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Abstract proceedings of the 43 rd Annual General Meeting and Scientific Conference of the Nigerian Cardiac Society held 18-19 th September 2014 at Amazing Grace Event Centre, 25 Obio Imoh Street, Uyo, Akwa Ibom State, Nigeria

Oral Presentation

OP-01: Prevalence and pattern of human immunodeficiency-related cardiac dysfunction among Nigerian patients

C. M. Godsent Isiguzo, Adesua S. Muoneme 1 , Michael Iroezindu 2 , Basil Okeahialam 1

Department of Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, 1 Jos University Teaching Hospital, Jos Plateau State, 2 University of Nigeria Teaching Hospital, Enugu State, Nigeria

Background: Increased life expectancy in human immunodeficiency virus (HIV)-infected patients have now exposed them to cardiovascular diseases burden.

Objectives: We determined the prevalence/pattern of cardiac dysfunction among Nigerian HIV-infected patients.

Materials and Methods: Two hundred HIV-positive consenting adults ≥18 years, had clinical examination, laboratory investigations, electrocardiography, echocardiography, and Doppler studies.

Results: Mean age 37 (9) years, 71% women. Median CD4 cell count 358 cells/mm 3 , 84.4% being on antiretroviral therapy. HIV-related cardiac dysfunction (HRCD) seen in 39.5%, more in males (52% vs. 35%) and at CD4 cell < 200 cells/mm 3 (72% vs. 29%). Diastolic and systolic dysfunction each 10.5%, pericardial effusion 8.5%, dilated cardiomyopathy 4.5%, isolated left ventricular dilatation 4.0%, pulmonary hypertension 4.0%, and right ventricular dysfunction 0.5%. Ejection fraction, fractional shortening, and left ventricular internal diameter differed between patients with HRCD and others.

Conclusion: Cardiac disease complicating HIV/AIDS is usually subtle initially, regular CV screening is, therefore, necessary for high-risk groups in order to institute early intervention.

OP-02: End stage heart failure: What choices are available for the Nigerian Cardiologist?

V. O. Ansa, A. Otu 1 , C. Onwurah, V. Uhegbu,

U. Njideoffor, H. Osim, E. Chukwudike, C. Akpan, C. O. Odigwe

Department of Medicine, Cardiology Unit, University of Calabar Teaching Hospital, 1 Department of Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria

Background: End stage heart failure (HF) is often characterized by refractory symptoms usually dyspnea and fatigue at most times despite optimal medical therapy. Sudden death is common. They usually require specialized interventions.

Objectives: The aim was to highlight the availability of some specialized interventions for patients with end stage HF and encourage cardiologists to avail their patients of the options despite the perceived cost.

Case Report: A 60-year-old man with chronic HF secondary to idiopathic dilated cardiomyopathy of 7 years remained in steady state until 6 months prior to presentation when he developed recurrent episodes of exacerbation of symptoms despite optimal medical therapy, some requiring hospitalization. He was found to be chronically ill with marked bilateral pitting pedal edema. Pulse was 90 beats/min, regular, blood pressure was 110/70 mmHg, jugular venous pressure was elevated, apex was displaced and diffuse. He had bilateral basal crepitations and tender hepatomegaly. Echocardiography showed grossly dilated cardiac chambers, hypokinetic left ventricle, and ejection fraction (EF) of 20%. He was managed as a case of end-stage HF. Response to medical therapy remained grossly unsatisfactory and specialized interventions were recommended. He opted for cardiac transplantation and was referred abroad as requested. He had successful orthotopic cardiac transplantation with marked improvement in symptomatology and quality-of-life. Postoperative echocardiography showed normal cardiac chamber sizes and EF of 68%. He is currently on triple immunosuppressant drug therapy.

Conclusion: Availability of resources permitting, all patients with end-stage HF should be availed the opportunity to have specialized interventions that would improve their quality-of-life and reduce mortality.

OP-03: Surgical management of recalcitrant peripheral bronchopleural fistula with empyema: Our preliminary experience

Kelechi E. Okonta, Emmanuel O. Ocheli, Tombari Gbeneol 1

Department of Surgery, Cardiothoracic Surgery Division, 1 Department of Surgery, Plastic and Reconstructive Surgery Division, University of Port Harcourt Teaching Hospital, Rivers, Nigeria

Background: Peripheral bronchopleural fistula (BPF) and empyema from necrotizing infections of the lung and pleural is difficult to treat, however, to use the latissimus dorsi muscle (LDM) flap is effective in managing this condition.

Objectives: The aim was to show the effectiveness of the LDM flap and patch closure technique in the management of recalcitrant peripheral BPFs via thoracotomy.

Materials and Methods: Five patients with BPF and empyema out of 26 patients who were initially treated for empyema thoracis by single or multiple chest tube insertions and/or ultrasound guided drainage were prospectively identified and followed-up for 2 years. The postoperative of hospital stay, dyspnea score, any loss of function of the ipsilateral upper limb, and any deformity of the chest wall were assessed at follow-up visits by asking relevant questions.

Results: The mean age was 46.8 years (23-69 years) (4 males and 1 female). The cause of the BPF in 16 patients was Mycobacterium tuberculosis, and 8 was pneumonia. The 5 (19.2%) patient had thoracotomy and closure of the fistula with LDM flap in 4 and pleural patch in a patient. The mean total months of insertion chest tube were 1.5 months (range: 2.5-6 months) and mean postoperative hospital stay was 20.8 days (13-28 days); complications were subcutaneous emphysema, empyema, and hemothorax in three patients. There was improved dyspnea score to 1 and 2. No recurrence of BPF or the empyema in all the patients; no loss of function or deformity of the chest wall.

Conclusion: The use of LDM flap is effective in treating peripheral BPF without any adverse long-term outcome.

OP-04: Early mobilization program for open heart surgery patients

Rita N. Ativie, Ezinne O. Nwosu, Chinwe P. Obiekwe, Emmanuel C. Kanu, Maranatha N. Anudu

Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria

Background: Mobilization and ambulation are the requisites for normal physiological function of the human body; therefore, early mobilization and physical therapy are essential for patients who undergo open heart surgery to enhance functional activity.

Objectives: The objective was to report the specific physical therapy interventions outcome of a patient who had heart valve surgery and required a longer stay in the Intensive Care Unit (ICU) due to development of left CVA after his surgery.

Materials and Methods: A 75-year-old patient who had open heart surgery due to rheumatic heart disease with mitral valve regurgitation. His preoperative assessment revealed he was asthmatic, had cough, body mass index of 25.5, 6 MWT of 243.84 m. Postoperatively, he commenced progressive mobilization within the first 4 h postextubation. It involved graded exercises, positioning, ankle pumps, active movements of lower extremities, sitting up on the bed, sitting by side of the bed with legs hanging, standing by bedside, weight shifting on legs, and sitting out on a chair. He underwent early walking program with frequent chest physiotherapy.

Result: The patient regained independent ambulation 12 days postoperative. There had been appreciable functional gains during the period of his stay in the ICU before he was moved to the step-downward. The patient was able to walk up to 106.68 meters by the time he was transferred out of ICU.

Conclusion: The result showed that early mobilization and ambulation are beneficial during the rehabilitation of patients who had open heart surgery. It also has the potential to improve the patient's exercise capacity and quality-of-life.

OP-05: Review of outcome of radiofrequency cardiac catheter ablations carried out at Madras Medical Mission, India

Uwanuruochi Kelechukwu, Sabari Saravanan 1 , Benjamin Solomon 2 , Anita Ganasekar 2 , Ravikumar Murugesan 2 , Jaishankar Krishnamoorthy 2 , Ulhas M. Pandurangi 2

Department of Medicine, Federal Medical Centre, Umuahia, Abia, Nigeria, 1 St. Jude Medical, 2 Department of Electrophysiology, Madras Medical Mission, Chennai, India

Background: Intracardiac catheter ablation techniques for treatment of cardiac arrhythmias in humans were first reported in 1982 by Gallagher et al. Initially, direct energy was used, and later on radiofrequency energy was introduced. It has since then become a standard modality of treatment, being accepted as a class 1 indication in cases of symptomatic supraventricular tachycardia and the modality of choice for patients with various drug refractory arrhythmias.

Objectives: The purpose of this study was to evaluate the intermediate term follow-up results of radiofrequency catheter ablations of patients.

Materials and Methods: A total of 140 cases of consecutive radiofrequency ablations (RFAs) involving 66 males and 74 females, were retrospectively reviewed at the cardiac electrophysiology department of Madras Medical Mission, India.

Results: There was a very high success rate (97.9%). Early complications were observed in only 3 (2.14%) patients, comprising cardiac tamponade, complete heart block and presyncope. Recurrence rate of the indication for RFA was very low (1.43%) and there was no mortality from the procedure.

Conclusion: There is a need for appropriate referrals of patients that will benefit from the procedure and increased interest among cardiologists for training in cardiac electrophysiology.

OP-06: Prevalence of traditional cardiovascular risk factors among staffs of Ladoke Akintola University of Technology, Ogbomoso, Nigeria

A. A. Akintunde, A. A. Salawu 1 , O.G. Opadijo

Departments of Medicine and 1 Chemical Pathology, Ladoke Akintola University of Technology and LAUTECH Teaching Hospital, Ogbomoso, Nigeria

Background: Cardiovascular disease (CVD) is the number one cause of death worldwide.

Objectives: This study was aimed to describe the frequency of occurrence of traditional cardiovascular (CV) risk factors among selected University workers in LAUTECH Nigeria.

Materials and Methods: A cross-sectional study of 206 staffs of LAUTECH, Ogbomoso, Nigeria had assessment for nine traditional CV risk factors. Demographic and clinical parameters were taken. Blood sample was taken to determine the random blood sugar and lipid profile. 12-lead resting (electrocardiogram [ECG]) was done for all participants. Statistical analysis was performed with the use of (SPSS) version 17.

Results: The study population included 96 males (46.6%) and 110 females. The mean age was 45.3 ΁ 7.9 years (range: 27-73 years). The prevalence of CV risk factors was as follows: Hypertension 84 (40.8%), visceral obesity 92 (44.7%), generalized obesity 79 (38.3%), low high density lipoprotein 113 (54.9%), impaired blood glucose 16 (7.8%), diabetes mellitus 3 (1.5%) hypercholesterolemia 102 (49.5%), ECG-left ventricular hypertrophy 24 c(11.7%), elevated Lowdensity lipoprotein-cholesterol 99 (48.1%). About three-fourth (72.3%) had two or more CV risk factors clustered together. Females had a higher prevalence of CV risk factors and its clusters than their male counterparts. Of those diagnosed with hypertension, in this study, more than half had never been told they were hypertensive 48 (57.1%).

Conclusion: This study suggests a very high prevalence of CV risk factors among University Staff in LAUTECH, Ogbomoso, Nigeria. Clustering of CV risk factors is more prevalent among women. Appropriate preventive strategy in terms of education and modification of risk factors is important to reduce the burden of CVD among this population.

OP-07: Twenty-four-hour Holter electrocardiographic assessment of hypertensive and diabetic patients in Nigeria

R. A. Adebayo, A. N. Ikwu, M. O. Balogun,

A. O. Akintomide, T. O. Mene-Afejuku, V. O. Adeyeye, O. J. Bamikole, L. A. Bisiriyu 1 , O. E. Ajayi,

S. A. Ogunyemi, O. A. Oketona

Department of Medicine, Cardiology Unit, Obafemi Awolowo University Teaching Hospitals Complex, 1 Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria

Background: There are very limited studies in Nigeria on the use of 24-h Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients.

Objectives: The aim was to evaluate indications, arrhythmic pattern of Holter ECG, and heart rate variability (HRV) among patients with hypertensive heart disease (HHD), hypertensive heart failure (HHF), and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit.

Materials and Methods: A total of 79 patients (32 males and 47 females) was studied consecutively over a year using schiller type (MT-101).

Results: Of the 79 patients, 17 (21.5%) had HHD, 33 (41.8%) had HHF, while 29 (36.7%) were T2DM patients. The mean (SD) ages of HHD, HHF, and T2DM patients were 59.65 (΁14.38), 65.15 (΁14.30), and 54.66 (΁8.88), respectively. The most common indication for Holter ECG was palpitation (38%), and then syncope (20.3%). Premature ventricular contraction (PVC) was the most common arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV, using SDNN was significantly reduced in T2DM patients (81.03 ΁ 26.33) compared to the HHD (119.65 ΁ 29.86) and HHF (107.03 ΁ 62.50). There was a negative correlation between the duration of T2DM and HRV (r = −0.613).

Conclusion: Palpitation was the most common Holter ECG indication and PVCs were the most common arrhythmic pattern among our patients. HRV was reduced in T2DM patients compared with hypertensive patients.

OP-08: Audit of back titration in the treatment of hypertension in Nigerians

Basil N. Okeahialam

Department of Medicine, Jos University Teaching Hospital, Jos, Plateau, Nigeria

Background: An audit of a hypertension service in Jos, Nigeria revealed the possibility of back titration of antihypertensive therapy without untoward effect. The impact was a reduction of disease economic burden. Consequently, a deliberate policy of back-titration was adopted in those who have remained well-controlled for >12 months.

Objectives: The objective was to see how low dosages could go without compromising control.

Materials and Methods: All consenting hypertensive clients in this specialist hypertension clinic who had been controlled for 12 months or longer on regular follow-up (between July and September 2011); with no heart failure, renal failure, stroke or myocardial infarction (<6 months) were enrolled. Drugs were sequentially back-titrated starting with one drug in those on multiple drugs. Follow-up continued in the usual manner, and if controlled by the next visit a further dose lowering was advised until loss of control when dose was promptly returned to the lowest maintaining control.

Results: There were 41 patients initially. 2 did not follow-up after the first back-titration visit leaving 39 as the subject of this analysis; 14 of whom were males. Their ages ranged from 40 to 91 years, and they had been consistently controlled (blood pressure [BP] <140/90 mmHg) for between 12 and 95 months. 18 remained normal at various stages of back-titration; in 5 (3 females, 2 males) all drugs had been completely withdrawn. In 21, control was lost in the course of back-titration and promptly recovered by returning to the previous dose that controlled BP. Those who were successfully back-titrated to no drug were mostly on one drug at low doses.

Conclusion: After a minimum of 12 months of sustained BP control, it is possible to back-titrate drug dosages in about 50% of this hypertensive cohort, a quarter of whom went completely without drugs for 1-year. The exact mechanism is unknown, but the benefit is in the psychological relief of lower pill burden and reduced cost of treatment. This observation should be extended to other cohorts to prove its applicability; advisedly only under expert care.

OP-09: Coronary artery bypass graft - two different indications in two patients

V. Okwulehi, O. C. Nzewi, M. A. C. Aghaji

Department of Surgery, Cardiothoracic Unit, University of Nigeria Teaching Hospital, Enugu State, Nigeria

Background: Coronary artery bypass graft (CABG) is the most widely studied cardiac operation and the most common indication for it is coronary artery disease causing coronary artery obstruction. Ischemic heart disease is the leading cause of mortality globally, but facilities for its accurate diagnosis in Sub-Saharan Africa are not commonly available. Two patients recently had CABG at our center - for different causes of coronary obstruction. These form the basis of this short term report.

Materials and Methods: Case 1: C.O is a 20-year-old male who had open heart surgery and cardiopulmonary bypass (CPB) on 25/3/14. His preoperative diagnosis was severe aortic stenosis (AS). However, at operation he was found to have severe calcific AS and a membranous stenosis at the sino-tubular junction. The aortic valve was replaced with a size 19 mechanical valve prosthesis and the supra AS was enlarged with a Dacron patch. On the release of the aortic cross-clamp, the heart rhythm was persistently in ventricular fibrillation despite multiple direct current shocks to the heart, correction of electrolyte status, warming and use of copious anti-arrhythmic drugs. Complete de-airing of the heart was confirmed by operative trans-esophageal 2-d echo. At this stage, coronary artery obstruction from the implant was the most plausible explanation for the persistent ventricular fibrillation. Cardio-pulmonary bypass was re-instituted and as cold cardioplegic solution was given at this stage - it was obvious that the cardiac temperature remained the same - indicating that the cardioplegic solution was not getting to the cardiac wall. The two options at this stage were - to explants the size 19 aortic valve prosthesis-and insert a smaller one-which may be very small for the patient's hemodynamic needs - or to graft the left anterior descending (LAD), right coronary artery (RCA) and circumflex the long saphenous vein (LSV) was harvested from both thighs and grafted to the proximal RCA and the LAD artery. He was then weaned off CPB. Total bypass time was 237 min, and total cross clamp time was 160 min. He was discharged home on the 7 th postoperative day. Case 2: T.N is 61-year-old male who presented with angina (Canadian Cardiovascular Society 11; New York Heart Association 1), triple vessel disease and left ventricular dysfunction. There was no previous myocardial infarction. He is hypertensive, but not diabetic. There was a family history of ischemic heart disease and hypertension. He had elective CABG under CPB and received 3 grafts: LSV - PDA; LSV - left circumflex; pedicled left internal mammary artery - mid LAD. Cold blood cardioplegic solutions were given both retrograde and ante grade. Total bypass time was 135 min and cross clamp time was 63 min. He was discharged on the 8 th postoperative day.

Results: Both patients are asymptomatic and are being followed-up. He is on routine drugs for patients who have had CABG. Graft patency rates will be assessed in due course.

Conclusion: CABG is the most widely studied cardiac operation and is applicable to a wide variety of obstructive lesions of the coronary arteries. We believe that-with better diagnostic and operative facilities at our center, CABG will soon be a very common and routine procedure for selected patients who need it.

OP-10: Cardiothoracic nursing training in Nigeria: Providing much needed nursing manpower for effective cardiothoracic patient management (an update)

N. O. Nnadozie, L. U. Igbokwe, B. J. C. Onwubere, C. H. Anyanwu

Department of Medicine and Surgery, Cardiothoracic Centre of Excellence, University of Nigeria Teaching Hospital, Enugu State, Nigeria

Background: Cardiothoracic nursing is a sub-specialty area in nursing that relates to patients with cardiovascular and thoracic disorders. Since the heart is vital to life, the cardiothoracic nurse must be skilled in all areas that pertain to heart function and hence that they could help to manage conditions such as coronary heart disease, cardiomyopathy, congestive heart failure, cardiac dysrythmias, among others, working closely and collaborating with cardiologists and other members of the cardiac team. Cardiothoracic nurses perform pre- and post-operative care on surgical units, stress test evaluations, ca Nrdiac monitoring, vascular and health assessments. In view of the growing number of cardiac centers in Nigeria rendering full cardiothoracic services (including open heart operations), there is a need for training of more cardio-thoracic nurses in Nigeria. Currently, the University of Nigeria Teaching Hospital is the only institution carrying out this training program.

Materials and Methods: The methodology used for this work is based on existing record in the Post Basic Cardiothoracic Nursing School, University of Nigeria Teaching Hospital, Enugu and feedbacks from various beneficiary institutions and hospitals in Nigeria and abroad. Records were from the year, 2000 when the Cardiothoracic Nursing Program started at the UNTH, Enugu.

Results: From available data in the school, from 2000 to 2014, the school has admitted and trained 293 students and graduated a total of 258 cardiothoracic nurses (an additional 60 from the previous update) who are currently practicing both within and outside the country. Out of the 258 graduated cardiothoracic nurses, 37 were males while 221 were females, making an average male:female ratio of 1:6. These figures make up a total of 235 representing 91% of overall registered cardiothoracic nurses in active service, while the locations of the remaining 13 representing 9% are undetermined. Beneficiary institutions/hospitals are major tertiary, secondary, corporate and private hospitals in all the three major regions of Nigeria. A significant number of the trained CT nurses are also abroad working or carrying out further self-development programmes.

Conclusion: Cardiothoracic Nursing training is a vital tool in the provision of a much needed Nursing manpower for effective management of cardiothoracic patients. Commendable efforts have been made by the only Institution in Nigeria currently approved and accredited by the Nursing and Midwifery Council of Nigeria to train this cadre of highly needed professionals.

In view of the above, the authors therefore recommend that more of such schools and training facilities be made available for the increasing number of nurses who are eager to be part of the cardiac workforce and also to supply much-needed skilled professionals to existing and emerging cardiac centers in the country.

OP-11: Cardiovascular abnormalities in human immunodeficiency infected patients at Jos University Teaching Hospital

Ganiyu A. Amusa, Solomon S. Danbauchi, Basil N. Okeahialam

Department of Internal Medicine, Jos University Teaching Hospital, Jos, Plateau, Nigeria

Background: Human immunodeficiency virus (HIV) infection is an important cause of cardiovascular (CV) morbidity particularly in sub-Saharan Africa. Early identification of CV abnormalities with prompt treatment in HIV-infected persons significantly reduces the attendant morbidity and mortality.

Objectives: The study aimed at evaluating the CV abnormalities and risk factors in HIV-infected patients at Jos University Teaching Hospital.

Materials and Methods: This was a cross-sectional analytical study. One hundred and fifty HIV-infected subjects (90 antiretroviral therapy [ART] exposed and 60 ART naive) with 50 (age and sex matched) HIV-negative controls who met the study criteria were recruited. Relevant history, physical examination, laboratory specimen (serum lipids, fasting plasma sugar, CD4 count and viral load) and electrocardiogram (ECG) were obtained from the subjects. Echocardiographic examination was performed in 1 in 3 subjects selected randomly. The Framingham risk score (FRS) for each participant was calculated and interpreted to assess CV risk.

Results: The prevalence of CV abnormalities and risk factors were significantly elevated among the HIV-infected subjects compared to HIV-negative controls. Dyslipidemia, hypertension and significant alcohol intake were the commonest identified CV disease risk factors. Most of the subjects had clustering of CV disease risk factors, 24.0% had >4 risks compared with none among the subjects (P < 0.001). The subjects had statistically significant higher mean FRS of 4.18 ΁ 4.30 compared with 2.54 ΁ 2.04 for controls (P = 0.010). Among the subjects, those on ART had statistically significant higher FRS mean scores compared to those, not on ART (P = 0.036); also those on protease inhibitor based regimen had statistically significant higher FRS compared to those not on protease inhibitors (P < 0.001). Electrocardiographic abnormalities were found in 71.3% of subjects compared to 10.0% of controls (P < 0.001) and echocardiographic abnormalities were found in 76.0% of subject compared to 15.0% of controls (P < 0.001). The commonest electrocardiographic and echocardiographic abnormality in the subjects was premature ventricular contractions (32.0%) and pericardial disease (46.0%), respectively. CD4 count <200 cells/ml was found to be an independent predictor of pericardial disease in the subjects. Similarly, detectable viral load >200 copies/ml was identified as an independent predictor of abnormal ECG in the subjects.

Conclusion: Increased CV abnormalities are common findings in HIV-infected persons. They can be identified early by routine CV work up which should include electrocardiography, echocardiography and use of CV disease risk tools. Early diagnosis and treatment will significantly reduce morbidity and mortality in these patients.

OP-12: Significant risk factors for atherosclerotic vascular disease in diabetes as measured by carotid intima media thickness

B. N. Okeahialam 1 , B. A. Alonge 1],[4 , A. I. Zoakah 2 ,

S. D. Pam 3 , F. H. Puepet 1

Departments of 1 Medicine, 2 Community Health and 3 Radiology. Jos University Teaching Hospital, Jos, 4 NNPC Medical Services, Kaduna, Nigeria

Background: Most patients with diabetes mellitus die from cardiovascular disease (CVD) largely due to atherosclerosis. Carotid intima media thickness (CIMT) is a measure of atherosclerotic CVD that captures comprehensively the effects of multiple risk factors for CVD over time. Consequently, it should be possible to use CIMT to determine which CVD risk factors are critical to atherosclerosis and manipulate such to prevent or retard atherosclerotic CVD.

Materials and Methods: Consenting nonhypertensive diabetics underwent CIMT measurement in the standard fashion after history, physical examination and blood sampling for common CVD risk factors namely lipid profile, uric acid and measures of glycemic control.

Results: The 70 patients (36 females, 34 males), mean age 51.2 years (10.63) standard deviation had mean CIMT of 0.94 mm (0.12). CIMT correlated significantly with systolic blood pressure (P = 0.0000), diastolic blood pressure (P = 0.0008), fasting plasma glucose (P = 0.0000), 2 h PPG (P = 0.0000), HbA1C (P = 0.0000) total cholesterol (P = 0.0000), high density lipoprotein cholesterol (HDL-C) (P = 0.0000) and uric acid (P = 0.0000).

Conclusion: Blood pressure (BP) though not in the hypertensive range correlated significantly with CIMT suggesting that the better the control of BP, the less the atherosclerotic process in the vessels. Other CVD risk factors correlating significantly with CIMT were measures of glycemic control, total and HDL-C as well as uric acid. Since most of these CVD revolve around hyperinsulinemia, tight control of sugar would to a large extent ameliorate atherosclerotic burden.

OP-13: Double valve replacement with mechanical prosthetic valves; case report and literature review

O. Orakwe, V. Okwulehie, M. Aghaji

Department of Medicine, Cardiothoracic unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria

Background: The first double valve replacement using 1 st generation mechanical prostheses for combined aortic and mitral valve disease was done in 1960s. Until 1970s, it was associated with high operative mortality. The high profile 1 st generations of mechanical valves, cardiopulmonary bypass techniques and imperfect myocardial protection did not allow this surgery to be performed under optimal conditions for achieving satisfactory results. With the development of 2 nd generation mechanical bileaflet low profile valves and advent of modern myocardial protection techniques, there has been an improved short term, medium term and long-term prognosis of these patients since the early 1980s. These valves are not prone to structural deterioration and offer good hemodynamics. Patients will usually need lifelong anticoagulation.

Objectives: To report the long-term survival of the 1 st double valve replacement for rheumatic heart disease in Nigeria-15 years follow-up.

Materials and Methods: Case report and literature review.

Case Report: An 18-year-old female presented with features of rheumatic mitral and aortic valve disease in New York Heart Association class 4. She had a double valve replacement with a St. Jude mechanical valve in May, 1999. She has been on anticoagulation and has maintained a good quality-of-life.

Conclusion: Long term results of double mechanical valve replacement are satisfactory in terms of both survival and quality of life with modern surgical perioperative treatment and durable bileaflet mechanical prostheses that have excellent hemodynamic performance. This patient has been on warfarin and had her international normalized ratio done every 3 months. She lives in Kaduna and gets her yearly stock of warfarin from us. The myth that Sub-Saharan African patients cannot maintain anticoagulation for a long time should be dispelled. Her story would have been different if she had received biologic valves-since she will not have the available funds for series of re-operations.

OP-14: Enhancing open heart surgical outcomes through effective intensive nursing care: Case study of 40-year-old male with ischemic heart disease and atrial fibrillation

Uju P. Louis-Egbuchiem, Victoria C. Nnajekwu, Marritta O. Ebizie, Chinyere Onyegbula

Department of Surgery, National Cardiothoracic Centre of Excellence, University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu State, Nigeria

Background: The possibility of achieving positive outcomes for patients with ischemic heart diseases who undergo. Open heart surgery depends much on instituting effective intensive nursing care by the cardiothoracic nurse.

Objectives: This article highlights the pre- and post-operation nursing care of a patient who had ischemic heart disease with symptomatic atrial fibrillation, and underwent a triple coronary artery bypass surgery.

Materials and Methods: Report is from personal observation and full participation in the management of the case by the authors as members of the cardiothoracic team.

Result: Mr. N.T, a 40-year-old male previously diagnosed to have coronary artery disease, was admitted into UNTH Ituku-Ozalla, Enugu on the 26 th of March, 2014 with a complaint of shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations and occasional dizziness. After initial assessment, he was transferred to the Intensive Care Unit on for intensive preoperative care. Arterial cannulation and other invasive lines were accessed; blood gases analyzed, two-dimensional echocardiography and other necessary investigations performed and the diagnosis was confirmed. He was managed under intensive monitoring. On the 2 nd of April, 2014, triple coronary bypass surgery was performed. Following this, intensive hemodynamic monitoring was carried out, and inotropic and other agents well titrated based on investigation results. Mr N.T. progressively improved and was discharged home on the 14 th of May, 2014.

Conclusion: Coronary heart disease is increasingly becoming common in our environment. Coronary artery bypass graft is the usual surgical intervention. Pre- and post-operative intensive care by trained cardiothoracic nurses is crucial to ensure positive outcomes. This case illustrates the benefits of such care in a well-equipped center.

OP-15: Initial experience with open heart surgery in a private hospital in West Africa: The biket medical center experience

Onakpoya Uvie, Adenle Adebisi 1 , A. T. Adenekan, Mishaly David 2 , Kumar Anil 3 , Adeniran Moshood 4 , Adesanya Victor 4 , Egbetunde Lawrence 4 , Tobi Kingsley 5 , Adekunle Michael 6 ,

Animasaun Adeola 7 , Mohammed Tunde 7

Department of Surgery, Cardithoracic Surgery Unit, Obafemi Awolowo University, 4 Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, 1 Biket Medical Centre, 6 LAUTECH Teaching Hospital, Osogbo, 5 University of Benin Teaching Hospital, Benin, 7 Lagos State University Teaching Hospital, Lagos, Nigeria, 2 Sheba Medical Centre, Israel, 3 Krishna Institute of Medical Sciences Hospital, India

Background: Forty years after the first open heart surgery in Nigeria, there exists no hospital in the country with a viable and regular open heart surgery program. The aim of this paper is to review our initial experience with open heart surgery at the biket medical center, a privately owned hospital in Osogbo.

Materials and Methods: All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined, and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data were analyzed using SPSS version 16.

Results: Twelve patients comprising of 9 males and 3 females with ages ranging between 1 and 52 years (mean = of 15.7 ΁ 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 4 patients (33.3%) while total correction of tetralogy of Fallot was carried out in 3 patients (25%). Two patients had mitral valve repair for rheumatic mitral regurgitation. 60 days mortality was 0%.

Conclusion: Safe conduct of open heart surgery in a private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

OP-16: Short-term outcome after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: Data from the abeokuta HF registry

Okechukwu S. Ogah 1],[2 , Simon Stewart 3 , Ayodele O. Falase 1 , Joshua O. Akinyemi 4 ,

Gail D. Adegbite 5 , Albert A. Alabi 5 ,

Olunuga T. O. 6 Amina Durodola 6 ,

Akinlolu A. Ajani 6 Karen Sliwa 7

1 Department of Medicine, Division of cardiology, University College Hospital, PMB 5116, 4 Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, 5 Department of Medicine, Sacred Heart Hospital, Lantoro, 6 Department of Medicine, Federal Medical Centre, PMB 3031, Abeokuta, Nigeria, 2 Faculty of Health Sciences, Soweto Cardiovascular Research Unit, University of the Witwatersrand, 3Q05, Parktown, 2193, Johannesburg, 7 Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Private Bag X3, Observatory 7935Cape Town, South Africa, 3 NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia

Background: Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa's most populous country-Nigeria.

Objectives: We examined 6 months outcome (including case-fatality) in 285 of 309 AHF subjects admitted with heart failure (HF) to a tertiary hospital in Abeokuta, Nigeria.

Materials and Methods: The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ΁ 15.6 years and the majority in New York Heart Association Class III (75%).

Results: There were a number of differences according to the subject's gender; men being older and more likely to present with hypertensive heart disease (HHD) (with greater left ventricular mass) while also have greater systolic dysfunction. Mean length of stay was 10.5 ΁ 5.9 days. Mean follow-up was 205 days with 23 deaths and 20 lost to follow-up. At 30 days 4.2% (95% confidence interval [CI], 2.4-7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7-11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort were readmitted at least once.

Conclusions: The characteristics of an AHF cohort in Nigeria are different from that reported in high-income countries. Cases were relatively younger and presented with nonischemic etiological risk factors for HF especially HHD. Moreover, mortality and readmission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.

OP-17: Predictors of rehospitalization in subjects admitted with heart failure in Abeokuta, Nigeria: Data from the Abeokuta HF Registry

Okechukwu S. Ogah 1],[2 , Simon Stewart 2],[3 , Ayodele O. Falase 1 , Joshua O. Akinyemi 4 , Gail D. Adegbite 5 , Albert A. Alabi 5 ,

T. O. Olunuga 6 , Akinlolu A. Ajani 6 ,

Julius O. Adesina 6 , Amina Durodola 6 , Karen Sliwa 2],[7

1 Department of Medicine, Division of Cardiology, University College Hospital, PMB 5116, 4 Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, 5 Department of Medicine, Sacred Heart Hospital, Lantoro, 6 Department of Medicine, Federal Medical Centre, PMB 3031, Abeokuta, Nigeria, 2 Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, 3Q05, Parktown, 2193, Johannesburg, 7 Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Private Bag X3, Observatory 7935 Cape Town, South Africa, 3 NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, VIC 3004, Australia

Background: Heart failure (HF) has become an increasingly important but poorly researched health issue in Sub-Saharan Africa.

Objectives: We sought, for the first time, to examine the rate and predictors of hospital readmission in subjects discharged after an episode of HF in Nigeria.

Materials and Methods: This was a hospital-based, prospective, observational study that used the data from the Abeokuta HF registry.

Results: Overall, 1.53% (95% confidence interval [CI], 0.58-4.02) and 12.2% (95% CI, 8.88-16.8) of subjects, respectively, were re-hospitalized at least once within 30 days and 6 months (5.3% had multiple readmissions); the latter comprising 21/138 men (15.2%) and 11/124 (8.9%) women. A total of 11 (4.2%) also died (all of whom had been re-hospitalized). Worsening HF (24 cases, 75%) was the most common reason for readmission. Among others, factors associated with rehospitalization include presence of mitral regurgitation (Odds ratio [OR]: 2.37; 95% CI: 1.26-4.46), age ≥60 years (OR: 2.04; 95% CI: 0.96-3.29), presence of tricuspid regurgitation (OR: 1.77; 95% CI: 0.86-3.61), and presence of atrial fibrillation (OR: 1.34; 95% CI: 0.59-3.03). However, on an adjusted basis, only female gender (adjusted OR: 0.33, 95% CI: 0.14-0.79; P = 0.014 versus men) and body mass index <19 kg/m 2 (adjusted OR: 3.74, 95% CI: 1.15-12.16; P = 0.028 versus rest) were independent correlates of readmission during 6-months follow-up.

Conclusions: HF rehospitalization within 6-months follow-up occurs in about 12% of our cohort living an environment where HF etiology is predominately nonischemic, and the HF population is relatively younger. Higher rates of readmission were noted in those of older age, lower body mass index, illiteracy, lower serum sodium level, presence of atrial fibrillation, renal dysfunction and valvular dysfunction.

OP-18: Peripheral artery disease: Knowledge and practice of medical doctors in Delta State, Nigeria

Ejiro M. Umuerri

Department of Medicine, Delta State University Teaching Hospital, P.M.B 07, Oghara, Delta State, Nigeria

Background: Peripheral arterial disease (PAD) is a marker of systemic atherosclerosis with significant cardiovascular (CV) mortality and morbidity. It is often asymptomatic, though its presence is a sign of widespread atherosclerosis in other vascular territories. Early detection and aggressive risk reduction therapy are important in reducing adverse CV outcomes.

Objectives: This study sought to assess the knowledge and practice of medical doctors about PAD in Delta State, Nigeria.

Materials and Methods: A descriptive cross-sectional self-administered survey of 92 physicians working across Delta State, Nigeria.

Results: Majority (67.4%) of the respondents were general medical practitioners. Atherosclerosis was identified as the main cause of PAD in 86.9% of the respondents. PAD was said to be often associated with leg-related symptoms in majority (52.2%) of the respondents while 23.9% were undecided. More than 80% of the respondents attributed CV events as the main cause of mortality. Knowledge on the use of ankle brachial index as a routine screening method was reported by 35 (38%) of respondents. Majority (62%) of respondents do not routinely screen for peripheral artery disease in patients with CV risk factors and only 6 (6.5%) use ankle brachial index as screening the tool. Perceived barriers to routine screening and risk reduction thserapy in PAD include lack of knowledge by attending physician, management guidelines and appropriate diagnostic equipment.

Conclusion: Gaps in the knowledge and practice of screening for PAD were identified among medical doctors. Bridging these gaps may improve the detection rate and treatment of PAD, thereby reducing adverse CV outcomes.

OP-19: Evaluation of the Indications and Arrhythmic Patterns of 24- hour Holter Electrocardiography among Hypertensiveand Diabetic Patients seen at OAUTHC, Ile-Ife Nigeria

R. A. Adebayo, A. N. Ikwu, M. O. Balogun, A. O. AkintomideΉ, T. O. Mene-Afejuku, V. O. Adeyeye, O. J. Bamikole, L. A. Bisiriyu 1 , O. E. Ajayi, S. A. Ogunyemi, O. A. Oketona

Background: There are very limited published studies in Nigeria on the use of 24-hour Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients.

Objective: To evaluate indications, arrhythmic pattern of Holter ECG and heart rate variability (HRV) among patients with hypertensive heart disease (HHD) with or without heart failure and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit.

Material and Methods: 79 patients (32 males and 47 females) were studied consecutively over a year using Schiller type (MT-101).

Results: Out of the 79 patients, 17(21.5%) had HHD without heart failure, 33(41.8%) had HHD with heart failure (HHF), while 29(36.7%) were T2DM patients. The mean (SD) ages of HHD without heart failure, HHF and T2DM patients were 59.65(΁14.38), 65.15(΁14.30) and 54.66(΁8.88) respectively. The commonest indication for Holter ECG was palpitation (38%), followed by syncope (20.3%). Premature ventricular contraction (PVC) was the commonest arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV, using SDNN was significantly reduced in T2DM patients (81.03΁26.33, CI=71.02-91.05) compared to the HHD without heart failure (119.65΁29.86, CI=104.30-135.00) and HHF (107.03΁62.50,CI=84.00-129.19). There was a negative correlation between the duration of T2DM and HRV(r = -0.613).

Conclusion: Palpitation was the commonest Holter ECG indication and PVCs were the commonest arrhythmic pattern among our patients. HRV was reduced in type 2 DM patients compared with hypertensive patients.