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Comparison of Afro-Caribbean patients presenting in heart failure with normal versus poor left ventricular systolic
1Antigua Heart Centre, Belmont Clinic, Antigua, West Indies. research@crossroadsantigua.org
Insights
Heart failure (HF) in Afro-Caribbean patients often shows preserved left ventricular (LV) systolic function and high rates of LV hypertrophy. This contrasts with other populations, highlighting unique HF characteristics in this demographic.
Area of Science:
- Cardiology
- Echocardiography
- Population Health
Background:
- Heart failure (HF) presentation can vary significantly across different ethnic groups.
- Afro-Caribbean populations may exhibit distinct patterns of HF, potentially linked to preserved left ventricular (LV) systolic function and structural changes.
Purpose of the Study:
- To investigate the echocardiographic characteristics of heart failure in a contemporary Afro-Caribbean population.
- To compare HF patients with preserved LV systolic function against those with impaired LV systolic function within this demographic.
Main Methods:
- Retrospective review of echocardiographic data from 505 Afro-Caribbean patients referred for heart failure.
- Analysis included left atrial and LV dimensions, wall thicknesses, valve function, and LV systolic/diastolic function metrics.
- Comparison of findings between patients with preserved LV systolic function (LV shortening fraction >0.27) and those with poor LV systolic function.
Main Results:
- 57% of HF patients had preserved LV systolic function.
- Patients with preserved LV systolic function were less likely to be male, have a dilated left atrium, or increased LV diastolic dimension.
- Conversely, they were more likely to exhibit LV hypertrophy (septal and posterior walls) and other abnormalities like valve issues or pericardial effusion.
Conclusions:
- The majority of Afro-Caribbean patients with heart failure present with preserved LV systolic function.
- High prevalence of LV hypertrophy, particularly septal hypertrophy, and other echocardiographic abnormalities are characteristic of HF in this population.
Abstract:
Data suggest that heart failure (HF) in Afro-Caribbean patients may be more often associated with preserved left ventricular (LV) systolic function, LV hypertrophy, and probable LV diastolic dysfunction than in other populations. Echocardiographic results on all patients referred for HF in a contemporary Afro-Caribbean population were reviewed, comparing findings in patients with and without preserved LV systolic function with. Echocardiographic findings included left atrial dimension, LV systolic and diastolic dimensions, ventricular septal and posterior wall thicknesses, right ventricular dimension, valve abnormality, or pericardial effusion. LV shortening fraction and ejection fraction were calculated. Age, gender, and presence of atrial fibrillation were recorded. Results from patients with preserved LV systolic function (LV shortening fraction >0.27) were compared with those with poor LV systolic function. There were 505 patients with HF with adequate studies; mean age +/- SD was 64 +/- 15 years, 46% were men, 17% had atrial fibrillation, and 285 of 505 (57%) had preserved LV systolic function. Those with preserved LV systolic function were no different in age (64 +/- 15 vs 64 +/- 14 years, p = 0.98) but were less likely to be men (40% vs 54%, p <0.01). They were less likely to have a dilated left atrium (61% vs 81%, p <0.001) or increased LV diastolic dimension (8% vs 63%, p <0.001). They were more likely to have increased ventricular septal or posterior wall hypertrophy (84% vs 66%, p <0.001) or other abnormal findings, including an abnormal valve, right ventricular enlargement, increased septal to posterior wall thickness ratio, or pericardial effusion (25% vs 6%, p <0.001). The presence of atrial fibrillation was no different (14% vs 20%, p = 0.10). In conclusion, most Afro-Caribbean patients with HF have preserved LV systolic function with high rates of LV hypertrophy, septal hypertrophy, and other echocardiographic abnormalities.
