Left Ventricular Hypertrophy in Young Africans With First Ever Stroke in Tanzania: A Prospective Cohort Study 

Abstract

Background: Left ventricular hypertrophy is a pathophysiological response to chronic hypertension and is an independent risk factor for vascular events. We sought to determine the magnitude, correlates and prognosis of left ventricular hypertrophy in young patients presenting with their first stroke at a tertiary hospital. We also sought to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography.Methods: This cohort study prospectively recruited consecutive stroke patients aged 18-45 years who had undergone brain imaging, electrocardiogram and transthoracic echocardiography. Baseline data were recorded and correlates of left ventricular hypertrophy were identified using the modified Poisson regression. Follow-up for functional outcomes was performed to 30-days using the modified Rankin Scale.Results: We enrolled 101 participants with first ever stroke. The mean age of patients was 39.7years and the mean National Institutes of Health Stroke Score was 18, reflecting severe disability. Brain imaging revealed ischemic strokes in 60 (59.4%) of patients and of those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia, in keeping with a hypertensive etiology. Left ventricular hypertrophy was present in 76 (75.3%; 95% CI 65.7% – 83.3%), and 30 (39.5%) and 28 (36.8%) had moderate to severe degree respectively. Young adults with left ventricular hypertrophy were more likely to have a higher systolic and diastolic blood pressure on arrival 156.3±19 and 96.4±10.6 respectively. On multivariable analysis, lack of antihypertensive medication was associated with left ventricular hypertrophy {adjusted risk ratio 1.42 (95% CI: 1.04–1.94). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively. At 30-days, functional independence was achieved in 12 (12.4%) and almost half had died.Conclusions: There is a high burden of left ventricular hypertrophy in young patients with first stroke. Untreated hypertension is the likely etiology associated with a high 30-day mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions such as blood pressure screening and control to reduce this burden in the young.