title: Prevalence and Prognostic Features of ECG Abnormalities in Acute Stroke: Findings From the SIREN Study Among Africans.
abstract: Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke outcomes have not been previously characterized in Africans.
  
  
  
  The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study.
  
  
  
  We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS).
  
  
  
  Patients' mean age was 58.4 ± 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p = 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p = 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02).
  
  
  
  About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability.
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Abiodun M
authors.initials: AM
authors.lastname: Adeoye
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Okechukwu S
authors.initials: OS
authors.lastname: Ogah
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Federal Medical Centre, Abeokuta, Nigeria.
authors.forename: Rufus
authors.initials: R
authors.lastname: Akinyemi
authors.affiliation: Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Vincent
authors.initials: V
authors.lastname: Shidali
authors.affiliation: University of Ghana Medical School, Accra, Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Agyekum
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Akinyemi
authors.initials: A
authors.lastname: Aje
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Oladimeji
authors.initials: O
authors.lastname: Adebayo
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Joshua O
authors.initials: JO
authors.lastname: Akinyemi
authors.affiliation: University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Philip
authors.initials: P
authors.lastname: Kolo
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Lambert Tetteh
authors.initials: LT
authors.lastname: Appiah
authors.affiliation: Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Henry
authors.initials: H
authors.lastname: Iheonye
authors.affiliation: Federal Medical Center, Umuahia, Nigeria.
authors.forename: Uwanuruochi
authors.initials: U
authors.lastname: Kelechukwu
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Amusa
authors.initials: A
authors.lastname: Ganiyu
authors.affiliation: Federal Medical Centre, Abeokuta, Nigeria.
authors.forename: Taiwo O
authors.initials: TO
authors.lastname: Olunuga
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Onoja
authors.initials: O
authors.lastname: Akpa
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Ojo Olakanmi
authors.initials: OO
authors.lastname: Olagoke
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Fred Stephen
authors.initials: FS
authors.lastname: Sarfo
authors.affiliation: University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Kolawole
authors.initials: K
authors.lastname: Wahab
authors.affiliation: University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Samuel
authors.initials: S
authors.lastname: Olowookere
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Adekunle
authors.initials: A
authors.lastname: Fakunle
authors.affiliation: University of Ghana Medical School, Accra, Ghana.
authors.forename: Albert
authors.initials: A
authors.lastname: Akpalu
authors.affiliation: Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Adebayo
authors.affiliation: University of Ghana Medical School, Accra, Ghana.
authors.forename: Kwadwo
authors.initials: K
authors.lastname: Nkromah
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yaria
authors.affiliation: Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Philip
authors.initials: P
authors.lastname: Ibinaiye
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Godwin
authors.initials: G
authors.lastname: Ogbole
authors.affiliation: Sacred Heart Hospital, Abeokuta, Nigeria.
authors.forename: Aridegbe
authors.initials: A
authors.lastname: Olumayowa
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Lakoh
authors.affiliation: University of Ghana Medical School, Accra, Ghana.
authors.forename: Benedict
authors.initials: B
authors.lastname: Calys-Tagoe
authors.affiliation: Federal University Teaching Hospital, Ido-Ekiti, Nigeria.
authors.forename: Paul
authors.initials: P
authors.lastname: Olowoyo
authors.affiliation: Federal Medical Center, Umuahia, Nigeria.
authors.forename: Chukwuonye
authors.initials: C
authors.lastname: Innocent
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Hemant K
authors.initials: HK
authors.lastname: Tiwari
authors.affiliation: University of Kentucky at Lexington, Lexington, KY, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Arnett
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Osaigbovo
authors.initials: O
authors.lastname: Godwin
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Bisi
authors.initials: B
authors.lastname: Ayotunde
authors.affiliation: University of Ghana Medical School, Accra, Ghana.
authors.forename: Josephine
authors.initials: J
authors.lastname: Akpalu
authors.affiliation: Federal Medical Center, Umuahia, Nigeria.
authors.forename: Okeke
authors.initials: O
authors.lastname: Obiora
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Odo
authors.initials: O
authors.lastname: Joseph
authors.affiliation: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
authors.forename: Adeleye
authors.initials: A
authors.lastname: Omisore
authors.affiliation: Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lackland
authors.affiliation: Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Lukman
authors.initials: L
authors.lastname: Owolabi
authors.affiliation: Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Suleiman
authors.initials: S
authors.lastname: Isah
authors.affiliation: Aminu Kano Teaching Hospital, Kano, Nigeria.
authors.forename: Abdu H
authors.initials: AH
authors.lastname: Dambatta
authors.affiliation: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
authors.forename: Morenikeji
authors.initials: M
authors.lastname: Komolafe
authors.affiliation: Delta State University Teaching Hospital, Ogara, Nigeria.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bock-Oruma
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Ezinne Sylvia
authors.initials: ES
authors.lastname: Melikam
authors.affiliation: Federal Medical Center, Umuahia, Nigeria.
authors.forename: Lucius Chidiebere
authors.initials: LC
authors.lastname: Imoh
authors.affiliation: Federal Medical Centre, Owo, Nigeria.
authors.forename: Taofiki
authors.initials: T
authors.lastname: Sunmonu
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria.
authors.forename: Oluyemisi
authors.initials: O
authors.lastname: Olabisi
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: Federal Medical Center, Umuahia, Nigeria.
authors.forename: Ugochukwu U
authors.initials: UU
authors.lastname: Onyeonoro
authors.affiliation: University of Ilorin Teaching Hospital, Ilorin, Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sanya
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Atinuke M
authors.initials: AM
authors.lastname: Agunloye
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Luqman
authors.initials: L
authors.lastname: Ogunjimi
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Oyedunni
authors.initials: O
authors.lastname: Arulogun
authors.affiliation: University of Ibadan, Ibadan, Nigeria.
authors.forename: Temitope H
authors.initials: TH
authors.lastname: Farombi
authors.affiliation: Delta State University Teaching Hospital, Ogara, Nigeria.
authors.forename: Olugbo
authors.initials: O
authors.lastname: Obiabo
authors.affiliation: Ahmadu Bello University, Zaria, Nigeria.
authors.forename: Reginald
authors.initials: R
authors.lastname: Obiako
authors.affiliation: University of Ibadan, Ibadan, Nigeria. Electronic address: mayowaowolabi@yahoo.com.
authors.forename: Mayowa
authors.initials: M
authors.lastname: Owolabi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology; D001921:Brain / Q000000981:diagnostic imaging; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed