M-mode echocardiographic findings in a contemporary Afro-Caribbean population referred for evaluation of congestive cardiac failure

RESUMO

Congestive cardiac failure is emerging as a significant public health problem around the world, including the Caribbean. Recent reports from developed countries suggest that 30 to 40 of patients with congestive cardiac failure have normal systolic function. This percentage may be even higher in non-Caucasian, non-male populations. This study was undertaken to determine the M-mode echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for congestive cardiac failure. There were 165 patients, 51 male, mean and standard deviation (SD) age of 63 +/- 15 years, referred between May 1998 and June 2000. Echocardiographic findings included left atrial size (LA), left ventricular (LV) end systolic (ESD) and end diastolic dimension (EDD), LV posterior wall thickness (PWT) and ventricular septal thickness (VST). LV ejection fraction (EF) was derived. LA > 4 cm, PWT or VST > 13 mm and LVEF < 50 were considered abnormal. Increased LV wall thickness (LV hypertrophy) only was the most frequent finding, 68/165 (41), consistent with possible diastolic dysfunction. If a less restrictive definition for abnormal LV wall thickness, 12 mm, is used, this finding increases to 79/165 (48). Decreased LVEF (LV systolic dysfunction) was seen in 57/165, (35) and was seen in significantly more men (42 versus 29, p < 0.01). Valvular disease was seen in 13/165, 8. Normal findings on echocardiography were found in 27/165 (16), more commonly in women (19 versus 8, p < 0.05) and younger patients (54 years versus 65 years, p < 0.05) and in only 10 if 12 mm is used for LV wall limit. LV hypertrophy was seen in 42 of patients (61 if 12 mm is used for LV wall limit) with systolic dysfunction. Thus, congestive cardiac failure with LV hypertrophy is the most frequent finding in this Afro-Caribbean population, with LV systolic dysfunction in only 35 of patients. These findings are consistent with possible diastolic LV dysfunction due to hypertension as the primary cause of cardiac failure in the population.