Redefining the ECG in urban South Africans: Electrocardiographic findings in heart disease-free Africans

Sliwa, Karen; Lee, Geraldine Anne; Carrington, Melinda; Obel, Pro; Okreglicki, A; Stewart, Simon

doi:10.1016/j.ijcard.2012.06.005

Cited by 23 publications

(15 citation statements)

References 38 publications

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“…There were several differences in the prevalence of the ECG abnormalities observed in this study and those in the original Tan score derivation cohort of US veterans ( [15] and supplemental data). The second commonest ECG abnormalities we observed was left ventricular hypertrophy (13.5% of patients) compared with 5.2% of the Tan score derivation cohort, but similar to the frequency seen in South African patients without known cardiac disease [23] . Although QRS voltage may be higher in those of African descent compared to Caucasians [31] , [32] , [33] , pre-existing hypertension is the most likely explanation of left ventricular hypertrophy in our patients as all their ECGs fulfilled the Romhilt–Estes criteria and their blood pressures, even when acutely ill, were higher than patients without left ventricular hypertrophy (i.e.…”

Section: Discussionsupporting

confidence: 76%

“…QTc prolongation was the commonest Tan score ECG abnormality: it was observed in more than 40% of our patients compared with 5% of the ECGs of performed on 387 urban South Africans who were not acutely ill [23] . Numerous factors associated with acute illness can influence the QTc interval (e.g.…”

Section: Discussionmentioning

confidence: 58%

“…This study shows that the ECG, unlike age, can help identify patients at imminent risk of death, even when their vital signs are not grossly deranged. Many of the ECG changes we found may be normal variants as several studies have described ECG characteristics in Africans such as inverted and flattened T waves, high R wave amplitude (especially in young males), ST elevation and axis deviation [23] . However, the ECGs in this study showed evidence of ischemic heart disease (i.e.…”

Section: Discussionmentioning

confidence: 61%

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Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda

Namujwiga

Nakitende

Kellett

et al. 2019

African Journal of Emergency Medicine

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Background There are few reports of electrocardiogram (ECG) findings and their prognostic value in acutely ill patients admitted to low resource hospitals in sub-Saharan Africa. Methods We undertook an observational study of acutely ill medical patients admitted to a low-resource hospital in Uganda. Vital signs were used to calculate the National Early Warning Score (NEWS), and all ECGs were assessed using Tan et al.’s scoring system as described in Clin Cardiol 2009;32:82–86. Results There were 1361 ECGs performed, covering 68% of all acutely ill medical patients admitted to the hospital during the study. The most common ECG abnormality was a prolonged QTc interval (42% of all patients) and left ventricular hypertrophy (13.5%). Compared to the 519 patients (38%) with no Tan score abnormality, the 842 (62%) patients with one or more abnormalities were more likely to die in hospital (OR = 2.82; CI 95% = 1.50–5.36) and within 30 days of discharge (OR = 2.46; CI 95% = 1.50–4.08). There was no relationship between age and mortality; however, after adjustment by logistic regression, any NEWS ≥1 on admission, a Tan score of ≥1, and male sex all remained clinically significant predictors of both in-hospital and 30-day mortality. Discussion The majority of acutely ill medical patients admitted in a low-resource hospital in sub-Saharan Africa had ECG abnormalities, of which prolonged QTc and left ventricular hypertrophy were most common. Those with any Tan score abnormality were twice as likely to die as those without an abnormality.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 61%

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Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda

Namujwiga

Nakitende

Kellett

et al. 2019

African Journal of Emergency Medicine

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“… 12 The Heart of Soweto study was a study of 387 urban South Africans of predominantly African descent, determined to be heart disease free (using the Minnesota code) following advanced cardiological assessment, including echocardiography. 13 …”

Section: Methodsmentioning

confidence: 99%

Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the Pan-African Pulmonary Hypertension Cohort (PAPUCO) study

Balieva

Dzudie

Thienemann

et al. 2017

CVJA

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SummaryBackgroundPulmonary hypertension (PH) is prevalent in Africa and is still often diagnosed only at an advanced stage, therefore it is associated with poor quality of life and survival rates. In resource-limited settings, we assessed the diagnostic utility of standard 12-lead electrocardiograms (ECG) to detect abnormalities indicating PH.MethodsSixty-five patients diagnosed with PH were compared with 285 heart disease-free subjects. The prevalence and diagnostic performance of ECG features indicative of PH and right heart strain were calculated.ResultsCompared to the control group, all abnormalitieswere more frequent in the PH cohort where no patient hada completely normal ECG. The most prevalent (cases vscontrol) ECG abnormalities were: pathological Q wave inat least two contiguous peripheral leads (47.7 vs 6.7%), leftventricular hypertrophy (38.5 vs 9.8%) and p-pulmonale(36.9 vs 20.7%) (all p < 0.05). The sensitivity of ECG criteriafor right heart strain ranged between 6.2 and 47.7%, whilespecificity ranged between 79.3 and 100%. Negative predictivevalue ranged between 81.5 and 88.9% and positive predictivevalue between 25 and 100%. Positive predictive value waslowest (25%) for right bundle branch block and QRS rightaxisdeviation (≥ 100°), and highest (100%) for QRS axis ≥+100° combined with R/S ratio in V1 ≥ 1 or R in V1 > 7 mm.ConclusionWhen present, signs of PH on ECG strongly indicated disease, but a normal ECG cannot rule out disease. ECG patterns focusing on the R and S amplitude in V1 and right-axis deviation had good specificity and negative predictive values for PH, and warrant further investigation with echocardiography.

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“…However, defined ECG abnormalities are found with high frequency in the disease-free state, which is especially common in healthy young black adults of African descent where up to 50% of such patients may harbour an ECG anomaly 5 . Many studies have attempted to relate the presence of these abnormalities to an increased risk of death 6,7 , but few of them have an adequate cohort of black adults of African descent.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization

Lohrmann

Peters

Srivathsan

et al. 2016

The American Journal of Cardiology

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Redefining the ECG in urban South Africans: Electrocardiographic findings in heart disease-free Africans

Cited by 23 publications

References 38 publications

Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda

Prognostic performance of ECG abnormalities compared to vital signs in acutely ill patients in a resource-poor hospital in Uganda

Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the Pan-African Pulmonary Hypertension Cohort (PAPUCO) study

Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization

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