CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 27, ISSUE
5, SEPT/OCT 2016
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- Title: From the Editor’s Desk:
Out-of-hospital cardiac arrest
Authors: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 275
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Abstract: Terminology may drive our perceptions of activities and our actions in response to the events we see occurring around us. Is it time to take the P (pulmonary) out of CPR (cardiopulmonary resuscitation) when referring to witnessed out-of-hospital cardiac arrests (OHCA)? I was prompted to consider this when I was personally involved in resuscitation of an individual who suffered an out-of-hospital cardiac arrest when walking his dog, as I was walking mine, in a park near our home. He collapsed a few metres in front of me, immediately after tossing a ball for his dog to chase, and when I examined him he was wheezing, cyanosed and pulseless.
- Title: Pre-anesthetic
echocardiographic findings in children
undergoing non-cardiac surgery at the University
of Benin Teaching Hospital, Nigeria
Authors:WE Sadoh, P Ikhurionan, C Imarengiaye
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 276-280
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DOI Number:10.5830/CVJA-2016-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-006
Background: A pre-anaesthestic echocardiogram (echo) is requested for most non-cardiac surgeries to identify possible cardiac structural anomalies.
Objective: To describe the prevalence and spectrum of structural cardiac abnormalities seen in various non-cardiac conditions.
Methods: We carried out a retrospective review of pre-anaesthetic echos performed over five years on children scheduled for non-cardiac surgery. The requests were categorised according to referring specialities, and the biodata and echo findings were noted.
Results: A total of 181 children and 181 echocardiograms were studied, and 100 (55.2%) of the patients were male. Most of the children (87, 48.1%) with oro-facial clefts were referred from dentistry. Of the 181 children, 39 (21.5%) had cardiac abnormalities, most (34, 87.2%) of whom had congenital heart disease (CHD). Ophthalmic requests with suspected congenital rubella syndrome (CRS) had the highest prevalence of 8/12 (66.7%) while the lowest was oro-facial clefts at 15/87 (17.2%). Atrial septal defect was the commonest abnormality, found in 14 patients (35.9%).
Conclusion: Pre-anaesthetic echo should be performed, especially for children with suspected CRS and other congenital anomalies, requiring non-cardiac surgery.
- Title: Gender-based differences in the relationship between fatty
liver disease and atherosclerosis
Authors: H-J Kim, C-W Lim, JH Lee, H-B Park, Y Suh, Y-H Cho, T-Y Choi, E-S Hwang, D-K Cho
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 281-286
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DOI Number:10.5830/CVJA-2016-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-014
Background: Carotid intima–media thickness (CIMT) is a surrogate of subclinical atherosclerosis. Fatty liver disease is also linked to increased risk of cardiovascular events. The aim of this study was to evaluate the association between fatty liver disease and CIMT according to gender.
Methods: Patients who had undergone carotid and abdominal ultrasound between June 2011 and December 2013 were retrospectively evaluated. The differences between the CIMT values measured in the common carotid artery and the prevalence of carotid plaque in patients with fatty liver disease and those with normal livers were investigated.
Results: Out of a total of 1 121 patients, the men had more fatty liver disease than the women. The mean CIMT of the men was significantly higher than that of the women, and the men had more plaque than the women. The women with fatty liver disease had a significantly higher mean CIMT value and more plaque than the women with normal livers. The differences between the men with fatty liver and those with normal livers in mean CIMT values and in the prevalence of plaque were not significant. In the women, multivariate analysis showed that fatty liver disease was independently associated with subclinical atherosclerosis [adjusted hazards ratio (HR) 1.65, 95% confidence interval (CI) 1.007–2.697, p = 0.047].
Conclusions: The men had more fatty liver disease, carotid plaque and higher CIMT values than the women. Fatty liver disease was a useful predictor of atherosclerosis, especially for the female study patients.
- Title: Congenital heart disease and
Down syndrome: various aspects of a confirmed
association
Authors: S Benhaourech, A Drighil, AE Hammiri
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 287-290
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DOI Number: 10.5830/CVJA-2016-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-019
Background: Congenital heart disease (CHD) is frequently described in patients with Down syndrome (DS) and is the main cause of death in this population during the first two years of life. The spectrum of CHD patterns in DS varies widely worldwide; this variation could be due to sociodemographic, genetic and geographic factors.
Methods: A six-year retrospective, descriptive study was carried out from December 2008 to October 2014, based on the Paediatric Unit CHD registry of Ibn Rochd University Hospital. Clinical, echocardiographic and outcomes data were collected and sorted according to confirmation of the syndrome.
Results: Among 2 156 patients with CHD, 128 were identified with Down syndrome. The genders were equally represented (gender ratio 1) and the median age at diagnosis was 9.5 months (2 days to 16 years). The median age of mothers at delivery was 39 years (16–47). Of the 186 CHD lesions reported, the most common was atrioventricular septal defect (AVSD, 29%), followed by ventricular septal defect (VSD, 21.5%) and atrial septal defect (ASD, 19.9). The most common associations of CHD were AVSD + ASD (10%) and VSD + ASD (7.8%). Surgery was the most common modality of treatment (54.3%). The overall mortality rate was 14.1%.
Conclusion: Our study confirmed that the profile and type of CHD in DS in the Moroccan setting exhibited slight differences in the distribution of these CHDs compared with European neighbours and other Western countries. Further studies are needed to determine which variables have an impact on these differences.
- Title: Could the novel ‘double-hole’ technique be an alternative for
the inflow occlusion method?
Authors: S Bozok, G Ilhan, H Kazdal, B Ozpak, I Yurekli, S Bayrak, M Kestelli
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 291-293
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DOI Number: 10.5830/CVJA-2016-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-020
Background: Inflow occlusion on beating heart and cardiopulmonary bypass techniques have been proposed for the removal of foreign material, such as stents, catheters and mass lesions, from cardiac chambers. However, both techniques are not devoid of disadvantages and complications. In this article, we define an alternative, novel ‘double-hole’ technique, which is based on opening the right atrium without cardiopulmonary bypass.
Methods: Bovine hearts were obtained from a local supermarket. Two purse-string sutures were placed in the right atrium using 2-0 braided, non-absorbable polyester suture material, one close to the auricle, and the other close to the interatrial septum. The guidewire of a haemodialysis catheter was inserted through the superior vena cava into the right atrium and passed all the way through the right ventricle.
Results: We suggest that the double-hole technique may be useful, especially in revision cases with adhesions. Further research should be performed to document the efficacy and safety of this method.
Conclusion: We are aware that further extensive research is necessary to investigate the utility of this novel technique in contemporary cardiovascular surgery. We believe the doublehole technique has the potential to become a safe, practical and effective measure in the future.
- Title: The relationship between
elevated magnesium levels and coronary artery
ectasia
Authors: M Yolcu, E Ipek, S Turkmen, Y Ozen, E Yıldırım, A Sertcelik, FR Ulusoy
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 294-298
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DOI Number: 10.5830/CVJA-2016-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-023
Background: Coronary artery ectasia (CAE) without specific symptoms is the localised or diffuse swelling of the epicardial coronary arteries. Magnessium (Mg) plays an important role in cardiac excitability, vascular tonus, contractibility, reactivity and vasodilatation. In our research, we aimed to study the vasodilatory effect of Mg in the aetiopathogenesis of ectasia.
Methods: Patients identified during routine coronary angiograms in our clinic between January 2010 and 2013 were included in the study. Sixty-two patients with isolated CAE, 57 with normal coronary angiograms (NCA), 73 with severe coronary artery disease (CAD), and 95 with stenosis of at least one coronary artery and CAE (CAD + CAE) were included in the study. Serum Mg levels were measured in mg/dl after 12 hours of fasting.
Results: There were no statistically significant differences between the groups in terms of age, hypertension, smoking, hyperlipidaemia, diabetes mellitus, family history of coronary artery disease and medications used. Serum glucose, thyroid stimulating hormone (TSH), urea, total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol, sodium and potassium levels were similar in all groups. Serum Mg levels were 1.90 ± 0.19 mg/dl in patients with isolated CAE, 1.75 ± 0.19 mg/dl in those with CAD, 1.83 ± 0.20 mg/dl in those with CAD + CAE, and 1.80 ± 0.16 mg/dl in the NCA group. These results show that Mg levels were higher in ectasia patients with or without CAD.
Conclusions: The histopathological characteristics of patients with CAE were similar to those with CAD. The specific mechanism of abnormal luminal dilatation seen in CAE however remains to be elucidated. Mg is a divalent cation with powerful vasodilatory effects. In our study, serum Mg levels were found to be statistically higher in ectasia patients with or without CAD.
- Title: Relationship between site of myocardial infarction, left
ventricular function and cytokine levels in patients undergoing coronary artery
surgery
Authors: I Kiris, S Kapan, C Narin, M Ozaydın, MC Cure, R Sutcu, H Okutan
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 299-306
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DOI Number: 10.5830/CVJA-2016-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-027
Background: The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG).
Methods: Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured.
Results: Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05).
Conclusions: The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.
- Title: Strain and strain rate echocardiography in children with
Wilson’s disease
Authors: C Karakurt, S Çelik, A Selimoğlu, İ Varol, H Karabiber, S Yoloğlu
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 307-314
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DOI Number: 10.5830/CVJA-2016-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2015-028
Objective: This study aimed to evaluate strain and strain rate echocardiography in children with Wilson’s disease to detect early cardiac dysfunction.
Methods: In this study, 21 patients with Wilson’s disease and a control group of 20 age- and gender-matched healthy children were included. All the patients and the control group were evaluated with two-dimensional (2D) and colour-coded conventional transthoracic echocardiography by the same paediatric cardiologist using the same echocardiography machine (Vivid E9, GE Healthcare, Norway) in standard precordial positions, according to the American Society of Echocardiography recommendations. 2D strain and strain rate echocardiography were performed after the ECG probes of the echocardiography machine were adjusted for ECG monitoring. Longitudinal, transverse and radial strain, and strain rate were assessed from six basal and six mid-ventricular segments of the left ventricle, as recommended by the American Society of Echocardiography.
Results: Left ventricular wall thickness, systolic and diastolic diameters, left ventricular diameters normalised to body surface area, end-systolic and end-diastolic volumes, cardiac output and cardiac index values were within normal limits and statistically similar in the patient and control groups (p > 0.05).
Global strain and strain rate: the patient group had a statistically significant lower peak A longitudinal velocity of the left basal point and peak E longitudinal velocity of the left basal (VAbasR) point, and higher global peak A longitudinal/ circumferential strain rate (GSRa) compared to the corresponding values of the control group (p < 0.05).
Radial strain and strain rate: end-systolic rotation [ROT (ES)] was statistically significantly lower in the patient group (p < 0.05). Longitudinal strain and strain rate: end-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05).
Segmental analysis showed that rotational strain measurement of the anterior and lateral segments of the patient group were statistically significantly lower than the corresponding values of the control group (p < 0.05). Segmental analysis showed statistically significantly lower values of end-systolic longitudinal strain [STSR (ES)] of the basal lateral (p < 0.05) and end-systolic longitudinal strain [SLSC (ES)] of the basal septal segment (p < 0.05) in the patient group.
End-systolic longitudinal strain [SLSC (ES)] and positive peak transverse strain (STSR peak P) were statistically significantly lower in the patient group (p < 0.05). Segmental analysis showed statistically significantly lower values of endsystolic longitudinal strain [SLSC (ES)] of the mid-anterior and basal anterior segments (p < 0.05), end-systolic longitudinal strain [STSR (ES)] measurements of the posterior and mid-posterior segments, end-systolic longitudinal displacement [DLDC (ES)] of the basal posterior, mid-posterior and mid-antero-septal segments in the patient group.
Conclusion: Cardiac arrhythmias, cardiomyopathy and sudden cardiac death are rare complications but may be seen in children with Wilson’s disease due to copper accumulation in the heart tissue. Strain and strain rate echocardiography is a relatively new and useful echocardiographic technique to evaluate cardiac function and cardiac deformation abnormalities. Our study showed that despite normal systolic function, patients with Wilson’s disease showed diastolic dysfunction and regional deformation abnormalities, especially rotational strain and strain rate abnormalities.
- Title: Cardiovascular risk factors in pre-pubertal schoolchildren in
Angola
Authors: ABT Silva, DP Capingana, P Magalhães, MAA Gonçalves, M del CB Molina, SL Rodrigues, MP Baldo, MSB Mateus, JG Mill
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 215-321
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DOI Number: 10.5830/CVJA-2016-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-029
Methods: The incidence of obesity is increasing worldwide, especially in countries with accelerated economic growth. We determined the prevalence of and associations between overweight/obesity and cardiovascular risk factors in pre-pubertal (seven- to 11-year-old) schoolchildren (both genders, n = 198) in Luanda, Angola. Biochemical (fasting blood) and clinical examinations were obtained in a single visit. Data are reported as prevalence (95% confidence intervals) and association (r, Pearson).
Results: Prevalence of overweight/obesity was 17.7% (12.4–23.0%), high blood pressure (BP > 90% percentile) was 14.6% (9.7–19.5%), elevated glucose level was 16.7% (11.5–21.9%) and total cholesterol level > 170 mg/dl (4.4 mmol/l) was 69.2% (62.8–75.6%). Significant associations between body mass index (BMI) and systolic and diastolic BP (r = 0.46 and 0.40, respectively; p < 0.05) were found. No association between BMI and elevated glucose or cholesterol levels was found.
Conclusion: The prevalence of cardiovascular risk factors was high in pre-pubertal schoolchildren in Angola and fat accumulation was directly associated with blood pressure increase but not with other cardiovascular risk factors.
- Title: Clustering of cardiovascular
risk factors in semi-urban communities in
south-western Nigeria
Authors: R Oluyombo, PO Akinwusi, MA Olamoyegun, OE Ayodele, MB Fawale, OO Okunola, TO Olanrewaju, A Akinsola
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 322-327
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DOI Number: 10.5830/CVJA-2016-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-024
Background: In addition to poor socio-economic indices and a high prevalence of infectious diseases, there have been various reports of a rising prevalence of cardiovascular diseases, with associated morbidity and mortality in developing countries. These factors co-exist, resulting in a synergy, with serious complications, difficult-to-treat conditions and fatal outcomes. Hence this study was conducted to determine the clustering of cardiovascular disease risk factors and its pattern in semi-urban communities in south-western Nigeria.
Methods: This was a cross sectional study over seven months in 11 semi-urban communities in south-western Nigeria.
Results: The total number of participants was 1 285 but only 1 083, with 785 (65%) females, completed the data. Participants were 18 years and older, and 51.2% were over 60 years. The mean age was 55.12 ± 19.85 years. There were 2.6% current cigarette smokers, 22% drank alcohol and 12.2% added salt at the table, while 2% had been told by their doctors they had diabetes, and 23.6% had hypertension. The atherogenic index of plasma was at a high-risk level of 11.1%. Elevated total cholesterol and low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol levels were seen in 5.7, 3.7 and 65.1%, respectively. Prevalence of hypertension was 44.9%, diabetes was 5.2%, obesity with body mass index (BMI) > 30 kg/m2 was 5.7%, and abdominal circumference was 25.7%. Prevalence of clusters of two, three, and four or more risk factors was 23.1, 15.5 and 8.4%, respectively. Increasing age 2.94 (95% CI: 1.30–6.67), BMI 1.18 (95% CI: 1.02–1.37), fasting plasma glucose level 1.03 (95% CI: 1.00– 1.05), albuminuria 1.03 (95% CI: 1.00–1.05), systolic blood pressure 1.07 (95% CI: 1.04–1.10), diastolic blood pressure 1.06 (95% CI: 1.00–1.11) and female gender 2.94 (95% CI: 1.30–6.67) showed increased odds of clustering of two or more cardiovascular risk factors.
Conclusion: Clustering of cardiovascular risk factors is prevalent in these communities. Patterns of clustering vary. This calls for aggressive and targeted public health interventions to prevent or reduce the burden of cardiovascular disease, as the consequences could be detrimental to the country.
- Title: Patient outcomes following after-hours and weekend admissions
for cardiovascular disease in a tertiary hospital in Calabar, Nigeria
Authors: A Ucak, V Temizkan, M Ugur, AE Yedekci, O Uz, A Selcuk, AT Yilmaz
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: 328-332
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DOI Number: 10.5830/CVJA-2016-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-025
Background: There are various reports of higher mortality rates occurring after admissions over the weekend and during after-hours. This study aimed to determine if there was a difference in mortality rates occurring during the weekend and after-hours among cardiovascular admissions in a tertiary hospital in Nigeria.
Methods: A review of cardiovascular admissions (including stroke) was carried out at the University of Calabar Teaching Hospital in Nigeria from January 2010 to December 2013. All admissions to the medical wards from the emergency department and medical out-patient department clinics during the study period were included.
Results: A total of 339 patients were studied and stroke was the commonest type of cardiovascular disease (CVD) admitted (187; 55.2%). Hypertension was the commonest cause of heart failure (70; 48.6%). Presentation to hospital during after-hours and length of stay of more than 14 days were significant predictors of death (OR: 3.37; 0.22).
Conclusion: An increase in CVD mortality rates occurred during after-hours, most likely a consequence of uneven staffing patterns and poor access to equipment. Healthcare providers in Nigeria need to consider remedies to this with a view to reducing excess mortality rates.
- Title: Takotsubo cardiomyopathy post liver transplantation
Authors: A Vachiat, K McCutcheon, A Mahomed, G Schleicher, L Brand, J Botha, M Sussman, P Manga
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2016-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-032
Abstract: A patient with end-stage liver disease developed stressinduced Takotsubo cardiomyopathy post liver transplantation, with haemodynamic instability requiring a left ventricular assist device. We discuss the diagnosis and management of this condition.
- Title: Active schistosomiasis, severe hypereosinophilia and rapid
progression of chronic endomyocardial fibrosis
Authors: AO Mocumbi, C Goncalves, A Damasceno, C Carrilho
From: Cardiovascular Journal of Africa, Vol 27, Issue 5, September/October
Published: 2016
Pages:e4-e6
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DOI Number: 10.5830/CVJA-2016-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-030
Abstract: Endomyocardial fibrosis (EMF) is a neglected restrictive cardiomyopathy of unknown aetiology and unclear natural history, which causes premature deaths in endemic areas. We present the case of a 13-year-old boy from a highly endemic area, presenting with concurrent signs of chronic EMF and severe hypereosinophilia associated with active schistosomal cystitis. We discuss the possible role of this parasitic infection in determining the progression of EMF in endemic areas for both conditions.
