|Year : 2018 | Volume
| Issue : 3 | Page : 153-156
Echocardiographic pattern of heart diseases at a Southwest Nigerian private clinic
Ebenezer Adekunle Ajayi1, Oladapo A Adewuya1, Afolabi Akinsanmi Ohunakin2, Olatunji Bukola Olaoye1
1 Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
2 Department of Family Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
|Date of Web Publication||4-Oct-2018|
Dr. Ebenezer Adekunle Ajayi
Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti
Background: Echocardiography is a noninvasive tool to evaluate morphological and hemodynamic features of the heart. Though echocardiography is increasingly being used in Nigeria, it is still mostly concentrated in the urban areas in government-owned tertiary health facilities. Materials and Methods: Echocardiograms of 1132 adult patients referred to the echocardiographic laboratory of a private clinic in Nigeria for cardiac evaluation over a 7-year period were retrospectively studied. Results: The age range was 18–95 years with a mean of 52.35 ± 18.03 years. The indications for echocardiography were systemic hypertension (42.5%), congestive cardiac failure (16.8%), and chest pain (9.5%). The common echocardiographic diagnoses were hypertensive heart disease (HHD), 39.9% and valvular heart disease (VHD), 15.0%. Rheumatic heart disease accounted for 67.7% of those diagnosed of VHD or 10.2% of the study population. Congenital heart disease was diagnosed in 1.7% of the cases comprising ventricular septal defect (0.5%), atrial septal defect (0.5%), persistent patent ductus arteriosus (0.4%), and bicuspid aorta (0.2%). The confirmation rate for HHD was 66.1%, while 70% and 57.1% of those referred on account of unexplained leg swelling and dyspnea, respectively, had heart disease. Heart disease was confirmed in 45.5% of the patients referred for routine test. Conclusion: Systemic hypertension and HHD was the most common indication for echocardiography and the most common echocardiographic diagnosis, respectively, in our study population. Rheumatic heart disease was the most common VHD. Echocardiographic confirmation rate was high in patients referred for HHD, and echocardiography may be useful in the evaluation of patients with unexplained leg swelling and dyspnea.
Keywords: Echocardiography, heart diseases, private practice
|How to cite this article:|
Ajayi EA, Adewuya OA, Ohunakin AA, Olaoye OB. Echocardiographic pattern of heart diseases at a Southwest Nigerian private clinic. Sahel Med J 2018;21:153-6
|How to cite this URL:|
Ajayi EA, Adewuya OA, Ohunakin AA, Olaoye OB. Echocardiographic pattern of heart diseases at a Southwest Nigerian private clinic. Sahel Med J [serial online] 2018 [cited 2019 Apr 20];21:153-6. Available from: http://www.smjonline.org/text.asp?2018/21/3/153/242740
| Introduction|| |
Hertz and Edler first published on the use of ultrasound to assess cardiac disease in the early 1950s and the procedure came into use in Nigeria in the mid-1970s. Though echocardiography is becoming increasingly used in Nigeria, it is still mostly concentrated in the urban areas in government-owned tertiary health facilities. As an important noninvasive investigative tool in the evaluation of cardiovascular diseases, it provides morphological and hemodynamic information which often guide the management of patients in a cost-effective manner. It also helps in understanding the pattern of cardiac diseases which is important in strategic planning of the use of scarce resources in the management of affected patients and preventive interventions to reduce the burden of cardiovascular diseases. The lack thereof of echocardiographic services may hinder proper classification of cardiovascular diseases and effective planning.
In the early 2009, echocardiographic services were pioneered in a private multispecialist clinic in Ekiti State, Southwest Nigeria. Prior to this time, patients in need of cardiac ultrasound traveled more than 100 km to access the procedure mostly in government-owned teaching hospitals. Since inception, referrals for the services have also come from the neighboring Kogi and Ondo States. Due to the concentration of these services in the urban government-owned teaching hospitals, the few reports on experience with two-dimensional (2D) and Doppler echocardiography in Nigeria have come mainly from such hospitals. Consequent upon this, we undertook the analysis of 2D and Doppler echocardiographic data from a multispecialist private clinic in an agrarian state in Southwest Nigeria. This, perhaps, as the first of its kind from a multispecialist private clinic in the Southwest region would help widen perspective on this subject in Nigeria where echocardiographic services remain predominantly in government-owned tertiary institutions.
| Materials and Methods|| |
Echocardiograms of 1132 adults 18 years and above, who were referred to the echocardiographic laboratory of a specialist private clinic in Ekiti State, Nigeria, for cardiac evaluation between April 2009 and March 2016 (7-year period), were retrospectively studied. Echocardiographic data of patients specifically recruited for other research works were excluded from the study. Referrals were received from within Ekiti state and neighboring Kogi and Ondo states. The patients had transthoracic 2D echocardiography and M-mode measurements taken according to standard procedure, using the SonoScape 1000 Ultrasound Imaging System with 4-2 MHZ transducer. All the patients had their demographic parameters including age and sex recorded.
The data obtained were analyzed for age, sex, clinical indication for echocardiography, and final echocardiographic diagnoses. Continuous variables are expressed as the mean ± standard deviation, with frequency expressed as a percentage. All statistical analyses were performed with computer program IBM SPSS version 20 (IBM Corp., Armonk, NY).
| Results|| |
There were 1132 patients whose ages ranged between 18 and 95 years with a mean age of 52.35 ± 18.03 years. Mean ages for males and females were 51.99 ± 18.25 years and 52.78 ± 17.79 years, respectively.
The most common indication for echocardiography was systemic hypertension to evaluate for the presence of hypertensive heart disease (HHD) in 481 (42.5%), congestive cardiac failure in 190 (16.8%), and chest pain in 107 (9.5%) patients. Other indications for echocardiography are summarized in [Table 1].
Of the 1132 patients referred for echocardiography, 70.7% had heart diseases and the spectrum of these diseases is depicted in [Figure 1]. [Table 2] summarizes echocardiographic diagnoses of the patients. Four hundred and fifty-two (39.9%) patients had HHD. Of this, 61/452 (15.6%) had hypertensive heart failure. Valvular heart disease (VHD) was diagnosed in 170/1132 (15.0%) of the study population. Rheumatic heart disease constituted 115/170 (67.7%) of the diagnosis of VHD or 115/1132 (10.2%) of the study population. There were 19/1132 (1.7%) cases of congenital heart disease comprising ventricular septal defect (0.5%), atrial septal defect (0.5%), persistent patent ductus arteriosus (0.4%), and bicuspid aorta (0.2%). Thirty-three (2.9%) patients in the age range of 38–70 years (mean: 58.67 ± 9.20 years) were referred for “routine” echocardiography, out of which 20/33 (60.6%) had abnormal echocardiogram, mostly HHD. Thirteen of the 332 (3.9%) patients who had normal echocardiographic studies were referred for routine medical examination.
Analysis of the data for diagnostic yield showed that, of the 481 patients referred for hypertension, 318 (66.1%) had HHD confirmed by echocardiography. Nearly 70% of those referred on account of unexplained leg swelling had heart disease. Similarly, 57.1% of those referred for unexplained dyspnea had heart disease. Of the 33 patients referred for routine test, 45.5% had abnormal echocardiographic findings indicating heart disease. The echocardiographic confirmation rate for patients referred for chest pain evaluation was the least as only 8/107 (7.5%) had heart disease. [Table 3] summarizes the confirmation rate for some of the other indications for echocardiography.
| Discussion|| |
The results of this study show that systemic hypertension and congestive heart failure are the most common indications for echocardiography. HHD was also the most common echocardiographic diagnosis. These findings are similar to findings from tertiary teaching hospitals and a private hospital in Nigeria.,,,,,,, This may be explained by the rising prevalence of hypertension in our society and the increasing number of patients with hypertension being referred for echocardiography. In Nigeria, the pooled prevalence of hypertension increased from 15% in 1990–1999 to 22.5% in 2000–2009. Similarly, the prevalence of uncontrolled hypertension is also high with the attendant consequence of development of complications of HHD including congestive heart failure.
Of all the reports on experience with echocardiography in Nigeria, only one till date documented VHD as more common indication for echo than hypertension, wherein the authors attributed the finding to the center being a national referral hospital for interventional and open cardiovascular surgery. Chest pain (9.45%), VHDs (4.24%), palpitations (4.06%), congenital heart diseases (3.62%), and unexplained dyspnea (3.09%) are the other common indications for patients' referral for echocardiography in our study. Chest pain as an indication for echocardiography in our study has a similar rate with other reports from Nigeria, but higher than the rate reported by Kolo et al. in the north central region of Nigeria and Adebayo et al. in the adjoining Osun State, Southwest Nigeria. The frequency of VHDs as an indication for echocardiography request appears to be generally low in Nigeria. We reported a frequency of 4.24% while Oyedeji et al., Uwanuruochi et al., and Adebayo et al. reported frequencies of 2.4%, 2.3%, and 0.4%, respectively. One common feature of these echocardiographic audit reports is the focus on adult population and may partly explain the reason for the low frequency. The same explanation may apply to the low frequency of congenital heart diseases as an indication for adult echocardiographic request in our study, similar to other studies in Nigeria.,,
Another common echocardiographic diagnosis is VHD. The most common VHD diagnosis was rheumatic valve disease in 10.2% of the study population or 67.65% of the subset of patients with VHD. In a review of 913 adult patients referred for echocardiography over a 3-year period, rheumatic heart disease was reported in 7% of the population. James et al. reported a frequency of 9% in a review of 234 patients over 1-year period.
There were a large number of normal findings at echocardiography in this study. This is similar to previous studies in Nigeria, but higher than what was reported by Kolo et al. and Adebayo et al. This is likely due to the diverse population of doctors in different areas of medical practice who referred patients for echocardiography with the increased likelihood of inappropriateness in their request for this imaging modality. It is also known that nonmedically qualified personnel such as nurses and laboratory scientists, especially those working in rural hospitals where doctors are not available, do refer patients for echocardiographic studies. The American College of Cardiologists Foundation in association with other bodies issued the appropriateness criteria for transthoracic and transesophageal echocardiography. This is aimed at encouraging the rational use of this imaging modality.
The echocardiographic confirmation rate was high for patients referred for HHD, similar to what was reported by Adebayo et al. and Kolo et al. Patients with unexplained leg swelling, unexplained dyspnea, and those sent for routine echocardiography eventually had heart disease confirmed in them. This indicates that echocardiography may be particularly necessary in the objective assessment of these categories of patients to appropriately manage their health conditions.
One major limitation of this study is its retrospective nature.
| Conclusion|| |
Systemic hypertension was the most common indication for echocardiography in our area, and HHD was the most common echocardiographic diagnosis. Though request for echocardiographic evaluation of adults for VHD was low, rheumatic heart disease was the most common VHD in this study. Echocardiographic confirmation rate was high in patients referred for HHD and echocardiography may be useful in the evaluation of patients with unexplained leg swelling and dyspnea.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Edler I, Hertz CH. The use of ultrasonic reflectoscope for the continuous recording of the movements of heart walls. 1954. Clin Physiol Funct Imaging 2004;24:118-36.
Troy BL, Pombo J, Rackley CE. Measurement of left ventricular wall thickness and mass by echocardiography. Circulation 1972;45:602-11.
Balogun MO, Omotoso AB, Bell E, Lip GY, Gemmill JD, Hogg KJ, et al.
An audit of emergency echocardiography in a district general hospital. Int J Cardiol 1993;41:65-8.
Agomuoh DI, Akpa MR, Alasia DD. Echocardiography in the university of Port Harcourt Teaching Hospital: April 2000 to March 2003. Niger J Med 2006;15:132-6.
Ukoh VA, Omuemu CO. Echocardiography in the university of Benin teaching hospital, Benin city, Nigeria. Niger J Cardiol 2005;2:24-47.
Sani MU, Karaye KM, Ibrahim DA. Cardiac morbidity in subjects referred for echocardiographic assessment at a tertiary medical institution in the Nigerian savanna zone. Afr J Med Med Sci 2007;36:141-7.
Ogah OS, Adegbite GD, Akinyemi RO, Adesina JO, Alabi AA, Udofia OI, et al.
Spectrum of heart diseases in a new cardiac service in Nigeria: An echocardiographic study of 1441 subjects in Abeokuta. BMC Res Notes 2008;1:98.
Kolo PM, Omotoso AB, Adeoye PO, Fasae AJ, Adamu UG, Afolabi J, et al
. Echocardiography at the university of Ilorin teaching hospital Nigeria. A three years audit. Res J Med Sci 2009;3:141-5.
Adebayo RA, Akinwusi PO, Balogun MO, Akintomide AO, Adeyeye VO, Abiodun OO, et al.
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. Int J Gen Med 2013;6:541-4.
Oyedeji AT, Akintunde AA, Owojori OO, Peter JO. Spectrum of echocardiographic abnormalities among 168 consecutive referrals to an urban private hospital in South-Western Nigeria. Clin Med Insights Cardiol 2014;8:35-8.
Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, et al.
Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012;4:327-40.
Ike SO. Echocardiographic analysis of valvular heart diseases over one decade in Nigeria. Trans R Soc Trop Med Hyg 2008;102:1214-8.
James OO, Efosa JD, Romokeme AM, Zuobemi A, Sotonye DM. Dominance of hypertensive heart disease in a tertiary hospital in Southern Nigeria: An echocardiographic study. Ethn Dis 2012;22:136-9.
Uwanuruochi K, Offia E, Ukpabi OJ, Chuku A, Ogah OS. Initial experience with echocardiography at the federal medical centre, Umuahia, Nigeria. Niger J Cardiol 2015;12:13-7.
Douglas PS, Khandheria B, Stainback R F, Weissman NJ. ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance. Endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Coll Cardiol, 2007; 50:187-204.
[Table 1], [Table 2], [Table 3]