Marc Tshilanda Balekelayi,1– 3 Brady Makanzu Madioko,1 Christian Kutoloka Mabiza,1 Jacques Ngayuna Nkiene,2 Dadi-Serge Nkarnkwin Kasanza,1 Richard Bokele Ntshikala,3 Chadrack Bosenedje,2 Michel Tshiasuma Pipo,2,3 Yves Nsimbi Lubenga,1,4 Nathan Buila Bimbi11Cardiology Department, Kinshasa University Clinics, Kinshasa, Democratic Republic of the Congo; 2Internal Medicine Department, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo; 3Department of Internal Medicine, Notre-Dame du Kasayi University, Kananga, Democratic Republic of the Congo; 4Cardiology Department, Initiative Plus Hospital Center, Kinshasa, Democratic Republic of the CongoCorrespondence: Marc Tshilanda Balekelayi, Email tshilandamarc@gmail.comBackground: Congestive heart failure (CHF) has been a major health problem in developing countries in recent years and is responsible for a mortality rate that is difficult to estimate accurately due to limited data availability. The Democratic Republic of the Congo is no exception; this study provides data on this topic.Objective: To identify the factors associated with in-hospital mortality and echocardiographic patterns in patients hospitalized with congestive heart failure patients in Kinshasa city.Methodology: This is a multicenter retrospective hospital-based observational study that used non-probability convenience sampling for the selection of 454 cases of congestive heart failure hospitalized in three hospitals in the city of Kinshasa in the Democratic Republic of Congo (DRC) from June 2021 to June 2024. The data collected were analyzed with Stata/IC version 15 software. The variables were presented in the form of central tendencies and frequencies. The factors associated with mortality were identified using logistic regression; the outcome was all-cause in hospital mortality.Results: 281 women and 173 men were evaluated, with a sex ratio M/F of 0.6 with a median age of 63 years. High blood pressure (HBP) was the most common cardiovascular risk factor (68.5%). Respiratory infections were the most common contributing factor (38.7%). HF-related mortality was 22.5%. Cardiomyopathies were the most common cause of HF with 239 cases or 52.6%. The mean left ventricular ejection fraction (LVEF) of our population was 39.6 ± 10.5%. Being 65 years of age or older doubles the risk of death (ORa = 2.02; IC95% = 1.1 to 3.6; p = 0.015), while systolic blood pressure greater than or equal to 90mmHg emerged as a protective factor against HF-related mortality (ORa = 0.04; IC95% = 0.02 to 0.08; p < 0.001) with sinus rhythm (ORa = 0.44; IC95% = 0.23 to 0.8; p = 0.013), glomerular filtration rate (GFR) greater than or equal to 30mL/min (ORa = 0.2; IC95% = 0.1 to 0.47; p < 0.001) and Serum potassium level above 3.4 mmol/L (ORa = 0.5; IC95% = 0.27 to 0.9; p = 0.025).Conclusion: Cardiomyopathies are the most common cause of heart failure in our setting. Good systolic blood pressure, renal function, serum potassium levels, and sinus rhythm are associated with a favorable evolution.Keywords: factors associated, hospital mortality, echocardiographic patterns, congestive heart failure, Kinshasa
Background: The success of pulmonary vein isolation (PVI) is limited with more advanced disease of the atrial myocardium which may develop due to aging, atrial fibrillation (AF), cardiac diseases and comorbidities leading to elevated atrial pressure. Our group has recently reported on long-term decrease in the levels of different biomarkers after PVI, potentially reflecting a reversal of the fibrotic process in the atria with arrhythmia control. Whether the presence of baseline comorbidities has a significant impact on long-term changes in the serum concentration of these substances is unknown. Aim: Herein, we compared the levels of 4 biomarkers (CA-125, Caspase-3, Cathepsin L and Galectin-3) before and 3 years after successful PVI in patients with versus without comorbidities at baseline. Methods: Serum concentrations of the 4 biomarkers were measured prospectively in consecutive patients undergoing PVI with any of 3 different techniques for paroxysmal/permanent AF 24 hours before and 3 years after ablation. Only patients free of AF recurrence at 3-year follow-up were included in this analysis. Results: 28 men and 9 women (age 56.5 +/- 9.2 years) were enrolled. Caspase-3 concentrations decreased significantly by the end of follow-up in patients without (from 500.9 (345.7-719.5) to 340.5 (255.9-387.3); p=0.016 as well as with comorbidities: from 623.8 (476.9-751.4) to 447.7 (327.6-636.9) p=0.039. Caspase-3 concentrations (pg/mL) were higher at 3-year follow-up in patients with versus without comorbidities: 447.7 (327.6-636.9) vs 340.5 (255.9-387.3); p=0.038. For Caspase-3, a significant overall time effect was observed (beta=-0.437, p=0.010), consistent with lower concentrations at 3-year follow-up after adjustment for age, sex, AF type, and ablation technique. No differences were measured with the other biomarkers. Conclusion: Serum levels of Caspase-3 decreased in patients maintaining sinus rhythm after PVI regardless of the presence or absence of comorbidities, suggesting that it might be a sensitive biomarker indicating long-term arrhythmia suppression.
Yasser Mohammed Abdo Ali Al-Shawki Department of Medicine, Faculty of Medicine and Health Sciences, Amran University, Amran, YemenCorrespondence: Yasser Mohammed Abdo Ali Al-Shawki, Department of Medicine, Faculty of Medicine and Health Sciences, Amran University, Amran, Yemen, Email yasseralshowky@gmail.comBackground: Congenital Heart Disease (CHD) remains the most prevalent congenital anomaly globally, with approximately 90% of affected neonates born in low- and middle-income countries (LMICs). Despite significant advances in paediatric cardiac care over the preceding decade, a substantial proportion of CHD cases in resource-limited settings evade timely detection, resulting in avoidable morbidity and premature mortality. This systematic review synthesizes contemporary evidence published between 2019 and 2025 to delineate the prevalence, determinants, and consequences of undiagnosed CHD in LMICs, whilst critically evaluating emerging strategies for diagnostic optimization.Methods: A systematic literature search was conducted across PubMed/MEDLINE, Emblaze, Scopus, and the Cochrane Library for peer-reviewed studies published between January 2019 and January 2025. The review adhered to PRISMA guidelines. Forty-five primary studies met predefined eligibility criteria, comprising observational cohorts, cross-sectional analyses, and health systems research investigations focusing on pediatric populations (neonates to 18 years) in World Bank-classified LMICs. Data regarding diagnostic timing, barrier categorization, screening implementation, and clinical outcomes were extracted and subjected to qualitative synthesis.Results: Analysis of 45 studies encompassing diverse geographical regions—including sub-Saharan Africa, Southeast Asia, the Middle East, and Latin America—revealed consistently protracted diagnostic delays, with median age at CHD confirmation ranging from 4 days for critically cyanotic lesions to 98 months for acyanotic defects. Pooled prevalence estimates indicated that 47– 63% of CHD cases in LMICs are diagnosed following the onset of irreversible complications. Congestive heart failure was present in 49.4% of patients at initial presentation, whilst Eisenmenger syndrome complicated 15.8% of delayed left-to-right shunt diagnoses. Three principal barrier domains were consistently identified: (i) infrastructural deficiencies, including absent or non-functional echocardiography services in peripheral facilities; (ii) workforce shortages, with pediatric cardiologist-to-population ratios reaching 1:8 million in several regions; and (iii) socioeconomic constraints, including prohibitive out-of-pocket expenditure and geographical maldistribution of specialized centres. Contemporary studies evaluating pulse oximetry screening demonstrated high diagnostic accuracy (sensitivity 76– 93%, specificity 99.4%) for critical CHD; however, implementation fidelity was compromised by absent referral infrastructure and inadequate postnatal follow-up.Conclusion: This systematic review confirms that undiagnosed CHD in resource-limited settings constitutes a persisting public health emergency, characterized by predictable diagnostic delays and preventable clinical deterioration. The evidence synthesis identifies actionable targets for health system strengthening, including mandatory pulse oximetry integration, task-shifting to non-specialist providers, and decentralized tele-echocardiography networks. Without urgent, context-appropriate intervention, the diagnostic gap will continue to exact an unacceptable toll on pediatric populations in LMICs.Keywords: congenital heart disease, undiagnosed CHD, resource-limited settings, diagnostic delay, paediatric cardiology, pulse oximetry screening, health systems strengthening, LMICs
Purpose: To explore clinical manifestations and treatment strategies in a patient with dual GLA and MYH7 mutations causing Fabry disease (FD) and hypertrophic cardiomyopathy (HCM), emphasizing the value of comprehensive genetic testing in complex cardiomyopathies. Patients and Methods: We studied a 40-year-old Han Chinese woman with FD and familial HCM due to GLA and MYH7 mutations. Diagnosis involved echocardiography, electrocardiography, cardiac MRI, genetic sequencing, and alpha-galactosidase A activity assays. Treatment included pharmacotherapy (rivaroxaban, sacubitril/valsartan, bisoprolol, spironolactone, torasemide), agalsidase alpha enzyme replacement, and surgery for left ventricular outflow tract obstruction. Results: The patient had severe left ventricular hypertrophy (interventricular septum 35 mm) and significant obstruction (LVOTG 121 mmHg). After 3 months, the 6-minute walk test distance increased from 132 to 369 meters, NT-proBNP levels dropped from 2164 to 1911 pg/mL, and the KCCQ score rose from 30.9 to 85.5, indicating improved quality of life. Conclusion: Comprehensive genetic testing is crucial for diagnosing complex cardiomyopathies. A multidisciplinary approach effectively improves symptoms and quality of life in patients with dual genetic mutations.
