Clinical and echocardiographic characteristics of patients with diastolic dysfunction in Kenya
Date of Award
2020
Document Type
Dissertation
Degree Name
Master of Medicine (MMed)
First Supervisor/Advisor
Dr. Mzee Ngunga
Second Supervisor/Advisor
Dr. Anders Barasa
Third Supervisor/Advisor
Dr. Mohamed Jeilan
Department
Internal Medicine (East Africa)
Abstract
Background: Left ventricular diastolic dysfunction is commonly a preclinical stage of heart failure. Data on clinical and echocardiographic features of diastolic dysfunction (DD) is scarce in Sub-Saharan Africa. This study sought to determine the prevalence, clinical and echocardiographic factors associated with diastolic dysfunction in a cohort of patients from a Sub-Saharan Africa center.
Methods: Adult patients referred for echocardiography at Aga Khan University hospital Nairobi Kenya were screened for enrollment. DD was defined according to the 2016 ASE/EACVI guidelines. A total of 1205 echo examinations were reviewed for presence of abnormal LV diastolic function between December 2019 and May 2020.
Results: Over a six-month period, 519 (43.07%) echo studies had at least one feature of abnormal LV diastology, of whom 387 (32.1%) fulfilled criteria for inclusion. 53% met criteria for definite DD where as 47% were classified in the indeterminate DD group.
The mean age of participants was 62.8 years. Dyspnea, chest pain and fatigue were the reasons for presentation in 54.8%, 31.5% and 27.1% of participants respectively. Dyspnea was the only symptom associated with definite DD in multivariate analysis. Hypertension was the most common comorbid condition, occurring in78.6% of participants. Hypertension was also found to be an independent factor for definite DD. In a multivariate analysis, other factors associated with definite DD were presence of CKD, previously established diagnosis of heart failure, atrial fibrillation, history of pacemaker implant, anemia and high NT proBNP levels.
Additionally, echo parameters associated with definite DD were low normal left ventricular systolic function (LVEF of 50-55%), presence of left ventricular hypertrophy, and abnormal GLS.
Conclusions: The present study showed a high prevalence of DD in a heterogeneous group of patients referred for echocardiography. It also confirmed correlation of clinical presentation and echo markers of diastolic dysfunction, and demonstrated clinical and echo factors associated with advanced degree of DD among patients with a preserved ejection fraction of the left ventricle.
Recommended Citation
Amendezo, E. (2020). Clinical and echocardiographic characteristics of patients with diastolic dysfunction in Kenya (Unpublished master's dissertation). Aga Khan University, East Africa.