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- Title
Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test.
- Authors
Mene-Afejuku, Tuoyo O.; Balogun, Michael O.; Akintomide, Anthony O.; Adebayo, Rasaaq A.
- Abstract
<bold>Background: </bold>Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors.<bold>Objective: </bold>The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients.<bold>Methods: </bold>A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as "mortality vs alive" and as "events vs no-events" based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group.<bold>Results: </bold>HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the "alive" group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p = 0.009), Holter-detected atrial fibrillation (AF; p = 0.028) and PVCs (p = 0.017) following logistic regression than those in the no-events group (n = 59).<bold>Conclusion: </bold>High NYHA class, elevated serum urea, Holter ECG-detected AF and ventricular arrhythmias are predictive of a poor outcome among HHF patients. The 6-MWT was not a useful prognostic index in this study.
- Subjects
NIGERIA; HEART failure; HYPERTENSION; ELECTROCARDIOGRAPHY; HEART disease diagnostic equipment; PHYSIOLOGICAL aspects of walking; PROGNOSIS; ARRHYTHMIA diagnosis; ATRIAL fibrillation diagnosis; AMBULATORY electrocardiography; ARRHYTHMIA; ATRIAL fibrillation; BIOCHEMISTRY; CHI-squared test; COMPARATIVE studies; DOPPLER echocardiography; HEALTH status indicators; HEART beat; LONGITUDINAL method; PHENOMENOLOGY; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH evaluation; TIME; UREA; LOGISTIC regression analysis; VENTRICULAR tachycardia; EVALUATION research; PREDICTIVE tests; PROPORTIONAL hazards models; EXERCISE tolerance; DISEASE complications; DIAGNOSIS
- Publication
Vascular Health & Risk Management, 2017, Vol 13, p71
- ISSN
1176-6344
- Publication type
journal article
- DOI
10.2147/VHRM.S124477