Sura Markos

Background: Congenital heart disease (CHD) is a leading noninfectious cause of mortality during childhood and adolescence, particularly in developing countries where timely diagnosis and treatment are limited. Despite its public health significance, data on mortality trends and their predictors in resource-limited settings remain scarce. This study aimed to assess mortality trends and identify predictors among children with CHD in a resource-limited setting. Materials and Methods: We conducted a retrospective follow-up study on 6228 children and adolescents with CHD who received care at the Cardiac Center of Ethiopia, either as outpatients or inpatients, with follow-up between 2015 and 2024. Data were collected through medical record reviews and phone interviews with caregivers from January 1 to August 1, 2025. Joinpoint was used to assess trends in CHD-related mortality by calculating the annual percent change (APC), and the average APC (AAPC) was used to evaluate overall mortality trends. Predictors of CHD-related mortality were identified using a Cox proportional hazards model. Results: The median age of patients was 0.7 years (interquartile range, 0.3–3.8 years), with a female-to-male ratio of 1.42:1. During follow-up, 827 patients (13.3%) died. The overall AAPC in mortality per 1000 CHD cases was −8.19% (95% confidence interval [CI]: −11.2–−5.47, P < 0.001), indicating a statistically significant annual decline. A marked decrease occurred between 2019 and 2022 (APC: −40.94%; 95% CI: −47.41–−27.50; P = 0.04). Malnutrition increased mortality risk by 2.9-fold (adjusted hazard ratio [AHR]: 2.9; 95% CI: 1.9–3.9; P < 0.001), pulmonary hypertension (PH) by 3.5-fold (AHR: 3.5; 95% CI: 2.2–6.6; P < 0.001), and the presence of syndromic associations (with or without extracardiac anomalies) by 30% (AHR: 1.3; 95% CI: 1.1–2.2; P = 0.04). Conversely, undergoing surgery or an interventional procedure reduced mortality risk by 80% (AHR: 0.2; 95% CI: 0.1–0.8; P < 0.001). Conclusion: Mortality among children and adolescents with CHD in Ethiopia has shown a significant decline in recent years. However, malnutrition, PH, syndromic associations, and lack of surgical or interventional care remain key predictors of poor outcomes. Strengthening timely access to interventions, enhancing nutritional and multidisciplinary support, and prioritizing early identification of high-risk patients are essential to further reduce CHD-related mortality in resource-limited settings.

Acute heart failure is a leading cause of hospital admissions and mortality in Africa. Data on in-hospital outcomes and predictors of mortality remain limi

Kounis syndrome (KS) describes the occurrence of acute coronary syndromes precipitated by allergic, hypersensitivity, or anaphylactic reactions and represents a unique intersection between immunologic activation and cardiovascular disease. The epidemiology of KS is likely underestimated due to diagnostic overlap with other cardiac and allergic conditions and limited awareness across medical specialties. This narrative review focuses on the distinctive features of KS in special populations, emphasizing how patients’ age, comorbidities, immune status, and vascular substrate modify presentation, diagnosis, and outcomes. In elderly patients, polypharmacy, increased plaque vulnerability, and endothelial dysfunction favor Type II and III KS. Pediatric cases, although rare, are predominantly Type I and strongly associated with food allergies, insect stings, vaccines, and antibiotics, with under-recognition driven by diagnostic bias and ethical concerns surrounding invasive testing. Patients with coronary stents, cardiac devices, chronic kidney disease, and those receiving dialysis exhibit heightened susceptibility due to chronic inflammation, foreign-body hypersensitivity, and prothrombotic states. Pregnancy and the peripartum period represent a unique immuno-hemodynamic milieu in which Th2 immune shift, increased coronary vasoreactivity, and obstetric triggers can compromise both maternal and fetal perfusion. Additional risk modulation is observed in atopic individuals, asthmatics, patients with autoimmune, inflammatory, oncologic, psychiatric, and neurodevelopmental conditions, as well as in COVID-19 and post-infectious states. We propose a host-modified framework for KS that complements traditional classification by integrating immune phenotype and vascular substrate, enabling improved risk stratification and personalized preventive strategies.

To determine the prevalence, clinical predictors, and embolic complications of atrial fibrillation among adults hospitalized with heart failure in Southern

Cardiovascular diseases (CVDs) are major causes of premature mortality and disability, especially in settings where timely cardiac surgery or percutaneous interventions are limited. Globally, the prevalence of CVDs is rising, with significant regional differences. Africa bears a high burden of congenital heart disease (CHD) and rheumatic heart disease (RHD) but has limited access to surgical and interventional resources. This study describes the spectrum and management of cardiac diseases at the Cardiac Center of Ethiopia (CCE), highlighting treatment gaps. A hospital-based retrospective descriptive study was conducted from February 1 to June 1, 2023, reviewing records of 10,999 cardiac patients managed between 2012 and 2023. Variables included were demographics, type of heart disease, and management type (surgery or percutaneous intervention). Categorical data were summarized using frequencies and percentages, and continuous data using median and interquartile range (IQR). Among 10,999 patients, the median age was 7.5 years (IQR 3–17.5), and 66.6% were younger than 18 years. CHD was the most common diagnosis (49.6%), followed by valvular heart disease (VHD) (35.4%) and hypertensive heart disease (HHD) (6.6%). Of 8,689 patients with guideline directed indications, only 2,900 (33.4%) received surgical or percutaneous intervention. Among patients with CHD, 950 (56.5%) underwent surgery and 730 (43.5%) received percutaneous treatment. The most common surgical procedures were ventricular septal defect (VSD) patch closure (26.2%), atrial septal defect (ASD) patch closure (19.4%), and patent ductus arteriosus (PDA) ligation (18.7%). The most frequent percutaneous procedures were PDA device closure (43.8%), ASD device closure (27.4%), and balloon pulmonary valvuloplasty (24.7%). Among patients with acquired heart disease, 23.5% underwent surgery and 76.5% received percutaneous intervention, most commonly percutaneous mitral commissurotomy (47.6%). Notably, 3.1% of patients with CHD progressed to an inoperable state, primarily due to delayed surgical or percutaneous intervention, necessitating exclusive medical management of their complications. The cardiac caseload was predominantly pediatric, with congenital heart disease as the most frequent diagnosis and rheumatic heart disease remaining a major acquired condition. Despite availability of surgery and percutaneous interventions, only one-third of patients received guideline directed care, and delays rendered some cases inoperable. These findings highlight the urgent need to expand access to timely cardiac interventions, implement early detection and screening programs, and strengthen prevention strategies for rheumatic heart disease in resource-limited settings. The online version contains supplementary material available at 10.1186/s13104-026-07799-2.

Rheumatic heart disease (RHD) remains highly prevalent in low-income countries and is associated with severe complications and premature mortality. Limited local evidence in Ethiopia hinders understanding of disease progression and risk stratification. This study aimed to assess patterns of complications, survival, and predictors of mortality among adults with RHD in Ethiopia. We conducted a retrospective cohort study of 1,811 adults (≥ 18 years) with definite RHD diagnosed by transthoracic echocardiography according to the 2012 World Heart Federation criteria. Patients received care at the Cardiac Center of Ethiopia between January 1, 2015, and January 1, 2025. Complications and mortality were summarized descriptively. Survival was estimated using Kaplan–Meier methods and compared with log-rank tests. Independent predictors of mortality were identified using multivariable Cox proportional hazards regression. The median age was 32 years, with a female-to-male ratio of 1.5:1. Over a median follow-up of 5 years (IQR 2.5–6.5), 1,037 participants (57.3%) developed at least one complication, most commonly New York Heart Association (NYHA) class III–IV heart failure with pulmonary hypertension (31.4%) and isolated pulmonary hypertension (19.8%). A total of 326 participants (18.0%) died, with significantly lower survival among those with complications (p < 0.001). Independent predictors of mortality included presence of comorbidities (AHR 5.8), increased left ventricular internal diastolic diameter (LVIDd) (AHR 2.1), monthly income < 2,000 Ethiopian birr (≈ 13 USD) (AHR 1.2), NYHA class III–IV heart failure (AHR 2.2), and pulmonary hypertension (AHR 2.4). Adults with RHD in Ethiopia experience high rates of complications and premature mortality, driven by advanced heart failure, pulmonary hypertension, ventricular dilation, comorbidities, and socioeconomic disadvantage. Early detection, optimized chronic disease management, and expanded access to surgical and percutaneous interventions are urgently needed to improve outcomes in this resource-limited setting.

Down syndrome (DS) is the most common chromosomal disorder associated with congenital heart disease (CHD). However, data on CHD patterns, survival, and mor

Aim: To determine the prevalence of pulmonary hypertension (PH), identify associated factors, and evaluate outcomes after adenotonsillectomy in children and adolescents with adeno-tonsillar hypertrophy (ATH) in a low-resource setting. Methods: We retrospectively analyzed 1500 patients ≤ 20 years undergoing adenotonsillectomy for ATH in Hawassa, Ethiopia (2022-2025). Pulmonary pressure was estimated via tricuspid regurgitation or pulmonary acceleration time; right ventricular function was assessed with TAPSE and RVMPI. Logistic regression identified PH predictors, and the Friedman test compared pre- and 12-week postoperative measurements. Results: PH prevalence was 5.9%. Independent predictors included wasting, overweight/obesity, AN ratio > 0.75, daytime mouth breathing, stertor, and obstructive sleep apnea. Among 89 affected patients, 8 had longitudinal and 6 global RV dysfunction. PH and RV dysfunction resolved by 12 weeks post-surgery ( P < .001). Conclusion: PH affects a subset of children with ATH but is showed significant improvement following adenotonsillectomy, emphasizing early detection and surgical intervention.