Biomedical subjects

Akinyemi Aje

Publications and source records attributed to Akinyemi Aje.

6 recordsLinked to original sources

PubMed2006

Echocardiographic partition values and prevalence of left ventricular hypertrophy in hypertensive Nigerians.

BACKGROUND: Left ventricular hypertrophy (LVH) is a well known independent risk factor for cardiovascular events. It has been shown that combination of left ventricular mass (LVM) and relative wall thickness (RWT) can be used to identify different forms of left ventricular (LV) geometry. Prospective studies have shown that LV geometric patterns have prognostic implications, with the worst prognosis associated with concentric hypertrophy. The methods for the normalization or indexation of LVM have also recently been shown to confer some prognostic value especially in obese population. We sought to determine the prevalence of echocardiographic lLVH using eight different and published cut-off or threshold values in hypertensive subjects seen in a developing country's tertiary centre. METHODS: Echocardiography was performed in four hundred and eighty consecutive hypertensive subjects attending the cardiology clinic of the University college Hospital Ibadan, Nigeria over a two-year period. RESULTS: Complete data was obtained in 457 (95.2%) of the 480 subjects (48.6% women). The prevalence of LVH ranged between 30.9-56.0%. The highest prevalence was when LVM was indexed to the power of 2.7 with a partition value of 49.2 g/ht2.7 in men and 46.7 g/ht2.7 in women. The lowest prevalence was observed when LVM was indexed to body surface area (BSA) and a partition value of 125 g/m2 was used for both sexes. Abnormal LV geometry was present in 61.1%-74.0% of our subjects and commoner in women. CONCLUSION: The prevalence of LVH hypertensive patients is strongly dependent on the cut-off value used to define it. Large-scale prospective study will be needed to determine the prognostic implications of the different LV geometry in native Africans.

Journal Article↗

PubMed2006

Left ventricular geometric patterns in newly presenting Nigerian hypertensives: an echocardiographic study.

BACKGROUND: Hypertension is a global problem and it is prevalent in Nigeria. Left ventricular hypertrophy is a major complication of hypertension with risk of sudden death and arrhythmias among others. Abnormal left ventricular geometric patterns also increase the burden of morbidity and mortality. It is therefore important to know the different left ventricular geometric patterns in Nigerian hypertensives because of their prognostic significance. METHODS: One hundred (100) newly presenting hypertensives (53 males and 47 females) and 100 controls (53 males and 47 females) were recruited for the study. All were subjected to clinical evaluation and full echocardiographic examination was performed according to the ASE recommendation. The relative wall thickness and the presence or absence of echocardiographic left ventricular hypertrophy were used to determine the various geometric patterns. RESULTS: The mean age of the hypertensive subjects was 56.06 (+/- 7.68) years while that of the control subjects was 56.10 (+/- 7.68) years. There was no significant difference in the mean ages of the two groups. In the hypertensive subjects 28% had normal geometry, 26% had concentric remodeling, 28% had concentric hypertrophy and 18% had eccentric hypertrophy. In the control group, 86% had normal geometry, 11% had concentric remodeling, 3% had eccentric hypertrophy and none had concentric hypertrophy. There was statistical significance when the geometric patterns of the hypertensive and controls were compared (chi2 = 74.30, p value < 0.0001). CONCLUSION: The study showed that only 28% of the hypertensive subjects had normal LV geometric pattern while 86% of the normal subjects had normal geometry. There is need for longitudinal studies in order to prognosticate the various geometric patterns.

Adult↗

PubMed2006

Clinical characteristics and initial management of patients with tuberculous pericarditis in the HIV era: the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry.

BACKGROUND: The incidence of tuberculous pericarditis has increased in Africa as a result of the human immunodeficiency virus (HIV) epidemic. However, the effect of HIV co-infection on clinical features and prognosis in tuberculous pericarditis is not well characterised. We have used baseline data of the Investigation of the Management of Pericarditis in Africa (IMPI Africa) registry to assess the impact of HIV co-infection on clinical presentation, diagnostic evaluation, and treatment of patients with suspected tuberculous pericarditis in sub-Saharan Africa. METHODS: Consecutive adult patients in 15 hospitals in three countries in sub-Saharan Africa were recruited on commencement of treatment for tuberculous pericarditis, following informed consent. We recorded demographic, clinical, diagnostic and therapeutic information at baseline, and have used the chi-square test and analysis of variance to assess probabilities of significant differences (in these variables) between groups defined by HIV status. RESULTS: A total of 185 patients were enrolled from 01 March 2004 to 31 October 2004, 147 (79.5%) of whom had effusive, 28 (15.1%) effusive-constrictive, and 10 (5.4%) constrictive or acute dry pericarditis. Seventy-four (40%) had clinical features of HIV infection. Patients with clinical HIV disease were more likely to present with dyspnoea (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.4 to 7.4, P = 0.005) and electrocardiographic features of myopericarditis (OR 2.8, 95% CI 1.1 to 6.9, P = 0.03). In addition to electrocardiographic features of myopericarditis, a positive HIV serological status was associated with greater cardiomegaly (OR 3.89, 95% CI 1.34 to 11.32, P = 0.01) and haemodynamic instability (OR 9.68, 95% CI 2.09 to 44.80, P = 0.0008). However, stage of pericardial disease at diagnosis and use of diagnostic tests were not related to clinical HIV status. Similar results were obtained for serological HIV status. Most patients were treated on clinical grounds, with microbiological evidence of tuberculosis obtained in only 13 (7.0%) patients. Adjunctive corticosteroids were used in 109 (58.9%) patients, with patients having clinical HIV disease less likely to be put on them (OR 0.37, 95% CI 0.20 to 0.68). Seven patients were on antiretroviral drugs. CONCLUSION: Patients with suspected tuberculous pericarditis and HIV infection in Africa have greater evidence of myopericarditis, dyspnoea, and haemodynamic instability. These findings, if confirmed in other studies, may suggest more intensive management of the cardiac disease is warranted in patients with HIV-associated pericardial disease.

Adolescent↗

PubMed2005

Left ventricular diastolic function parameters in hypertensives.

BACKGROUND: Hypertension is associated with left ventricular diastolic function abnormalities. There have been few studies evaluating left ventricular diastolic function in an African populace. MATERIALS AND METHODS: Ninety-eight hypertensives (52 females, 46 males) and 99 normal controls (49 females, 50 males) were recruited for echocardiography. M-mode measurements and Doppler measurements of Mitral inflow and pulmonary venous flow were taken. RESULTS: The hypertensives had significantly larger left ventricular wall thicknesses than the controls PWT: 0.93 (0.214) vs. 0.88 (0.130), p=0.039: septum: 0.93 (0.255) vs. 0.87 (0.131), p=0.039. The left ventricular mass indexed to the allometric power of height was larger in the hypertensives than in the controls. The Doppler parameters of peak A-wave velocity, E/A ratio, deceleration time, peak pulmonary venous S-wave, peak pulmonary venous D-wave, S/D ratio and peak pulmonary reverse flow velocity were significantly different between the hypertensives and the controls. The major determinant of left ventricular diastolic function parameters were age and the duration of hypertension. The level of the systolic blood pressure, left atrial size and ejection fraction are less important determinants. CONCLUSION: Nigerian hypertensives have significantly different diastolic function indices when compared with normal controls.

Age Factors↗

PubMed2005

Standard electrocardiographic criteria for left ventricular hypertrophy in Nigerian hypertensives.

OBJECTIVES: Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular morbidity and mortality. Various electrocardiographic criteria for LVH have differing sensitivities and specificities. Most of the available electrocardiographic criteria for LVH have not been evaluated in the African populace. METHODS: Electrocardiograms (ECGs) and echocardiograms were obtained from 100 hypertensive subjects and 60 controls. Electrocardiogram (ECG) LVH was determined by the Sokolow-Lyon, Sokolow-Lyon-Rappaport, Cornell voltage, Romhilt-Estes point score, and the Perugia score criteria. Echocardiographic LVH was defined by LV mass indexed for height at 97.5 percentile of the controls (126 g/m and 130 g/m in females and males respectively). RESULTS: The prevalence of echocardiographic LVH indexed for height was 34% and 1.67% in the hypertensive patients and controls respectively. The prevalence of ECG LVH obtained in the hypertensive patients with the various ECG criteria were 56% for Sokolow-Lyon-Rappaport voltage, 48% for Sokolow-Lyon voltage, 41% for Perugia score, 22% for Cornell sex specific voltage, and 18% for Romhilt-Estes score. Sokolow-Lyon-Rappaport voltage criteria had the best sensitivity (80%) and area under the receiver operating characteristic (ROC) curve while the Romhilt-Estes score had the best specificity (93%). CONCLUSION: Sokolow-Lyon and Sokolow-Lyon-Rappaport voltage criteria combine the best sensitivity and specificity values and would seem better suited for the diagnosis of ECG LVH in Nigerians.

Adult↗

PubMedDate not supplied

Correlates of left atrial size in Nigerian hypertensives.

AIM: Left atrial (LA) enlargement is a common finding in systemic hypertension and is a risk factor for the development of atrial fibrillation and stroke. We determined the correlates of LA enlargement in a Nigerian hypertensive population. METHODS: A total of 361 hypertensives were recruited for echocardiography. Enlarged left atrium was defined as LA diameter > 4.2 cm in men or > 3.8 cm in women. RESULTS: Enlarged LA was found in 15.8% of the hypertensives (19.2% in females and 12.5% males). Compared with those without dilated LA, subjects with dilated LA had higher age, body mass index, left ventricular end diastolic diameter, left ventricular wall thickness, lower ejection fraction and fractional shortening. In multivariate analysis, body mass index and left ventricular (LV) mass were the major predictors of LA size, whereas dilated LA was related to age, female gender and LV mass or the presence of left ventricular hypertrophy in logistic regression analysis. CONCLUSION: Left atrial size in Nigerian hypertensives is influenced by age, female gender, left ventricular mass and body mass index.

Age Factors↗