Background: Venous thromboembolic (VTE) disease burden is increasing worldwide, representing a major cause of cardiovascular death and public health problem. Pulmonary embolism (PE) is the most serious clinical presentation of VTE. Epidemiological and clinical data on PE are still lacking in Africa, particularly in Cameroon. This study aimed at determining the clinical features as well as imaging presentation and outcome of pulmonary embolism. Methods: A cross-sectional study was carried out in three hospitals in Douala. We retrospectively reviewed patient records admitted for PE from January 2009 to May 2017. We collected data on epidemiology, clinical presentation, venous Doppler/pulmonary computed tomographic angiography (CTA), and outcome. Results: We included 103 patients (56 males) with PE. Their median age was 52 years. The main risk factors were obesity (49.5%), hypertension (35.0%), long trip (24.3%) and cancer (18.4%). The most frequent clinical presentations were dyspnoea (83.4%), chest pain (78.6%), and cough (40.8%). Additionally, pleural effusion (32.8%), atelectasis (25.7%) and pulmonary hyperlucency (20.0%) were the most frequent findings on chest X-ray. The main abnormalities found in electrocardiogram were sinus tachycardia (63.4%), S1Q3T3 aspect (37.6%) and right axial deviation (28.7%). Moreover, right cavities dilatation (26.0%), pulmonary artery hypertension (35.0%) and pulmonary artery dilatation (21.0%) were the main echocardiographic findings. Low-molecular-weight heparin (LMWH) was the initial anticoagulant in all cases. There were 19 (18.4%) in-hospital deaths, and the mean hospital stay was 8.5 ± 5 days. Conclusion: PE is not rare in our setting. Obesity, long trip and cancer are the main risk factors, while dyspnoea, chest pain and respiratory distress are the main clinical presentation for PE. LMWH remains the therapeutic agent of choice. Lastly, in-hospital mortality is very high.
References
[1]
Goldhaber, S.Z. and Bounameaux, H. (2012) Pulmonary Embolism and Deep Vein Thrombosis. The Lancet, 379, 1835-1846.
https://doi.org/10.1016/S0140-6736(11)61904-1
[2]
Pollack, C.V., Schreiber, D., Goldhaber, S.Z., Slattery, D., Fanikos, J., O’Neil, B.J., et al. (2011) Clinical Characteristics, Management, and Outcomes of Patients Diagnosed with Acute Pulmonary Embolism in the Emergency Department: Initial Report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). Journal of the American College of Cardiology, 57, 700-706.
https://doi.org/10.1016/j.jacc.2010.05.071
[3]
Goldhaber, S.Z., Hennekens, C.H., Evans, D.A., Newton, E.C. and Godleski, J.J. (1982) Factors Associated with Correct Antemortem Diagnosis of Major Pulmonary Embolism. The American Journal of Medicine, 73, 822-826.
https://doi.org/10.1016/0002-9343(82)90764-1
[4]
Tambe, J., Moifo, B., Fongang, E., Guegang, E. and Juimo, A.G. (2012) Acute Pulmonary Embolism in the Era of Multi-Detector CT: A Reality in Sub-Saharan Africa. BMC Medical Imaging, 12, 31. https://doi.org/10.1186/1471-2342-12-31
[5]
Saleh, J.A. and Alasia, D.D. (2007) Acute Pulmonary Embolism: A Review. Nigerian Journal of Medicine, 6, 11-17. https://doi.org/10.4314/njm.v16i1.37274
[6]
DeMonaco, N.A., Dang, Q., Kapoor, W.N. and Ragni, M.V. (2008) Pulmonary Embolism Incidence Is Increasing with Use of Spiral Computed Tomography. The American Journal of Medicine, 121, 611-617.
https://doi.org/10.1016/j.amjmed.2008.02.035
[7]
Minges, K.E., Bikdeli, B., Wang, Y., Kim, N., Curtis, J.P., Desai, M.M., et al. (2015) National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010). American Journal of Cardiology, 116, 1436-1442. https://doi.org/10.1016/j.amjcard.2015.07.068
[8]
Bouée, S., Emery, C., Samson, A., Gourmelen, J., Bailly, C. and Cotté, F.-E. (2016) Incidence of Venous Thromboembolism in France: A Retrospective Analysis of a National Insurance Claims Database. Thrombosis Journal, 14, 2-9.
https://doi.org/10.1186/s12959-016-0078-0
[9]
Yang, Y., Liang, L., Zhai, Z., He, H., Xie, W., Peng, X., et al. (2011) Pulmonary Embolism Incidence and Fatality Trends in Chinese Hospitals from 1997 to 2008: A Multicenter Registration Study. PLoS ONE, 6, e26861.
https://doi.org/10.1371/journal.pone.0026861
[10]
Bajaj, N., Bozarth, A.L., Guillot, J., Kojokittah, J., Appalaneni, S.R., Cestero, C., et al. (2014) Clinical Features in Patients with Pulmonary Embolism at a Community Hospital: Analysis of 4 Years of Data. Journal of Thrombosis and Thrombolysis, 37, 287-292. https://doi.org/10.1007/s11239-013-0942-8
[11]
European Society of Cardiology (ESC) (2014) 2014 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. Endorsed by the European Respiratory Society. European Heart Journal, 35, 3033-3080.
https://doi.org/10.1093/eurheartj/ehu283
[12]
Diall, I.B., Coulibaly, S., Minta, I., Ho, B., Diakite, M., Sidibe, N., et al. (2011) Causes, Signs and Outcome of 30 Patients with Pulmonary Embolus. Le Mali Médical, 26, 3-6.
[13]
Houenassi, M., Sacca-Vehounkkpe, J. and Tchabi, Y. (2013) Evaluation de la prise en charge de l’embolie pulmonaire dans un pays à faible niveau socio-économique: Cas du Benin. Cardiologie Tropicale, 136, 1-8.
[14]
Elegbeleye, O.O. and Femi-Pearse, D. (1975) Pulmonary Embolism in Africans. Tropical and Geographical Medicine, 27, 31-33.
[15]
Kingue, S., Tagny-Zukam, D., Binam, F., Nouedoui, C., Teyang, A. and Muna, W.F. (2002) Venous Thromboembolism in Cameroon (Report of 18 Cases). Medecine Tropicale: Revue du Corps de Sante Colonial, 62, 47-50.
[16]
Bakebe, A., Kashongwe, I., Mulenga, C., Tshiasuma, M., Kabengele, B., Bisuta, S.F., et al. (2017) Pulmonary Embolism: Epidemiological Data and Diagnosis in Kinshasa Hospitals. International Journal of Tuberculosis and Lung Disease, 21, 875-879.
https://doi.org/10.5588/ijtld.16.0418
[17]
Kamdem, F., Ngahane, B.H.M., Hamadou, B., Mongyui, A., Doualla, M.S., Jingi, A.M., et al. (2018) Epidemiology, Clinical Presentations and In-Hospital Mortality of Venous Thromboembolism at the Douala General Hospital: A Cross-Sectional Study in Cameroon, Sub-Saharan Africa. World Journal of Cardiovascular Diseases, 8, 123-132. https://doi.org/10.4236/wjcd.2018.82012
[18]
Manuel, A., Aufico, A., Africano, R., Peralta, T., Salas, A., Silva, A., et al. (2017) Clinical Profile, Management and Outcomes of Patients with Pulmonary Embolism: A Retrospective Tertiary Centre Study in Angola. Cardiovascular Journal of Africa, 28, 356-361. https://doi.org/10.5830/CVJA-2017-017
[19]
Nganou-Gnindjio, C.N., Njonnou, S.R.S., Hamadou, B., Jemea, B., Mbede, M., Jingi, A.M., et al. (2018) Characteristics of Venous Thrombo-Embolic Disease in People with and without HIV Infection in Yaounde: A Cross-Sectional Study. Health Sciences and Diseases, 19, 21-26.
[20]
Pessinaba, S., Atti, Y.D.M., Baragou, S., Pio, M., Afassinou, Y., Kpélafia, M., et al. (2017) Pulmonary Embolism at the University Hospital Campus of Lome (Togo): A Retrospective Study about 51 Cases. Pan African Medical Journal, 27, 129.
https://doi.org/10.11604/pamj.2017.27.129.6855
[21]
Abah, J.P., Menanga, A., Ngahane, B.H.M., Minkande, J.Z., Akono, M.N. and Kingue, S. (2016) Pattern of Venous Thromboembolic Diseases in a Resources-Limited Setting in Cameroon. Pan African Medical Journal, 23, 236.
https://doi.org/10.11604/pamj.2016.23.236.7034
[22]
Ogeng’o, J.A., Obimbo, M.M., Olabu, B.O., Gatonga, P.M. and Ong’era, D. (2011) Pulmonary Thromboembolism in an East African Tertiary Referral Hospital. Journal of Thrombosis and Thrombolysis, 32, 386-391.
https://doi.org/10.1007/s11239-011-0607-4
[23]
Husain, S.J., Zubairi, A.B.S., Fatima, K., Irfan, M., Atif, M. and Saeed, M.A. (2009) Clinical Characteristics, Management and Outcome of Major Pulmonary Embolism: An Experience from a Tertiary Care Center in Pakistan. Journal of Pakistan Medical Association, 59, 372-375.
[24]
Algahtani, F.H., Bayoumi, N., Abdelgadir, A., Al-Nakshabandi, N., Al Aseri, Z., Al Ghamdi, M., et al. (2013) Clinical Characteristics and Risk Factors of Pulmonary Embolism: Data from a Saudi Tertiary-Care Center. Journal of Thrombosis and Haemostasis, 11, 388-390. https://doi.org/10.1111/jth.12083
[25]
Casazza, F., Becattini, C., Bongarzoni, A., Cuccia, C., Roncon, L., Favretto, G., et al. (2012) Clinical Features and Short Term Outcomes of Patients with Acute Pulmonary Embolism. The Italian Pulmonary Embolism Registry (IPER). Thrombosis Research, 130, 847-852. https://doi.org/10.1016/j.thromres.2012.08.292
[26]
Alikhan, R., Cohen, A.T., Combe, S., Samama, M.M., Desjardins, L., Eldor, A., et al. (2004) Risk Factors for Venous Thromboembolism in Hospitalized Patients with Acute Medical Illness: Analysis of the MEDENOX Study. Archives of Internal Medicine, 164, 963-968. https://doi.org/10.1001/archinte.164.9.963
[27]
Anderson, F.A., Wheeler, H.B., Goldberg, R.J., Hosmer, D.W., Patwardhan, N.A., Jovanovic, B., et al. (1991) A Population-Based Perspective of the Hospital Incidence and Case-Fatality Rates of Deep Vein Thrombosis and Pulmonary Embolism. The Worcester DVT Study. Archives of Internal Medicine, 151, 933-938.
https://doi.org/10.1001/archinte.151.5.933
[28]
Morrone, D. and Morrone, V. (2018) Acute Pulmonary Embolism: Focus on the Clinical Picture. Korean Circulation Journal, 48, 365-3681.
https://doi.org/10.4070/kcj.2017.0314
[29]
NATSPUTE (2006) The Clinical Features of 516 Patients with Acute Pulmonary Thromboembolism. Chinese Medical Journal, 86, 2161-2165.
[30]
Altınsoy, B., Erboy, F., Tanrıverdi, H., Uygur, F., Örnek, T., Atalay, F., et al. (2016) Syncope as a Presentation of Acute Pulmonary Embolism. Therapeutics and Clinical Risk Management, 12, 1023-1028. https://doi.org/10.2147/TCRM.S105722
[31]
Stein, P.D., Matta, F., Musani, M.H. and Diaczok, B. (2010) Silent Pulmonary Embolism in Patients with Deep Venous Thrombosis: A Systematic Review. The American Journal of Medicine, 123, 426-431.
https://doi.org/10.1016/j.amjmed.2009.09.037
[32]
Calwin Davidsingh, S., Srinivasan, N., Balaji, P., Kalaichelvan, U. and Mullasari, A.S. (2014) Study of Clinical Profile and Management of Patients with Pulmonary Embolism—Single Center Study. Indian Heart Journal, 66, 197-202.
https://doi.org/10.1016/j.ihj.2013.12.037
[33]
Padley, S.P.G. (2002) Lung Scintigraphy vs. Spiral CT in the Assessment of Pulmonary Emboli. The British Journal of Radiology, 75, 5-8.
https://doi.org/10.1259/bjr.75.889.750005
