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Published on: February 20, 2017
Left ventricular hypertrophy among adults in a population-based cohort in Haiti
Anju Ogyu1, Vanessa Rouzier2, Rodney Sufra2
1Center for Global Health, Weill Cornell Medicine, New York City, NY, USA. ano4011@med.cornell.edu.
Insights
Left ventricular hypertrophy (LVH) is common in high-risk Haitian adults. Echocardiography (TTE) is superior to electrocardiography (ECG) for diagnosing LVH, highlighting a need for better diagnostic tools in resource-limited settings.
Area of Science:
- Cardiology
- Medical Diagnostics
- Public Health
Background:
- Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular disease (CVD) and mortality.
- Diagnostic methods for LVH are limited in resource-constrained settings.
- High-risk populations require accessible and accurate LVH screening.
Purpose of the Study:
- To determine the prevalence of LVH using transthoracic echocardiography (TTE) in a high-risk Haitian adult population.
- To compare the diagnostic accuracy of TTE versus electrocardiography (ECG) for detecting LVH.
- To assess the management of identified LVH cases with antihypertensive medications.
Main Methods:
- Analysis of enrollment data from the Haiti cardiovascular disease cohort study (n=3,005).
- Participants underwent questionnaires, vital signs, physical exams, and 12-lead ECGs.
- Transthoracic echocardiography (TTE) was performed on 1040 participants with hypertension or CVD symptoms, with LVH defined by ASE guidelines.
Main Results:
- Prevalence of TTE-diagnosed LVH was 39.0% (95% CI 36.6-41.5%), associated with older age.
- Only 26% of TTE-LVH patients with elevated blood pressure received antihypertensives.
- ECG-based LVH detection showed low agreement (κ < 0.20), low sensitivity (<10%), and high specificity (>90%) compared to TTE.
Conclusions:
- There is a high prevalence of LVH among high-risk Haitian adults, underscoring the need for effective diagnostic strategies.
- Electrocardiography (ECG) demonstrates poor sensitivity for LVH detection compared to TTE in this population.
- Antihypertensive treatment for individuals with TTE-diagnosed LVH may mitigate the risk of adverse CVD outcomes.
Abstract:
Left ventricular hypertrophy (LVH) is one of the strongest predictors of cardiovascular disease (CVD) and mortality; yet the means to diagnose LVH in resource-constrained settings remain limited. The objectives of this study were to determine LVH prevalence by transthoracic echocardiography (TTE) in a high-risk group, and compare TTE vs. electrocardiography (ECG-LVH) for LVH detection. We analyzed enrollment data from the Haiti cardiovascular disease cohort study on adults (≥ 18 years, n = 3,005) in Port-au-Prince between 2019 and 2021. All participants underwent questionnaires, vital signs, physical exams, and 12-lead ECGs. TTEs were acquired on those with hypertension or exhibiting CVD symptoms (n = 1040, 34.7%). TTE-LVH was defined according to the American Society of Echocardiography guidelines and ECG-LVH by Sokolow-Lyon, Cornell, and Limb-Lead Voltage criteria. The prevalence of TTE-LVH was 39.0% (95% CI 36.6-41.5%) and associated with older age. Only 26% of those with TTE-LVH and elevated blood pressure were on antihypertensives. Prevalence of ECG-LVH ranged from 1.9 to 5.0%, and compared to TTE-LVH had low agreement (κ < 0.20), low sensitivity (< 10%) and high specificity (> 90%). These findings indicate a high prevalence of TTE-LVH among high-risk Haitian adults, and poor detection using ECGs compared to TTEs. For those with TTE-LVH, treatment with antihypertensives may reduce the risk of adverse CVD outcomes.
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