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

Adeoye, Abiodun M.; Ogah, Okechukwu S; Ovbiagele, Bruce; Akinyemi, Rufus; Shidali, Vincent; Agyekum, Francis; Aje, Akinyemi; Adebayo, Oladimeji; Akinyemi, Joshua; Kolo, P.M.; Appiah, Lambert; Iheonye, Henry; Uwanuruochi, Kelechukwu; Amusa, Ganiyu; Olunuga, Taiwo; Akpa, Onoja; Olagoke, Ojo Olakanmi; Sarfo, Fred Stephen; Wahab, Kolawole; Olowookere, Samuel Anu; Fakunle, Adekunle; Akpalu, Albert; Adebayo, Philip; Nkromah, Kwadwo; Yaria, Joseph; Ibinaiye, Philip Oluleke; Ogbole, Godwin; Aridegbe, Olumayowa; Lakoh, Sulaiman; Calys‐Tagoe, Benedict; Olowoyo, Paul; Innocent, Chukwuonye; Tiwari, Hemant K.; Arnett, Donna K.; Osaigbovo, Godwin; Bisi, Ayotunde; Akpalu, Josephine; Okeke, Obiora; Joseph, Odo; Omisore, Adeleye Dorcas; Jenkins, Carolyn; Lackland, Daniel T.; Owolabi, Mayowa; Isah, Suleiman Yahaya; Dambatta, Abdu Hamisu; Komolafe, Morenikeji; Bock-Oruma, Andrew; Melikam, Ezinne Sylvia; Imoh, Lucius Chidiebere; Sunmonu, Taofiki; Gebregziabher, Mulugeta; Olabisi, Oluyemisi; Armstrong, Kevin; Onyeonoro, Ugochukwu Uchenna; Sanya, Emmanuel; Agunloye, Atinuke M; Ogunjimi, Luqman; Arulogun, Oyedunni; Farombi, Temitope; Obiabo, Olugbo; Obiako, Reginald

doi:10.1016/j.gheart.2017.01.002

Cited by 30 publications

(21 citation statements)

References 33 publications

(32 reference statements)

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“…Table 1 summarizes key findings from hospital-based and community-based AF/AFL studies in SSA. AF prevalence is low in the general population of SSA at <1% and increases with age [3,15,16], 3-7% in hospital cardiology admissions or newly diagnosed cardiovascular diseases [17][18][19][20][21], 16-22% in heart failure patients [22,23], 10-14% in newly diagnosed and 18-28% in established rheumatic heart disease (RHD) patients [24][25][26], 25% in patients with tuberculous pericarditis [27], 6% de novo cases post-cardiac surgery [28], 9.5% in pregnant women with structural heart disease [29], 2-10% of de novo stroke patients [30][31][32][33], and varies between 25-65% in patients attending oral anti-coagulation clinics in SSA [34][35][36]. In SSA there is a high proportion of permanent AF (12-81.4% across studies) and persistent AF (9.6-70.6%), compared to prevalence of paroxysmal AF (8.9-50%) [20,[37][38][39][40][41] as shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

Yuyun

Bonny

et al. 2020

Global Heart

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Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely noninvasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights:-Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).-Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.-Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.-Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

Yuyun

Bonny

et al. 2020

Global Heart

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“…From 292 records identified from database searches and additional reference lists screening, 72 articles were included in this review (Figure S1). Most of the articles (n = 55) reported primary data on the prevalence, risk factors, and treatment of AF . Those studies were mostly hospital‐based (91.…”

Section: Resultsmentioning

confidence: 99%

“…The prevalence of AF varied widely, from 1.5% to 28.7% in patients with either ischemic or hemorrhagic stroke, and from 6.7% to 34.8% in those specifically with ischemic stroke (Table ).…”

Section: Resultsmentioning

confidence: 99%

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

Noubiap

Nyaga²

2019

Cardiovasc electrophysiol

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This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub‐Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community‐based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one‐third of patients with AF, and valvular heart disease (12.3%‐44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.

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“…Following AIS, 24% of patients develop autonomic dysfunction [9], 28% show impairment of left ventricular ejection fraction, and 13-29% develop systolic dysfunction [5]. Electrocardiographic abnormalities are observed in 60-85% of AIS patients within the first 24 h [10,11] (Table S1, Additional file 1).…”

Section: Epidemiology Of Cardiac Dysfunction In Ischemic Strokementioning

confidence: 99%

“…Cardiac arrhythmias Electrocardiographic changes occur in 60-90% of AIS patients [10,11]. Common features include T wave inversion (35%), ST depression (33%), prolonged QTc interval (29%), and U waves (28%) [49].…”

Section: Acute and Chronic Cardiac Dysfunction Pre-aismentioning

confidence: 99%

Brain–heart interaction after acute ischemic stroke

et al. 2020

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Early detection of cardiovascular dysfunctions directly caused by acute ischemic stroke (AIS) has become paramount. Researchers now generally agree on the existence of a bidirectional interaction between the brain and the heart. In support of this theory, AIS patients are extremely vulnerable to severe cardiac complications. Sympathetic hyperactivity, hypothalamic-pituitary-adrenal axis, the immune and inflammatory responses, and gut dysbiosis have been identified as the main pathological mechanisms involved in brain-heart axis dysregulation after AIS. Moreover, evidence has confirmed that the main causes of mortality after AIS include heart attack, congestive heart failure, hemodynamic instability, left ventricular systolic dysfunction, diastolic dysfunction, arrhythmias, electrocardiographic anomalies, and cardiac arrest, all of which are more or less associated with poor outcomes and death. Therefore, intensive care unit admission with continuous hemodynamic monitoring has been proposed as the standard of care for AIS patients at high risk for developing cardiovascular complications. Recent trials have also investigated possible therapies to prevent secondary cardiovascular accidents after AIS. Labetalol, nicardipine, and nitroprusside have been recommended for the control of hypertension during AIS, while beta blockers have been suggested both for preventing chronic remodeling and for treating arrhythmias. Additionally, electrolytic imbalances should be considered, and abnormal rhythms must be treated. Nevertheless, therapeutic targets remain challenging, and further investigations might be essential to complete this complex multi-disciplinary puzzle. This review aims to highlight the pathophysiological mechanisms implicated in the interaction between the brain and the heart and their clinical consequences in AIS patients, as well as to provide specific recommendations for cardiovascular management after AIS.

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

Cited by 30 publications

References 33 publications

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

Brain–heart interaction after acute ischemic stroke

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