Etiology, characteristics and occurrence of heart diseases in rural Lesotho (ECHO-Lesotho): A retrospective echocardiography cohort study

<strong>Background</strong> In 2019, 600’000 people in Africa died of heart failure and heart diseases will increase on the continent. It is crucial to understand the regional etiologies and risk factors for heart failure and underlying heart diseases. However, echocardiography data from rural Africa are scarce and from Lesotho non-existent. This study aims to examine the occurrence, characteristics and etiology of heart failure and heart diseases using echocardiography data from a referral hospital in rural Lesotho. <strong>Methods</strong> We conducted a retrospective cohort study at Seboche Mission Hospital, the only referral hospital in Butha-Buthe district (Lesotho) with an echocardiography department. We included data from all individuals referred to the department between January 2020 and May 2021. From non-hospitalized patients echocardiographic diagnosis, sex and age were available, from hospitalized patients additional sociodemographic and clinical data could be extracted. <strong>Results</strong> In the study period, a total of 352 echocardiograms were conducted; 213 had abnormal findings (among them 3 children). The majority of adult participants (130/210; 64%) were female and most frequent heart diseases were hypertensive (62/210, 30%), valvular (39/210, 19%) and chronic pulmonary (37/210, 18%). Heart failure represented 11% of hospitalizations in the same period. Among the 126 hospitalized heart failure patients, the most common etiology was chronic pulmonary heart disease (32/126; 25%). Former mine workers and people with a history of tuberculosis were more likely to have a chronic pulmonary heart disease. <strong>Conclusions</strong> The leading cause of heart disease in this setting is hypertension. However, in contrast to other African epidemiological studies, chronic pulmonary heart disease is unexpectedly common. There is an urgent need to improve awareness and knowledge about lung diseases, make diagnostic and therapeutic options available and increase prevention.背景：2019年，非洲有60万人死于心力衰竭，且该大陆的心脏疾病负担持续上升。明确心力衰竭及潜在心脏疾病的区域病因与危险因素，对公共卫生干预至关重要。然而，非洲农村地区的超声心动图（echocardiography）数据极为匮乏，莱索托更是尚无相关临床数据。本研究拟依托莱索托农村布塔布特区唯一设有超声心动图科的转诊医院——塞博赫传教医院的超声心动图数据，分析心力衰竭与心脏疾病的发生特征、流行现状及致病病因。 方法：本研究为回顾性队列研究，实施于莱索托布塔布特区的塞博赫传教医院（该区域唯一配备超声心动图科的转诊医院）。研究纳入2020年1月至2021年5月期间所有转诊至该超声心动图科的患者数据。其中，非住院患者可提供超声心动图诊断结果、性别及年龄信息；住院患者则可额外获取其社会人口学特征与临床相关资料。 结果：研究周期内，共计完成352例超声心动图检查，其中213例检查结果异常（包含3例儿童患者）。成年受试者中，女性占比达64%（130/210），最常见的心脏疾病依次为高血压性心脏病（62/210，30%）、瓣膜性心脏病（39/210，19%）及慢性肺源性心脏病（37/210，18%）。同期住院患者中，心力衰竭占总住院人次的11%。在126例因心力衰竭住院的患者中，最常见的致病诱因为慢性肺源性心脏病（32/126，25%）。既往有矿工职业史及肺结核病史的人群，罹患慢性肺源性心脏病的风险显著升高。 结论：本研究场景中心脏疾病的首要致病因素为高血压。但与其他非洲地区的流行病学研究结果不同，慢性肺源性心脏病在此地的患病率出乎意料地高。当前亟需提升公众对肺部疾病的认知水平，完善相关诊疗服务供给，并加强疾病预防工作。