Cardiovascular Journal of Africa: Vol 28 No 1 (January/February 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 1, January/February 2017 60 AFRICA
Echocardiographic predictors of outcome in acute heart
failure patients in sub-Saharan Africa: insights from
THESUS-HF
Mahmoud U Sani, Beth A Davison, Gad Cotter, Albertino Damasceno, Bongani M Mayosi, Okechukwu
S Ogah, Charles Mondo, Anastase Dzudie, Dike B Ojji, Charles Kouam Kouam, Ahmed Suliman,
Gerald Yonga, Sergine Abdou Ba, Fikru Maru, Bekele Alemayehu, Christopher Edwards, Karen Sliwa
Abstract
Background: The role of echocardiography in the risk strati-
fication of acute heart failure (HF) is unknown. Some small
studies and retrospective analyses have found little change in
echocardiographic variables during admission for acute HF
and some echocardiographic parameters were not found to
be associated with outcomes. It is unknown which echocar-
diographic variables will predict outcomes in sub-Saharan
African patients admitted with acute HF. Using echocardio-
grams, this study aimed to determine the predictors of death
and re-admissions within 60 days and deaths up to 180 days
in patients with acute heart failure.
Methods: Out of the 1 006 patients in the THESUS-HF
registry, 954 had had an echocardiogram performed within
a few weeks of admission. Echocardiographic measure-
ments were performed according to the American Society of
Echocardiography guidelines. We examined the associations
between each echocardiographic predictor and outcome using
regression models.
Results: Heart rate and left atrial size predicted death within 60
days or re-admission. Heart rate, left ventricular posterior wall
thickness in diastole (PWTd), and presence of aortic stenosis
were associated with the risk of death within 180 days. PTWd
added to clinical variables in predicting 180-day mortality rates.
Conclusions: Echocardiographic variables, especially those
of left ventricular size and function, were not found to have
additional predictive value in patients admitted for acute HF.
Left atrial size, aortic stenosis, heart rate and measures of
hypertrophy (LV PWTd) had some predictive value, suggest-
ing the importance of early treatment of hypertension and
severe valvular heart disease.
Keywords: echocardiography, acute heart failure, predictors,
outcome
Submitted 12/7/15, accepted 10/7/16
Cardiovasc J Afr 2017; 28: 60–67
DOI: 10.5830/CVJA-2016-070
Recent data clearly indicate that heart failure (HF) is an
important healthcare problem in Africa, where it is estimated to
constitute about 3–7% of all medical admissions.1,2 The causes of
HF in Africa are different from those outside Africa. The recent
THESUS-HF registry3 showed that in sub-Saharan Africa, the
disease affects men and women in the most productive years of
life, at an average age of 52 years. Furthermore, HF in Africa
Department of Medicine, Bayero University Kano; Aminu
Kano Teaching Hospital, Kano, Nigeria
Mahmoud U Sani, MBBS, FWACP, FACP, FACC,
Momentum Research, Inc, Durham, North Carolina, United
States of America
Beth A Davison, PhD
Gad Cotter, MD, FACC, FESC
Christopher Edwards, BS
Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
Albertino Damasceno, MD, PhD, FESC
Department of Medicine, GF Jooste and Groote Schuur
Hospitals, University of Cape Town, Cape Town, South Africa
Bongani M Mayosi, DPhil, FCP (SA)
Department of Medicine, University College Hospital,
Ibadan and Ministry of Health, Abia State, Nigeria
Okechukwu S Ogah, MBBS, FWACP, FACC, FESC
Uganda Heart Institute, Kampala, Uganda
Charles Mondo, MB ChB, PhD
Department of Internal Medicine, Douala General Hospital
and Buea Faculty of Health Sciences, Douala, Cameroon
Anastase Dzudie, MD, FESC
Charles Kouam Kouam, MD
Department of Medicine, University of Abuja Teaching
Hospital, Abuja, Nigeria
Dike B Ojji, MBBS, PhD, FACP
Faculty of Medicine, University of Khartoum, Khartoum, Sudan
Ahmed Suliman, MD
Department of Medicine, Aga Khan University, Nairobi, Kenya
Gerald Yonga, MD
Department of Cardiology, Faculty of Medecine, Dakar, Senegal
Sergine Abdou, Ba MD, PhD
Addis Cardiac Hospital, Addis Ababa, Ethiopia
Fikru Maru, MD
Bekele Alemayehu, MD
Hatter Institute for Cardiovascular Research in Africa,
Department of Medicine, Faculty of Health Sciences,
University of Cape Town, South Africa
Karen Sliwa, MD, PhD, FESC, FACC