Abstract
BackgroundLeft ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Our primary aim was to investigate the magnitude, correlates and outcomes of left ventricular hypertrophy as a surrogate maker for chronic uncontrolled hypertension in young adults ≤ 45 years with stroke. Our secondary aim was to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography.MethodsThis cohort study recruited young strokes who had undergone brain imaging, electrocardiography and transthoracic echocardiography at baseline. The modified Poisson regression model examined baseline correlates for left ventricular hypertrophy. The National Institute of Health Stroke Scale assessed stroke severity and the modified Rankin Scale assessed outcomes to 30-days. Performance of electrical voltage criterions was estimated using receiver operator characteristics.ResultsWe enrolled 101 stroke participants. Brain imaging revealed ischemic strokes in 60 (59.4%) and those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia. Left ventricular hypertrophy was present in 76 (75.3%:95%CI 65.7%–83.3%), and 30 (39.5%) and 28 (36.8%) had moderate or severe hypertrophy respectively. Young adults with premorbid or a new diagnosis of hypertension were more likely to have left ventricular hypertrophy, 47 (61.8%), and 26 (34.2%). On multivariable analysis, left ventricular hypertrophy was independently associated with not being on anti-hypertensive medications among hypertensives participants {adjusted risk ratio 1.4 (95%CI:1.04–1.94). The mean National Institute of Health Stroke score was 18 and 30-day mortality was 42 (43.3%). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively.ConclusionsWe identified a high proportion of left ventricular hypertrophy in young adults with stroke associated with chronic undertreated hypertension. While the study methodology does not allow us to determine causation, this association and knowledge of pathophysiological processes supports the notion that chronic hypertension is a major risk factor for young strokes associated with high mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions like blood pressure screening and treatment to reduce this burden.
Highlights
Left ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension
In sub Saharan Africa (SSA), 50% of stroke in the young is attributed to uncontrolled hypertension [5] and 45% of all stroke cases could be prevented by adequate blood pressure control [6, 7]
There were a total of 484 medical admissions of patients aged ≤ 45 years between June 2018 to January 2019, of whom 128 (26.4%) participants met the World Health Organization (WHO) clinical diagnosis of first ever stroke [14]
Summary
Left ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Uncontrolled chronic hypertension leads to target end organ damage, one manifestation of which is left ventricular hypertrophy (LVH). This occurs as a pathophysiological adaption to chronic increased afterload and serves as an independent predictor for coronary events, heart failure, ventricular arrhythmias, stroke and peripheral arterial disease [8, 9]. Transthoracic echocardiography (TTE) is a noninvasive modality of choice to assess cardiac structure and function (including the detection of LVH) [12]. It is considered gold standard and superior to the 12-lead electrocardiogram (ECG) for diagnosing LVH [13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
