Harvard Medical School, Boston, MA (E.G.F.).
Department of Internal Medicine (E.G.F.), Brigham & Women's Hospital, Boston, MA.
Circ Cardiovasc Qual Outcomes. 2021 Nov;14(11):e007847. doi: 10.1161/CIRCOUTCOMES.121.007847. Epub 2021 Nov 16.
Sub-Saharan Africa is undergoing an epidemiological transition fueled by the interaction between infectious and cardiovascular diseases. Our cross-sectional study aimed to characterize the spectrum of abnormalities suggesting end-organ damage on ECG and transthoracic echocardiograms (TTE) among older adults with cardiovascular diseases in rural South Africa.
The prevalence of ECG and TTE abnormalities was estimated; χ analyses and multivariable logistic regressions were performed to test their association with sex, hypertension, and other selected comorbidities.
Overall, 729 ECGs and 155 TTEs were completed, with 74 participants completing both. ECG evaluation showed high rates of left ventricular hypertrophy (LVH, 36.5%) and T wave abnormalities (13.6%). TTE evaluation showed high rates of concentric LVH (31.6%), with moderate-severe (56.8%) diastolic dysfunction. Participants with hypertension showed more cardiac remodeling on ECG by LVH (45.4% versus 22.1%, <0.01), and TTE by concentric LVH (42.5% versus 8.2%, <0.01) and increased left ventricular mass (58.5% versus 20.4%, <0.0001). In multivariable logistic regression, systolic blood pressure remained significantly associated with LVH on ECG (adjusted odds ratio, 1.03 per mm Hg [95% CI, 1.03-1.04], <0.0001) and increased left ventricular mass on TTE (adjusted odds ratio, 1.04 per mm Hg [95% CI, 1.01-1.06], =0.001). Male participants (n=326, 40.2%) were more likely than females (n=484, 59.8%) to show ECG abnormalities like LVH (45% versus 30.8%, <0.01), whereas females were more likely to show TTE abnormalities like concentric LVH (40.8% versus 13.5%, <0.01) and increased left ventricular mass (58.4% versus 23.1%, <0.0001). Similar results were confirmed in multivariable models.
Our findings suggest that cardiovascular diseases are widespread in rural South Africa, with a larger burden of hypertensive heart disease than previously appreciated, and define the severity of end-organ damage that is already underway. Local health systems must adapt to face the growing burden of hypertension, as suboptimal rates of hypertension diagnosis and treatment may dramatically increase the heart failure burden.
撒哈拉以南非洲正在经历一场由传染病和心血管疾病相互作用引发的流行病学转变。我们的横断面研究旨在描述在南非农村地区患有心血管疾病的老年人的心电图和经胸超声心动图（TTE）上提示终末器官损伤的异常谱。
估计心电图和 TTE 异常的患病率；进行卡方检验和多变量逻辑回归，以检验它们与性别、高血压和其他选定合并症的关系。
总共完成了 729 份心电图和 155 份 TTE，其中 74 名参与者完成了这两项检查。心电图评估显示左心室肥厚（LVH，36.5%）和 T 波异常（13.6%）的发生率很高。TTE 评估显示，同心性 LVH 的发生率很高（31.6%），舒张功能中度至重度障碍（56.8%）。高血压参与者的心电图 LVH（45.4%比 22.1%，<0.01）和 TTE 同心性 LVH（42.5%比 8.2%，<0.01）和左心室质量增加（58.5%比 20.4%，<0.0001）显示出更多的心脏重塑。在多变量逻辑回归中，收缩压与心电图上的 LVH（校正优势比，每毫米汞柱 1.03 [95%CI，1.03-1.04]，<0.0001）和 TTE 上的左心室质量增加（校正优势比，每毫米汞柱 1.04 [95%CI，1.01-1.06]，=0.001）显著相关。男性参与者（n=326，40.2%）比女性参与者（n=484，59.8%）更有可能出现心电图异常，如 LVH（45%比 30.8%，<0.01），而女性更有可能出现 TTE 异常，如同心性 LVH（40.8%比 13.5%，<0.01）和左心室质量增加（58.4%比 23.1%，<0.0001）。多变量模型也得到了类似的结果。
我们的研究结果表明，心血管疾病在南非农村地区广泛存在，高血压性心脏病的负担比以前认为的要大，并且明确了已经开始的终末器官损伤的严重程度。当地卫生系统必须适应日益增加的高血压负担，因为高血压的诊断和治疗率不理想可能会显著增加心力衰竭的负担。
