Correlation between Echocardiographic Left Ventricular Hypertrophy and various Electrocardiographic Criteria of Left Ventricular Hypertrophy among Black Hypertensives.

BACKGROUND: Systemic hypertension remains an important risk factor for cardiovascular diseases and a major global public health problem. Left ventricular hypertrophy (LVH) is a recognized complication of systemic hypertension and strongly predicts cardiovascular morbidity and mortality. In Nigeria, few studies have evaluated the correlation of ECG criteria in the diagnosis of left ventricular hypertrophy among hypertensives and almost all the previous studies on ECG LVH used only one or two criteria. This study sets out to determine the correlations between various ECG criteria of LVH and echocardiographic LVH among patients with hypertension using six ECG LVH criteria. METHODS: One hundred and seventy-eight hypertensives and eighty- nine age and sex matched controls were recruited consecutively into the study. All participants including hypertensives and control subjects had echocardiography whereas only hypertensive subjects had both echocardiography and ECG. ECG LVH was determined using Sokolow-Lyon, Cornell voltage, Goldberger, Massoleini, Romhilt-Estes and Cornell duration product ECG criteria. RESULTS: Sokolow-Lyon and Cornell voltage criteria had significant positive correlation with echocardiographic LVH (p=0.001 and 0.003, respectively). Although Goldberger and Massoleini criteria had positive correlation coefficients, these were not statistically significant. CONCLUSION: There are significant correlations between echocardiographic LVH and ECG LVH determined by Cornell voltage and Sokolow-Lyon criteria.

CONTEXTE: L'hypertension systémique reste un facteur de risque important pour les maladies cardiovasculaires et un problème majeur de santé publique mondiale. L'hypertrophie ventriculaire gauche (HVG) est une complication reconnue de l'hypertension systémique et prédit fortement la morbidité et la mortalité cardiovasculaires. Au Nigeria, peu d'études ont évalué la corrélation des critères ECG dans le diagnostic de l'hypertrophie ventriculaire gauche chez les hypertendus et presque toutes les études précédentes sur l'ECG HVG n'utilisaient qu'un ou deux critères. Cette étude vise à déterminer les corrélations entre divers critères ECG de l'HVG et l'HVG échocardiographique chez les patients hypertendus à l'aide de six critères ECG LVH. MÉTHODES: Cent soixante-dix-huit hypertendus et quatre-vingtneuf témoins appariés selon l'âge et le sexe ont été recrutés consécutivement dans l'étude. Tous les participants, y compris les hypertendus et les sujets témoins, ont eu une échocardiographie alors que seuls les sujets hypertendus ont eu à la fois une échocardiographie et un ECG. ECG L'HVG a été déterminée en utilisant les critères ECG de produit de durée de Sokolow-Lyon, de tension de Cornell, de Goldberger, de Massoleini, de Romhilt-Estes et de Cornell. RÉSULTATS: Les critères de tension de Sokolow-Lyon et de Cornell avaient une corrélation positive significative avec l'HVG échocardiographique (p=0,001 et 0,003, respectivement). Bien que les critères de Goldberger et Massoleini aient des coefficients de corrélation positifs, ceux-ci n'étaient pas statistiquement significatifs. CONCLUSION: Il existe des corrélations significatives entre l'HVG échocardiographique et l'HVG ECG déterminées par le voltage de Cornell et les critères de Sokolow-Lyon. MOTS-CLÉS: Corrélation; échocardiographie; électrocardiographie; Hypertrophie ventriculaire gauche; Hypertendus noirs.

Sensorineural Hearing Loss among Hypertensives.

BACKGROUND: The effect of hypertension on the vascular system leads to Target Organ Damage (TOD). The cochlea is one of the target organs affected by hypertension, giving rise to Sensorineural Hearing Loss (SNHL). OBJECTIVE: To determine the prevalence and pattern of Sensorineural Hearing Loss (SNHL) among hypertensives. DESIGN: Case-Control Study. SETTING: Tertiary hospital. SUBJECTS: Two hundred and twenty six hypertensives, aged 21 to 60 years and a corresponding number of age and sex matched control. METHODOLOGY: Eligible participants were prospectively evaluated. Their blood pressures were verified, hearing thresholds assessed through Pure Tone Audiometry, Pure Tone Average were calculated and the types and degree of hearing loss were confirmed. Data was analyzed using SPSS 21 and statistical significance was set at p-value 0.05. RESULTS: Each group had 127 (56.19% ) females and 99 ( 43.81 % ) males. The difference in the mean age between the cases (40.02 ± 0.70years) and the controls (37.42 ± 0.47years) was not statistically significant (p = 0.542).The difference in the mean Pure Tone Average in dBHL between the cases (15.53± 6.95) and the controls (13.98 ± 4.35) was significant (p = 0.005) with a 12.83% prevalence of SNHL among the hypertensives against 1.77% in the controls. Majority (96.6 %) of them demonstrated bilateral, symmetrical, mild SNHL with 51.7% of them being above 50 years. The odds ratio in this study was 8.17 (p = 0.0001). CONCLUSION: This study demonstrated a SNHL prevalence of 12.83% with a mild, bilateral, symmetrical pattern among hypertensives; increasing with advanced age and an eight-fold risk of occurrence.

Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.

AIMS: The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria. METHODS AND RESULTS: The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors. CONCLUSIONS: In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.

Acute heart failure and cardiogenic shock: a multidisciplinary practical guidance.

PURPOSE: Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings. RESULTS: Tissue congestion and hypoperfusion are the two leading mechanisms of end-organ injury and dysfunction, which are associated with worse outcome in AHF. Diagnosis of AHF is based on clinical assessment, measurement of natriuretic peptides, and imaging modalities. Simultaneously, emphasis should be given in rapidly identifying the underlying trigger of AHF and assessing severity of AHF, as well as in recognizing end-organ injuries. Early initiation of effective treatment is associated with superior outcomes. Oxygen, diuretics, and vasodilators are the key therapies for the initial treatment of AHF. In case of respiratory distress, non-invasive ventilation with pressure support should be promptly started. In patients with severe forms of AHF with cardiogenic shock (CS), inotropes are recommended to achieve hemodynamic stability and restore tissue perfusion. In refractory CS, when hemodynamic stabilization is not achieved, the use of mechanical support with assist devices should be considered early, before the development of irreversible end-organ injuries. CONCLUSION: A multidisciplinary approach along the entire patient journey from pre-hospital care to hospital discharge is needed to ensure early recognition, risk stratification, and the benefit of available therapies. Medical management should be planned according to the underlying mechanisms of various clinical scenarios of AHF.

Development of the roadmap and guidelines for the prevention and management of high blood pressure in Africa: Proceedings of the PASCAR Hypertension Task Force meeting: Nairobi, Kenya, 27 October 2014.

Africa has one of the fastest growing economies in the world. The economic changes are associated with a health transition characterised by a rise in cardiovascular risk factors and complications, which tend to affect the African population at their age of maximum productivity. Recent data from Africa have highlighted the increasing importance of high blood pressure in this region of the world. This condition is largely underdiagnosed and poorly treated, and therefore leads to stroke, renal and heart failure, and death. Henceforth, African countries are taking steps to develop relevant policies and programmes to address the issue of blood pressure and other cardiovascular risk factors in response to a call by the World Health Organisation (WHO) to reduce premature deaths from non-communicable diseases (NCDs) by 25% by the year 2025 (25 × 25). The World Heart Federation (WHF) has developed a roadmap for global implementation of the prevention and management of raised blood pressure using a health system approach to help realise the 25 × 25 goal set by the WHO. As the leading continental organisation of cardiovascular professionals, the Pan-African Society of Cardiology (PASCAR) aims to contextualise the roadmap framework of the WHF to the African continent through the PASCAR Taskforce on Hypertension. The Taskforce held a workshop in Kenya on 27 October 2014 to discuss a process by which effective prevention and control of hypertension in Africa may be achieved. It was agreed that a set of clinical guidelines for the management of hypertension are needed in Africa. The ultimate goal of this work is to develop a roadmap for implementation of the prevention and management of hypertension in Africa under the auspices of the WHF.

The effect of left ventricular remodelling on soluble ST2 in a cohort of hypertensive subjects.

Soluble ST2 is a biomarker of cardiomyocyte stretch that is useful in the diagnosis and prognosis of coronary artery disease. Its role in the field of hypertension and hypertensive heart failure (HHF) has not yet been well investigated. We studied the effect of left ventricular remodelling on the concentration of soluble ST2 in a cohort of 210 subjects with hypertension (HT). Left ventricular hypertrophy (LVH) was considered present when echocardiographic left ventricular mass indexed for height in metres (m) was greater than 46.2 g m(-1 2.7) in women and 49.2 g m(-1 2.7) in men. Subjects were subdivided into three groups: those without LVH (HT, n = 83); those with LVH (hypertension with left ventricular hypertrophy (HTLVH), n = 50) and those with HHF, n=77). Plasma ST2 and NT-pro BNP were measured using electrochemiluminescence type immunoassay. Subjects with HHF had higher plasma ST2 concentrations compared to HTLVH (134.7 ± 57.3 ng ml(-1) versus 23.0 ± 8.3 ng ml(-1), P < 0.001) and those with HT (134.7 ± 57.3 ng ml(-1) versus 14.5 ± 4.9 ng ml(-1), P < 0.0001). NT-pro BNP levels were similar when HTLVH was compared with HT (P = 0.68), but subjects with HHF had significantly higher NT-pro BNP compared to HTLVH (P < 0.0002). Soluble ST2 had strong correlation with clinical and echocardiograhic parameters, and correlated well with NT-pro BNP (r = 0.41, P < 0.0001). Plasma ST2 is a useful biomarker in not only differentiating HHF from HT with or without LVH, but also distinguishes hypertensive LVH from HT without LVH.

Crossed fused renal ectopia presenting as recurrent lower abdominal pain and urinary tract infection.

BACKGROUND: Crossed fused renal ectopia is a relatively rare condition which may remain undiagnosed for a long time. Renal function is usually preserved. It usually involves the left kidney. It is usually associated with mal-rotation, and may be a cause of urinary tract infection, hydronephrosis and renal calculi. MATERIAL AND METHOD: We report a case of a 15-year old boy who was referred to our clinic with complaints of abdominal pain, and an ultrasound report of "absent right kidney". RESULTS: Urine examination indicated a partially treated infection, but the tests of kidney functions were normal. Intravenous urography confirmed crossed fused renal ectopia, and a flush aortogram showed two anomalous right renal arteries arising from the left side of aorta. CONCLUSION: An "absent" kidney in its normal location should prompt further investigations. Recurrent chronic lower abdominal pain and urinary tract infection in a young person may be due to congenital renal abnormality. Evaluation of persistent urinary abnormalities in a child should include screening for congenital abnormalities.

Early diastolic functional abnormalities in normotensive offspring of Nigerian hypertensives.

BACKGROUND: Some studies have suggested that diastolic dysfunction precedes the clinical manifestation of hypertension. Whether changes in cardiac structure and function predate the clinical manifestation of hypertension later in life is now being investigated. The aim of this study was to assess the differences in cardiac structure and function between the offspring of hypertensive and normotensive parents. METHODS: Eighty normotensive offspring of hypertensive parents (OHyp) (41 females and 39 males) and 62 normotensive offspring of normotensive parents (ONorm) (31 males and 31 females) were recruited for echocardiography. RESULTS: The mean age was 25.0 (5.31) and 24.3 (3.60) years in the OHyp and ONorm participants, respectively (p = 0.369). Other baseline parameters were comparable between the two groups. Septal wall thickness in systole was higher in the OHyp than the ONorm subjects [1.3 (0.35) vs 1.1 (0.25), p = 0.0173]. Indexed left ventricular mass [28.1 (7.33) vs 27.5 (7.23), p = 0.631] and relative wall thickness [(0.3 (0.10) vs 0.3 (0.90), p = 0.280] were similar in the two groups. The offspring of hypertensives had lower deceleration time [149.9 (38.89) vs 169.0 (50.08) ms, p = 0.012], prolonged duration of pulmonary A reverse flow [113.5 (70.69) vs 81.7 (38.31) ms, p = 0.024], increased myocardial isovolumic relaxation time [173.4 (47.98) vs 156.1 (46.74) ms, p = 0.033] and a lower myocardial Em [0.2 (0.05) vs 0.3 (1.38), p = 0.037] and myocardial Em/Am ratio [1.6 (0.01) vs 2.1 (0.01), p = 0.019] than the offspring of normotensives. CONCLUSION: This study showed that offspring of OHyp subjects had early diastolic functional abnormalities when compared with offspring of ONorm participants. Longitudinal studies are needed to determine the implications of this finding in this African population.

Pattern of heart failure in Abuja, Nigeria: an echocardiographic study.

AIM: Despite heart failure having been identified in subjects in sub-Saharan Africa over the last 60 years, there is still a dearth of data, especially echocardiographic data on heart failure. We therefore set out to analyse the clinical and echocardiographic features of all consecutive subjects presenting with heart failure in a tertiary institution in Nigeria. METHODS: Three hundred and forty subjects with heart failure, according to the guidelines of the European Society of Cardiology, were studied. Each patient had two-dimensional guided transthoracic echocardiography. RESULTS: The mean age of the patients was 50.60 +/- 15.29 years, and 50.9% of the study population were males while 49.1% were females. The commonest cause of heart failure identified was hypertension in 61.5% of the patients; 75.5% had systolic heart failure, whereas 23.5% had heart failure with preserved ejection fraction. CONCLUSIONS: Untreated hypertension has been identified as the leading cause of heart failure in Abuja, Nigeria, which is similar to that in many other parts of sub-Saharan Africa. Coronary artery disease is a rare cause of heart failure in this population group.

Audit of Echocardiographic Services at the University College Hospital Ibadan.

BACKGROUND: Echocardiography is useful in the diagnosis of cardiovascular diseases and it influences management. It is becoming widely available in our Teaching Hospitals though expensive. It is therefore important to know the value of echocardiography in patients' diagnosis. METHODS: One thousand five hundred and forty four patients referred for transthoracic echocardiography over 19-month period (March 2003 to September 2004) were studied. M mode, two dimensional and Doppler studies were out using ALOKA SSD 1700. RESULTS: One thousand five hundred and forty four patients (778 males and 766 females) had echocardiography. Mean age was 51.4 +/- 15.5. Minimal age was 15 years while maximum was 100 years. The commonest indication for echocardiography include Hypertension 727 (47.1%), Pre-Chemotherapy assessment 127 (8.2%), Heart failure 117 (7.6%) and Routine Medical Check Up 99 (6.4%). The highest source of referral came from Cardiology unit 746 (48.3%). Staff Clinic 128 (8.3%), Surgery 127 (8.2%) and Nephrology 88 (5.7%). Six hundred and eighty seven (44.6%) were diagnosed as Hypertensive Heart Disease, 674 (36.5%) were Normal Study and 54 (3.5%) had Valvular Heart Disease. CONCLUSION: The study showed the different indications for echocardiography, source of referral and diagnosis. There is an emerging need for echocardiography in our patients so as to improve their management.

Blood Pressure Control and Left Ventricular Hypertrophy in Hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications; leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital; Ibadan; Nigeria; using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital; Ibadan; Nigeria. Methods : Patients had 6 visits; when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2) of the normotensive group; 40 (20.8) of the uncontrolled hypertensive group and 14 (24.1) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height; left ventricular hypertrophy was found in none of the subjects of the normotensive group; while it was found present in 43 (22.4) and 14 (24.1) subjects of the uncontrolled and controlled hypertensive groups; respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects; based on office blood pressure; cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events

Electrocardiographic left ventricular hypertrophy with strain pattern: prevalence, mechanisms and prognostic implications.

BACKGROUND: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence, mechanism and prognostic implications of this ECG abnormality. MATERIALS AND METHODS: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches. RESULTS: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36%. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50%, while the specificity was in the range of 89.8 to 100%. Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality. ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects. CONCLUSION: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality.

Electrocardiographic Left Ventricular Hypertrophy with Strain Pattern : Prevalence; Mechanisms and Prognostic Implications : Review Article

Background: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence; mechanism and prognostic implications of this ECG abnormality. Materials and methods: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches. Results: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50; while the specificity was in the range of 89.8 to 100. Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality. ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects. Conclusion: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality

Association between electrocardiographic left ventricular hypertrophy with strain pattern and left ventricular structure and function.

BACKGROUND AND PURPOSE: Electrocardiographic left ventricular hypertrophy (LVH) with strain pattern has been documented as a marker for LVH. Its presence on the ECG of hypertensive patients is associated with poor prognosis. The study was carried out to assess the association of the electrocardiographic strain with left ventricular mass (LVM) and function in hypertensive Nigerians. MATERIAL AND METHODS: ECG as well as echocardiograms were performed in 64 hypertensive patients with ECG-LVH and strain pattern, 65 patients with ECG-LVH by Sokolow-Lyon (SL) voltage criteria and 62 normal controls. RESULTS: The study showed that electrocardiographic left ventricular (LV) strain pattern is associated with dilated left atrium, larger LV internal dimensions and greater absolute and indexed LVM in hypertensive Nigerians compared with ECG-LVH by SL voltage criteria alone or normal controls. CONCLUSION: The findings of this study support the fact that the ECG strain pattern is associated with increased LVM and an increased risk of developing abnormal LV geometry.