Mene-Afejuku Tuoyo O, Balogun Michael O, Akintomide Anthony O, Adebayo Rasaaq A
Department of Medicine, Metropolitan Hospital Center, New York, NY, USA; Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.
Vasc Health Risk Manag. 2017 Feb 27;13:71-79. doi: 10.2147/VHRM.S124477. eCollection 2017.
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.
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.
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.
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, = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk ( = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher ( = 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 ( = 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 ( = 0.001), Holter-detected ventricular tachycardia (VT; = 0.009), Holter-detected atrial fibrillation (AF; = 0.028) and PVCs ( = 0.017) following logistic regression than those in the no-events group (n = 59).
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.
高血压性心力衰竭（HHF）与不良预后相关。在尼日利亚，关于HHF患者预后的数据匮乏，阐明24小时动态心电图（ECG）与其他危险因素协同作用的研究较少。
本研究旨在确定24小时动态心电图、6分钟步行试验（6-MWT）、超声心动图、临床和实验室参数在HHF患者中的预后价值。
共招募113例HHF患者，并随访6个月。其中13例患者失访，因此仅对100例HHF患者进行分析。所有患者均接受基线实验室检查、超声心动图、24小时动态心电图和6-MWT。根据6个月末的结局，将HHF患者分析为“死亡与存活”以及“事件与无事件”。事件定义为因心力衰竭（HF）再次住院、住院时间延长或死亡的HHF患者。无事件组定义为不符合事件组标准的HHF患者。
死亡组（n = 7）的HHF患者血清尿素水平（5.71±2.07 mmol/L对3.93±1.45 mmol/L，P = 0.003）显著高于存活患者。经逻辑回归分析，高血清尿素会增加死亡风险（P = 0.035）。在6个月随访期末，经逻辑回归分析，死亡组24小时动态心电图上显著的室性早搏（PVCs）也显著高于“存活”组（n = 93）（P = 0.015）。死亡的HHF患者6分钟步行距离（6-MWD）最短（167.26 m±85.24 m）。然而，经逻辑回归分析，6-MWT对预测HHF患者的不良结局无显著意义（P = 0.777）。事件组（n = 41）的患者经逻辑回归分析后，纽约心脏协会（NYHA）分级（P = 0.001）、动态心电图检测到的室性心动过速（VT；P = 0.009）、动态心电图检测到的心房颤动（AF；P = 0.028）和PVCs（P = 0.017）均显著高于无事件组（n = 59）。
高NYHA分级、血清尿素升高、动态心电图检测到的AF和室性心律失常可预测HHF患者的不良结局。在本研究中，6-MWT不是一个有用的预后指标。
