CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 28, ISSUE 1, JAN/FEB 2017
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  1. Title: From the Editor’s Desk
    Authors: Patrick Commerford
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 3
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  2. Title: Relationship between myocardial performance index and severity of coronary artery disease in patients with non-ST -segment elevation acute coronary syndrome
    Authors: O Abaci, C Kocas, V Oktay, S Arslan, Y Turkmen, C Bostan, U Coskun, A Yildiz, M Ersanlı
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 4-7
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    DOI Number:10.5830/CVJA-2016-041
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-041
    Objectives: We aimed to investigate the relationship between myocardial performance index (MPI) and severity of coronary artery disease, as assessed by the Gensini score (GS), in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
    Methods: Ninety patients with an initial diagnosis of NSTEMI were enrolled in our study. They were divided into tertiles according to the GS: low GS < 19; mid GS > 19 and ≤ 96; and high GS > 96.
    Results: The low-, mid- and high-GS groups included 24, 38 and 28 patients, respectively. Clinical features such as gender distribution; body mass index (BMI); prevalence of diabetes mellitus, hypertension and hyperlipidaemia; and smoking status were similar in the three groups. MPI and isovolumic relaxation time were significantly higher in the high-GS group than in the low- and mid-GS groups (p < 0.001 and p = 0.005, respectively). Furthermore, the high-GS group had a significantly lower ejection fraction and ejection time (p = 0.01 and p < 0.001, respectively). MPI was positively correlated with the GS (r = 0.47, p < 0.001), and multivariate regression analysis showed that MPI was an independent predictor of the GS (β = 0.358, p < 0.001).
    Conclusions: Patients with NSTEMI who fall within the high-risk group may be identified by means of a simple MPI measurement.
     
  3. Title: Peripartum cardiomyopathy among cardiovascular patients referred for echocardiography at Parirenyatwa Teaching Hospital, Harare, Zimbabwe
    Authors: ET Gambahaya, J Hakim, D Kao, N Munyandu, J Matenga
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 8-13
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    DOI Number:10.5830/CVJA-2016-043
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-043
    Objectives: The main aim was to evaluate the outcome of patients with peripartum cardiomyopathy (PPCM) within six months of diagnosis. The secondary aim was to describe demographic and clinical characteristics of patients with PPCM in Harare, Zimbabwe.
    Methods: This was a prospective cohort study in which patients recruited into a detailed PPCM registry were followed up for six months. Echocardiograms were performed at enrolment, and three and six months after diagnosis, to determine left ventricular function.
    Results: From 1 August 2012 to 31 July 2013, 43 patients with a new diagnosis of PPCM were recruited at Parirenyatwa Hospital in Harare. At six months, mean ejection fraction improved from 29.7 ± 9.8 to 44.9 ± 14.9%, p < 0.001 and New York Heart Association (NYHA) functional class improved significantly (p < 0.0001). Five (11.6%) patients died.
    Conclusions: Left ventricular function improved in a substantial number of patients (42.9%) in this Zimbabwean cohort compared to other African cohorts. However the mortality rate remained high.

  4. Title: Non-dipper hypertension is associated with slow coronary flow among hypertensives with normal coronary angiogram
    Authors: E Aksit, E Gursul, F Aydin, M Samsa, F Ozcelik
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 14-18
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    DOI Number: 10.5830/CVJA-2016-045
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-045
    Aim: A person with a drop of more than 10% in nocturnal arterial blood pressure during the circadian rhythm is referred to as a dipper and one with a smaller decrease is referred to as a non-dipper. In our study, we aimed to compare the thrombolysis in myocardial infarction (TIMI) frame count in non-dipper and dipper hypertensive patient groups who had normal coronary artery angiography.
    Methods: Patients with normal coronary arteries and with ambulatory blood pressure monitoring follow ups were retrospectively investigated and 60 patients (35%, female) were included in our study. The patients were grouped as dipper (n = 30) and non-dipper (n = 30) hypertensives.
    Results: The TIMI frame counts in all three coronary arteries and the mean TIMI frame count in the dipper hypertensive patient group were significantly lower than those of the non-dipper hypertensives (right coronary artery TIMI frame count: 16.83 ± 3.70; 21.63 ± 3.44, p < 0.001; circumflex artery TIMI frame count: 21.28 ± 3.52; 25.65 ± 3.61, p < 0.001; left anterior descending artery TIMI frame count: 34.20 ± 2.80; 37.05 ± 3.30, p = 0.001; corrected left anterior descending artery TIMI frame count: 20.05 ± 1.63; 21.74 ± 1.95, p = 0.001; mean TIMI frame count: 19.31 ± 2.3; 22.94 ± 2.61, p < 0.001). The body mass index (BMI) was 23.79 ± 2.81 kg/m2 in the dipper patient group, while it was 25.47 ± 2.92 in the non-dippers. BMI was found to be significantly higher in the non-dipper group than in the dipper group (p = 0.027).
    Conclusion: In this study, TIMI frame count, which is a simple, productive, objective and reproducible method for determination of microvascular changes, was found to be higher in non-dipper hypertensive patients than in the dipper patients.

  5. Title: Surgical placement of left ventricular lead for cardiac resynchronisation therapy after failure of percutaneous attempt
    Authors: M Ezelsoy, M Bayram, S Yazici, N Yazicioglu, E Sagbas
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 19-22
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    DOI Number: 10.5830/CVJA-2016-046
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-046
    Objective: Cardiac resynchronisation therapy has been shown to be an effective treatment to improve functional status and prolong survival of patients in advanced chronic heart failure. This study assessed the surgical outcomes of left anterior mini-thoracotomy for the implantation of left ventricular epicardial pacing leads in cardiac resynchronisation therapy.
    Methods: Our study consisted of 30 consecutive patients who underwent cardiac resynchronisation therapy with a left thoracotomy between November 2010 and April 2012 inour clinic. Postoperative follow up included the assessment of New York Heart Association (NYHA) functional class, electrocardiography and echocardiography.
    Results: There were 22 male and eight female patients with a mean age of 68 ± 5.04 years. All patients were in NYHA class III or IV. Pre-procedure mean left ventricular ejection fraction was 28.1 ± 4.5% and post-procedural ejection fraction improved to 31.7 ± 5.1%. The pre-operative QRS duration changed from 171.7 ± 10.8 to 156.2 ± 4.4 ms after the operation. Also there was a significant reduction in left ventricular end-diastolic dimension from 6.98 ± 0.8 to 6.72 ± 0.8 mm (p < 0 .05), but no change in left ventricular end-systolic dimension and severity of mitral regurgitation. All patients had successful surgical left ventricular lead placement. There was no procedure-related mortality. The mean follow-up time was 40.4 months.
    Conclusion: Surgical epicardial left ventricular lead placement procedure is a safe and effective technique in patients with a failed percutaneous attempt.

  6. Title: Endothelial dysfunction and arterial stiffness in pre-eclampsia demonstrated by the EndoPAT method
    Authors: A Meeme, GAB Buga, M Mammen, A Namugowa
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 23-29
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    DOI Number: 10.5830/CVJA-2016-047
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-047
    Objectives: The EndoPAT method has been used as a noninvasive method for assessing endothelial function in several non-pregnant populations. We investigated its possible use in assessing endothelial dysfunction in pre-eclampsia.
    Methods: Two hundred and fifteen participants were recruited and grouped as pre-eclamptic cases (105) and normotensive controls (110). Endothelial function and arterial stiffness were measured as reactive hyperaemia index and augmentation index, respectively, using the EndoPAT 2000 machine. Results: The reactive hyperaemia index was significantly lower in the pre-eclamptic group compared to the normotensive group (p < 0.05). Augmentation index on the other hand was significantly higher in the pre-eclamptic group compared to the normotensive group (p < 0.0001).
    Conclusion: The EndoPAT method demonstrates endothelial dysfunction and arterial stiffness in pre-eclampsia.

  7. Title: A comparison of off- and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular event
    Authors: O Gurbuz, G Kumtepe, A Yolgosteren, H Ozkan, IH Karal, A Ercan, S Ener
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 30-35
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    DOI Number: 10.5830/CVJA-2016-049
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-049
    Objective: Our aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE)-free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG).
    Methods: We retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217).
    Results: OPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089–1.361; p = 0.001).
    Conclusion: OPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result.

  8. Title: Myocardial dysfunction in children with intrauterine growth restriction: an echocardiographic study
    Authors: K Niewiadomska-Jarosik, J Zamojska, A Zamecznik, A Wosiak, P Jarosik, J Stańczyk
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 36-39
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    DOI Number: 10.5830/CVJA-2016-053
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-053
    Introduction: The prevalence of intrauterine growth restriction (IUGR) is about 3–10% of live-born newborns and can be as high as 20% in developing countries. It may result in the occurrence of cardiovascular diseases later in life.
    Methods: The aim of this study was echocardiographic evaluation, with the use of conventional and tissue Doppler parameters, of cardiac function in children born with IUGR, and comparison with healthy peers born as normally grown foetuses.
    Results: In the IUGR group, E wave and E/A ratio were significantly lower compared to the control group. A wave, isovolumetric relaxation time, deceleration time, myocardial performance index as well as E/E′ septal and E/E′ lateral indices were significantly higher compared to healthy peers.
    Conclusion: Children with IUGR presented with subclinical myocardial dysfunction.

  9. Title: Adropin as a potential marker of enzyme-positive acute coronary syndrome
    Authors: S Aydin, MN Eren, M Yilmaz, M Kalayci, M Yardim, OD Alatas, T Kuloglu, H Balaban, T Cakmak, MA Kobalt, A Çelik, S Aydin
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 40-47
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    DOI Number: 10.5830/CVJA-2016-055
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-055
    Aim: Enzyme-positive acute coronary syndrome (EPACS) can cause injury to or death of the heart muscle owing to prolonged ischaemia. Recent research has indicated that in addition to liver and brain cells, cardiomyocytes also produce adropin. We hypothesised that adropin is released into the bloodstream during myocardial injury caused by acute coronary syndrome (ACS), so serum and saliva levels rise as the myocytes die. Therefore, it could be useful to investigate how ACS affects the timing and significance of adropin release in human subjects.
    Methods: Samples were taken over three days after admission, from 22 EPACS patients and 24 age- and gendermatched controls. The three major salivary glands (submandibular, sublingual and parotid) were immunohistochemically screened for adropin production, and serum and saliva adropin levels were measured by an enzyme-linked immuno- sorbent assay (ELISA). Salivary gland cells produce and secrete adropin locally.
    Results: Serum adropin, troponin I, CK and CK-MB concentrations in the EPACS group became gradually higher than those in the control group up to six hours (p < 0.05), and troponin I continued to rise up to 12 hours after EPACS. The same relative increase in adropin level was observed in the saliva. Troponin I, CK and CK-MB levels started to decrease after 12 hours, while saliva and serum adropin levels started to decrease at six hours after EPACS. In samples taken four hours after EPACS, when the serum adropin value averaged 4.43 ng/ml, the receiver operating characteristic curve showed that the serum adropin concentration indicated EPACS with 91.7% sensitivity and 50% specificity, while when the cut-off adropin value in saliva was 4.12 ng/ml, the saliva adropin concentration indicated EPACS with 91.7% sensitivity and 57% specificity.
    Conclusion: In addition to cardiac troponin and CK-MB assays, measurement of adropin level in saliva and serum samples is a potential marker for diagnosing EPACS.

  10. Title: The effects of the metabolic syndrome on coronary artery bypass grafting surgery
    Authors: S Özkan, F Özdemir, O Uğur, R Demirtunç, AY Balcı, M Kızılay, Ü Vural, M Kaplan, İ Yekeler
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 48-53
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    DOI Number: 10.5830/CVJA-2016-056
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-056
    Background: The metabolic syndrome (MS) is a clustering of factors that are associated with increased cardiovascular risk. A low-grade inflammatory process acts as the underlying pathophysiology, which suggests that the MS may have a detrimental effect on coronary interventions, including coronary artery bypass grafting (CABG) surgery performed with cardiopulmonary bypass (CPB). We aimed to evaluate the effect of the MS on morbidity and mortality rates in the early postoperative period in patients undergoing CABG.
    Methods: We prospectively included 152 patients (109 males and 43 females; mean age 60.1 ± 8.6 years) who underwent elective CABG on CPB between January and September 2011. Early postoperative morbidity and mortality rates were compared between subjects with and without the MS. Diagnosis of the MS was based on the American National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria.
    Results: Of the study group, 64 patients (42%) had the MS. The two groups were similar in age and gender. In the postoperative period, rates of atrial fibrillation, wound infection, pulmonary complications, and lengths of intubation, hospitalisation and intensive care unit stay were significantly higher in MS patients (p < 0.01). The MS was significantly associated with wound infection (OR 6.64, 95% CI: 1.72–25.75), pulmonary complications (OR 6.44, 95% CI: 1.58–26.33), arrhythmia (OR 5.47, 95% CI: 1.50–19.97) and prolonged intubation (OR 1.17, 95% CI: 1.05–1.32). The mortality rate was 3.1% in the MS group and 1.1% in the non-MS group, with no significant difference (p > 0.05).
    Conclusion: The MS was associated with a higher rate of early postoperative morbidity following CABG, without having a significant effect on the mortality rate.

  11. Title: Audit of availability and distribution of paediatric cardiology services and facilities in Nigeri
    Authors: EN Ekure, WE Sadoh, F Bode-Thomas, AA Orogade, AB Animasahun, OO Ogunkunle, I Babaniyi, MU Anah, BE Otaigbe, A Olowu, F Okpokowuruk, SI Omokhodion, OC Maduka, UU Onakpoya, DK Adiele, UM Sani, M Asani, CS Yilgwan, Q Daniels, CC Uzodimma, CO Duru, MB Abdulkadir, JK Afolabi, JA Okeniyi
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 54-59
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    DOI Number: 10.5830/CVJA-2016-057
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-057
    Background: Paediatric cardiac services in Nigeria have been perceived to be inadequate but no formal documentation of availability and distribution of facilities and services has been done.
    Objective: To evaluate and document the currently available paediatric cardiac services in Nigeria.
    Methods: In this questionnaire-based, cross-sectional descriptive study, an audit was undertaken from January 2010 to December 2014, of the personnel and infrastructure, with their distributions according to geopolitical zones of Nigeria.
    Results: Forty-eight centres participated in the study, with 33 paediatric cardiologists and 31 cardiac surgeons. Echocardiography, electrocardiography and pulse oximetry were available in 45 (93.8%) centres while paediatric intensive care units were in 23 (47.9%). Open-heart surgery was performed in six (12.5%) centres. South-West zone had the majority of centres (20; 41.7%).
    Conclusions: Available paediatric cardiac services in Nigeria are grossly inadequate and poorly distributed. Efforts should be intensified to upgrade existing facilities, establish new and functional centres, and train personnel.

  12. Title: Echocardiographic predictors of outcome in acute heart failure patients in sub-Saharan Africa: insights from THESUS-HF
    Authors: MU Sani, BA Davison, G Cotter, A Damasceno, BM Mayosi, OS Ogah, C Mondo, A Dzudie, DB Ojji, C Kouam Kouam, A Suliman, G Yonga, SA Ba, F Maru, B Alemayehu, C Edwards, K Sliwa
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages: 60-67
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    DOI Number: 10.5830/CVJA-2016-070
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-070
    Background: The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure.
    Methods: Out of the 1 006 patients in the THESUS-HF registry, 954 had had an echocardiogram performed within a few weeks of admission. Echocardiographic measurements were performed according to the American Society of Echocardiography guidelines. We examined the associations between each echocardiographic predictor and outcome using regression models.
    Results: Heart rate and left atrial size predicted death within 60 days or re-admission. Heart rate, left ventricular posterior wall thickness in diastole (PWTd), and presence of aortic stenosis were associated with the risk of death within 180 days. PTWd added to clinical variables in predicting 180-day mortality rates.
    Conclusions: Echocardiographic variables, especially those of left ventricular size and function, were not found to have additional predictive value in patients admitted for acute HF. Left atrial size, aortic stenosis, heart rate and measures of hypertrophy (LV PWTd) had some predictive value, suggesting the importance of early treatment of hypertension and severe valvular heart disease.

  13. Title: Hypertrophic angulation deformity of the basal interventricular septum combined with abnormality of the papillary muscle and chordae tendineae
    Authors: Y Wang, L Ye, L Yin, J Zeng
    From: Cardiovascular Journal of Africa, Vol 28, Issue 1, January/February
    Published: 2017
    Pages:e1-e3
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    DOI Number: 10.5830/CVJA-2016-050
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-050
    Abstract: A Chinese woman was admitted to our hospital because of syncope. Transthoracic echocardiography revealed a hypertrophic basal interventricular septum of 15 mm with a sharp angle protruding into the left ventricular outflow tract. Moreover, an anomalous anterolateral papillary muscle (maximum width of 11 mm) was inserted into the left ventricular outflow tract, with short chordae tendineae connecting both basal interventricular septum and anterior leaflet of the mitral valve. All of these abnormalities resulted in a left ventricular outflow gradient of 136 mmHg. Surgical septal myectomy of the sharp angle combined with partial papillary muscle resection and removal of the abnormal chordae tendineae was selected to relieve the left ventricular outflow obstruction. This was a rare combination of deformity of the angulation of the focal basal interventricular septum and abnormalities of the papillary muscle and chordae tendineae, which led to left ventricular outflow obstruction.

A preliminary review of warfarin toxicity in a tertiary hospital in Cape Town, South Africa

Published: 21 June 2017
 
Perceptions of radiation safety training among interventionalists in South Africa

Published: 24 May 2017
 
Effects of age on systemic inflamatory response syndrome and results of coronary bypass surgery

Published: 23 May 2017
 
Pilot study of risk factors associated with cardiovascular disease in northern and southern Cameroonians

Published: 17 May 2017
 
Clinical profile, management and outcomes of patients with pulmonary embolism: a retrospective tertiary centre study in Angola

Published: 17 May 2017
 
Role of melatonin in glucose uptake by cardiomyocytes from insulin-resistant Wistar rats

Published: 17 May 2017
 
Atorvastatin inhibits cholesterol-induced caspase-3 cleavage through down-regulation of p38 and up-regulation of Bcl-2 in the rat carotid artery

Published: 10 May 2017
 
Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit

Published: 26 April 2017
 
Clinical presentation and outcomes of patients with acute rheumatic fever and rheumatic heart disease seen at a tertiary hospital setting in Port Elizabeth, South Africa

Published: 20 April 2017
 
 
Electrocardiographic abnormalities in treatment-naïve HIV subjects in south-east Nigeria

Published: 24 March 2017
 
 
Medication adherence among cardiac patients in Khartoum State, Sudan: a cross-sectional study

Published: 24 March 2017
 
 
An unusual case of aorta–right atrial tunnel with windsock aneurysm: imaging, diagnosis and treatment

Published: 15 March 2017
 
 
Prevalence of rheumatic valvular heart disease in Rwandan school children: echocardiographic evaluation using the World Heart Federation criteria

Published: 1 March 2017
 
 
Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria

Published: 1 March 2017
 
 
New World’s old disease: cardiac hydatid disease and surgical principles

Published: 20 February 2017
 
 
The prevalence and radiological findings of pulmonary embolism in HIV-positive patients referred for computed tomography pulmonary angiography in the Western Cape of South Africa

Published: 15 February 2017
 
 
Right ventricular strain as predictor of pulmonary complications in patients with femur fracture

Published: 01 February 2017
 
 
Atrial myxoma: a rare cause of hemiplegia in children

Published: 09 December 2016
 
 
Telmisartan decreases microalbuminuria in patients with type 2 diabetes mellitus following coronary artery bypass grafting

Published: 10 November 2016
 
 
Left ventricular haematoma mimicking lateral wall myocardial infarction secondary to percutaneous coronary intervention

Published: 10 November 2016
 
 
Symptom-to-balloon time and myocardial blush grade are predictors of left ventricular remodelling after successful primary percutaneous coronary intervention

Published: 27 October 2016
 
 
Effects of Ramadan intermittent fasting on North African children’s heart rate and oxy-haemoglobin saturation at rest and during sub-maximal exercise

Published: 21 October 2016
 
 
Xanthine oxidase inhibitors in ischaemic heart disease

Published: 09 September 2016
 
 
Prevalence of selected cardiometabolic risk factors among adults in urban and semi-urban hospitals in four sub-Saharan African countries

Published: 22 August 2016
 
 
Assessment of indirect inflammatory markers in patients with myocardial bridging

Published: 19 August 2016
 
 
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