title: The VALVAFRIC study: A registry of rheumatic heart disease in Western and Central Africa.
abstract: BACKGROUND
  There are few African data available on rheumatic heart disease (RHD).
  
  
  OBJECTIVE
  To provide data on the clinical characteristics and treatment of patients with RHD hospitalized in sub-Saharan Africa.
  
  
  METHODS
  The VALVAFRIC study is a multicentre hospital-based retrospective registry of patients with RHD hospitalized in African cardiology departments from 2004 to 2008.
  
  
  RESULTS
  Among 3441 patients with at least one mild RHD lesion seen on echocardiography in 5 years in 12 cardiology departments from seven countries, 1385 had severe lesions (502 men; 803 women; mean age 29.3±15.6 years). The ratio of severe to any RHD valvular lesion was higher in countries with the lowest gross domestic product (GDP). Mitral valve regurgitation was seen in 52.8% of cases, aortic regurgitation in 32.1%, mitral stenosis in 13.4% and aortic stenosis in 1.8%. Combined valvular lesions were observed in 13% of cases. Heart failure was present in 40% of patients. Major left ventricular dilatation was observed in 13.6% of patients, ectasic left atrial dilatation in 13.8%, dilatation of the right cardiac chambers in 19.8% and pulmonary hypertension in 28.7%. Patients with no formal schooling (41.5%) were older and had a higher New York Heart Association (NYHA) class and a lower ejection fraction (EF). Among patients aged<20 years (mean age 14.5±3.8 years), those who were schooled had a lower NYHA class (2.86±0.92 vs 3.42±0.93; P<0.01) and a higher EF (60.3±11.7 vs. 54.8±12.8; P<0.05) than those who were not. RHD-related delays or school failures were affected by NYHA class, EF and the number of children in the household. Although 1200 of 1334 patients required valve repair or replacement, only 27 had surgery. In-hospital outcomes included death (16%), heart failure (62%), arrhythmias (22%), endocarditis (4%) and thromboembolic events (4%). Subsequently, 176 patients were readmitted (13.6%).
  
  
  CONCLUSIONS
  Patients with RHD hospitalized in sub-Saharan Africa are young, socially disadvantaged, with a high mortality rate and extremely low access to surgery. Poverty, as quantified by GDP and educational level, affects RHD-related severity, NYHA class and left ventricular dysfunction.
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kingué
authors.affiliation: Department of Cardiology, Hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Serigne Abdou
authors.initials: SA
authors.lastname: Ba
authors.affiliation: Department of Cardiology, CHU Ignace Deen, Conakry, Guinea.
authors.forename: Dhadi
authors.initials: D
authors.lastname: Balde
authors.affiliation: Department of Cardiology, CHU de Bamako, Bamako, Mali.
authors.forename: Mamadou Bocary
authors.initials: MB
authors.lastname: Diarra
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Ivory Coast.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Anzouan-Kacou
authors.affiliation: Department of Cardiology, CHU de Lagos, Lagos, Nigeria.
authors.forename: Benedict
authors.initials: B
authors.lastname: Anisubia
authors.affiliation: Department of Cardiology, CHU de Lomé, Lomé, Togo.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Damorou
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ndobo
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Alain
authors.initials: A
authors.lastname: Menanga
authors.affiliation: Department of Cardiology, Hôpital Aristide Le Dantec, Dakar, Senegal.
authors.forename: Abdoul
authors.initials: A
authors.lastname: Kane
authors.affiliation: Institut de Cardiologie d'Abidjan, CHU de Treichville, Abidjan, Ivory Coast.
authors.forename: Maurice
authors.initials: M
authors.lastname: Kakou-Guikahué
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Monique
authors.initials: M
authors.lastname: Kenfack
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Bernard
authors.initials: B
authors.lastname: Metogo
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: David
authors.initials: D
authors.lastname: Chelo
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Euloge
authors.initials: E
authors.lastname: Yangnigni
authors.affiliation: Department of Cardiology, CHU de Yaoundé, Hôpital Général de Yaoundé, HCY, FCB/CMEY, Cardiac Centre Shisong, Yaoundé, Cameroon.
authors.forename: Cabral
authors.initials: C
authors.lastname: Tantchou
authors.affiliation: Cardiologie, 84200 Carpentras, France.
authors.forename: Edmond
authors.initials: E
authors.lastname: Bertrand
authors.affiliation: AP-HP, Cardiologie, Hôpital René-Muret, Hôpitaux Universitaires de Paris Seine-Saint-Denis, avenue du Dr-Schaeffner, 93270 Sevran, France. Electronic address: jean-jacques.monsuez@aphp.fr.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Monsuez
mesh_terms: D000328:Adult; D000350:Africa, Central / Q000453:epidemiology; D000354:Africa, Western / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000453:epidemiology*
keywords: Africa; Afrique; Rheumatic fever; Rheumatic heart disease; Rhumatisme articulaire aigu; Valvulopathie rhumatismale