Echocardiographic and Electrocardiographic Abnormalities Among Elderly Adults With Cardiovascular Disease in Rural South Africa

Background: Sub-Saharan Africa is undergoing an epidemiological transition fueled by the interaction between infectious and cardiovascular diseases. Our cross-sectional study aimed to characterize the spectrum of abnormalities suggesting end-organ damage on ECG and transthoracic echocardiograms (TTE) among older adults with cardiovascular diseases in rural South Africa. Methods: The prevalence of ECG and TTE abnormalities was estimated; χ 2 analyses and multivariable logistic regressions were performed to test their association with sex, hypertension, and other selected comorbidities. Results: Overall, 729 ECGs and 155 TTEs were completed, with 74 participants completing both. ECG evaluation showed high rates of left ventricular hypertrophy (LVH, 36.5%) and T wave abnormalities (13.6%). TTE evaluation showed high rates of concentric LVH (31.6%), with moderate-severe (56.8%) diastolic dysfunction. Participants with hypertension showed more cardiac remodeling on ECG by LVH (45.4% versus 22.1%, P <0.01), and TTE by concentric LVH (42.5% versus 8.2%, P <0.01) and increased left ventricular mass (58.5% versus 20.4%, P <0.0001). In multivariable logistic regression, systolic blood pressure remained significantly associated with LVH on ECG (adjusted odds ratio, 1.03 per mm Hg [95% CI, 1.03–1.04], P <0.0001) and increased left ventricular mass on TTE (adjusted odds ratio, 1.04 per mm Hg [95% CI, 1.01–1.06], P =0.001). Male participants (n=326, 40.2%) were more likely than females (n=484, 59.8%) to show ECG abnormalities like LVH (45% versus 30.8%, P <0.01), whereas females were more likely to show TTE abnormalities like concentric LVH (40.8% versus 13.5%, P <0.01) and increased left ventricular mass (58.4% versus 23.1%, P <0.0001). Similar results were confirmed in multivariable models. Conclusions: Our findings suggest that cardiovascular diseases are widespread in rural South Africa, with a larger burden of hypertensive heart disease than previously appreciated, and define the severity of end-organ damage that is already underway. Local health systems must adapt to face the growing burden of hypertension, as suboptimal rates of hypertension diagnosis and treatment may dramatically increase the heart failure burden.

Download Full-text

220 Relationship of blood pressure variability to left ventricular mass and micro-albuminuria as measures of target-organ damage

Journal of Hypertension ◽

10.1097/00004872-199312050-00389 ◽

1993 ◽

Vol 11 (5) ◽

pp. S494

Author(s):

Dirk P. Veerman ◽

K. de Blok ◽

B. L.M. Delemarre ◽

Gert A. van Montfrans

Keyword(s):

Blood Pressure ◽

Left Ventricular Mass ◽

Blood Pressure Variability ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Ventricular Mass ◽

Relationship Of

Download Full-text

Abstract 432: Race Differences in the Relationship between Urinary ET-1 and BP-related Target Organ Damage in Youth

Hypertension ◽

10.1161/hyp.60.suppl_1.a432 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Gregory A Harshfield ◽

Jennifer Pollock ◽

David Pollock

Keyword(s):

Blood Pressure ◽

Left Ventricular Mass ◽

Target Organ Damage ◽

Albumin Excretion Rate ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

Related Target ◽

Ventricular Mass ◽

Lv Mass

The overall goal of this study was to determine race/ethnic differences in the associations between renal ET-1 and indices of blood pressure-related target organ damage in healthy adolescents. The subjects ranged in age between 15-19 years, had no history of any disease, and were not on any prescription medications. The 92 subjects consisted of 48 Caucasians (CA) and 44 African-Americans (AA). The two groups were similar with respect to height, weight, body mass index, blood pressure, ET-1), albumin excretion rate (AER), and left ventricular mass). Results: The CA’s were slightly older 17±1 v 16±1 (p=.02). The protocol was preceded by a 3 day self-selected sodium controlled diet of 250 mEq/day day which the subject picked up each day. The test day began with an echocardiogram for the assessment of left ventricular mass. Next, the subjects were seated for 60 minutes of rest during which the subjects consumed 200 ml of water. This was followed by the collection of a urine sample for the measurement of ET-1 and AER. Overall, ET-1 excretion was correlated with AER (r=.278), LV mass/ht 2.7 (r=.341), and systolic blood pressure (SBP; r=.365; p=.01 for each). The significant overall correlations were the result of significant correlations in AAs for AER (r=.344; p=.05), LV mass/ht 2.7 (r=.520; p=.01), and SBP (r=.645; p=.01) which were not apparent in CA’s. These findings suggest urinary ET-1 contributes to the development of BP-related target organ damage in AA youths prior to the development of increases in blood pressure.

Download Full-text

INAPPROPRIATE LEFT VENTRICULAR MASS IS ASSOCIATED WITH VASCULAR ORGAN DAMAGE INDEPENDENTLY ON LEFT VENTRICULAR HYPERTROPHY IN HYPERTENSION

Journal of Hypertension ◽

10.1097/00004872-201106001-00096 ◽

2011 ◽

Vol 29 ◽

pp. e38

Author(s):

C. Giannattasio ◽

F. Cesana ◽

F. Soriano ◽

M. Alloni ◽

M. Cairo ◽

...

Keyword(s):

Left Ventricular Hypertrophy ◽

Left Ventricular Mass ◽

Ventricular Hypertrophy ◽

Organ Damage ◽

Left Ventricular ◽

Ventricular Mass

Download Full-text

Marinobufagenin and left ventricular mass in young adults: The African-PREDICT study

European Journal of Preventive Cardiology ◽

10.1177/2047487318788140 ◽

2018 ◽

Vol 25 (15) ◽

pp. 1587-1595 ◽

Cited By ~ 10

Author(s):

Michél Strauss ◽

Wayne Smith ◽

Ruan Kruger ◽

Wen Wei ◽

Olga V Fedorova ◽

...

Keyword(s):

Young Adults ◽

Stroke Volume ◽

Left Ventricular Mass ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Target Organ ◽

End Diastolic Volume ◽

Ventricular Mass ◽

Predict Study

Background The endogenous steroidal inhibitor of sodium–potassium-dependent adenosine triphosphate and natriuretic hormone, marinobufagenin, plays a physiological role in ionic homeostasis. Animal models suggest that elevated marinobufagenin adversely associates with cardiac and renal, structural and functional alterations. It remains uncertain whether marinobufagenin relates to the early stages of target organ damage development, especially in young adults without cardiovascular disease. We therefore explored whether elevated 24-hour urinary marinobufagenin excretion was related to indices of subclinical target organ damage in young healthy adults. Design This cross-sectional study included 711 participants from the African-PREDICT study (black 51%, men 42%, 24.8 ± 3.02 years). Methods We assessed cardiac geometry and function by two-dimensional echocardiography and pulse wave Doppler imaging. 24-Hour urinary marinobufagenin and sodium excretion were measured, and the estimated glomerular filtration rate determined. Results Across marinobufagenin excretion quartiles, left ventricular mass ( P < 0.001), end diastolic volume ( P < 0.001), stroke volume ( P = 0.004) and sodium excretion ( P < 0.001) were higher within the fourth compared with the first quartile. Partial regression analyses indicated that left ventricular mass ( r = 0.08, P = 0.043), end diastolic volume ( r = 0.10, P = 0.010) and stroke volume ( r = 0.09, P = 0.022) were positively related to marinobufagenin excretion. In multivariate-adjusted regression analysis, left ventricular mass associated positively with marinobufagenin excretion only in the highest marinobufagenin excretion quartile (adjusted R2 = 0.20; β = 0.15; P = 0.043). This relationship between left ventricular mass and marinobufagenin excretion was evident in women (adjusted R2 = 0.06; β = 0.127; P = 0.015) but not in men (adjusted R2 = 0.06; β = 0.007; P = 0.92). Conclusions Left ventricular mass positively and independently associates with marinobufagenin excretion in young healthy adults with excessively high marinobufagenin excretion. Women may be more sensitive to the effects of marinobufagenin on early structural cardiac changes.

Download Full-text

Mortality trends and access to care for cardiovascular diseases in Agincourt, rural South Africa: a mixed-methods analysis of verbal autopsy data

BMJ Open ◽

10.1136/bmjopen-2020-048592 ◽

2021 ◽

Vol 11 (6) ◽

pp. e048592

Author(s):

Jessica Newberry Le Vay ◽

Andrew Fraser ◽

Peter Byass ◽

Stephen Tollman ◽

Kathleen Kahn ◽

...

Keyword(s):

South Africa ◽

Cardiovascular Disease ◽

Cardiovascular Diseases ◽

Mortality Rate ◽

Verbal Autopsy ◽

Rural South ◽

Cardiovascular Disease Mortality ◽

Disease Mortality ◽

Autopsy Data ◽

Rural South Africa

ObjectivesCardiovascular diseases are the second leading cause of mortality behind HIV/AIDS in South Africa. This study investigates cardiovascular disease mortality trends in rural South Africa over 20+ years and the associated barriers to accessing care, using verbal autopsy data.DesignA mixed-methods approach was used, combining descriptive analysis of mortality rates over time, by condition, sex and age group, quantitative analysis of circumstances of mortality (CoM) indicators and free text narratives of the final illness, and qualitative analysis of free texts.SettingThis study was done using verbal autopsy data from the Health and Socio-Demographic Surveillance System site in Agincourt, rural South Africa.ParticipantsDeaths attributable to cardiovascular diseases (acute cardiac disease, stroke, renal failure and other unspecified cardiac disease) from 1993 to 2015 were extracted from verbal autopsy data.ResultsBetween 1993 and 2015, of 15 305 registered deaths over 1 851 449 person-years of follow-up, 1434 (9.4%) were attributable to cardiovascular disease, corresponding to a crude mortality rate of 0.77 per 1000 person-years. Cardiovascular disease mortality rate increased from 0.34 to 1.12 between 1993 and 2015. Stroke was the dominant cause of death, responsible for 41.0% (588/1434) of all cardiovascular deaths across all years. Cardiovascular disease mortality rate was significantly higher in women and increased with age. The main delays in access to care during the final illness were in seeking and receiving care. Qualitative free-text analysis highlighted delays not captured in the CoM, principally communication between the clinician and patient or family. Half of cases initially sought care outside a hospital setting (50.9%, 199/391).ConclusionsThe temporal increase in deaths due to cardiovascular disease highlights the need for greater prevention and management strategies for these conditions, particularly for the women. Strategies to improve seeking and receiving care during the final illness are needed.

Download Full-text

Heart Rate Variability, HIV and the Risk of Cardiovascular Diseases in Rural South Africa

Global Heart ◽

10.5334/gh.532 ◽

2020 ◽

Vol 15 (1) ◽

pp. 17

Author(s):

Noortje G. Godijk ◽

Alinda G. Vos ◽

Vita W. Jongen ◽

Robert Moraba ◽

Hugo Tempelman ◽

...

Keyword(s):

South Africa ◽

Heart Rate ◽

Heart Rate Variability ◽

Cardiovascular Diseases ◽

Rural South ◽

Rural South Africa

Download Full-text

Cardiovascular risk and unproportional high weight of left ventrical myocardium in climacteric women

Kazan medical journal ◽

10.17816/kmj1504 ◽

2014 ◽

Vol 95 (3) ◽

pp. 315-322

Author(s):

A R Sadykova ◽

A R Shamkina ◽

R I Gizyatoullova

Keyword(s):

Left Ventricle ◽

Arterial Hypertension ◽

Left Ventricular Mass ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Left Ventricle Mass ◽

Ventricular Mass ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

Aim. To study the distribution of cardiovascular risk factors, target organ damage, associated clinical conditions and to stratify the 10-year risk of arterial hypertension complications in menopausal females depending on presence of inappropriately high left ventricular mass. Methods. 107 females from city of Kazan aged 42-59 years entered the study, including 11 women with normal blood pressure, 16 patients with high normal blood pressure, and 80 patients with hypertension according to All-Russia scientific Society of Cardiologists classification (2010) with disease duration of 0-34 years. Mean age of patients with hypertension was 51.4±4.0 years. Patients with secondary hypertension were excluded from the study. All patients underwent a questionnaire survey, physical examination, biochemical blood test, ECG, echocardiography, and cervical extracranial vessel ultrasonography. Actual left ventricle mass was calculated according to R.B. Devereux et al. (1977) and was adjusted to the body surface area. Proper left ventricle mass was defined by G. Simone et al. (1998). Disproportion coefficient was calculated as a ratio of actual left ventricle mass to proper left ventricle mass. Left ventricle hypertrophy was diagnosed using the Sokolow-Lyon index and left ventricle mass index ≥ 110 g/m2 (Echo-signs of left ventricle hypertrophy). Results. In menopausal women, inappropriately high left ventricular mass was associated with significantly (р 0.05, Fisher exact test) higher frequency of obesity, especially its abdominal type, as well as target organ damage, including Echo-signs of left ventricle hypertrophy, very high added 10-year risk of developing arterial hypertension complications. It was also associated with significantly (р 0.05, the U-criterion) higher mean values of waist circumference, waist to hip circumference ratio, body mass index, total number of damaged target organs and 10-year risk for developing arterial hypertension complications. Conclusion. Distinguishing the patients with inappropriately high left ventricular mass among menopausal women is important for planning the measures to prevent cardiovascular events.

Download Full-text

Cardiovascular Organ Damage and Blood Pressure Levels Predict Adverse Events in Multiple Myeloma Patients Undergoing Carfilzomib Therapy

Cancers ◽

10.3390/cancers11050622 ◽

2019 ◽

Vol 11 (5) ◽

pp. 622 ◽

Cited By ~ 2

Author(s):

Giulia Bruno ◽

Sara Bringhen ◽

Ilaria Maffei ◽

Andrea Iannaccone ◽

Teresa Crea ◽

...

Keyword(s):

Blood Pressure ◽

Multiple Myeloma ◽

Adverse Events ◽

Pulse Wave Velocity ◽

Left Ventricular Mass ◽

Wave Velocity ◽

Pulse Wave ◽

Organ Damage ◽

Left Ventricular ◽

Ventricular Mass

Carfilzomib is a second-generation proteasome inhibitor approved for the treatment of multiple myeloma (MM). It seems to determine cardiovascular toxicity, primarily arterial hypertension. No predictive factors for cardiovascular adverse events (CVAEs) are known in patients affected by multiple myeloma treated with carfilzomib. We evaluated the role of cardiovascular organ damage parameters to predict CVAEs in MM patients taking carfilzomib. Seventy patients affected by MM were prospectively enrolled. A comprehensive cardiovascular evaluation was performed before carfilzomib therapy; they underwent a transthoracic echocardiogram and the assessment of carotid-femoral pulse wave velocity. All the patients were followed up (FU) to determine the incidence of CVAEs. The mean age was 60.3 ± 8.2, and 51% were male. The median FU was 9.3 (4.3; 20.4) months. A proportion of 33% experienced CVAEs, 91% of them had uncontrolled hypertension, 4.5% acute coronary syndrome, and 4.5% cardiac arrhythmias. Subjects with CVAEs after carfilzomib treatment had significantly higher blood pressure values, left ventricular mass (98 ± 23 vs. 85 ± 17 g/m2, p = 0.01), and pulse wave velocity (8.5 ± 1.7 vs. 7.5 ± 1.6 m/s, p = 0.02) at baseline evaluation compared to the others. Furthermore, baseline uncontrolled blood pressure, left ventricular hypertrophy, and pulse wave velocity ≥ 9 m/s were able to identify patients at higher risk of developing CVAEs during FU. These preliminary findings indicate that blood pressure control, left ventricular mass, and pulse wave velocity may predict CVAEs in MM patients treated with carfilzomib.

Download Full-text