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Original Research

Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans

Authors:

Abiodun M. Adeoye,

University of Ibadan, Ibadan, NG
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Okechukwu S. Ogah,

University of Ibadan, Ibadan, NG
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Bruce Ovbiagele,

Medical University of South Carolina, Charleston, SC, US
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Rufus Akinyemi,

Federal Medical Centre, Abeokuta, NG
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Vincent Shidali,

Ahmadu Bello University, Zaria, NG
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Francis Agyekum,

University of Ghana Medical School, Accra, GH
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Akinyemi Aje,

University of Ibadan, Ibadan, NG
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Oladimeji Adebayo,

University of Ibadan, Ibadan, NG
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Joshua O. Akinyemi,

University of Ibadan, Ibadan, NG
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Philip Kolo,

University of Ilorin Teaching Hospital, Ilorin, NG
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Lambert Tetteh Appiah,

Komfo Anokye Teaching Hospital, Kumasi, GH
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Henry Iheonye,

Ahmadu Bello University, Zaria, NG
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Uwanuruochi Kelechukwu,

Federal Medical Center, Umuahia, NG
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Amusa Ganiyu,

Jos University Teaching Hospital, Jos, NG
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Taiwo O. Olunuga,

Federal Medical Centre, Abeokuta, NG
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Onoja Akpa,

University of Ibadan, Ibadan, NG
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Ojo Olakanmi Olagoke,

University of Ibadan, Ibadan, NG
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Fred Stephen Sarfo,

Komfo Anokye Teaching Hospital, Kumasi, GH
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Kolawole Wahab,

University of Ilorin Teaching Hospital, Ilorin, NG
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Samuel Olowookere,

University of Ilorin Teaching Hospital, Ilorin, NG
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Adekunle Fakunle,

University of Ibadan, Ibadan, NG
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Albert Akpalu,

University of Ghana Medical School, Accra, GH
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Philip B. Adebayo,

Ladoke Akintola University of Technology, Ogbomoso, NG
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Kwadwo Nkromah,

University of Ghana Medical School, Accra, GH
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Joseph Yaria,

University of Ibadan, Ibadan, NG
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Philip Ibinaiye,

Ahmadu Bello University, Zaria, NG
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Godwin Ogbole,

University of Ibadan, Ibadan, NG
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Aridegbe Olumayowa,

Sacred Heart Hospital, Abeokuta, NG
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Sulaiman Lakoh,

University of Ibadan, Ibadan, NG
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Benedict Calys-Tagoe,

University of Ghana Medical School, Accra, GH
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Paul Olowoyo,

Federal University Teaching Hospital, Ido-Ekiti, NG
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Chukwuonye Innocent,

Federal Medical Center, Umuahia, NG
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Hemant K. Tiwari,

University of Alabama at Birmingham, Birmingham, AL, US
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Donna Arnett,

University of Kentucky at Lexington, Lexington, KY, US
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Osaigbovo Godwin,

Jos University Teaching Hospital, Jos, NG
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Bisi Ayotunde,

University of Ibadan, Ibadan, NG
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Josephine Akpalu,

University of Ghana Medical School, Accra, GH
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Okeke Obiora,

Federal Medical Center, Umuahia, NG
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Odo Joseph,

University of Ibadan, Ibadan, NG
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Adeleye Omisore,

Obafemi Awolowo University Teaching Hospital, Ile-Ife, NG
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Carolyn Jenkins,

Jos University Teaching Hospital, Jos, NG
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Daniel Lackland,

Medical University of South Carolina, Charleston, SC, US
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Lukman Owolabi,

Aminu Kano Teaching Hospital, Kano, NG
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Suleiman Isah,

Aminu Kano Teaching Hospital, Kano, NG
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Abdu H. Dambatta,

Aminu Kano Teaching Hospital, Kano, NG
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Morenikeji Komolafe,

Obafemi Awolowo University Teaching Hospital, Ile-Ife, NG
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Andrew Bock-Oruma,

Delta State University Teaching Hospital, Ogara, NG
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Ezinne Sylvia Melikam,

University of Ibadan, Ibadan, NG
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Lucius Chidiebere Imoh,

Federal Medical Center, Umuahia, NG
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Taofiki Sunmonu,

Federal Medical Centre, Owo, NG
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Mulugeta Gebregziabher,

Medical University of South Carolina, Charleston, SC, US
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Oluyemisi Olabisi,

Obafemi Awolowo University Teaching Hospital, Ile-Ife, NG
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Kevin Armstrong,

Medical University of South Carolina, Charleston, SC, US
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Ugochukwu U. Onyeonoro,

Federal Medical Center, Umuahia, NG
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Emmanuel Sanya,

University of Ilorin Teaching Hospital, Ilorin, NG
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Atinuke M. Agunloye,

University of Ibadan, Ibadan, NG
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Luqman Ogunjimi,

University of Ibadan, Ibadan, NG
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Oyedunni Arulogun,

University of Ibadan, Ibadan, NG
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Temitope H. Farombi,

University of Ibadan, Ibadan, NG
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Olugbo Obiabo,

Delta State University Teaching Hospital, Ogara, NG
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Reginald Obiako,

Ahmadu Bello University, Zaria, NG
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Mayowa Owolabi ,

University of Ibadan, Ibadan, NG
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on behalf of the SIREN Team as part of the H3Africa Consortium

Abstract

Background: Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans.

Objectives: The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study.

Methods: We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS).

Results: Patients’ mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02).

Conclusions: About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability.

Highlights

  • 4 in 5 acute stroke patients in this African cohort had at least 1 ECG abnormality.
  • Atrial fibrillation was rare in the cohort, occurring in <5% overall.
  • Atrial fibrillation was more common in female stroke patients.
  • Presence of any atrial enlargement was the only independent ECG predictor of death or disability.
How to Cite: Adeoye AM, Ogah OS, Ovbiagele B, Akinyemi R, Shidali V, Agyekum F, et al.. Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans. Global Heart. 2017;12(2):99–105. DOI: http://doi.org/10.1016/j.gheart.2017.01.002
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Published on 01 Jun 2017.
Peer Reviewed

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