharaf, Mervat Al-Anany, Essam Saeed Nigerian Journal of Cardiology 2019 16(1):25-31 Background: Left ventricular hypertrophy (LVH) is an important predictor of cardiovascular risk and its detection contributes to risk stratification. Chemerin is a secreted protein with a complex but well-established role in immune function. It regulates adipocyte development and metabolic function as well as glucose metabolism in liver and skeletal muscle tissues. Purpose of the Study: The aim of the current study was to investigate the correlation between the serum chemerin level and occurrence of LVH in patients with coronary artery disease (CAD). Patients and Methods: The study included 100 patients with CAD. Patients were classified according to their body mass index (BMI) into two groups, 50 patients (Group A) with BMI (&#8805;30 kg/m2) and 50 patients (Group B) with BMI &#8804;25 kg/m2. Transthoracic echocardiography was done for all patients after a thorough clinical assessment. Left ventricular study was done according to the guidelines endorsed by the American society of echocardiography. Results: Serum chemerin level was positively correlated with BMI, waist circumference, and left ventricle mass index (P &#60; 0.005 for all). Conclusion: Serum chemerin levels were higher in obese patients with CAD. Levels were associated with LVH and increased high-sensitivity C-reactive protein as a marker of inflammation.

Air quality index and cardiovascular risk factors among automobile technicians in Southwest Nigeria Adeseye A Akintunde, Jamiu Adeniran, Temitope S Akintunde, Taofeek O Oloyede, Afolabi A Salawu, Oladimeji G Opadijo Nigerian Journal of Cardiology 2019 16(1):32-37 Background: Prolonged inhalational injury among automechanics may predispose them to increased oxidative process and cardiovascular diseases. This study was aimed at describing air quality index and pattern of cardiovascular risk factors among automechanics in Ogbomoso, Nigeria. Materials and Methods: One hundred and three automechanics were randomly recruited from Ogbomoso, Nigeria. Demographic and clinical parameters were collected. Cardiovascular risk factors were assessed. Air quality sampling was done using the gt-321 particle counter. Statistical analysis was done using SPSS 18.0. Results: The mean age of the study participants was 38.54 &#177; 11.94 years. The prevalence of cardiovascular risk factors among the study participants was hypertension (25.2&#37;), low high-density lipoprotein-cholesterol (45.6&#37;), elevated low-density lipoprotein-cholesterol (29.1&#37;), and hypercholesterolemia (26.2&#37;). The air quality index for particulate matter (PM)2.5were often three to five times higher than average 24 h mean in urban centers and more than 10 times the total annual mean. Similarly, average PM10,7,4and total suspended particle(TSP) were also significantly higher in automechanic workshops compared to the average urban measure of air quality index reported in 2014. Conclusion: Air quality indices around autotechnicians workshop are very poor. Cardiovascular risk factors such as hypertension and dyslipidemia still occur frequently among automechanic despite their high physical activity. Proper automobile and emission control and implementation of workplace protection are advised to minimize the impact of air pollution on automechanics in Nigeria.

Electrocardiographic abnormalities in sickle cell disease patients in Kano, Northwest Nigeria Jamila Ado Yau, Hadiza Saidu, Ahmad Maifada Yakasai Nigerian Journal of Cardiology 2019 16(1):38-42 Background: Cardiovascular abnormalities are important causes of morbidity and mortality in sickle cell disease (SCD) patients. Data on electrocardiography (ECG) changes in SCD are lacking in Kano, Northwest Nigeria. This study, therefore, aimed to identify the pattern of ECG changes in steady state adult sickle cell patients. Methodology: A case&#8211;control cross-sectional study was conducted among SCD patients attending the sickle cell clinic in Murtala Muhammad Specialist Hospital, Kano. One hundred SCD patients were consecutively recruited and compared with 100 age- and sex-matched controls. All consenting participants had hemoglobin (Hb) electrophoresis and were subjected to electrocardiography. Results: The mean age of the cases is 20.98 &#177; 5.74 years, whereas that of the controls was 22.31 &#177; 3.27 years, P &#61; 0.047. Among the cases, 57&#37; were male, whereas in the control group, 55&#37; were male (P &#61; 0.443). The mean body mass index (BMI) for the cases was 18.14 &#177; 3.57 kg/m2, whereas that of the control was 22.74 &#177; 2.18 kg/m2, P &#60; 0.001. The mean Hb concentration of the cases and the controls was 7.22 &#177; 0.94 g/dl and 12.00 &#177; 9.51 g/dl, respectively, P &#60; 0.001. Nonspecific ST-T wave changes were the most common ECG abnormality detected in 76&#37; of cases and 42&#37; of controls, P &#60; 0.0001. Other ECG abnormalities found among the SCD patients were right ventricular hypertrophy (64&#37;), right atrial enlargement (24&#37;), left atrial enlargement (4&#37;), biatrial enlargement (8&#37;), atrial ectopics (6&#37;), premature ventricular contractions (1&#37;), and prolonged PR interval (4&#37;). An association was observed between low BMI and abnormal ECG findings among the cases (P &#61; 0.006). Conclusion: ECG abnormalities are common in SCD patients and early identification would lead to early intervention to prevent cardiac events.

Reliability and validity of a disease-specific quality of life tool in Nigerian patients with heart failure Iseko Iyoko Iseko, Adewole A Adebiyi, Ayodele O Falase Nigerian Journal of Cardiology 2019 16(1):43-48 Background: Heart failure results in varying limitation in activities of daily living, and consequently on the individual&#39;s quality of life. There is a thus a need for a reliable and valid tool to assess HRQoL in Nigerian patients. Aims and Objectives: To determine the health-related quality of life of Nigerian patients with heart failure using the Minnesota Living with Heart Failure Questionnaire (MLHFQ), its validity and reliability, and its relationship between to disease severity as defined by the NYHA class. Materials and Methods: 106 consecutive stable participants diagnosed with HF were recruited and studied. The MLHFQ was self-administered by recruited participants and NYHA class was determined by clinical evaluation. Appropriate descriptive and inferential statistical analysis was subsequently carried out. Results: The mean age (SD) of the subjects was 56.8 (13.4) years. 41.6&#37; of HF subjects had suboptimal HRQoL in varying degrees with a median score of 19. The MLHFQ was found to be reliable exhibiting high internal consistency (Cronbach&#39;s alpha reliability coefficient - 0.928), similarly high for each of the subscale domains and there was a significant relationship between the MLHFQ and the NYHA class (rho: 0.7706; P &#60; 0.001), a finding that also validates the MLHFQ. Conclusion: HRQoL evaluation in Nigerian participants with HF using the MLHFQ should be considered in routine practice as it is a reliable and valid assessment with possible significant clinical utility.

Normogram of right ventricular echocardiographic dimensions in a cohort of normal term neonates in Ibadan Oluwakemi Ashubu, Adejumoke Idowu Ayede, Bosede Adebayo, Samuel I Omokhodion Nigerian Journal of Cardiology 2019 16(1):49-53 Introduction: The study of the right ventricle is a relatively young field, particularly in the newborn. This study assessed the right ventricular echocardiographic dimensions in a cohort of normal term neonates in Ibadan. Materials and Methods: This was a longitudinal cohort study involving 120 term neonates with normal maternal cardio topographic (CTG) parameters, physical findings, and oxygen saturation. The right ventricular dimensions were measured at birth and then weekly till age 28 days. The measurements obtained in millimeters were as follows: the main pulmonary artery, right ventricular anterior wall thickness, right ventricular diameter in diastole, interventricular septum thickness in diastole, and interventricular septal thickness in systole. Echocardiographic assessment was done with the Sonosite Titan mobile ultrasound machine with 5.0MHz transducer; measurements were made according to the American Society of Echocardiography recommendations. Results: A total of 120 normal term newborns were studied, of which 60 males and 60 females. The mean weight varied from 3.16 to 4.02 kg, the length varied from 48.25 to 54.38 cm, whereas the body surface area varied from 0.036/m2 to 0.037/m2. The mean values and their respective standard deviations relative to the echocardiographic measurements are presented and right ventricular normograms derived from echo parameters and weight using 95&#37; confidence interval. Conclusions: This study has focused on right ventricular echocardiographic dimensions in normal newborn using a longitudinal cohort of newborn evaluated using CTG and pulse oximetry monitoring, thus demonstrating true normal zero probability of recruiting asphyxiated babies. The parameters thus can be used for evaluating Nigerian newborns pending the availability of results from larger multicenter studies.

Left ventricular echocardiographic nomograms in a cohort of normal term neonates in Ibadan Adejumoke Idowu Ayede, Oluwakemi Ashubu, Oluwatoyin Ogunkunle, Samuel I Omokhodion Nigerian Journal of Cardiology 2019 16(1):54-59 Background: Previous studies on neonatal cardiac dimensions in Africa were cross-sectional, evaluating mainly children with very few newborns. This study was carried out in a cohort of normal newborns with normal maternal cardiotocograms, systemic finding, and pulse oximetry at birth. Materials and Methods: One-hundred and twenty term normal newborns were recruited from March 2015 to December 2015 from the Adeoyo Maternity Teaching Hospital and the University College Hospital, Ibadan, Oyo State, Southwest Nigeria. The mothers were monitored during labor using cardiotocography 7 fetal/maternal monitor to ensure that the baby suffered no perinatal stress. Pulse oximetry was also done at birth. Left ventricular dimension in diastole, left ventricular posterior wall thickness in diastole, left ventricular dimension in systole, and left ventricular posterior wall thickness in systole and aortic dimension were measured at birth and weekly till 28 days using M-mode according to American Society of Echocardiography. Results: All mothers recruited had spontaneous vaginal delivery with normal cardiotocographic measurements. Appearance, pulse, grimace, activity, and respiration scores ranged between 7&#8211;8 at 1 min and 8&#8211;10 at 5 min. There were 60 (50&#37;) males and 60 (50&#37;) females. All of the left ventricular measurements showed a linear increase in their values with age. Nomograms have been plotted based on age using 95&#37; confidence interval. Conclusion: This study has shed some light on the possibility of deriving normal values of echocardiographic dimensions for this age group and derived nomogram. This has added to the already existing data on the nomograms of the newborn, especially in the Nigerian Newborn.