Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans

Background Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans. Objectives The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study. Methods We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS). Results Patients\u27 mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02). Conclusions About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability

Assessment of cardiac dyssynchrony in Nigerian patients with dilated cardiomyopathy

Background: Interventricular, intraventricular, and atrioventricular dyssynchrony (AVD) have been reported in patients with dilated cardiomyopathy (DCM). However, the causes of DCM vary with the regional distribution in various etiologies, with expected differences in the pattern and frequency of cardiac dyssynchrony. Objective: The aim of this study was to evaluate cardiac dyssynchrony in patients with DCM by conventional echocardiographic assessment. Materials and Methods: Fifteen patients with DCM were studied. All patients underwent conventional Doppler echocardiographic evaluation including septal-to-posterior wall motion delay (SPWMD), interventricular motion delay (IVMD), and diastolic filling period. Results: Cardiac dyssynchrony was present in 13 of the 15 patients (86.7%). The overall frequencies of intra-left ventricular dyssynchrony (intra-LVD), interventricular dyssynchrony (inter-VD), and AVD are 38.5%, 30.8%, and 53.9%, respectively. Conclusion: The prevalence of dyssynchrony in our patients with DCM was significant. This raises the need for the development of local expertise in interventional cardiology including cardiac resynchronization therapy (CRT)