Socio-demographic characteristics
An overall response rate of 98.8% was achieved with a total of 417 study participants. The mean age (± SD) of the participants was 50.42 years (with a SD of ± 0.62 years). Among the study participants, 214 (51.3%) were male, 275 (65.9%) were married, and more than half (351) (84.2%) of the patients were older than 40 years. Most of the patients resided in urban areas (354, 84.9%), and the mean follow-up duration was 2.54 ± 0.08 years. Among all the participants, 68 (16.3%) had a family history of cardiovascular disease, 44 (10.6%) had a history of smoking, 127 (30.5%) were drinking alcohol, and 32 (7.7%) had a history of smoking and current khat chewing. (Table 1)
Table 1
Socio-demographic characteristics of adult patients visiting the cardiac clinic at SPHMMC, Addis Abeba, Ethiopia, 2023.
Variables(n = 417) | Category | Frequency | Percent (%) |
Age category (Years) | < 40 | 66 | 15.8 |
≥ 40 | 351 | 84.2 |
Sex | Male | 214 | 51.3 |
Female | 203 | 48.7 |
Marital status | single | 129 | 30.9 |
married | 275 | 65.9 |
widowed/divorced | 13 | 3.1 |
Widowed | 16 | 4.8 |
Residents | Urban | 354 | 84.9 |
Rural | 63 | 15.1 |
Follow-up (mean ± standard deviation), years. | 2.54 ± 0.08 |
Family history of cardiovascular disease | Yes | 68 | 16.3 |
No | 349 | 83.7 |
Any history of Smoking | Yes | 44 | 10.6 |
No | 373 | 89.4 |
Any history of Alcohol | Yes | 127 | 30.5 |
No | 290 | 69.5 |
Any history of Khat chewing | Yes | 32 | 7.7 |
No | 385 | 92.3 |
Pattern of comorbidity
Hypertension (20.8%) was the most frequently identified comorbid disease, followed by chronic obstructive lung disease and asthma (17.0%), adult malnutrition (12.1%), retroviral infection (8.3%), thyroid-cardiac diseases (7.3%), a history of diabetic millet (6.4%) and tuberculosis (6.1%). (Table 2)
Table 2
Pattern of comorbidity among adult patients visiting the cardiac clinic at SPHMMC, Addis Abeba, Ethiopia, 2023.
Variables(n = 417) | Category | Frequency | Percent (%) |
History of Diabetic Miletus | Yes | 27 | 6.4 |
No | 396 | 93.6 |
Any history of hypertension | Yes | 88 | 20.8 |
No | 335 | 79.2 |
Thyroid diseases | Yes | 31 | 7.3 |
No | 392 | 92.7 |
Adult Malnutrition | Yes | 51 | 12.1 |
No | 372 | 87.9 |
Chronic obstructive lung disease/Asthma | Yes | 72 | 17.0 |
No | 351 | 83.0 |
Retroviral infection | Yes | 35 | 8.3 |
No | 388 | 91.7 |
Tuberculosis | Yes | 26 | 6.1 |
No | 397 | 93.9 |
Renal failure/CKD, ARF, NS/* | Yes | 13 | 3.1 |
No | 410 | 96.9 |
*CKD: Chronic kidney disease, ARF: Acute renal failure, NS: Nephrotic syndrome |
Patterns of cardiac valve involvement and Doppler findings
Approximately 91 (21.5%) of the patients had at least one cardiac chamber dilation. Of the study participants, 63.5% of the patients had at least one valve lesion. The pulmonary valve (10.4%) was the most commonly affected valve morphology, followed by the mitral valve (3.8%). The pulmonic valve was involved in approximately 2.4% of patients. Among VHD patients, regurgitation (67.6%) was the most common Doppler finding in all VHD patients, followed by shunting (17.6%) and pulmonary hypertension (14.7%), and thickening was the most common Doppler finding in intracardiac masses. Among the participants, only 19 (4.6%) patients’ Doppler findings showed that the inferior vena cavve structure was dilated (Table 3).
Table 3
Patterns of cardiac valve involvement and Doppler findings among adult patients visiting the cardiac clinic at SPHMMC, Addis Abeba, Ethiopia, 2023.
Variables (n = 417) | Category | Frequency | Percent |
Cardiac chamber | Normal | 328 | 78.7 |
Dilated | 89 | 21.3 |
Intracardiac mass(n = 89) | Effusion | 11 | 12.4 |
Thickening | 77 | 86.5 |
Calcification | 1 | 1.1 |
Valve structure | Normal | 339 | 81.3 |
Dilated | 78 | 18.7 |
Affected valve(n = 78) | Aortic Valve | 10 | 13.3 |
Mitral valve | 14 | 18.7 |
Pulmonary valve | 44 | 58.7 |
Tricuspid valve | 6 | 8.0 |
Mitral valve prolapse | 1 | 1.3 |
Inferior Vena-cave structure | Normal | 398 | 95.4 |
Dilated | 19 | 4.6 |
Echocardiography-identified etiologies
Rheumatic heart disease (35.90%) was the most commonly reported etiology causing valvular lesions, followed by infective endocarditis (30.77%). Rheumatic and other causes of VHD were more common in older patients (aged greater than 40 years). Degenerative VHD (4.5%), cardiomyopathy, ischemia (IHD), and aortic dissection were only reported in those aged greater than 40 years. (Table 4)
Table 4
Echocardiography-identified etiologies among adult patients visiting the cardiac clinic at SPHMMC, Addis Abeba, Ethiopia, 2023.
Variables(n = 73) | Frequency | Percent (%) |
Rheumatic heart disease | 46 | 63.01% |
Infective endocarditis | 10 | 13.69% |
Inflammatory conditions | 9 | 12.32% |
Idiopathic | 5 | 6.84% |
Cardiomyopathies | 5 | 6.84% |
Ischemia (IHD) | 2 | 2.73% |
Aortic dissection | 2 | 2.73% |
Aortic sclerosis | 2 | 2.73% |
Burden of valvular heart disease
The proportion of VDH among adult patients visiting the cardiac clinic at St. Paul’s Hospital Millennium Medical College was 73 (17.06%) (95% CI, 14.13–21.47). In rheumatic heart disease (RHD) patients, the pulmonary valve (10.4%) was the most commonly affected valve morphology, followed by the mitral valve (3.8%). The pulmonic valve was involved in approximately 2.4% of patients. Among VHD patients, regurgitation (67.6%) was the most common Doppler finding in all VHD patients, followed by shunting (17.6%) and pulmonary hypertension (14.7%), and thickening was the most common Doppler finding in intra-cardiac masses (Fig. 1).
Associated factors of VHD among adult patients visiting cardiac clinics
The candidate variables identified by bivariate analysis for multiple variables were residence status, alcohol use status, family history of cardiovascular disease, hypertension, diabetes mellitus, thyroid disease, chronic obstructive pulmonary disease, asthma, presence of adult malnutrition, history of retroviral infection, and history of tuberculosis; these variables were associated with depression, with p values < 0.25. A family history of cardiovascular disease, hypertension, and thyroid disease and the presence of adult malnutrition were significantly associated with depression in patients living with VDH. The model was fit with the Hosmer and Lemeshow test, with a p value of 0.133 (df = 7, x2 11.13).
Patients with a family history of cardiovascular disease were 3.56 times more likely to develop VHD (AOR = 3.56, 95% CI: (1.76–7.12)) than patients with no family history of cardiovascular disease. Patients with a history of hypertension were 2.83 times more likely to develop VHD (AOR = 2.83, 95% CI: (1.48–5.41)) than patients with no history of hypertension. Patients with thyroid disease were 3.59 times more likely to develop VHD (AOR = 3.59, 95% CI: (1.51–8.56)) than patients with no thyroid disease. Patients with a history of adult malnutrition were 4.93 times more likely to develop VHD (AOR = 4.93, 95% CI: 2.04–10.14) than patients with no history of adult malnutrition (Table 5).
Table 5
Binary logistic regression analysis for adult patients visiting the cardiac clinic at SPHMMC, Addis Abeba, Ethiopia, 2023 (n = 417).
Variables | Category | VHD (%) | *COR (95% CI) | AOR (95% CI) | p value** |
Yes | No |
Residents | Urban Rural | 55(15.6) | 298(84.4) | 0.47(0.25–0.27) | 0.923(0.41–2.05) | 0.843 |
18(28.1) | 46(71.9) | 1.00 (reference) | 1.00 (reference) | |
Presence of retroviral infection(RVI) | Yes No | 5(14.7) | 29(85.3) | 0.77(0.29–1.51) | 0.83(0.27–2.54) | 0.748 |
68(17.8) | 315(82.2) | 1.00 (reference) | 1.00 (reference) | |
COPD and Asthma | Yes No | 19(26.7) | 52(73.3) | 1.97(1.08–3.61) | 2.03(0.93–4.29) | 0.063 |
54(15.6) | 292(84.4) | 1(reference) | 1(reference) | |
Presence of Adult Malnutrition | Yes No | 21(42.0) | 29 (58.0) | 4.38(2.38–8.26) | 4.93(2.04–10.14) | < 0.001 |
52(14.2) | 315(85.8) | 1(reference) | 1(reference) | |
Presence of Thyroid disease | Yes No | 14(45.2) | 17(54.8) | 2.67(1.67–4.35) | 3.59 (1.51–8.56) | 0.004 |
59(14.5) | 327(85.6) | 1.00 (reference) | 1.00 (reference) | |
Presence of Tuberculosis infection | Yes No | 7(26.9) | 19 (73.1) | 1.81(0.73–3.48) | 1.47(0.49–4.37) | 0.483 |
66(17.1) | 325(82.8) | 1.00 (reference) | 1.00 (reference) | |
History of Diabetic Mellitus | Yes no | 9(34.6) | 17(65.4) | 2.70(1.15–6.33) | 2.52(0.92–6.83) | 0.070 |
64(16.4) | 327(83.6) | 1(reference) | 1(reference) | |
History of Hypertension | Yes No | 30(34.9) | 56(65.1) | 3.58(2.07–6.20) | 2.83(1.48–5.41) | 0.002 |
43(12.9) | 288(87.1) | 1(reference) | 1(reference) | |
Family history of any cardiovascular disease | Yes No | 41(59.4) | 287(40.6) | 3.64(2.04–6.50) | 3.56(1.76–7.12) | < 0.000 |
32(35.9) | 57(64.1) | 1(reference) | 1(reference) | |
History of Alcohol use | Yes No | 13(10.2) | 114(89.8) | 0.43(0.23–0.82) | 0.506(0.23–1.06) | 0.074 |
60(20.7) | 230(79.3) | 1(reference) | 1(reference) | |
*AOR: adjusted odds ratio; COR: crude odds ratio: P value < 0.05** |