title: Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF.
abstract: BACKGROUND
  The role of echocardiography in the risk stratification 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 echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, 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 measurements 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, suggesting the importance of early treatment of hypertension and severe valvular heart disease.
authors.affiliation: Department of Medicine, Bayero University Kano; Aminu Kano Teaching Hospital, Kano, Nigeria. Email: sanimahmoud@yahoo.com.
authors.forename: Mahmoud U
authors.initials: MU
authors.lastname: Sani
authors.affiliation: Momentum Research, Inc, Durham, North Carolina, United States of America.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.affiliation: Momentum Research, Inc, Durham, North Carolina, United States of America.
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
authors.forename: Albertino
authors.initials: A
authors.lastname: Damasceno
authors.affiliation: Department of Medicine, GF Jooste and Groote Schuur Hospitals, University of Cape Town, Cape Town, South Africa.
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.affiliation: Department of Medicine, University College Hospital, Ibadan and Ministry of Health, Abia State, Nigeria.
authors.forename: Okechukwu S
authors.initials: OS
authors.lastname: Ogah
authors.affiliation: Uganda Heart Institute, Kampala, Uganda.
authors.forename: Charles
authors.initials: C
authors.lastname: Mondo
authors.affiliation: Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon.
authors.forename: Anastase
authors.initials: A
authors.lastname: Dzudie
authors.affiliation: Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria.
authors.forename: Dike B
authors.initials: DB
authors.lastname: Ojji
authors.affiliation: Department of Internal Medicine, Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon.
authors.forename: Charles Kouam
authors.initials: CK
authors.lastname: Kouam
authors.affiliation: Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Suliman
authors.affiliation: Department of Medicine, Aga Khan University, Nairobi, Kenya.
authors.forename: Gerald
authors.initials: G
authors.lastname: Yonga
authors.affiliation: Department of Cardiology, Faculty of Medecine, Dakar, Senegal.
authors.forename: Sergine Abdou
authors.initials: SA
authors.lastname: Ba
authors.affiliation: Addis Cardiac Hospital, Addis Ababa, Ethiopia.
authors.forename: Fikru
authors.initials: F
authors.lastname: Maru
authors.affiliation: Addis Cardiac Hospital, Addis Ababa, Ethiopia.
authors.forename: Bekele
authors.initials: B
authors.lastname: Alemayehu
authors.affiliation: Momentum Research, Inc, Durham, North Carolina, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Edwards
authors.affiliation: Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D000208:Acute Disease; D017954:Africa South of the Sahara / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology