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Little is known about pulmonary hypertension in left heart disease (PH-LHD) in sub-Saharan Africa. We used multivariate logistic and cox-hazard proportional regression models to investigate factors associated with increased right ventricular systolic pressure (RVSP) and the impact of real-world HIV status scenarios on six-month survival rate in the Pan African Pulmonary Hypertension Cohort (PAPUCO) study, a prospective cohort in four African countries. Upon presentation, exposure to biomass fuel smoke (aOR, 95%CI: 3.07, 1.02-9.28), moderate to severe NYHA/FC III/IV (aOR, 95%CI: 4.18, 1.01-17.38) and unknown HIV status (aOR, 95%CI: 2.73, 0.96-7.73) predicted moderate to severe RVSP. After six months, HIV infection, moderate to severe NYHA/FC and alcohol consumption were associated with reduced survival odds. After accounting for HIV infection, each additional increase in RVSP (1 mmHg) and interventricular septal thickness (1 mm) increased the likelihood of dying from PH-LHD by 8% (aHR, 95%CI: 1.08, 1.02-1.13) and 20% (aHR, 95%CI: 1.2, 1.00-1.43), respectively. However, for each additional unit of BMI, the hazard of dying from PH-LHD was reduced by 23%. (aHR, 95%CI: 0.77, 0.59-1.00). We provide factors that are significantly associated with poor survival in PH-LHD patients, some of which are easily assessable and modifiable in resource-constrained settings.

Background Data characterizing risk factors and long-term outcome studies on human immunodeficiency virus (HIV)-associated pulmonary hypertension (PH) in Africa are lacking. Methods The Pan African Pulmonary Hypertension Cohort, a multinational registry of 254 consecutive patients diagnosed with PH (97% of African descent) from 9 centers in 4 African countries was implemented. We compared baseline characteristics and 3-year survival of an HIV-infected cohort newly diagnosed with PH (PH/HIV+) to an HIV-uninfected cohort with PH (PH/HIV−). Results One hundred thirty-four participants with PH completed follow up (47 PH/HIV+ and 87 PH/HIV−; age median, 36 versus 44 years; P = .0004). Cardiovascular risk factors and comorbidities were similar except for previous tuberculosis (62% versus 18%, P < .0001). Six-minute walk distance (6MWD) Conclusions The PH/HIV + patients were younger and commonly had previous tuberculosis compared to PH/HIV− patients. Despite a better 6MWD at presentation, they had more signs and symptoms of early onset heart failure and a worse survival rate. Early echocardiography assessment should be performed in HIV-infected patients with history of tuberculosis who present with signs and symptoms of heart failure or posttuberculosis lung disease.

Background Epidemiology, aetiology, management and outcome data for various forms of pulmonary hypertension (PH) in Africa are scarce. Methods A prospective, multinational cohort registry of 220 consecutive patients (97% of African descent) from 9 specialist centres in 4 African countries. The antecedents, characteristics and management of newly diagnosed PH plus 6-month survival were studied. Results There were 209 adults (median age 48years [IQR 35, 64]) and 11 children (age range 1 to 17years). Most adults had advanced disease - 66% WHO Functional Class III-IV, median 6-minute walk test distance of 252m (IQR 120, 350) and median right ventricular systolic pressure 58mmHg (IQR 49, 74). Adults comprised 16% pulmonary arterial hypertension, 69% PH due to left heart disease, 11% PH due to lung disease and/or hypoxia, 2% chronic thromboembolic pulmonary hypertension, and 2% PH with unclear multifactorial mechanism. At 6-months, 21% of adults with follow-up data had died. On an adjusted basis (independent of sub-groups) mortality was associated with increasing functional impairment ( p =0.021 overall - WHO Class IV versus I, OR 1.68 [95% CI 0.13, 4.36]) and presence of combined right atrial and ventricular hypertrophy (46% - OR 2.88, 95% CI 1.45, 5.72). Children commonly presented with dyspnoea, fatigue, cough, and palpitations with six and three children, respectively diagnosed with concurrent PH associated congenital heart disease and left heart disease. Conclusions These data provide new insights into PH from an African perspective, with clear opportunities to improve its prevention, treatment and outcomes. Trial Registration ClinicalTrials.gov (NCT02265887).

IntroductionPulmonary hypertension (PH) is a devastating, progressive disease with increasingly debilitating symptoms and usually shortened overall life expectancy due to a narrowing of the pulmonary vasculature and consecutive right heart failure. Little is known about PH in Africa, but limited reports suggest that PH is more prevalent in Africa compared with developed countries due to the high prevalence of risk factors in the region.Methods and analysisA multinational multicentre registry-type cohort study was established and tailored to resource-constraint settings to describe disease presentation, disease severity and aetiologies of PH, comorbidities, diagnostic and therapeutic management, and the natural course of PH in Africa. PH will be diagnosed by specialist cardiologists using echocardiography (right ventricular systolic pressure >35 mm Hg, absence of pulmonary stenosis and acute right heart failure), usually accompanied by shortness of breath, fatigue, peripheral oedema and other cardiovascular symptoms, ECG and chest X-ray changes in keeping with PH as per guidelines (European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines). Additional investigations such as a CT scan, a ventilation/perfusion scan or right heart catheterisation will be performed at the discretion of the treating physician. Functional tests include a 6 min walk test and the Karnofsky Performance Score. The WHO classification system for PH will be applied to describe the different aetiologies of PH. Several substudies have been implemented within the registry to investigate specific types of PH and their outcome at up to 24 months. Data will be analysed by an independent institution following a data analyse plan.Ethics and disseminationAll local ethics committees of the participating centres approved the protocol. The data will be disseminated through peer-reviewed journals at national and international conferences and public events at local care providers.