CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 19, ISSUE 6, NOVEMBER 2008
  1. Title: From the Editor's Desk
    Authors: Brink, A.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 291
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    Abstract: The Cardiovascular Journal of South Africa (CVJSA) has made unprecedented strides in the past 18 months, based on steady progress since its inception in 1989.
    In October 2007 the Journal became the Cardiovascular Journal of Africa (CVJA), incorporating the CVJSA, in issue 5 of volume 18. It is now widely visible, not only in Africa, but also in North America, Europe and the Middle East.
    Currently, both CVJSA and CVJA are recorded in databases by their printed and on-line ISSN numbers for indexing and listing purposes. These data can be retrieved and viewed, providing an integrated statistical history, some of which will be reflected for the month of September 2008 on page 308 in this issue.
     
  2. Title: A randomised, controlled, double-blind, cross-over pilot study assessing the effects of spironolactone, losartan and their combination on heart rate variability and QT dispersion in patients with chronic heart failure : cardiovascular topic
    Authors: Shehab, A.; Elnour, A.A.; Struthers, A.D.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 292-296
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    Abstract: Background and objective : The blocking of aldosterone or angiotensin II receptors improves mortality in patients with chronic heart failure. We explored whether combining losartan and spironolactone would have any added benefit on the known surrogate of mortality by using heart rate variability (HRV) and QT dispersion as our endpoints.
    Methods : We designed a three-phase, consecutive, randomised, controlled, double-blind, cross-over pilot study to assess the effects of losartan alone (50 mg / day), spironolactone (25 mg / day) with angiotensin converting enzyme (ACE) inhibitor and, finally, losartan with spironolactone, on HRV and QT dispersion. We enrolled eight patients (aged 47 to 72 years, mean = 63.7 years), with New York Heart Association (NYHA) class II-III heart failure and ejection fraction (EF) < 35%, in the study at a university-affiliated hospital in Dundee, Scotland. Digital 24-hour Holter recordings were analysed for time-domain HRV and the 12-lead ECG was optically scanned and digitised for analysis of QT dispersion. Evaluations were done at baseline, and at six, 12 and 18 weeks from baseline.
    Results : Losartan and spironolactone showed statistically significant, favourable effects on HRV, QT dispersion and mean heart rate (p < 0.05).
    Conclusion : The data showed that in these patients with heart failure, the addition of spironolactone to an ACE inhibitor, or the use of losartan on its own, or the combination of losartan plus spironolactone induced a favourable sympathovagal balance. The drugs significantly improved HRV indices and QT dispersion further, and the combination appeared to be safe. However, no significant differences were seen between the effects of each of these regimes on HRV and QT dispersion.
     
  3. Title: In-hospital and mid-term adverse clinical outcomes of a direct stenting strategy versus stenting after predilatation for the treatment of coronary artery lesions : cardiovascular topic
    Authors: Alidoosti, M.; Salarifar, M.; Kassaian, S.E.; Zeinali, A.M.H.; Fathollahi, M.S.; Dehkordi, M.R.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 297-302
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    Abstract: Background : Direct stenting without balloon dilatation may reduce procedural costs and duration, and hypothetically, the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after pre-dilatation (PS) in our routine clinical practice.
    Methods : The 1 603 patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours, and those with highly calcified lesions, total occlusions, or a lesion in a saphenous graft were excluded. The baseline, angiographic and procedural data, in-hospital outcomes and follow-up data were recorded in our database and analysed with appropriate statistical methods.
    Results : Eight hundred and fifty-seven patients (53.5%) were treated with DS and 746 (46.5%) underwent PS. In the DS group, lesions were shorter in length, larger in diameter and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were found less often (p < 0.001). With univariate analysis, dissection and non-Q-wave MI occurred less frequently in this group (0.2 and 0.6% vs 3.9 and 2.1%, p < 0.001 and p = 0.01, respectively). However, the cumulative major adverse cardiac events (MACE) did not differ significantly (4.9 vs 4.6%, p = 0.79). With multivariate analysis, direct stenting reduced the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33, but neither the cumulative endpoint of MACE (OR = 1.1, 95% CI = 0.58-2.11, p = 0.7) nor its constructing components were different between the groups.
    Conclusions : Direct stenting in the real world has at least similar long-term outcomes in patients treated with stenting after pre-dilatation, and is associated with lower dissection rates.
     
  4. Title: William Nelson ECG quiz
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 302, 310
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    Abstract: This is the ECG of a 73-year-old man.
    Rhythm? How many MIs?
     
  5. Title: Validation of a model to predict all-cause in-hospital mortality in vascular surgical patients : cardiovascular topic
    Authors: Biccard, B.M.; Pooran, R.R.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 303-308
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    Abstract: Objective : To develop and validate a pre- and postoperative model of all-cause in-hospital mortality in South African vascular surgical patients.
    Methods : We carried out a retrospective cohort study. A multivariate analysis using binary logistic regression was conducted on a derivation cohort using clinical, physiological and surgical data. Interaction and colinearity between covariates were investigated. The models were validated using the Homer-Lemeshow goodness-of-fit test.
    Results : Independent predictors of in-hospital mortality in the pre-operative model were : (1) age (per one-year increase) [odds ratio (OR) 1.03, 95% confidence interval (CI) 1.0-1.06), (2) creatinine > 180 µmol.l-1 (OR 6.43, 95% CI: 3.482-11.86), (3) chronic beta-blocker therapy (OR 2.48, 95% CI: 1.38-4.48), and (4) absence of chronic statin therapy (OR 2.81, 95% CI: 1.15-6.83). Independent predictors of mortality in the postoperative model were: (1) age (per one-year increase) (OR 1.05, 95% CI: 1.02-1.09), (2) creatinine > 180 µmol.l-1 (OR 5.08, 95% CI: 2.50-10.31), (3) surgery out of hours without statin therapy (OR 8.27, 95% CI: 3.36-20.38), (4) mean daily postoperative heart rate (HR) (OR 1.02, 95% CI: 1.0-1.04), (5) mean daily postoperative HR in the presence of a mean daily systolic blood pressure of less than 100 beats per minute or above 179 mmHg (OR 1.02, 95% CI: 1.01-1.03) and (6) mean daily postoperative HR associated with withdrawal of chronic beta-blockade (OR 1.02, 95% CI: 1.01-1.03). Both models were validated.
    Conclusion : The pre-operative model may predict the risk of in-hospital mortality associated with vascular surgery. The postoperative model may identify patients whose risk increases as a result of surgical or physiological factors.
     
  6. Title: Readership survey on CVJA
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 308
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    Abstract: The Cardiovascular Journal of Africa (CVJA), incorporating the Cardiovascular Journal of South Africa, is widely read locally and internationally.
     
  7. Title: FDG-PET and MIBI-Tc SPECT as follow-up tools in a patient with cardiac sarcoidosis requiring a pacemaker : case report
    Authors: Smedema, J.P.; White, L.; Klopper, A.J.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 309-310
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    Abstract: A 63-year-old man presented with recent-onset symptoms secondary to third-degree atrio-ventricular block, for which a dual-chamber pacemaker was inserted. Additional investigations resulted in the diagnosis of cardiac sarcoidosis. FDG-PET and MIBI-technetium SPECT were used as follow-up tools for monitoring active granulomatous myocardial infiltration.
     
  8. Title: Ischaemic postconditioning : from bench to bedside ... : review article
    Authors: Van Vuuren, D.; Lochner, A.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 311-320
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    Abstract: The increase in the incidence of ischaemic heart disease and acute myocardial infarction (AMI) in both high- and low-income countries necessitates the development of myocardial salvaging / protection interventions, to be applied alongside standard reperfusion therapies. Although the phenomenon of ischaemic preconditioning (IPC) is associated with the desired protective capacity, the necessity of its application before sustained ischaemia limits its clinical potential.
    The recently described phenomenon of postconditioning (postC), or short cycles of reperfusion / ischaemia applied at the onset of reperfusion, falls within the clinically relevant time period of reperfusion, but can it elicit reliable and potent cardioprotection? The answer to this problem is intimately related to the question whether postC can be translated from a laboratory technique to a clinical therapy.
    In this brief overview of postconditioning, the experimental set-ups and postC algorithms utilised, and their associated outcomes in all animal models studied (dog, rabbit, mouse, rat and pig) are discussed. The therapeutic potential of postC is also addressed by discussing reported preliminary studies on the efficacy and feasibility of postC (both ischaemic and pharmacological) in humans.
     
  9. Title: Hatter Institute Cardiac Horizons series : in my opinion
    Authors: Hitzeroth, J.; Hendricks, N.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 321-323
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    Abstract: We recently had the privilege of attending the Hatter Institute Cardiac Horizons lectures. Among the prestigious panel of speakers were Profs Yellon, Opie and Commerford, who shed some light on two of the most common conditions cardiologists treat on a daily basis : acute myocardial infarction (AMI) and congestive cardiac failure (HF). Prof Schwartz provided some insights on sudden cardiac death and the long QT (LQT) syndrome.
     
  10. Title: Letters to the Editor
    Response to Dr A Bonny, et al.
    Authors: Bonny, A.; Yitemben, I.D.M.; Hamdaoui, B.; Larrazet, F.; Aalbers, J.L.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 323-324
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    Abstract: Referring to the BEAUTIfUL study, we would like to point out why adding ivabradine in the management of stable coronary artery disease with left ventricular dysfunction is worthless.
    Ivabradine failed to reduce the primary composite endpoint : cardiovascular death, admission to hospital for acute myocardial infarction and admission to hospital for new-onset or worsening heart failure.
     
  11. Title: Heparin-induced thrombocytopaenia : cardiovascular prescriber
    Authors: Gounden, R.; Blockman, M.
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 325-327
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    Abstract: Heparin-induced thrombocytopaenia (HIT) is an acquired, transient prothrombotic disorder caused by heparin. The predominant problem is the creation of a prothrombotic milieu, accompanied by a fall in the platelet count. This explains the apparent paradox of thrombosis in the face of thrombocytopaenia and why non-heparin antithrombotic agents are integral to its management.
     
  12. Title: Jump on the bus of opportunity : cardio news
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 327
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    Abstract: PACE, the support organisation for patients with arrhythmias, hit the fast lane at the recent South African Heart Congress, with a presentation on its 2009 plans to interested pharmaceutical industry stakeholders. PACE CEO, Lusan Luscombe and Franciska du Toit from Medical Society Management described the achievements of the past few years, which include the development of five regional contract offices in Cape Town, Johannesburg, Bloemfontein, Port Elizabeth and Durban, and the development of their website (www.paceafrica.org.za) lobbying Parliament and medical aid funders for improved facilities and care for patients.
     
  13. Title: Impact of recent trial results on cardiovascular risk management (Hatter Institute Cardiac Horizons series) : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 328, 330-331
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    Abstract: 'Results of recent clinical trials from this year's major international cardiology meetings are challenging the way we treat our patients at risk of experiencing adverse cardiovascular events.' This view was expressed by Dr Colin Schamroth and Dr Naomi Rapeport and substantiated during two thought-provoking presentations at the annual Hatter Institute cardiology registrars' symposium, held in association with Servier Laboratories.
     
  14. Title: 2009 PASCAR Conference, Nigeria
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 331
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    Abstract: We are planning the 2009 Pan-African Society of Cardiology (PASCAR) conference, which will be held in Abuja, Nigeria, from 26-30 September 2009.
     
  15. Title: Low-risk older patients (50 years and older) with raised high-sensitivity CRP (hs-CRP) benefit from rosuvastatin therapy : the JUPITER study
    A South African expert comments on the JUPITER study : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 332-335
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    Abstract: The JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) study, which tested the role of underlying low-grade inflammation using the determination of high-sensitivity C-reactive protein levels (hs-CRP) as the differential of additional risk in an otherwise healthy population, has shown that statin therapy using rosuvastatin significantly reduced the incidence of major cardiovascular events.
     
  16. Title: Heart failure patients with preserved left ventricular ejection fraction did not benefit from additional ARB therapy : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 337-339
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    Abstract: The addition of an angiotensin receptor blocker (ARB), irbesartan, to the normal treatment therapy of heart failure patients who had a left ventricular ejection fraction (LVEF) of at least 45% did not improve outcomes in this difficult-to-treat patient group (Fig. 1).
    Currently, there is no specific evidence-based therapy for this group of patients who typically, according to both registry and community-based studies, tend to be older, overweight females who have a history of hypertension, rather than ischaemia and heart failure symptoms. These patients are frequently also diabetic and have atrial fibrillation (Table 1).
  17. Title: SA Heart 2008 : cardio news
    From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov / Dec
    Published: 2008
    Pages: 340
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    Abstract: The recent South African Heart Congress, held at the Wild Coast Sun from 2-5 November, proved to be a tremendous success, with 16 international guests and 1 200 delegates.
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