Abstract 4370244: Prevalence of Common ECG Findings in a Typical East African Cohort

Abstract

Introduction/Background: People with HIV (PWH) in high-income countries experience an increased risk of ischemic heart disease and arrythmia. Little is known, though, about the relative frequency of electrocardiogram (ECG) abnormalities in PWH on modern ART in Africa. Research Questions: What is the prevalence of standard ECG findings in a typical East African population of PWH compared to HIV-uninfected community controls and test characteristics of ECG criteria for left ventricular hypertrophy (LVH)? Methods: We conducted a cross-sectional analysis of baseline ECG data from an ongoing prospective cohort of PWH and HIV-uninfected community controls enrolled from three public HIV clinics in Tanzania (the Mwanza HIV&CVD Cohort). ECGs were coded by a cardiologist blinded to the patient’s clinical characteristics. LVH ECG criteria were compared to evidence of LVH on transthoracic echocardiogram (TTE). The prevalence of ECG findings in PWH and HIV-uninfected were compared using a chi-square test. Results: Of 1000 participants enrolled between March 2022 and May 2023, 999 had ECG completed (500 PWH and 499 HIV-uninfected). The median age was 44 years [IQR 38-50] and 69.8% were female. Among PWH, all participants had been on a combination of tenofovir, lamivudine, and dolutegravir for at least 3 months and 98% were virologically suppressed. The prevalence of hypertension according to office blood pressure was 13.4%. Sinus bradycardia was common in this population and more so in PWH (37.2%) vs. community controls (30.7%, p = 0.029) (Table 1). Atrial premature contractions were more common in HIV-uninfected (5.2% vs 1.2% in PWH, p = 0.048) while changes of anterior ischemia were more common in PLH (2.8% vs 0.8% in community controls, p = 0.018). ECG criteria for LVH had low sensitivity but high specificity when compared to TTE (for any level of LVH, sensitivity by specific ECG criteria ranged from 0 to 19.6% with specificity ranging from 89.7% to 99.6%) (Table 2). Conclusion: Sinus bradycardia, 1 st degree AV block, LVH, and atrial premature contractions were the most common ECG abnormalities observed in this East African population. PWH had more sinus bradycardia and anterior ischemia but less atrial premature contractions. ECG criteria for LVH had low sensitivity but high specificity. These findings will inform the clinical care of similar patients in the future, as baseline prevalence of these findings in East African populations is unknown.