Background: The electrocardiogram (ECG) and Doppler transthoracic echocardiography (TTE) remain key diagnostic tools that also help identify the etiology, assess severity and guide the therapeutic strategy for heart failure. This study aimed to characterize sex-specific electrocardiographic and echocardiographic profiles among patients admitted for heart failure. Methods: We conducted a retrospective descriptive study at Central Hospital of Yaoundé, including all adults aged ≥18 years hospitalized for heart failure between September 2022 and April 2024. Data from resting surface ECGs and Doppler TTEs performed during hospitalization were extracted from medical records. Results: We included 397 patients: 230 women [F] vs 167 men [M] with heart failure. Smoking was more frequent in men (19.8%) than in women (6.09%) (p < 0.001), as well as alcohol use (3.2% vs 0.5%, p < 0.001). On ECG, sinus rhythm predominated without a significant sex difference (73.8% in men vs 66.8% in women; p = 0.10), with a similar median heart rate (87 vs 87.5 bpm; p = 0.50). The most frequent arrhythmia was atrial fibrillation (8.2% in women vs 7.7% in men; p = 0.06), followed by left bundle branch block (2.6% vs 4.1%; p = 0.20), with no significant differences. On TTE, only right atrial dilatation differed significantly (23.4% in women vs 11.3% in men; p = 0.03). We observed left ventricular remodeling (16.5% vs 16.7%; p = 0.60), left ventricular hypertrophy (12.6% vs 11.9%; p = 0.90), right ventricular hypertrophy (1.3% vs 2.9%; p = 0.40), left ventricular dilation (8.6% vs 8.9%; p = 0.80), and right ventricular dilation (36.6% vs 51.9%; p = 0.20) without significant sex differences. Left ventricular ejection fraction (LVEF) was mostly reduced (20.5%), with a comparable distribution between sexes (p = 0.70), and right ventricular systolic dysfunction was rare (2%) with no significant difference (p = 0.20). Conclusion: Among hospitalized patients with heart failure, electrocardiographic and echocardiographic profiles were broadly similar between sexes, except for Doppler echocardiography evidence of right atrial dilation, which was more frequent in women. On ECG, sinus rhythm predominated; on TTE, LVEF was mostly reduced.
References
[1]
Savarese, G., Becher, P.M., Lund, L.H., Seferovic, P., Rosano, G.M.C. and Coats, A.J.S. (2022) Global Burden of Heart Failure: A Comprehensive and Updated Review of Epidemiology. Cardiovascular Research, 118, 3272-3287. https://doi.org/10.1093/cvr/cvac013
[2]
Agbor, V.N., Essouma, M., Ntusi, N.A.B., Nyaga, U.F., Bigna, J.J. and Noubiap, J.J. (2018) Heart Failure in Sub-Saharan Africa: A Contemporaneous Systematic Review and Meta-Analysis. International Journal of Cardiology, 257, 207-215. https://doi.org/10.1016/j.ijcard.2017.12.048
[3]
Kingue, S., Dzudie, A., Menanga, A., Akono, M., Ouankou, M. and Muna, W. (2005) A New Look at Adult Chronic Heart Failure in Africa in the Age of the Doppler Echocardiography: Experience of the Medicine Department at Yaounde General Hospital. Annales de Cardiologie et d’Angéiologie, 54, 276-283. https://doi.org/10.1016/j.ancard.2005.04.014
[4]
Nganou-Gnindjio, C.N., Awah Epoupa, R.A., Wafeu Sadeu, G., Tchapmi Njeunje, D.P., Endomba Angong, F.T. and Menanga, A.P. (2021) Seasonal Variation of Decompensated Heart Failure Admissions and Mortality Rates in Sub-Saharan Africa, Cameroon. Annales de Cardiologie et d’Angéiologie, 70, 148-152. https://doi.org/10.1016/j.ancard.2021.04.002
[5]
Hamadou, B., Ngweth, M.N., Fotso, M.M., Mfeukeu-Kuate, L., Jingi, A.M., Noubiap, J.J., et al. (2017) Echocardiographic and Electrocardiographic Abnormalities in Adults Living with Human Immunodeficiency Virus: A Cross-Sectional Study in the Yaoundé Central Hospital, Cameroon. Cardiovascular Diagnosis and Therapy, 7, 607-615. https://doi.org/10.21037/cdt.2017.10.12
[6]
McDonagh, T.A., Metra, M., Adamo, M., Gardner, R.S., Baumbach, A., Böhm, M., et al. (2021) ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. European Heart Journal, 42, 3599-3726.
[7]
Behnoush, A.H., Khalaji, A., Naderi, N., Ashraf, H. and von Haehling, S. (2022) ACC/AHA/HFSA 2022 and ESC 2021 Guidelines on Heart Failure Comparison. ESC Heart Failure, 10, 1531-1544. https://doi.org/10.1002/ehf2.14255
[8]
Whitbeck, M.G., Charnigo, R.J., Shah, J., Morales, G., Leung, S.W., Fornwalt, B., et al. (2013) QRS Duration Predicts Death and Hospitalization among Patients with Atrial Fibrillation Irrespective of Heart Failure: Evidence from the AFFIRM Study. Europace, 16, 803-811. https://doi.org/10.1093/europace/eut335
[9]
Hawkins, N.M., Wang, D., McMurray, J.J.V., Pfeffer, M.A., Swedberg, K., Granger, C.B., et al. (2006) Prevalence and Prognostic Implications of Electrocardiographic Left Ventricular Hypertrophy in Heart Failure: Evidence from the CHARM Programme. Heart, 93, 59-64. https://doi.org/10.1136/hrt.2005.083949
[10]
Aguiló, O., Castells, X., Miró, Ò., Mueller, C., Chioncel, O. and Trullàs, J.C. (2022) The Prognostic Significance of Bundle Branch Block in Acute Heart Failure: A Systematic Review and Meta-Analysis. Clinical Research in Cardiology, 112, 1020-1043. https://doi.org/10.1007/s00392-022-02105-z
[11]
Pender, A., Lewis-Owona, J., Ekiyoyo, A. and Stoddard, M. (2025) Echocardiography and Heart Failure: An Echocardiographic Decision Aid for the Diagnosis and Management of Cardiomyopathies. Current Cardiology Reports, 27, Article No. 64. https://doi.org/10.1007/s11886-025-02194-y
[12]
Lam, C.S.P., Arnott, C., Beale, A.L., Chandramouli, C., Hilfiker-Kleiner, D., Kaye, D.M., et al. (2019) Sex Differences in Heart Failure. European Heart Journal, 40, 3859-3868c. https://doi.org/10.1093/eurheartj/ehz835
[13]
Kaur, G. and Lau, E. (2022) Sex Differences in Heart Failure with Preserved Ejection Fraction: From Traditional Risk Factors to Sex-Specific Risk Factors. Women’s Health, 18, 1-11. https://doi.org/10.1177/17455057221140209
[14]
Yilmaz, R. and Öz, E. (2023) Comparison of Electrocardiographic Parameters by Gender in Heart Failure Patients with Preserved Ejection Fraction via Artificial Intelligence. Diagnostics, 13, Article No. 3221. https://doi.org/10.3390/diagnostics13203221
[15]
Bloomfield, G.S., Barasa, F.A., Doll, J.A. and Velazquez, E.J. (2013) Heart Failure in Sub-Saharan Africa. Current Cardiology Reviews, 9, 157-173. https://doi.org/10.2174/1573403x11309020008
[16]
Sokolow, M. and Lyon, T.P. (1949) The Ventricular Complex in Left Ventricular Hypertrophy as Obtained by Unipolar Precordial and Limb Leads. American Heart Journal, 37, 161-186. https://doi.org/10.1016/0002-8703(49)90562-1
[17]
Ponikowski, P., Voors, A.A., Anker, S.D., Bueno, H., Cleland, J.G.F., Coats, A.J.S., et al. (2016) 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) Developed with the Special Contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 37, 2129-2200. https://doi.org/10.1093/eurheartj/ehw128
[18]
Ntusi, N.B. and Mayosi, B.M. (2009) Epidemiology of Heart Failure in Sub-Saharan Africa. Expert Review of Cardiovascular Therapy, 7, 169-180. https://doi.org/10.1586/14779072.7.2.169
[19]
Stewart, S., Wilkinson, D., Hansen, C., Vaghela, V., Mvungi, R., McMurray, J., et al. (2008) Predominance of Heart Failure in the Heart of Soweto Study Cohort: Emerging Challenges for Urban African Communities. Circulation, 118, 2360-2367. https://doi.org/10.1161/circulationaha.108.786244
[20]
Dzudie, A., Barche, B., Nkoke, C., Ngatchuesi, V.G., Ndom, M.S., Mouliom, S., et al. (2022) Survival Rate and Predictors of 36-Month Mortality in Patients with Heart Failure in Sub Saharan Africa: Insights from the Douala Heart Failure Registry (Do-HF). Cardiovascular Diagnosis and Therapy, 12, 577-588. https://doi.org/10.21037/cdt-22-166
[21]
Redfield, M.M. (2016) Heart Failure with Preserved Ejection Fraction. New England Journal of Medicine, 375, 1868-1877. https://doi.org/10.1056/nejmcp1511175
[22]
Redfield, M.M. and Borlaug, B.A. (2023) Heart Failure with Preserved Ejection Fraction: A Review. JAMA, 329, 827-838. https://doi.org/10.1001/jama.2023.2020
[23]
Zaidi, A., Knight, D.S., Augustine, D.X., Harkness, A., Oxborough, D., Pearce, K., et al. (2020) Echocardiographic Assessment of the Right Heart in Adults: A Practical Guideline from the British Society of Echocardiography. Echo Research & Practice, 7, G19-G41. https://doi.org/10.1530/erp-19-0051
[24]
Rudski, L.G., Lai, W.W., Afilalo, J., Hua, L., Handschumacher, M.D., Chandrasekaran, K., et al. (2010) Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 23, 685-713. https://doi.org/10.1016/j.echo.2010.05.010
[25]
Aune, D., Schlesinger, S., Norat, T. and Riboli, E. (2018) Tobacco Smoking and the Risk of Heart Failure: A Systematic Review and Meta-Analysis of Prospective Studies. European Journal of Preventive Cardiology, 26, 279-288. https://doi.org/10.1177/2047487318806658
[26]
Lee, H. and Son, Y. (2019) Influence of Smoking Status on Risk of Incident Heart Failure: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. International Journal of Environmental Research and Public Health, 16, Article No. 2697. https://doi.org/10.3390/ijerph16152697
[27]
Piano, M. (2017) Alcohol’s Effects on the Cardiovascular System. Alcohol Research: Current Reviews, 38, 219-241. https://doi.org/10.35946/arcr.v38.2.06
[28]
Rasoul, D., Ajay, A., Abdullah, A., Mathew, J., En, B.L.W., Mashida, K., et al. (2023) Alcohol and Heart Failure. European Cardiology Review, 18, e65. https://doi.org/10.15420/ecr.2023.12
[29]
Tsang, T.S.M., Abhayaratna, W.P., Barnes, M.E., Miyasaka, Y., Gersh, B.J., Bailey, K.R., et al. (2006) Prediction of Cardiovascular Outcomes with Left Atrial Size: Is Volume Superior to Area or Diameter? Journal of the American College of Cardiology, 47, 1018-1023. https://doi.org/10.1016/j.jacc.2005.08.077
[30]
Hoit, B.D. (2014) Left Atrial Size and Function. Journal of the American College of Cardiology, 63, 493-505. https://doi.org/10.1016/j.jacc.2013.10.055
[31]
Cleland, J.G.F., Daubert, J., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005) The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure. New England Journal of Medicine, 352, 1539-1549. https://doi.org/10.1056/nejmoa050496
[32]
Moss, A.J., Hall, W.J., Cannom, D.S., Klein, H., Brown, M.W., Daubert, J.P., et al. (2009) Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events. New England Journal of Medicine, 361, 1329-1338. https://doi.org/10.1056/nejmoa0906431
[33]
Lang, R.M., Badano, L.P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. (2015) Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28, 1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003
[34]
Casale, P.N., Devereux, R.B., Kligfield, P., Eisenberg, R.R., Miller, D.H., Chaudhary, B.S., et al. (1985) Electrocardiographic Detection of Left Ventricular Hypertrophy: Development and Prospective Validation of Improved Criteria. Journal of the American College of Cardiology, 6, 572-580. https://doi.org/10.1016/s0735-1097(85)80115-7
[35]
Hanna, E.B., Glancy, D.L. and Oral, E. (2010) Sensitivity and Specificity of Frequently Used Electrocardiographic Criteria for Left Ventricular Hypertrophy in Patients with Anterior Wall Myocardial Infarction. Baylor University Medical Center Proceedings, 23, 15-18. https://doi.org/10.1080/08998280.2010.11928573
[36]
Su, F., Li, Y., Lin, Y., Lee, C., Wang, C., Meng, F., et al. (2017) A Comparison of Cornell and Sokolow-Lyon Electrocardiographic Criteria for Left Ventricular Hypertrophy in a Military Male Population in Taiwan Region: The Cardiorespiratory Fitness and Hospitalization Events in Armed Forces Study. Cardiovascular Diagnosis and Therapy, 7, 244-251. https://doi.org/10.21037/cdt.2017.01.16
