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Nomura N, Tani T, Konda T, Kim K, Kitai T, Nomoto N, Suganuma N, Nakamura H, Sumida T, Fujii Y, Kawai J, Kaji S, Furukawa Y. Significance of isolated papillary muscle hypertrophy: A comparison of left ventricular hypertrophy diagnosed using electrocardiography vs echocardiography. Echocardiography 2017; 35:292-300. [PMID: 29280520 DOI: 10.1111/echo.13789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS The clinical significance of papillary muscle hypertrophy and its electrocardiography (ECG) findings has not been fully elucidated. This study aimed to investigate the relationship between ECG findings and papillary muscle hypertrophy and to confirm the importance of papillary muscle measurements on transthoracic echocardiography (TTE). METHODS AND RESULTS Of the 237 consecutive patients who showed left ventricular hypertrophy (LVH) pattern on a 12-lead ECG, TTE data were available for 101 patients. The patients were divided into the two groups according to the presence (ECG-LVH [strain pos] group, n = 60) or absence (ECG-LVH [strain neg] group, n = 41) of LV strain pattern (study 1). The prevalence of papillary muscle hypertrophy using TTE was significantly higher in the ECG-LVH (strain neg) group than in the ECG-LVH (strain pos) group (P = .0002). Of the 42 cases with papillary muscle hypertrophy, 5 cases (12%) showed isolated papillary muscle hypertrophy with normal geometry. ECG data were prospectively analyzed for 36 patients who were diagnosed with papillary muscle hypertrophy by TTE (study 2). The prevalence of LV strain pattern was significantly higher in patients with LV wall hypertrophy than in those without LV wall hypertrophy (P = .04). Of the 25 cases with papillary muscle hypertrophy, 6 cases (24%) showed normal geometry and 4 cases (16%) showed ECG abnormality. CONCLUSIONS Isolated papillary muscle hypertrophy can cause ECG abnormalities such as LV high voltage and LV strain pattern. Particular attention must be paid to the papillary muscle during echocardiographic examinations.
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Affiliation(s)
- Namiko Nomura
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Tomoko Tani
- Basic Medical Science, Kobe City College of Nursing, Nishi-ku, Kobe, Japan
| | - Toshiko Konda
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Natsumi Nomoto
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Naoko Suganuma
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Hitomi Nakamura
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Toshiaki Sumida
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Yoko Fujii
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Junichi Kawai
- Department of Clinical Technology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
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Ogah OS, Sliwa K, Akinyemi JO, Falase AO, Stewart S. Hypertensive heart failure in Nigerian Africans: insights from the Abeokuta Heart Failure Registry. J Clin Hypertens (Greenwich) 2015; 17:263-72. [PMID: 25688932 PMCID: PMC8031496 DOI: 10.1111/jch.12496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
Data from the Abeokuta Heart Failure Registry were used to determine the clinical characteristics, mode of treatment, and short- and medium-term outcomes of patients with hypertensive heart failure. A total of 320 patients were consecutively studied, comprising 184 men (57.5%) and 136 women (42.5%) aged 58.4±12.4 and 60.6±14.5 years, respectively. Most patients (80%) presented with New York Heart Association functional class III or IV and around one third (35%) had preserved systolic function. Median hospital stay was 9 days (interquartile range 5-21) while intra-hospital mortality was 3.4%. The 30-day, 90-day, and 180-day mortality rates were 0.9% (95% confidence interval, -0.2 to 3.5), 3.5% (95% confidence interval, -1.7 to 7.3), and 11.7% (95% confidence interval, -7.8 to 17.5), respectively. In a multiple logistic regression analysis, only serum creatinine was an independent predictor of mortality at 180 days (adjusted odds ratio, 1.76; 95% confidence interval, -1.17 to 2.64). Hypertension is the most common etiological risk factor for heart failure in Nigeria. Most patients present in the fourth decade of life with severe heart failure and secondary valvular dysfunction and significant in-hospital mortality.
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Affiliation(s)
- Okechukwu S. Ogah
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
- Department of MedicineFaculty of Health SciencesHatter Institute for Cardiovascular Research in Africa & IIDMMUniversity of Cape TownCape TownSouth Africa
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical StatisticsCollege of MedicineUniversity of IbadanIbadanNigeria
| | - Ayodele O. Falase
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
| | - Simon Stewart
- Mary MacKillop Institute for Health Research/NHMRC CRE to Reduce Inequality in Heart DiseaseAustralian Catholic UniversityMelbourneVictoriaAustralia
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Cordeiro AC, Moraes AA, Cerutti V, França F, Quiroga B, Amodeo C, Picotti JC, Dutra LV, Rodrigues GD, Amparo FC, Lindholm B, Carrero JJ. Clinical determinants and prognostic significance of the electrocardiographic strain pattern in chronic kidney disease patients. ACTA ACUST UNITED AC 2014; 8:312-20. [DOI: 10.1016/j.jash.2014.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 12/12/2022]
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Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, Stewart S, Sliwa K. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012; 4:327-40. [PMID: 23272273 PMCID: PMC3530788 DOI: 10.4330/wjc.v4.i12.327] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023] Open
Abstract
To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.
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Affiliation(s)
- Okechukwu S Ogah
- Okechukwu S Ogah, Ministry of Health, Nnamdi Azikiwe Secretariat, Umuahia 440233, Abia State, Nigeria
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Shah N, Chintala K, Aggarwal S. Electrocardiographic strain pattern in children with left ventricular hypertrophy: a marker of ventricular dysfunction. Pediatr Cardiol 2010; 31:800-6. [PMID: 20422173 DOI: 10.1007/s00246-010-9707-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 04/01/2010] [Indexed: 01/19/2023]
Abstract
The objective of this study was to assess the relation between strain pattern on electrocardiogram (ECG-strain) and echocardiographic indices of left ventricular (LV) structure and function in children with LV hypertrophy (LVH). ECG-strain is a marker of LVH and is associated with adverse cardiovascular prognosis in adults. The significance of ECG-strain and its relation to LV structure and function has not been studied in children. We retrospectively analyzed electrocardiograms (ECGs) and echocardiograms of 101 children enrolled in this study. Subjects were divided into three groups: group I (n = 21) comprised children with LVH confirmed by echocardiography (LVH(echo)) with ECG-strain pattern; group II (n = 54) comprised children with LVH(echo) without ECG-strain pattern; and group III (n = 26) comprised children without LVH (control group). ECG-strain was defined as a down-sloping convex ST-segment depression (> or = 0.1 mV) with an inverted asymmetrical T-wave opposite to the QRS axis in leads V5 and/or V6. LV structure and function was measured using conventional and tissue Doppler echocardiography. ECG-strain was associated with greater interventricular septal thickness, posterior wall thickness, and LV mass index (LVMI) compared with those without ECG-strain (P < 0.0001 for each variable). Concentric LVH was more common in those with ECG-strain (16 of 21 vs. 9 of 54 patients; P = < 0.0001). ECG-strain was associated with systolic, diastolic, and combined systolic-diastolic dysfunction in children with LVH(echo). Among children with LVH, ECG-strain is associated with higher LVMI, concentric pattern of LVH, and LV systolic and diastolic dysfunction. Whether this has similar adverse prognostic implications as it does in adults remains to be determined.
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Affiliation(s)
- Nishant Shah
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA.
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Buchner S, Debl K, Haimerl J, Djavidani B, Poschenrieder F, Feuerbach S, Riegger GAJ, Luchner A. Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:18. [PMID: 19486532 PMCID: PMC2696426 DOI: 10.1186/1532-429x-11-18] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 06/01/2009] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed. METHODS 120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score. RESULTS All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 +/- 1.0 ms vs. 43 +/- 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 +/- 0.01 vs. -0.02 +/- 0.01) and T-wave (V5 -0.03 +/- 0.04 vs. 0.18 +/- 0.05) in the anterolateral leads (p < 0.05) were deeper. CONCLUSION By calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted.
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Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Kurt Debl
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Josef Haimerl
- Medizinische Klinik, Klinikum Landshut Achdorf, Germany
| | - Behrus Djavidani
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Germany
| | | | - Stefan Feuerbach
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Germany
| | - Guenter AJ Riegger
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
| | - Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Germany
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Ogah OS, Adebanjo AT, Otukoya AS, Jagusa TJ. "Echocardiography in Nigeria: use, problems, reproducibility and potentials". Cardiovasc Ultrasound 2006; 4:13. [PMID: 16551364 PMCID: PMC1440870 DOI: 10.1186/1476-7120-4-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2006] [Accepted: 03/21/2006] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although echocardiography is a useful and cost-effective technique for the detection of morphological and functional cardiac abnormalities, it has a main limitation in its subjectivity. Therefore the aim of the present study was to assess the intra-observer reproducibility and validity of 2-dimensional guided M-mode echo measurements at a Nigerian metropolitan Hospital. METHODS Standard echocardiographic examination was performed on twenty randomly selected patients (11 men and 9 women) aged 59.8 +/- 12.6 years in two different sessions seven days apart. RESULTS A good degree of intraobserver agreement was observed between test 1 and test 2. The correlation coefficient between the first and second studies ranged between 0.60 and 0.96; measurement errors between 0.050 and 0.205. CONCLUSION We would conclude that 2-dimensional guided M-mode measurements at echocardiography performed at our centre are reproducible with low intra-observer variability.
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Affiliation(s)
- Okechukwu S Ogah
- Department of Medicine, Federal Medical Centre, Idi-Aba, PMB 3031 Abeokuta, Nigeria
| | - Ademola T Adebanjo
- Department of Medicine, Federal Medical Centre, Idi-Aba, PMB 3031 Abeokuta, Nigeria
| | - Adedeji S Otukoya
- Department of Medicine, Federal Medical Centre, Idi-Aba, PMB 3031 Abeokuta, Nigeria
| | - Tarwanger J Jagusa
- Department of Family Medicine, Federal Medical Centre, Idi-Aba, PMB 3031 Abeokuta, Nigeria
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