TY - JOUR
T1 - The causes, treatment, and outcome of pulmonary hypertension in Africa
T2 - Insights from the Pan African Pulmonary Hypertension Cohort (PAPUCO) Registry
AU - Thienemann, Friedrich
AU - Dzudie, Anastase
AU - Mocumbi, Ana O.
AU - Blauwet, Lori
AU - Sani, Mahmoud U.
AU - Karaye, Kamilu M.
AU - Ogah, Okechukwu S.
AU - Mbanze, Irina
AU - Mbakwem, Amam
AU - Udo, Patience
AU - Tibazarwa, Kemi
AU - Damasceno, Albertino
AU - Keates, Ashley K.
AU - Stewart, Simon
AU - Sliwa, Karen
PY - 2016/10/15
Y1 - 2016/10/15
N2 - Background Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. Methods A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. Results There were 209 adults (median age 48 years [IQR 35, 64]) and 11 children (age range 1 to 17 years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252 m (IQR 120, 350) and median right ventricular systolic pressure 58 mm Hg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment (p = 0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. Conclusions These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. Trial Registration ClinicalTrials.gov (NCT02265887).
AB - Background Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. Methods A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. Results There were 209 adults (median age 48 years [IQR 35, 64]) and 11 children (age range 1 to 17 years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252 m (IQR 120, 350) and median right ventricular systolic pressure 58 mm Hg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment (p = 0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. Conclusions These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. Trial Registration ClinicalTrials.gov (NCT02265887).
KW - Africa
KW - Congenital heart disease
KW - HIV
KW - Pulmonary hypertension
KW - Registries
UR - http://www.scopus.com/inward/record.url?scp=84978488616&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.06.242
DO - 10.1016/j.ijcard.2016.06.242
M3 - Article
C2 - 27404676
AN - SCOPUS:84978488616
VL - 221
SP - 205
EP - 211
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -