Background:Sub-Saharan Africa is undergoing an epidemiological transition fueled by the interaction between infectious and cardiovascular diseases. Our cross-sectional study aimed to characterize the spectrum of abnormalities suggesting end-organ damage on ECG and transthoracic echocardiograms (TTE) among older adults with cardiovascular diseases in rural South Africa.Methods:The prevalence of ECG and TTE abnormalities was estimated; χ² analyses and multivariable logistic regressions were performed to test their association with sex, hypertension, and other selected comorbidities.Results:Overall, 729 ECGs and 155 TTEs were completed, with 74 participants completing both. ECG evaluation showed high rates of left ventricular hypertrophy (LVH, 36.5%) and T wave abnormalities (13.6%). TTE evaluation showed high rates of concentric LVH (31.6%), with moderate-severe (56.8%) diastolic dysfunction. Participants with hypertension showed more cardiac remodeling on ECG by LVH (45.4% versus 22.1%, P<0.01), and TTE by concentric LVH (42.5% versus 8.2%, P<0.01) and increased left ventricular mass (58.5% versus 20.4%, P<0.0001). In multivariable logistic regression, systolic blood pressure remained significantly associated with LVH on ECG (adjusted odds ratio, 1.03 per mm Hg [95% CI, 1.03–1.04], P<0.0001) and increased left ventricular mass on TTE (adjusted odds ratio, 1.04 per mm Hg [95% CI, 1.01–1.06], P=0.001). Male participants (n=326, 40.2%) were more likely than females (n=484, 59.8%) to show ECG abnormalities like LVH (45% versus 30.8%, P<0.01), whereas females were more likely to show TTE abnormalities like concentric LVH (40.8% versus 13.5%, P<0.01) and increased left ventricular mass (58.4% versus 23.1%, P<0.0001). Similar results were confirmed in multivariable models.Conclusions:Our findings suggest that cardiovascular diseases are widespread in rural South Africa, with a larger burden of hypertensive heart disease than previously appreciated, and define the severity of end-organ damage that is already underway. Local health systems must adapt to face the growing burden of hypertension, as suboptimal rates of hypertension diagnosis and treatment may dramatically increase the heart failure burden.

中文翻译：

---

南非农村地区老年心血管疾病患者的超声心动图和心电图异常

背景：撒哈拉以南非洲正在经历由传染病和心血管疾病之间的相互作用推动的流行病学转变。我们的横断面研究旨在描述南非农村地区患有心血管疾病的老年人心电图和经胸超声心动图 (TTE) 提示终末器官损伤的异常谱。方法：估计心电图和 TTE 异常的患病率；χ2 ^_进行了分析和多变量逻辑回归，以测试它们与性别、高血压和其他选定合并症的关联。结果：总体而言，完成了 729 次心电图和 155 次 TTE，其中 74 名参与者完成了这两项。心电图评估显示左心室肥厚 (LVH, 36.5%) 和 T 波异常 (13.6%) 发生率很高。TTE 评估显示向心 LVH 发生率高 (31.6%)，伴有中度至重度 (56.8%) 舒张功能障碍。患有高血压的参与者通过 LVH（45.4% 对 22.1%，P <0.01）和 TTE 通过同心 LVH（42.5% 对 8.2%，P <0.01）显示出更多的心电图心脏重塑，并且左心室质量增加（58.5% 对 20.4%） ,磷<0.0001)。在多变量逻辑回归中，收缩压仍然与 ECG 上的 LVH 显着相关（调整后的比值比为 1.03/mm Hg [95% CI，1.03–1.04]，P <0.0001）和 TTE 上的左心室质量增加（调整后的比值比， 1.04/mm Hg [95% CI, 1.01–1.06], P =0.001)。男性参与者 (n=326, 40.2%) 比女性 (n=484, 59.8%) 更可能表现出 LVH 等心电图异常（45% 对 30.8%，P <0.01），而女性更可能表现出 TTE 异常如同心 LVH（40.8% 对 13.5%，P <0.01）和左心室质量增加（58.4% 对 23.1%，P<0.0001)。类似的结果在多变量模型中得到证实。结论：我们的研究结果表明，心血管疾病在南非农村很普遍，高血压性心脏病的负担比以前认为的要大，并确定了已经发生的终末器官损伤的严重程度。地方卫生系统必须适应日益增长的高血压负担，因为高血压诊断和治疗的不理想率可能会显着增加心力衰竭的负担。