Abstract The May Measurement Month (MMM) campaign was conducted in Mali in 2023 to raise awareness of raised blood pressure (BP). This article reports the results of the campaign. Adults aged ≥18 years were recruited through convenience sampling at six districts in Bamako, Mali. Three seated BP readings were taken on each participant, and a questionnaire collected information on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥140mmHg or diastolic BP ≥90mmHg or being on BP-lowering medication. Controlled BP was defined as being on BP-lowering medication with a BP <140/90mmHg. Multiple imputation was used to estimate missing BP readings. In total, 2,717 adults were screened, with a mean age of 42.4 years and 62.5% were female. Of all participants, 1,184 (43.6%) had hypertension, of whom 661 (55.8%) were aware, and 611 (51.6%) were on antihypertensive medication. Of those on antihypertensive medication, 230 (37.6%) had controlled BP, and of all participants with hypertension, 19.4% had controlled BP. The MMM campaign in Mali identified a substantial number of participants with untreated or inadequately treated hypertension. These data highlight the need for improved diagnosis and treatment of hypertension. Therefore, current practice needs to be strengthened, and more research is needed to evaluate the reasons for shortcomings and improvements put in place.

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a hereditary arrhythmia syndrome that can cause sudden cardiac death, particularly in young individuals. CPVT is often linked to triadin (TRDN) variants that disrupt calcium regulation in the cardiac muscle. Although TRDN-associated CPVT is well documented, its association with resting sinus bradycardia is rarely reported. We describe 2 siblings from a consanguineous Malian family presenting with exertional syncope and bradycardia, in whom a novel homozygous pathogenic TRDN variant was identified. The probands, a 17-year-old male and his 11-year-old sister, presented with recurrent exertional syncope beginning at ages 7 and 11, respectively. After obtaining informed consent and assent, a detailed clinical evaluation was performed, including physical examination, electrocardiography, echocardiography, and exercise stress testing. Whole-exome sequencing and segregation analysis were conducted, and variant pathogenicity was assessed using in silico prediction tools. Both patients presented sinus bradycardia on electrocardiography and exercise-induced ventricular arrhythmias consistent with a diagnosis of CPVT. Exome sequencing revealed a novel homozygous 5-bp deletion in TRDN (NM_006073.4: c.613_617delCAGAA; p.Gln205GlufsTer3), which was classified as pathogenic according to American College of Medical Genetics and Genomics (ACMG) criteria (PVS1, PP5, PM2). The variant co-segregated with the disease in the family. The patients were treated with the nonselective β-blocker nadolol. Therapy effectively resolved exertional syncope and reduced the frequency of arrhythmic episodes during follow-up. This report highlights an uncommon presentation of bradycardia-associated CPVT caused by a novel TRDN variant. To our knowledge, this is the first genetically confirmed case of a TRDN variant in sub-Saharan Africa. These findings expand the clinical spectrum of TRDN-related cardiac disorders and emphasize the need for genetic exploration of arrhythmic disorders in sub-Saharan Africa, especially for actionable genes.

Introduction: Venous thromboembolic diseases (VTED) include deep vein thrombosis of the lower limbs and pulmonary embolism (PE), which is its severe form due to its high mortality. The objective of our study was to determine the epidemio-clinical and paraclinical aspects of patients hospitalized for venous thromboembolic diseases. Patients and method: Cross-sectional study with prospective recruitment from patient records hospitalized for (VTED) from January to December 2023 in the cardiology department of the Mother-Child University Hospital in Bamako, Luxembourg. Results: We collected 55 out of 580 patient records hospitalized for (VTED), a hospital frequency of 9.48%. PE accounted for 58.20% of cases, 10.90% for deep vein thrombosis (DVT), and 30.90% for their association. The mean age of patients was 55.56 years ± 15.52 years. The majority of patients, 90%, were under 66 years of age. The predominance was female, 56%. In lower extremity DVT, calf pain and Homans' sign were present in 56% and 24% of patients. In pulmonary embolism, dyspnea and chest pain were present in 85.50% and 65.50% of patients. Etiological factors were dominated by neoplasia in 10.90%, contraception 5.45% and orthopedic surgery in 5.45% of cases. Cardiovascular risk factors were a sedentary lifestyle (50.90%), obesity (34.45%), high blood pressure (36.36%) and diabetes (21.81%). Laboratory abnormalities were elevation of troponin (46.87%), BNP (40.62%), D-Dimer (62.50%) and anemia (9.09%). Electrocardiographic abnormalities were tachycardia in 65.4% and S1Q3 in 21.81% of patients. Echocardiography showed dilation of the right cavities (47.27%), systolic pulmonary arterial hypertension (38.18%) and thrombus in the right cavitary (5.45%). On thoracic CT angiography, PE was proximal (36.40%), bilateral (61.80%) and massive (29.10%). On venous Doppler ultrasound, TVP was proximal in 65.21%. Conclusion: VETD was more common in women and younger subjects.

OBJECTIVE:To assess the profile of metabolic syndrome (MS) in a hypertensive population in Mali. PATIENTS AND METHODS:Prospective study from June 1, 2022 to June 31, 2022, in the cardiology department of the Mother-Child University Hospital in Bamako, Luxembourg. Our study sample consisted of adult hypertensive patients, aged 18 years and older, received as an outpatient. Patients were included in our study after informed consent. The SM was established based on International Diabetes Federation (IDF) definitions. RESULTS:Out of 520 patients, 238 were included in our study. The prevalence of SM was 30.2% according to IDF criteria. There was a female predominance (66%). The mean age was 57 ± 5 years. Grade II hypertension was in the majority with 39%. Seventy-five percent of patients with metabolic syndrome had 3 risk factors. Ischemic stroke was the most common complication with a rate of 12%. Dual therapy was indicated in 59.23% of patients. Calcium channel blockers were the most prescribed with a rate of 74.5%. SM is a reality in Mali. Adequate preventive measures are necessary to limit its progression.

Introduction: High blood pressure is a major public health problem worldwide due to its frequency and cardiovascular complications. Adherence to treatment for chronic diseases is a global problem. The aim was to study therapeutic adherence in hypertensive patients followed in ambulatory. Materials and Methods: This was a cross-sectional, descriptive study with prospective recruitment that took place from July 1 to December 31, 2022 (6 months) in the cardiology department of the university hospital of Kati. The variables studied were sociodemographic data, cardiovascular risk factors, comorbidities, the possession of insurance and compliance (the Girerd questionnaire was used to assess adherence). Results: A total of 1182 patients were consulted, including 887 for hypertension, a frequency of 75%. Fifty-six patients were included in the study. The average age was 58.18 ± 13.25 years with extremes of 30 and 80 years. There was a female predominance (75%) with a sex ratio of 0.3. The majority of patients lived in urban areas (89.3%). Out-of-school patients accounted for 44.6%, more than half of patients or 55.4% had no income, patients with medical coverage accounted for 67.9% of cases. The main risk factors were physical inactivity (25%) followed by smoking 14.3%. More than 71% of patients had a compliance problem and the main reasons were forgetting to take the drug with 73.2%, followed by delayed treatment of 50% and drug discontinuation of 28.6%. Conclusion: Compliance is a real challenge and a major public health issue. This study allowed us to find a real problem of compliance in our hypertensive patients. There was a statistically significant relationship between drug adherence and forgetting to take the drug and drug discontinuation.

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the "TOUCAM" medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

Introduction: Type 2 diabetes is on the increase in Africa as a result of the epidemiological transition. Cardiovascular complications, particularly ischemic complications, are common in diabetic patients. They are life-threatening. It is important to identify the angiographic appearance of the coronary arteries in diabetic patients in order to guide treatment. Objective: to identify the results of coronary angiography in diabetic patients. Patients and method: Descriptive, cross-sectional study with retrospective recruitment over a three-year period from September 2019 to August 2022. All diabetic patients who underwent coronary angiography at the CHU mother child Luxembourg in Bamako were included. Results: We enrolled 371 patients out of 985 during the study period, i.e. a hospital frequency rate of 37.66%. The mean age of the patients was 60.76 +/- 10.26 years, with extremes of 32 and 84 years. They were predominantly male, with a sex ratio of 1.45. The predominant functional signs were typical chest pain (39.4%), atypical chest pain (27.8%) and dyspnea (13.2%). The predominant risk factors were hypertension (74.7%), sedentary lifestyle (48.8%) and smoking (17.5%). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%). Coronary angiography was pathological in 78.4% of patients, with tritruncular lesions in 38% and bi-truncal lesions in 21%. Lesions were located on the common trunk in 5.4%, on the anterior interventricular in 59.8%, on the right coronary in 51.8% and on the circumflex in 47.4%. Conclusion: Ischemic heart disease is common in diabetic patients with tri- and bi-truncular lesions.

Introduction: Acute coronary syndrome is often the first event of coronary disease of young subjects. Objective: To study sociodemographic, clinical, paraclinical, therapeutic and evolutionary aspects of acute coronary syndrome of young subjects. Patients and Methods: Descriptive cross-sectional study with prospective recruitment from October 01, 2020 to March 31, 2022. Were included all patients admitted for acute coronary syndrome whose age was less or equal to 45 years and who had undergone coronary angiography at the Mother-Child University Hospital on Luxembourg from Bamako. Results: During the study period, we collected 60 patient files out of 198. These 60 patient files met our inclusion criteria. Hospital frequency was 30.30%. Average age of patients was 40.43 ± 3.9 years. Sex ratio M/F was 5.3. Main cardiovascular risk factor was smoking tobacco (23.42%), followed by dyslipidemia (13.92%). Functional signs were dominated by angina 62% followed by dyspnea 25.3%. Persistent ST-segment elevation on electrocardiogram was present in 76.4%. Left ventricular systolic dysfunction was present in 26.5%. Time to first medical contact was more than 12 hours in 62.7% of cases. Radial approach was adopted in 94% of cases. Coronary angiography was pathological in 85% (n = 51) of cases. Lesions were single-vessel disease in 47.1% and culprit artery was anterior interventricular in 51% of cases. Dual anti-platelet aggregation was aspirin and ticagrelor in 91.8% of cases. Angioplasty was performed in all patients who had significant abnormalities at coronary angiography. In-hospital mortality was 3.9%. Conclusion: Acute coronary syndromes exist in young Africans with a male predominance. Main cardiovascular risk factor is smoking tobacco. Coronary lesions are single vessel disease in the majority of case. Most of patients meet medical team after 12 hours. Time to first medical contact is a main challenge in our country.

Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome.These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and technicians with highly specialized training.Aims: To describe epidemiological, clinical and coronary angiography aspects of patients with acute coronary syndrome.Patients and Methods: Descriptive study from September 2019 to December 2023 in the Cardiology Department of the Hôpital Mère-Enfant of Bamako.Inclusion criteria were patients admitted for coronary angiography with the diagnosis of acute coronary syndrome.Results: During the study period, 1253 patients underwent coronary angiography, 596 of whom had acute coronary syndrome as an indication, representing a hospital frequency of 47%.Sex-ratio was 2.10.Mean age of patients was 58.5 ± 11.39 years.ST elevation acute coronary syndrome was the most common indication with 63.92% of cases.High blood pressure was the main cardiovascular risk factor with 58.7% of cases, and radial access approach was used in 98% of cases.Coronary angiography was pathological in 91.70% of cases (n = 548).Patients with lesions of anterior interventricular artery were 73.73% of cases.Tritruncal lesions accounted for 40.63% of cases.Conclusion: ST elevation acute coronary syndrome is the most frequent manifestation of acute coronary syndrome.Anterior interventricular artery is most often the culprit lesion for our patients.

Introduction: High blood pressure is defined as blood pressure greater than or equal to 140 mm Hg for systolic and or 90 mm Hg for diastolic. It constitutes a major public health problem, the leading chronic disease in the world. The objective was to determine the prevalence, treatment rate and control of hypertension. Methods: This was a cross-sectional and descriptive study which took place over a period of 6 months in a hospital environment and in the general population. Results: Of the 1000 participants, 637 had hypertension, giving a prevalence of 63.70% with a female predominance. Thirty-three percent (33%) were unaware of their high blood pressure. The age group 60 and more was the most represented (44%). A proportion of 33 and 23.20 were overweight and obese participants, respectively. Male subjects were more overweight than female, unlike obesity which was more common among female subjects. Sixty-two percent (62%) of hypertensives were treated, of whom 44% were non-compliant. The excessively high cost and consumption of medications as needed were the main factors in therapeutic non-compliance. Twenty-two percent (22%) of all hypertensive patients and 35% of treated hypertensive patients were controlled. Women were more treated but less observant and less controlled than men. Therapeutic coverage and combination therapy rates were lower in rural areas. Hypertensives who had a high level of education were better treated and controlled than those who had no level. Conclusion: High blood pressure remains a real public health problem in Mali. It is more common in people aged 60 and over and in females. One in three hypertensives were unaware of their hypertension. The majority received antihypertensive treatments, but only a minority of them had their hypertension controlled.

Background: There is a lack of data on ECG and echocardiographic modifications in hypertensive patients in our setting that justify their inclusion. Methods: This study aims to compare induced ECG and echocardiographic modifications in female and male hypertensive patients. It was a cross-sectional study among outpatients seen in the cardiology department of the UH-GT in Bamako-Mali and included hypertensive patients aged 18 years or older. Data were first collected on a survey form, inserted into a MS Access database, and finally analyzed with IBM SPSS software. Quantitative data are presented as mean with standard deviation and qualitative data as proportion. The level of significance for the statistical test was set at 5%. Results: Of 524 patients, 52.9% were new patients, and 96% had no known cardiac disease. The female sex represented 61.8%. The mean age was 55.33±15.013 years, and obesity based on body mass index was more prevalent in women's sex (81 vs. 19% in men's sex). The global prevalence of HTN was 38.8% in males and 61.1% in females. Among ECG modifications, rhythm disorders and hypertrophy were significantly higher in males, respectively (37.5 vs. 21.9 and 49.5 vs. 29). The most frequent echocardiographic signs included left ventricular end diastolic diameter (LVEDD) and interventricular septum (IVS), with 53 mm vs. 49,3 mm and 10 vs. 9,3 mm (<0.001). Other structural echocardiographic changes were an increase in left ventricular mass and index left ventricular mass with, respectively, 210.5 vs. 176.4 g and 115.4 vs. 96.8 g/m2. Conclusion: The prevalence of hypertension is high in both sexes, with consequences led by left ventricular hypertrophy in ECG and echocardiography. The higher prevalence of female HTN must be further studied, as must the associated factors.

Introduction: Cardiovascular disease is the leading cause of death in diabetics. The objective of our study was to investigate the echocardiographic aspects of type 2 diabetics. Patients and Method: Descriptive and cross-sectional study of 12 months from June 2020 to June 2021. We included hospitalized type 2 diabetics who underwent transthoracic cardiac ultrasound in the Department of Medicine and Endocrinology at the Mali Hospital. Results: We collected 128 type 2 diabetics. The predominance was male with a sex ratio of 1.2. The mean age of patients was 60.06 ± 11.54 years with extremes of 28 and 84 years. Echocardiographic abnormalities were dominated by abnormal relaxation of left ventricle in 62.5%, increased of left ventricle mass in 54.7% and left atrium dilation in 28.1%. Patients with type 2 diabetes mellitus and hypertension had more left atrium dilation with a p of 0.02. Disorders of global kinetics and systolic dysfunction were more prevalent in smoking patients with statistically significant associations, respectively, p = 0.02; p = 0.03. Dyslipidemia had a statistically significant association with segmental kinetic disorders with a p of 0.008. Duration of diabetes greater than 5 years was associated with left atrium dilation and p-value was 0.04. Conclusion: Diabetes is responsible for cardiovascular manifestations that can be identified with transthoracic echocardiography. Its performance in diabetic patients makes it possible to refine the patient's management.

Introduction: Heart failure is a complex syndrome and very frequently observed and secondary to the outcome of many advanced heart diseases. It is made up of a set of symptoms that reflect the tissue and visceral consequences of heart failure. The objective was to determine the hospital prevalence and to describe the management of heart failure in the medical department of Tombouctou hospital in Mali. Methods: This is a descriptive cross-sectional study with retrospective data collection, carried out over 24 months and involving the analysis of 266 records of patients hospitalized for heart failure. Results: The frequency of heart failure was 17.6% with a female predominance. The average age was 48 years with extremes of 16 and 90 years. Cardiovascular risk factors were dominated by high blood pressure with 38%. Global heart failure was the mode of discovery in 72.2% of cases. The etiologies were dominated by hypertensive dilated cardiomyopathy in 36.8% and peripartum cardiomyopathy in 32% of cases. The majority of our patients benefited from diuretic treatment, i.e. 95.9% frequency; with a favorable evolution in 96.2% of cases. We recorded 10 deaths, i.e. a lethality of 3.7%. We report some difficulties encountered during our security study because Tombouctou is a war zone and the lack of a technical platform for biology such as (BNP or NT-proBNP). Conclusion: Heart failure is a real public health problem. Its prevalence is increasing due to the aging of the population and especially the poor management of arterial hypertension in our context.