Heart failure with preserved ejection fraction in a war zone apropos of 61 cases in tombouctou (mali)

Introduction: Heart failure with preserved ejection fraction is a common condition the diagnosis of which is difficult because it predominates in elderly subjects with other pathologies. Objective: To describe the epidemiological, clinical, paraclinical and therapeutic aspects of this condition in the medical department of Tombouctou hospital in Mali. Methods: This is a descriptive, cross-sectional study carried out over 24 months and relating to the analysis of 61 files of patients hospitalized for clinical heart failure with isolated diastolic dysfunction of the left ventricle on cardiac echodoppler. Results: The study involved sixty-one patients with isolated diastolic dysfunction of the left ventricle with preserved ejection fraction out of 266 cases of heart failure, i.e. a prevalence of 23%. The average age was 52.6 ± 18.8 years with extremes of 18 and 90 years. There was a female predominance with a sex ratio of 1.2. Cardiovascular risk factors were dominated by arterial hypertension (52.5%), tobacco (21.3%) and obesity (9.8%). The electrocardiogram showed complete arrhythmia by atrial fibrillation with 34.4% frequency and left ventricular hypertrophy with 14.8% frequency. Transthoracic cardiac echo-Doppler revealed left ventricular hypertrophy and dilatation of the left atrium in (13%) and (75.4%) of the patients, respectively. Mitral flow was restrictive, pseudo-normal, or of the relaxation type disorder in 25 (41%), 18 (29.5%) and 18 (29.5%) patients, respectively. Conclusion: Heart failure with preserved ejection fraction is a condition increasingly encountered in daily practice in Africa. It is characterized in our context by the precocity of its occurrence in subjects with a long history of unbalanced arterial hypertension and chronic stress.