Pulmonary hypertension in the Shisong Cardiac Centre - Cameroon: Prevalence, Clinical features and Mortality

CaHReF 20116, Yaoundé Conges hall, 23 – 26 August 2016 , PL093

Pulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and eventually death due to a narrowing of the pulmonary vasculature and consequent right heart failure. The epidemiology of PH in low-to-middle income countries is unknown, but recent data suggest a high prevalence in the African continent. We assessed the prevalence, and characteristics of PH in patients attending the rural Cardiac centre of Shisong, Cameroon.

The current study forms part of the ongoing Pan African Pulmonary Hypertension Cohort (PAPUCO) Study. From September 2013 to December 2014, all consecutive patients with newly diagnosed PH were recruited. PH was diagnosed in patients with clinical suspicion and echographically measured right ventricular systolic pressure (RVSP) >35mmHg. PH was classified as mild (RVSP: 36-50 mmHg), moderate (RVSP: 51-60 mmHg) and severe (RVSP: >60 mmHg). All recruited participants were prospectively followed up for a period of 6 months.
Out of 2194 patients who had echocardiograms done, 343 had PH (15.6 %). In all, 150 (mean age 62.7±18.7 years, 54.7% women) were included in the analysis. Overall mean RVSP was 68.6 mmHg, 7.3%, 29.3% and 63.3% presented with mild, moderate and severe PH respectively. PH due to left heart disease (PHLHD) was the commonest type (64.7%), with rheumatic valvular heart disease accounting for 36.1%. Comorbidities at presentation included indoor smoke from cooking (80.7%), hypertension (52.0%), family history of cardiovascular disease (50.0%), diabetes (31.3%), alcohol abuse (21.3%) and HIV (8.7%). Clinical features at presentation were dyspnoea (78.7%), fatigue (76.7%), palpitation (57.3%), cough (56.7%), jugular venous distension (68%) and peripheral oedema (66.7%). In all, 70% of patients presented at World Health Organization functional class III/IV. Mortality rate at 6 months was 34.4%

PH is common among patients attending the Shisong cardiac centre and is associated with a high mortality. PHLHD is the most frequent type. High prevalence of indoor smoking, rheumatic heart diseases and late presentation to hospital may reflect poor socio-economic context. These findings should increase awareness of PH among physicians in this setting, thus leading to early diagnosis and management.

Pulmonary Hypertension, Shisong cardiac centre, prevalence, mortality, Africa