Cardiovascular abnormalities on patients followed up for chronic inflammatory rheumatism diseases at the Yaoundé Central Hospital

Murielle Orlaine Guimbang Ndem
Internal medicine, University of Yaounde I
June, 2018


Chronic inflammatory rheumatism disease (CIRD) is a heterogeneous group of disorders characterized by humoral disorders or cell-mediated immune responses against various autoantigens, with significant synovial and joint involvement. It is frequently associated with comorbidities such as cardiovascular disease, which are disorders affecting the heart and vessels. Given the burden of chronic inflammatory rheumatism disease and cardiovascular diseases in Sub Saharan Africa, a study was conducted in Cameroon to show the relationship between CIRD and cardiovascular risk. However, no study has been published to our knowledge on the different cardiovascular diseases encountered during the different CIRD.
OBJECTIVE: Look for cardiovascular anomalies in patients followed for CIRD at Yaoundé Central Hospital.
We conducted a prospective descriptive and analytical cross-sectional study from 3 February to 31 May 2018 in the rheumatology and cardiology departments and in the laboratory of the National Obesity Centre at the Yaoundé Central Hospital (HCY). All patients were examined and then sampled to determine the lipid profile. Screening for cardiovascular abnormalities was performed by automatic systolic pressure index measurement, electrocardiogram (ECG), trans-thoracic echocardiography (TTE) and Doppler ultrasound of the supra-aortic and arterial trunks of the lower limbs. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software 23.0.The significance threshold was set at 5%.
The study involved a population of 52 patients, 37 women and 15 men. The median age was 36.19 ± 14.42 years with extremes of 14 and 82 years. We were able to perform 49 TTE and 38 doppler’s ultrasounds of the supra-aortic and arterial trunks of the lower limbs. The cardiovascular risk factors found were dyslipidemia (59.62%) followed by obesity (21.15%), menopausal statut (13.46%), sedentary life (9.62%) and hypertension (9.6%). We found 1,92% of peripheral artery disease (PAD), 25% of branch block, 5.55% of ventricular hypertrophy during lupus, 21.62% corrected elongated QT. Of the 49 patients who performed the TTE, we found 44.9% of valvulopathy mostly represented by tricuspidian insufficiencies (20.4%) and mitral insufficiencies (18.37%), 2 cases of pericardial effusions (4, 08%), a prelapse of the mitral leaflet, a mitral annulus and aortic valve calcification. On the 38 doppler’sultrasoundof -supra-aortic trunks carried out, we found 21.09% of subjects having a thickness intima media(EIM) > 1mm ; 7.89% of subjects with atheromatous plaques located in the right common carotid artery (ACC) without significant stenosis, in the right carotid bulb with 10.24% stenosis according to the European Carotid Surgical Trial (ECST), in the left carotid bulb with 12.50% stenosis and two in the right common femoral artery (AFC) with 19.97% and 9.19% stenosis. The frequency of calcifications was 13.15%, they were located in the left and right carotid bulbs and in the right common femoral artery. We also noted a circumferential thickening of the proximal walls and 1/3 mean of the right primary carotid artery. The cardiovascular risk according to Framingham reveals a low cardiovascular risk at 97.78% and moderate at 2.22%.
The patients followed for chronic inflammatory rheumatism disease at the Central Hospital of Yaoundé have a diversity of cardiovascular anomalies although their cardiovascular risk is low for the great majority.