- 作者：Anastase Dzudie ; Olga Milo ; Christopher Edwards ; Gad Cotter ; Beth A. Davison ; Albertino Damasceno ; Bongani M. Mayosi ; Charles Mondo ; Okechukwu Ogah ; Dike Ojji ; Mahmoud U. Sani ; Karen Sliwa
- 关键词：Africa ; heart failure ; electrocardiogram ; outcome ; prognosis
- 刊名：Journal of Cardiac Failure
- 出版年：January, 2014
- 年：2014
- 卷：20
- 期：1
- 页码：45-52
- 全文大小：742 K
Objective
The aim of this study was to assess the predictive utility of 12-lead electrocardiogram (ECG) abnormalities among Africans with acute heart failure (HF).Methods and Results
We used the Sub-Saharan Africa Survey of Heart Failure, a multicenter prospective cohort study of 1,006 acute HF patients, and regression models to relate baseline ECG findings to all-cause mortality and readmission during a 6-month follow-up period. Of 814 ECGs available, 523 (49.0% male) were obtained within 15聽days of admission, among which 97.7% showed abnormalities. Mean age was 52.0聽years and median follow-up was 180聽days, with 77 deaths (Kaplan-Meier 17.5%) through day 180 and 63 patients with death or readmission to day 60. QRS width, QT duration, bundle branch block, and ischemic changes were not associated with outcomes. Increasing ventricular rate was associated with increasing risk of both outcomes (hazard ratio [HR] 1.07 per 5 beats/min increase for 60-day death or readmission, 95% confidence interval [CI] 1.02-1.12; P聽= .0047), and the presence of sinus rhythm was associated with lower risk (HR 0.58, 95% CI 0.34-0.97; P聽= .0385). There was a strong association between survival and heart rate in patients in sinus rhythm, with heart rate >119 beats/min conveying the worst mortality risk.
Conclusions
ECG abnormalities are almost universal among Africans with acute HF, which may add to the immediate diagnosis of patients presenting with dyspnea. Although some ECG findings have prognostic value for risk of adverse outcomes, most of them are nonspecific and add little to the risk stratification of these patients.