Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test

Tuoyo O Mene-Afejuku,1,2 Michael O Balogun,2 Anthony O Akintomide,2 Rasaaq A Adebayo2 1Department of Medicine, Metropolitan Hospital Center, New York, NY, USA; 2Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria Background: Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors.Objective: The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients.Methods: A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as “mortality vs alive” and as “events vs no-events” based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group.Results: HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the “alive” group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs (p = 0.017) following logistic regression than those in the no-events group (n = 59).Conclusion: High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study. Keywords: hypertensive heart failure, ventricular tachycardia, Holter electrocardiography, prognosi

Right ventricular systolic function in hypertensive heart failure

OA Oketona,1 MO Balogun,2 AO Akintomide,2 OE Ajayi,2 RA Adebayo,2 TO Mene-Afejuku,3 OT Oketona,1 OJ Bamikole2 1Fort Nelson General Hospital, Fort Nelson, BC, Canada; 2Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ife, Osun State, Nigeria; 3Department of Medicine, Metropolitan Hospital Center, New York, NY, USA Background: Heart failure (HF) is a major cause of cardiovascular admissions and hypertensive heart failure (HHF) is the most common cause of HF admissions in sub-Saharan Africa, Nigeria inclusive. Right ventricular (RV) dysfunction is being increasingly recognized in HF and found to be an independent predictor of adverse outcomes in HF. This study aimed to determine the prevalence of RV systolic dysfunction in HHF by several echocardiographic parameters.Methodology: One hundred subjects with HHF were recruited consecutively into the study along with 50 age and sex-matched controls. All study participants gave written informed consent, and had a full physical examination, blood investigations, 12-lead electrocardiogram, and transthoracic echocardiography. RV systolic function was assessed in all subjects using different methods based on the American Society of Echocardiography guidelines for echocardiographic assessment of the right heart in adults. This included tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (MPI), and RV systolic excursion velocity by tissue Doppler (S′).Results: RV systolic dysfunction was found in 53% of subjects with HHF by TAPSE, 56% by RV MPI, and 48% by tissue Doppler systolic excursion S′. RV systolic dysfunction increased with reducing left ventricular ejection fraction (LVEF) in subjects with HHF.Conclusion: A high proportion of subjects with HHF were found to have RV systolic functional abnormalities using TAPSE, RV MPI, and RV S′. Prevalence of RV systolic dysfunction increased with reducing LVEF. Keywords: right ventricle, systolic function, TAPSE, RV MPI, RV S′, hypertensive heart failur

Evaluation of the indications and arrhythmic patterns of 24 hour Holter electrocardiography among hypertensive and diabetic patients seen at OAUTHC, Ile-Ife Nigeria

Rasaaq A Adebayo,1 Amanze N Ikwu,1 Michael O Balogun,1 Anthony O Akintomide,1 Tuoyo O Mene-Afejuku,1 Victor O Adeyeye,1 Olaniyi J Bamikole,1 Luqman A Bisiriyu,2 Olufemi E Ajayi,1 Suraj A Ogunyemi,1 Omolola A Oketona1 1Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, 2Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria Background: There are very limited published studies in Nigeria on the use of 24 hour Holter electrocardiogram (Holter ECG) in the arrhythmic evaluation of hypertensive and diabetic patients. Objective: To evaluate indications, arrhythmic pattern of Holter ECG, and heart rate variability (HRV) among patients with hypertensive heart disease (HHD) with or without heart failure and type 2 diabetes mellitus (T2DM) seen in our cardiac care unit. Methods: Seventy-nine patients (32 males and 47 females) were studied consecutively over a year using Schiller type (MT-101) Holter ECG machine. Results: Out of the 79 patients, 17 (21.5%) had HHD without heart failure, 33 (41.8%) had HHD with hypertensive heart failure (HHF), while 29 (36.7%) were T2DM patients. The mean (standard deviation) ages of HHD without heart failure, HHF and T2DM patients were 59.65 (±14.38), 65.15 (±14.30), and 54.66 (±8.88) respectively. The commonest indication for Holter ECG was palpitation (38%), followed by syncope (20.3%). Premature ventricular contraction was the commonest arrhythmic pattern among the 79 patients, especially among HHF patients. The HRV, using standard deviation of all normal-normal intervals was significantly reduced in T2DM patients (81.03±26.33, confidence interval [CI] =71.02–91.05) compared to the HHD without heart failure (119.65±29.86, CI =104.30–135.00) and HHF (107.03±62.50, CI =84.00–129.19). There was a negative correlation between the duration of T2DM and HRV (r=−0.613). Conclusion: Palpitation was the commonest Holter ECG indication and premature ventricular contractions were the commonest arrhythmic pattern among our patients. HRV was reduced in T2DM patients compared with hypertensive patients. Keywords: Holter electrocardiography, arrhythmias, hypertension, diabetes mellitus, Nigerian

Heart rate variability and arrhythmic patterns of 24-hour Holter electrocardiography among Nigerians with cardiovascular diseases

Rasaaq Ayodele Adebayo, Amanze Nkemjika Ikwu, Michael Olabode Balogun, Anthony Olubunmi Akintomide, Olufemi Eyitayo Ajayi, Victor Oladeji Adeyeye, Tuoyo Omasan Mene-Afejuku, Olaniyi James Bamikole, Suraj Adefabi Ogunyemi, Adeola Olubunmi Ajibare, Omolola Abiodun OketonaCardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, NigeriaBackground: Facilities for Holter electrocardiography (ECG) monitoring in many Nigerian hospitals are limited. There are few published works in Nigeria on the use of 24-hour Holter ECG in cardiac arrhythmic evaluation of patients with cardiovascular diseases.Objective: To study the clinical indications, arrhythmic pattern, and heart rate variability (HRV) among subjects referred for 24-hour Holter ECG at our Cardiac Care Unit.Methods: Three-hundred and ten patients (134 males and 176 females) were studied consecutively over a 48-month period using Schiller type (MT-101) Holter ECG machine.Results: Out of the 310 patients reviewed, 134 were males (43.2%) and 176 were females (56.8%). The commonest indication for Holter ECG was palpitation followed by syncope in 71 (23%) and 49 (15.8%) of subjects, respectively. Premature ventricular complex and premature atrial complex were the commonest types of arrhythmia in 51.5% and 15% subjects, respectively. Ventricular arrhythmia was more prevalent in dilated cardiomyopathy patients (85.7%). The HRV of subjects with palpitation, stroke, and diabetes mellitus with autonomic neuropathy, using standard deviation of normal to normal intervals average (milliseconds), were 107.32±49.61, 79.15±49.15, and 66.50±15.54, respectively. The HRV, using standard deviation of averages of normal to normal intervals average (milliseconds), of patients with palpitation, stroke, and diabetes mellitus with autonomic neuropathy were 77.39±62.34, 57.82±37.05, and 55.50±12.71, respectively.Conclusion: Palpitation and syncope were the commonest indications for Holter ECG among our subjects. The commonest arrhythmic patterns were premature ventricular complex and premature atrial complex, with ventricular arrhythmia being more prevalent in dilated cardiomyopathy. There was a reduction in HRV in patients with stroke and diabetic autonomic neuropathy.Keywords: heart rate, arrhythmia, Holter electrocardiography, cardiovascular diseases, Nigerian