¹ ³F KAMDEM; ² ⁵ P VAN DE BORNE ; ¹ ³Y  MAPOURE;

 ⁶C NJOMOU;  ¹ ⁴ H  N. LUMA; ² ³ D LEMOGOUM.

1.Service de Médecine Interne et Spécialités, Hôpital Général de Douala,

2. Service de Cardiologie, Hôpital Erasme – Bruxelles,

3. Faculté de Médecine et des Sciences Pharmaceutiques – Université de Douala, 

4 Faculté de Médecine et des Sciences Biomédicales  - Université de Yaoundé I, 

5 Université Libre de Bruxelles, 6 Faculté des Sciences de la Santé- Université des Montagnes.

Addresse pour correspondance: Dr Kamdem Félicité, Email: Cette adresse e-mail est protégée contre les robots spammeurs. Vous devez activer le JavaScript pour la visualiser.

Background: Increased aortic stiffness (AS), a marker of Early Vascular Aging (EVA), is an independent determinant of acute and long-term stroke mortality, especially in Caucasian patients. Whether aortic pulse wave velocity (PWV), a direct marker of AS, and augmentation index (AI), a surrogate measure of AS,are related to mortality in acute stroke in black African patients has been poorly investigated. Therefore, the aim of our study was to evaluate the prognostic impact of PWV and AI, both biomarkers of EVA on mortality in Cameroonian patients with acute stroke.

Methods: We prospectively enrolled 138 patients who were admitted with acute stroke in the two main public teaching hospitals of Douala town, Cameroon (53.9 % females, mean age: 64± 13 years). The severity of stroke was assessed on admission with the National Institutes of Health Stroke Scale (NIHSS) score. Heart rate (HR), central blood pressures (BP), AI corrected for HR (AIx) and aortic PWV were measured (SphygmoCor) ≤one week following stroke onset. The outcome was evaluated at discharge with in-hospital mortality and after discharge with community mortality within 30 days following stroke onset.

Results: BP did not differ between those who died vs. those who survived (p>0.05). PWV was faster in patients with NIHSS score>14 as compared to those with NIHSS score ≤ 14 on admission: 10.7±2.3 m/s vs 9. 7 ± 1.9 m/s, P=0.012. PWV and AIx were greater in those who died vs. those who survived: 10.9±2.2 m/s vs 9.7 ± 1.9 m/s (PWV; P=0.0022) and 31 ± 12% vs 26±12%, (AIx; P=0.023), respectively. PWV increased markedly with aging, but to a larger extend in patients who died as compared to those who survived (P=0,014). Importantly, aged-adjusted PWV≥10 m/s was strongly associated with early and high mortality rate as compared to participants with PWV<10 m/s (P=0,006). AIx increased significantly with aging to a comparable extend in both two groups (P=0.5). Multivariate regression analysis revealed that PWV≥ 10 m/s, diabetes mellitus, Glasgow score≤8 and NIHSS score>14, were independent predictors of mortality during acute stroke in our study population.

Conclusion: Increased aortic PWV is associated with early and high mortality rate in black Cameroonian patients with acute stroke; independently of other know prognostic factors. Our results suggest that EVA may be a potential underlying mechanism explaining severe burden of stroke in black African ancestry.

Key words: Early vascular aging, pulse wave velocity, augmentation index, mortality, stroke.