CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 19, ISSUE 5, SEP 2008
  1. Title: Significant changes in resuscitation guidelines : current and future recommendations? : editorial
    Authors: Kloeck, W.G.J.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 237-240
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    Abstract: Since the first description of cardiopulmonary resuscitation in 1960, a cumulative meta-analysis of published outcomes after pre-hospital cardiac arrest 40 years later showed that survival is still dismal, and is generally less than 6%. Furthermore, an analysis of mortality rates over a 19-year period has shown that survival rates have not been improving. Clearly, dramatic changes to recommendations on cardiovascular resuscitation need to be made.
     
  2. Title: Unique features of non-compaction of the ventricular myocardium in Arab and African patients : cardiovascular topics
    Authors: Ali, S.K.M.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 241-245
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    Abstract: Non-compaction of the ventricular myocardium (NCVM) is an under-diagnosed cardiomyopathy. Patients diagnosed with NCVM at the King Abdulaziz Cardiac Centre, Riyadh, KSA from January 2000 to July 2004 and at the Sudan Heart Centre from August 2004 to July 2007 were included. Fifty-two patients with NCVM were identified (22 per 10 000 echocardiograms). Patients were divided into three groups, namely, group 1 : isolated NCVM (21 patients), group 2 : NCVM associated with congenital heart disease (CHD) (26 patients), and group 3 : NCVM associated with mitral regurgitation (MR) (seven patients).
    Group 1 included 14 females and four males. Five patients (27%) had a positive family history with a lethal outcome in five other siblings; 14 patients (76%) presented with myocardial dysfunction and two had left ventricle thrombus. Group 2 included CHD; the most common pathologies were ventricular septal defects (VSD), pulmonary and tricuspid atresia and hypoplastic left heart syndrome. Sixteen patients (61%) had myocardial dysfunction, seven had surgical repair / palliation, and four (80%) developed serious post-operative complications. Group 3 included seven patients with MR associated with deformity of the anterior mitral leaflet and malcoaptation. Myocardial function was preserved in all patients with this pathology. In four patients of the whole cohort there was clinical as well as echocardiographic improvement. In two patients, left ventricular hypertrophy was noted. There were significantly more females in the group with isolated NCVM than in the group with associated CHD (p = 0.03, odds ratio = 4.2, 95% CI = 0.529-16.1).
    We presented the largest series of NCVM in our area and found it to be not as rare as was thought, with females being more affected. Spontaneous improvement and left ventricular hypertrophy were unique features, and mitral valve deformity leading to MR was an established association.
     
  3. Title: Cardiovascular effects of Helichrysum ceres S Moore [Asteraceae] ethanolic leaf extract in some experimental animal paradigms : cardiovascular topic
    Authors: Musabayane, C.T.; Kamadyaapa, D.R.; Gondwe, M.; Moodley, K.; Ojewole, J.A.O.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 246-253
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    Abstract: The aim of this study was to examine some in vivo and in vitro cardiovascular effects of Helichrysum ceres leaf ethanolic extract (HCE) in experimental animal paradigms. The acute effects of HCE on blood pressure were studied in anaesthetised normotensive male Wistar rats challenged with intravenous hypotonic saline infusion after a 3.5-hour equilibration for four hours of one-hour control, 1.5-hour treatment and 1.5-hour recovery periods. HCE was added to the infusate during the treatment period. Sub-chronic hypotensive effects of HCE were examined in weanling Dahl salt-sensitive (DSS) genetically hypertensive rats, which progressively develop hypertension with age, treated with HCE (80 mg / kg) every third consecutive day for seven weeks. isolated atrial muscle strips, portal veins and descending thoracic aortic rings of healthy normotensive Wistar rats were used to investigate the vascular effects of HCE.
    Acute HCE administration caused a significant (p < 0.05) fall in blood pressure in the normotensive anaesthetised Wistar rats. DSS hypertensive rats treated with HCE displayed low arterial blood pressure and heart rate values from weeks five to seven. HCE produced concentration-dependent negative inotropic and chronotropic effects on rat isolated electrically driven left, and spontaneously beating right atrial muscle preparations, respectively. HCE also evoked concentration-dependent relaxation responses of endothelium-intact aortic rings and portal veins isolated from healthy normotensive Wistar rats. The vasorelaxant effects of HCE in intact aortic rings were significantly reduced, but not completely abolished by adding endothelial-derived factor (EDRF) inhibitor, L-NAME, suggesting that the vasorelaxant effect of the extract is mediated via EDRF-dependent and independent mechanisms.
    The results of the study suggest that the hypotensive action of HCE is elicited, in part, directly by decreasing myocardial contractile performance and total peripheral vascular resistance due to its negative inotropic and chronotropic effects on rat isolated atrial muscle strips; and vasorelaxant effects on isolated vascular smooth muscles. The observed cardiovascular effects of HCE partly support the basis for its use in the management of high blood pressure in folkloric medicine.
     
  4. Title: The G-308A polymorphism of the TNF-α gene does not predict changes in cardiac function in response to medical therapy for idiopathic dilated cardiomyopathy : cardiovascular topic
    Authors: Brooksbank, R.; Badenhorst, D.; Sliwa, K.; Norton, G.; Woodiwiss, A.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 254-258
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    Abstract: The G-308A polymorphism of the tumour necrosis factor-α (TNF-α) gene, a variant that influences TNF-α transcription, may contribute to non-ischaemic dilated cardiomyopathy. To evaluate whether TNF-α genotyping may assist in identifying a subset of patients who could potentially benefit from immunomodulatory therapy, we assessed the relationship between the G-308A polymorphism of the TNF-α gene and changes in left ventricular (LV) chamber dimensions and systolic function in patients with idiopathic dilated cardiomyopathy (IDC) before and six months after diuretic, digoxin and angiotensin-converting enzyme inhibitor (ACEI) therapy.
    In 331 patients with IDC and 349 controls, the TNF-2 (A) allele (odds ratio = 1.509, 95% CI = 1.130-2.015, p < 0.01) and the TNF-12/22 (AG/GG) genotype (odds ratio = 1.620, 95% CI = 1.159-2.266, p < 0.01) were associated with IDC. However, in 122 patients with IDC, the TNF-α genotype was not associated with plasma TNF-α concentrations. In 133 patients with IDC, the TNF-α genotype failed to predict either the severity of pump dysfunction and cardiac dilatation at baseline, or changes in pump function and cardiac dimensions after six months of medical treatment.
    We conclude therefore that although the TNF-α gene G-308A polymorphism may contribute to the development of IDC, it does not influence pump function or adverse cardiac remodelling in patients with IDC. Genotyping for this variant is therefore unlikely to assist in identifying patients with heart failure who may be particularly susceptible to novel immunomodulatory therapeutic strategies.
     
  5. Title: Characterisation of left ventricular function by tissue Doppler imaging technique in newly diagnosed, untreated hypertensive subjects : cardiovascular topic
    Authors: Adebayo, A.K.; Oladapo, O.O.; Adebiyi, A.A.; Ogunleye, O.O.; Ogah, O.S.; Ojji, D.B.; Adeoye, M.A.; Ochulor, K.C.; Enakpene, E.O.; Falase, A.O.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 259-263
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    Abstract: Background : Hypertension results in structural and functional changes in the heart. Early detection of abnormalities of cardiac structure and function is important in the assessment and treatment of hypertensive subjects. The aim of this study was to evaluate the utility of the tissue Doppler echocardiographic technique in characterising diastolic and systolic functions in untreated native black African hypertensive subjects.
    Materials and methods : Forty consecutive, newly diagnosed, untreated hypertensives with adequate conventional echocardiographic (2-D, M-mode, transmitral and pulmonary Doppler flow velocities) and tissue Doppler echocardiographic images were recruited into the study. The control subjects were apparently normal individuals. Each arm of the study consisted of 21 male and 19 female subjects.
    Results : The two groups were comparable by age (48.6 ± 11.35 years in the hypertensives vs 48.1 ± 11.33 years in the controls; p = 0.844) and gender distribution (M/F: 21/19 in both groups). Other baseline characteristics, except for blood pressure parameters, which were predictably higher in the hypertensive subjects, were comparable between the two groups. The hypertensive subjects had a lower systolic myocardial velocity (Sm) and early diastolic myocardial velocity (Em) in comparison with the controls (p = 0.033 and p = 0.018, respectively). The late diastolic myocardial velocity (Am) was comparable in the two groups (p = 0.430).
    Conclusions : Tissue Doppler echocardiography demonstrates diastolic dysfunction relatively early in native African hypertensives and may be useful for detecting subtle deterioration in systolic function.
     
  6. Title: NT-proBNP and the diagnosis of exercise-induced myocardial ischaemia : cardiovascular topic
    Authors: De Greef, J.; Funk, M.; Vermaak, W.J.H.; Perumal, N.S.; Libhaber, C.D.; Vangu, M.

    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 264-267
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    Abstract: Background : Amino terminal pro-B-type natriuretic peptide (NT-proBNP) is a sensitive marker of ventricular dysfunction. Exercise causes an increase in the secretion of NT-proBNP, and with myocardial ischaemia the increase is more pronounced. This increase has been found to improve the diagnostic sensitivity of the stress ECG in diagnosing myocardial ischaemia in subjects with normal ventricular function.
    Objective : To assess whether the change in NT-proBNP can be used to diagnose effort-induced myocardial ischaemia in an unselected population.
    Methods : We enrolled a total of 51 consecutive patients, referred for exercise stress 99mTc-sestamibi SPECT MPI (single-photon emission computed tomography myocardial perfusion imaging) to diagnose inducible myocardial ischaemia. NT-proBNP was determined at rest and 30 minutes after cessation of exercise.
    Results : Of the 51 patients, 28 had normal perfusion scans, seven had scans with fixed perfusion defects (previous myocardial infarction with no inducible ischaemia) and 16 had reversible perfusion defects (inducible ischaemia). There was no correlation between ischaemia and resting NT-proBNP, post-stress NT-proBNP or the change in NT-proBNP (delta-NT-proBNP).
    Conclusion : In an unselected population the change in NT-proBNP cannot be used to diagnose effort-induced myocardial ischaemia.
     
  7. Title: Annulo-aortic ectasia with thoraco-abdominal aortic aneurysm in a case of dilated cardiomyopathy : case report
    Authors: Mukerjee, D.; Jesuraj, M.L.; Halder, S.K.; Islam, S.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 268-270
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    Abstract: We report on a case of idiopathic dilated cardiomyopathy with aortic aneurysm involving the aortic root and thoroco-abdominal aorta. This patient presented with exertional chest pain and backache radiating to both the upper limbs. His echocardiogram revealed dilated cardiomyopathy with mild to moderate aortic regurgitation and a hugely dilated aortic root. His angiogram showed normal coronary arteries, a dilated aortic root and thoroco-abdominal aortic aneurysm.
     
  8. Title: News from the 2008 ESC Congress : combination therapy with perindopril and amlodipine : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 271-272
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    Abstract: Evidence from recent key clinical trials supports the approach of using a combination of perindopril / amlodipine in patients with coronary artery disease (CAD) and either hypertension or symptoms of angina.
    This focused approach was discussed in a satellite symposium held during the European Society of Cardiology (ESC) Congress in Munich in September 2008, and evidence for this strategy was published in a supplement of the European Heart Journal.
     
  9. Title: Telmisartan shown to reduce cardiovascular death, myocardial infarction and stroke in ACE-intolerant high-risk patients
    Comment by Prof Brian Rayner, University of Cape Town : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 275
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    Abstract: The TRANSCEND study, using telmisartan, is the first long-term outcome study of angiotensin receptor blocker (ARB) therapy in a group of high-risk, ACE-intolerant patients and has shown telmisartan's positive benefits over a range of outcomes, including the composite of cardiovascular death, myocardial infarction and stroke. The study results were announced by Prof Teo Koon of Mc Master University, Hamilton, Canada during the hot-line session of the 2008 European Society of Cardiology Congress in Munich.
     
  10. Title: Elevated heart rate proven to increase coronary events
    Comment from South African experts attending the ESC Congress : drug trends in cardiology

    Authors: Aalbers, J.; Schamroth, C.; Rapeport, N.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 276-278
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    Abstract: Ivabradine, the only pure heart rate-reducing agent registered for anti-anginal and anti-ischaemic properties, has provided a unique opportunity to test and quantify the hypothesis that elevated heart rate increases cardiac risk. It has also highlighted its own value in the setting of increased heart rate.
     
  11. Title: Mild-to-moderate aortic stenosis not improved by lipid-lowering therapy : SEAS study : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 280-282
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    Abstract: Long-term, intensive lipid-lowering therapy using simvastatin and ezetimibe in patients with aortic stenosis failed to show overall benefits on the course of aortic stenosis. However, the risk of ischaemic cardiovascular events was reduced, especially the need for coronary artery bypass surgery, in the ezetimibe-treated patients who had no traditional indications for lipid-lowering therapy.
     
  12. Title: Rimonabant improves weight and glycaemic control : first oral antidiabetic therapy in newly diagnosed type 2 diabetics : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 282-283
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    Abstract: The results of the SERENADE trial, initially reported on at the International Diabetes Federation meeting in Cape Town last year, have now been published and confirm the value and safety of rimonabant usage in lowering cardiovascular risk factors in overweight men and women with type 2 diabetes.
     
  13. Title: Vascular and renal benefits are additive using intensive blood pressure control and incremental glucose control in type 2 diabetic patients
    Comment from attending South African experts : drug trends in cardiology

    Authors: Aalbers, J.; Amod, A.; Distiller, L.; Mollentze, W.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 284, 286
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    Abstract: The results of the ADVANCE trial studying the effect of the interaction between the two interventions (intensive glucose lowering with modified-release gliclazide and fixed combination of perindopril and indapamide) were released at the European Association for the Study of Diabetes (EASD) on Monday, 8 September.
     
  14. Title: Cardio news
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
    Pages: 287-288
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    Abstract: Clinics Cardive and advisory group meet in Cape Town
    Launch of Vanguard site targeting RF / RHD in Africa
    AstraZenec shows its heart through World Heart Day art competition
     
  15. Title: Chronic heart failure : diagnosis & treatment algorithm : leaflet
    From: Cardiovascular Journal of Africa, Vol 19, Issue 5, Sep / Oct
    Published: 2008
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    Abstract:
    * Ideal for the primary-care practitioner
    * With South African and African case studies
    * Printed versions available from Pharma Dynamics, email r.moult@pharmadynamics.co.za
    * Electronically available on www.cvja.co.za
    * Sponsored by the Cardiovascular Journal of Africa
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