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Published on: January 14, 2014
Echocardiographic diagnosis of heart disease in Uganda
J Freers1, H Mayanja-Kizza, J L Ziegler
1Department of Medicine, Makerere University Medical School, Kampala, Uganda.
Insights
Endomyocardial fibrosis (EMF) is the most common heart disease in Uganda, according to a Mulago Hospital echocardiography study. Echocardiography proved highly accurate in diagnosing various cardiac conditions, offering a cost-effective diagnostic solution.
Area of Science:
- Cardiology
- Medical Imaging
- Public Health
Background:
- Mulago Hospital serves as a key referral center for complex cardiological cases.
- Previous studies on heart disease patterns in Uganda may not reflect current epidemiological trends.
Purpose of the Study:
- To evaluate the diagnostic utility and accuracy of echocardiography in a large cohort of cardiological patients.
- To identify the most prevalent heart diseases in Uganda based on echocardiographic findings.
- To assess the contribution of echocardiography to specific cardiac diagnoses.
Main Methods:
- Retrospective review of 500 consecutive cardiological patients.
- Echocardiographic evaluation for diagnostic purposes.
- Correlation of echocardiographic findings with previous autopsy data for validation.
Main Results:
- Endomyocardial fibrosis (EMF) was the most common diagnosis (19.8%), followed by congenital heart disease (CHD) (15%) and rheumatic heart disease (RHD) (11%).
- Echocardiography demonstrated high accuracy, contributing up to 90% to mitral valve prolapse (MVP) diagnoses and confirming subacute bacterial endocarditis (SBE) in 69% of cases.
- Anatomical distribution of EMF lesions via echocardiography correlated with prior autopsy findings.
Conclusions:
- Echocardiography is a valuable and accurate tool for diagnosing heart diseases in Uganda.
- EMF may be the predominant cardiac condition in Uganda, challenging previous epidemiological data.
- Echocardiography offers a favorable cost-benefit ratio compared to other diagnostic modalities.
Abstract:
Five hundred consecutive cardiological patients were reviewed and evaluated by echocardiography in Mulago Hospital as a referral service. All diagnostic problems in cardiology in the hospital and to a certain degree from other institutions were reviewed. The commonest diagnosis was endomyocardial fibrosis (EMF) 19.8%, followed by congenital heart disease (CHD) 15% and rheumatic heart disease (RHD) 11%. The anatomical distribution of fibrotic lesions in EMF (left, right or biventricular) correlated with that found in previous autopsy series from Mulago Hospital thus demonstrating the accuracy of echocardiography. We were able to quantify the contribution of echocardiography to a correct diagnosis which varied between 13% in RHD to 90% in mitral valve prolapse (MVP). Echocardiography was able to confirm the clinical diagnosis of subacute bacterial endocarditis (SBE) in 69% of cases. The obtained data suggests that EMF may be the most common heart disease in Uganda contrary to the pattern of heart disease outlined in earlier works. The favourable cost/benefit ratio of echocardiography (i.e. its easy availability and maintenance), as well as the absence of consumable materials in comparison to other cardiac diagnostic tools such as catheterization, chest X-ray and ECG is emphasized, together with the multipurpose use of the machine.
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