Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa : insights from THESUS-HF

• Published in: Cardiovascular Journal of Africa Vol. 28; no. 1; pp. 60 - 67
• Main Authors: Suliman, Ahmed, Ogah, Okechukwu S., Davison, Beth A., Abdou, Sergine, Maru, Fikru, Edwards, Christopher, Sani, Mahmoud U., Ojji, Dike B., Mayosi, Bongani M., Sliwa, Karen, Dzudie, Anastase, Cotter, Gad, Yonga, Gerald, Kouam Kouam, Charles, Mondo, Charles, Damasceno, Albertino, Alemayehu, Bekele
• Format: Journal Article
• Language: English
• Published: South Africa Clinics Cardive Publishing 01-01-2017
• Subjects: Acute Disease; Acute heart failure; Africa South of the Sahara - epidemiology; Cardiovascular Topics; Echocardiography; Echocardiography - methods; Female; Follow-Up Studies; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Incidence; Male; Middle Aged; Outcome; Predictive Value of Tests; Predictors; Prognosis; Prospective Studies; Stroke Volume - physiology; Survival Rate - trends; Ventricular Function, Left - physiology; Sub-Saharan Africa
• ISSN: 1995-1892; 1680-0745
• DOI: 10.5830/CVJA-2016-070

Background: The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure.Methods: Out of the 1 006 patients in the THESUS-HF registry, 954 had had an echocardiogram performed within a few weeks of admission. Echocardiographic measurements were performed according to the American Society of Echocardiography guidelines. We examined the associations between each echocardiographic predictor and outcome using regression models.Results: Heart rate and left atrial size predicted death within 60 days or re-admission. Heart rate, left ventricular posterior wall thickness in diastole (PWTd), and presence of aortic stenosis were associated with the risk of death within 180 days. PTWd added to clinical variables in predicting 180-day mortality rates.Conclusions: Echocardiographic variables, especially those of left ventricular size and function, were not found to have additional predictive value in patients admitted for acute HF. Left atrial size, aortic stenosis, heart rate and measures of hypertrophy (LV PWTd) had some predictive value, suggesting the importance of early treatment of hypertension and severe valvular heart disease.