In order to contribute to the improvement of brain infarction management in Brazzaville, a cross-sectional and analytical study with prospective data collection was conducted in the cardiology and neurology departments of the Brazzaville University Hospital, from February 1 to July 31, 2018. It included patients hospitalized for cerebral infarction confirmed with imaging, and having done an etiological assessment with at least one electrocardiogram at rest and one of long duration. Among these 138 patients included, 11 had atrial fibrillation, equaling？a frequency of 7.9%. The mean age of AF patients was 71 ± 8.8 years. The cardiovascular risk factors found were hypertension in eight cases (72.7%), diabetes in five cases (45.5%), abdominal obesity in four cases (36.4%). AF was permanent in 10 cases (91%), and paroxysmal in one case (9%). It was valvular in three cases (27.3%) and non-valvular in eight cases (72.7%). The cardiopathy involved was hypertensive in seven cases (63.6%), ischemic and valvular in two cases each. The CHA2DS2-VASc score, calculated in eight patients, was an average of 2.2, and ≥2 in more than 80% of patients; HAS-BLED score of 2.4 on average was ≥？3 in more than 72% of patients. Digoxin was prescribed in seven cases (63.6%) and an anti-vitamin K in eight cases (72.7%). In multivariate analysis, age (OR = 20.10, p = 0.023), arterial hypertension (OR = 23.82, p = 0.011), and dyslipidemia (OR = 2.03, p = 0.032) were the predictive factors found. AF is infrequent during brain infarction in Brazzaville. This systematic research raises the problem of age in our context.
References
[1]
Lemogoum, D., Degaute, J.P. and Bovet, P. (2005) Stroke Prevention, Treatment and Rehabilitation in Sub-Saharan Africa. American Journal of Preventive Medicine, 29, 95-101. https://doi.org/10.1016/j.amepre.2005.07.025
[2]
Murray, C.J.L. and Lopez, A.D. (1997) Mortality by Cause for Eight Regions of the World: Global Burden of Disease Study. The Lancet, 349, 1269-1276.
https://doi.org/10.1016/S0140-6736(96)07493-4
[3]
Dennis, M.S., Burn, J.P., Sandercock, P.A., Bamford, J.M., Wade, D.T. and Warlow, C.P. (1993) Long-Term Survival after First-Ever Stroke: The Oxfordshire Community Stroke Project. Stroke, 24, 796-800. https://doi.org/10.1161/01.STR.24.6.796
[4]
Hankey, G.J. and Warlow, C.P. (1999) Treatment and Secondary Prevention of Stroke: Evidence, Costs and Effects on Individuals and Populations. The Lancet, 354, 1457-1463. https://doi.org/10.1016/S0140-6736(99)04407-4
[5]
Heller, R.F., Langhorne, P. and James, E. (2000) Improving Stroke Outcome: The Benefits of Increasing Availability of Technology. Bulletin of the World Health Organization, 78, 1337-1343.
[6]
Mohr, J.P., Caplan, L.R., Melski, J.W., et al. (1978) The Harvard Cooperative Stroke Registry: A Prospective Registry. Neurology, 28, 754-762.
https://doi.org/10.1212/WNL.28.8.754
[7]
Sandercock, P., Bamford, J., Dennis, M., et al. (1992) Atrial Fibrillation and Stroke: Prevalence in Different Types of Stroke and Influence on Early and Long Term Prognosis (Oxfordshire Community Stroke Project). British Medical Journal, 305, 1460-1465. https://doi.org/10.1136/bmj.305.6867.1460
[8]
Hohnloser, S.H., Crijns, H.J., Van Eickels, M., et al. (2009) Effect of Dronaderone on Cardiovascular Events in Atrial Fibrillation. The New England Journal of Medicine, 360, 668-678. https://doi.org/10.1056/NEJMoa0803778
[9]
Connolly, S.J., Ezekowitz, M.D., Yusuf, S., et al. (2009) Dabigatran versus Warfarin in Patients with Atrial Fibrillation. The New England Journal of Medicine, 361, 1139-1151. https://doi.org/10.1056/NEJMoa0905561
[10]
Rizos, T., Rasch, C., Jenetzky, E., et al. (2010) Detection of Paroxysmal Atrial Fibrillation in Acute Stroke Patients. Cerebrovascular Diseases, 30, 410-417.
https://doi.org/10.1159/000316885
[11]
Alhadramy, O., Jeerakathil, T.J., Majumdar, S.R., Najjar, E., Choy, J. and Saqqur, M. (2010) Prevalence and Predictors of Paroxysmal Atrial Fibrillation on Holter Monitor in Patients with Stroke or Transient Ischemic Attack. Stroke, 41, 2596-2600.
https://doi.org/10.1161/STROKEAHA.109.570382
[12]
Jabaudon, D., Sztajzel, J., Sievert, K., Landis, T. and Sztajzel, R. (2004) Usefulness of Ambulatory 7-Day ECG Monitoring for the Detection of Atrial Fibrillation and Flutter after Acute Stroke and Transient Ischemic Attack. Stroke, 35, 1647-1651.
https://doi.org/10.1161/01.STR.0000131269.69502.d9
[13]
Second Congolese Household Survey for Monitoring and Evaluating Poverty (2011) Ministry of Planning and Integration. QUIBB-ECOM2 Analysis Report. 142.
[14]
Gombet, T.R., Ellenga-Mbolla, B., Ikama, M.S. and Etitiele, F. (2007) Risk Factors for Ischemic Stroke at the University Hospital of Brazzaville. Médecine d’Afrique noire électronique, 54, 639-645.
[15]
Damorou, F., Togbossi, E., Pessinaba, E., et al. (2008) Strokes and Emboligenic Cardiovascular Disease. Mali Médical, 23, 31-33.
[16]
Bendriss, L. and Khatouri, A. (2012) Ischemic Strokes. Frequency of Cardiovascular Etiologies Documented by an Extensive Cardiovascular Assessment. About 110 Ischemic Stroke Cases. Annales de Cardiologie et d’Angéiologie, 61, 252-256.
https://doi.org/10.1016/j.ancard.2012.04.011
[17]
Ikama, M.S., Makani, J., Mpandzou, G., et al. (2018) Contribution of the ECG Holter in the Etiological Assessment of Cerebral Infarction in Brazzaville, Congo. The Pan African Medical Journal, 31, 235.
https://doi.org/10.11604/pamj.2018.31.235.17709
[18]
Barthélémy, J.C., Féasson-Gérard, S., Garnier, P., et al. (2003) Automatic Cardiac Event Recorders Reveal Paroxysmal Atrial Fibrillation after Unexplained Strokes or Transient Ischemic Attacks. Annals of Noninvasive Electrocardiology, 8, 194-199.
https://doi.org/10.1046/j.1542-474X.2003.08305.x
[19]
Hornig, C.R., Haberbosh, W., Lammers, C., Waldecker, B. and Dorndorf, W. (1996) Specific Cardiological Evaluation after Focal Cerebral Ischemia. Acta Neurologica Scandinavica, 93, 297-302. https://doi.org/10.1111/j.1600-0404.1996.tb00524.x
[20]
Schaer, B.A., Zellweger, M.J., Cron, T.A., Kaiser, C.A. and Osswald, S. (2004) Value of Routine Holter Monitoring for the Detection of Paroxysmal Atrial Fibrillation in Patients with Cerebral Ischemic Events. Stroke, 35, e68-e70.
https://doi.org/10.1161/01.STR.0000117568.07678.4B
[21]
Elijovich, L., Josephson, S.A., Fung, G.L. and Smith, W.S. (2009) Intermittent Atrial Fibrillation May Account for a Large Proportion of Otherwise Cryptogenic Stroke: A Study of 30-Day Cardiac Event Monitors. Journal of Stroke and Cerebrovascular Diseases, 18, 185-189. https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.09.005
[22]
Rizos, T., Güntner, J., Jenetzky, E., et al. (2012) Continuous Stroke Unit Electrocardiographic Monitoring versus 24-Hour Holter Electrocardiography for Detection of Paroxysmal Atrial Fibrillation after Stroke. Stroke, 43, 2689-2694.
https://doi.org/10.1161/STROKEAHA.112.654954
[23]
Ritter, M.A., Kochhauser, S., Duning, T., et al. (2013) Occult Atrial Fibrillation in Cryptogenic Stroke: Detection by 7-Day Electrocardiogram versus Implantable Cardiac Monitors. Stroke, 44, 1449-1452.
https://doi.org/10.1161/STROKEAHA.111.676189
[24]
Wallmann, D., Tüller, D., Wusmann, K., et al. (2007) Frequent Atrial Premature Beats Predict Paroxysmal Atrial Fibrillation in Stroke Patients: An Opportunity for a New Diagnostic Strategy. Stroke, 38, 2292-2294.
https://doi.org/10.1161/STROKEAHA.107.485110
[25]
Tayal, A.H., Tian, M., Kelly, K.M., et al. (2008) Atrial Fibrillation Detected by Mobile Cardiac Outpatient Telemetry in Cryptogenic TIA or Stroke. Neurology, 71, 1696-1701. https://doi.org/10.1212/01.wnl.0000325059.86313.31
[26]
Cotter, P.E., Martin, P.J., Ring, L., Warburton, E.A., Belham, M. and Pugh, P.J. (2013) Incidence of Atrial Fibrillation Detected by Implantable Loop Recorders in Unexplained Stroke. Neurology, 80, 1546-1550.
https://doi.org/10.1212/WNL.0b013e31828f1828
[27]
Mapoure, N.Y., Tchaleu Nguenkam, C.B., Mbatchou Ngahane, H.B., et al. (2014) Predictors of in-Hospital Mortality for Stroke in Douala, Cameroon. Stroke Research and Treatment, 2014, Article ID: 681209.
https://doi.org/10.1155/2014/681209
[28]
Adoukonou, T.A., Vallat, J.M., Joubert, J., et al. (2010) Stroke Management in Sub-Saharan Africa. Revue Neurologique, 166, 882-893.
https://doi.org/10.1016/j.neurol.2010.06.004
[29]
Gunalp, M., Atalar, E., Coskun, F., et al. (2006) Holter Monitoring for 24 Hours in Patients with Thromboembolic Stroke and Sinus Rhythm Diagnosed in the Emergency Department. Advances in Therapy, 23, 854-860.
https://doi.org/10.1007/BF02850206
[30]
Furberg, C.D, Psaty, B.M., Manolio, T.A., Gardin, J.M. and Smith, V.E. (1994) Prevalence of Atrial Fibrillation in Elderly Subjects (the Cardiovascular Health Study). American Journal of Cardiology, 74, 236-241.
https://doi.org/10.1016/0002-9149(94)90363-8
[31]
Lévy, S., Maarek, M., Coumel, P., et al. (1999) Characterization of Different Subsets of Atrial Fibrillation in General Practice in France: The ALFA study. The College of French Cardiologists. Circulation, 99, 3028-3035.
https://doi.org/10.1161/01.CIR.99.23.3028
