Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans
Abiodun M Adeoye1, Okechukwu S Ogah1, Bruce Ovbiagele2
1University of Ibadan, Ibadan, Nigeria.
Insights
Nearly all African stroke patients have electrocardiogram (ECG) abnormalities. Atrial enlargement on ECG independently predicted worse outcomes, highlighting its importance in managing stroke patients in Africa.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Africa faces a significant and increasing burden of stroke.
- High stroke morbidity and mortality rates, with a 3-year fatality rate of 84%, underscore the severity of the issue.
- Cardiac disease is a known contributor to stroke, but the prognostic value of electrocardiogram (ECG) abnormalities in African stroke patients remains undercharacterized.
Purpose of the Study:
- To assess the prevalence of various ECG abnormalities in African acute stroke patients.
- To determine the prognostic significance of these ECG abnormalities on stroke outcomes.
- To investigate the relationship between ECG findings and stroke characteristics in a multi-site, cross-national study.
Main Methods:
- Included 890 patients from Nigeria and Ghana with acute stroke.
- Performed 12-lead ECG within 24 hours of admission.
- Classified stroke using brain imaging (CT/MRI) and assessed severity (SLS) and 1-month outcomes (mRS).
Main Results:
- 85.4% of patients had at least one ECG abnormality.
- Women showed higher rates of atrial fibrillation and left ventricular hypertrophy.
- Atrial enlargement was the sole independent ECG predictor of severe disability or death at 1 month (AOR: 1.45).
Conclusions:
- A high prevalence of baseline ECG abnormalities exists in African acute stroke patients.
- Atrial enlargement identified on ECG is a significant independent predictor of poor outcomes.
- ECG is a valuable tool for risk stratification in African stroke populations.
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.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:30Acute Coronary Syndrome I: Introduction
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...