CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 28, ISSUE 5, SEP/OCT 2017
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  1. Title: Editorial: Who is too fat?
    Authors: Julien IE Hoffman
    From: Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 279
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  2. Title: Is there a role for combination anti-remodelling therapy for heart failure secondary to chronic rheumatic mitral regurgitation?
    Authors: Ruchika Meel, Ferande Peters, Elena Libhaber, Mohammed R Essop
    From:  Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 280-284
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    DOI Number:10.5830/CVJA-2016-095
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-095
    Introduction: The value of combination anti-remodelling therapy for heart failure (HF) secondary to mitral regurgitation (MR) is unknown. We studied the effect of anti-remodelling therapy on clinical and echocardiographic parameters in patients with severe chronic rheumatic mitral regurgitation (CRMR) presenting in HF.
    Methods: Thirty-one patients (29 females) at Chris Hani Baragwanath Academic Hospital, treated with combination therapy for HF due to CRMR and New York Heart Association functional class II–III symptoms, underwent prospective six-month follow up.
    Results: Mean age was 50.7 ± 8.5 years. No patients died or were hospitalised for HF during the study period. No worsening of clinical symptoms or functional status, or left and right ventricular echocardiographic parameters (p > 0.05) was noted. Peak left atrial systolic strain improved at six months (18.7 ± 7.7 vs 23.6 ± 8.5%, p = 0.02).
    Conclusion: This preliminary analysis suggests that combination anti-remodelling therapy may be beneficial for HF secondary to CRMR. We had no HF-related admissions or deaths, and no deterioration in echocardiographic parameters of ventricular size and function.

  3. Title: Prevalence of rheumatic valvular heart disease in Rwandan school children: echocardiographic evaluation using the World Heart Federation criteria
    Authors: J Mucumbitsi, B Bulwer, L Mutesa, V Ndahindwa, M Semakula, E Rusingiza, P Arya, S Breakey, C Patton-Bolman, E L Kaplan
    From: Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 285-292
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    DOI Number:10.5830/CVJA-2017-007
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-007
    Background: Rheumatic fever (RF) and rheumatic valvular heart disease (RHD) remain important medical, surgical and public health concerns in many parts of the world, especially in sub-Saharan Africa. However, there are no published data from Rwanda. We performed a RHD prevalence study in a randomly selected sample of Rwandan school children using the 2012 World Heart Federation (WHF) criteria.
    Methods: Echocardiographic assessment of 2 501 Rwandan school children from 10 schools in the Gasabo district near Kigali was carried out. Resulting data were evaluated by four experienced echocardiographers. Statistical analyses were carried out by statisticians.
    Results: RHD prevalence was 6.8/1 000 children examined (95% CI: 4.2/1 000–10.9/1 000). Seventeen met WHF criteria for RHD, 13 fulfilled criteria for ‘borderline’ RHD and four were ‘definite’ RHD. None of these 17 had been previously identified.
    Conclusion: These data indicate a significant burden of RHD in Rwanda and support a need for defined public health RF control programmes in children there.

  4. Title: Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria
    Authors: Emeka B Kesieme, Umar Abubakar, Olugbenga Olusoji, Ismail Mohammed Inuwa, John Kefas, Ndubuisi Anumenechi
    From: Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 293–297
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    DOI Number: 10.5830/CVJA-2017-004
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-004
    Objective: A survey was undertaken to determine the factors that affect interest in cardiothoracic surgery (CTS) among junior surgical residents in Nigeria.
    Methods: A cross-sectional study was done using a pilottested, 56-item, semi-structured questionnaire, which was filled in by 238 junior surgical residents in accredited hospitals in Nigeria.
    Results: Few of the respondents (8.4%) were committed to specialising in CTS. A minority of them, 28.2 and 2.1%, had assisted in major thoracic procedures and open-heart surgeries, respectively. The relationship between the level of training, rotation in CTS in junior residency and interest in CTS were statistically significant (p < 0.05). The main important factors responsible for the low interest in CTS include the lack of equipment (92%), limited training positions (64.9%), poor or lack of exposure in CTS as a junior resident (63%) and in medical school (58.8%).
    Conclusion: There is a dire need to provide facilities and training opportunities to improve the cardiothoracic workforce in Nigeria.

  5. Title: Atorvastatin inhibits cholesterol-induced caspase-3 cleavage through down-regulation of p38 and up-regulation of Bcl-2 in the rat carotid artery
    Authors: Roshanak Bayatmakoo, Nadereh Rashtchizadeh, ParichehrehYaghmaei, Mehdi Farhoudi, Pouran Karimi
    From:  Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 298-303
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    DOI Number: 10.5830/CVJA-2017-005
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-005
    Aim: Atherosclerotic lesions in the carotid arteries lead to a broad range of cerebrovascular disorders such as vascular dementia and ischaemic stroke. Recent studies have verified the beneficial role of atorvastatin (AV) in atherosclerosis. Despite a large body of studies, the mechanisms underlying this effect have not been completely explained. In this study, several experiments were performed on atherosclerotic rat models to investigate the anti-inflammatory and anti-apoptotic effect of AV in the carotid artery.
    Methods: In this experimental study, 40 male Wistar rats (250 ± 25 g) were randomly divided into four groups: rats on a normal diet (ND; n = 10); a high-cholesterol diet (HD; n = 10); a high-cholesterol diet plus AV (HD + AV; n = 10); and the AV control group (AV; n = 10). Cleavage of caspase-3 protein, expression of B-cell lymphoma 2 (Bcl-2) as well as phosphorylation of p38 mitogen-activated protein kinase (MAPK) were determined by immunoblotting assay in the carotid artery homogenate. Plasma atherogenic indices, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured by colorimetric assay at the end of the experiment. Plasma levels of oxidised LDL (oxLDL) were measured by sandwich enzyme-linked immunosorbent assay (ELISA).
    Results: After eight weeks of feeding with a high-cholesterol diet, an elevated level of oxLDL was observed in the plasma in the HD group compared with the ND group [214.42 ± 17.46 vs 69.13 ± 9.92 mg/dl (5.55 ± 0.45 vs 1.78 ± 0.26 mmol/l); p < 0.01]. AV administration significantly reduced oxLDL levels in the HD + AV compared to the HD group [126.52 ± 9.46 vs 214.42 ± 17.46 mg/dl (3.28 ± 0.25 vs 5.55 ± 0.45 mmol/l); p < 0.01]. Results also showed that compared with the HC group, the HC + AV group had lower levels of p38 phosphorylation (p < 0.05) and higher levels of Bcl-2 expression (p < 0.05). Lower levels of cleaved caspase-3 were observed in the HC + AV group in comparison with the HC group (p < 0.05).
    Conclusions: The resultant data suggest that the anti-apoptotic effect of AV could be partially mediated by the pro-inflammatory protein p38 MAPK and the anti-apoptotic protein Bcl-2 in the rat carotid artery. Atorvastatin can therefore be considered a target drug in the prevention or development of atherosclerotic events.

  6. Title: New World’s old disease: cardiac hydatid disease and surgical principles
    Authors: Omer Tanyeli, Yuksel Dereli, Ilker Mercan, Niyazi Gormus, Tahir Yuksek
    From: Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 304-308
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    DOI Number: 10.5830/CVJA-2017-006
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-006
    Background: Hydatid cyst is a parasitic disease caused by infection with the Echinococcus granulosus tapeworm larva. It is a major public health problem in endemic regions. Cardiac involvement of the disease is rare.
    Methods: Between 1985 and 2015, 12 patients were admitted to our clinic with a possible diagnosis of cardiac hydatid disease. Of these patients, six (50%) were male and six (50%) were female. Mean age of the patients was 42.6 years.
    Results: The most common location of cardiac hydatid disease was left sided (six patients, 50%). Five (41.7%) patients had cysts located in the right heart, whereas one (8.3%) had a cyst in the interventricular septum. Eleven (91.7%) of the patients were operated on via median sternotomy and the remaining one was operated on via a left anterolateral thoracotomy. Ten (83.3%) of the patients were operated on using cardiopulmonary bypass under moderate hypothermia, whereas the remaining two (16.7%) had off-pump surgery. There was no surgical mortality in our series. All patients were discharged with medical therapy (mebendazole or albendazole) for the duration of six months. No recurrences were observed in their follow ups.
    Conclusion: Although cardiac hydatid disease is rare, its prevalence seems to have increased in the last decade. Any patient with suspected cardiac symptoms suggesting mass lesions should be considered for a differential diagnosis of cardiac hydatid disease, especially in developing countries. Definitive treatment is removal of the cyst, combined with medical therapy.

  7. Title: Right ventricular strain as predictor of pulmonary complications in patients with femur fracture
    Authors: Hyun-Jin Kim, Hyung-Bok Park, Yongsung Suh, Hyun-Sun Kim, Yoon-Hyeong Cho, Tae-Young Choi, Eui-Seok Hwang, Deok-Kyu Cho
    From:  Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 309–314
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    DOI Number: 10.5830/CVJA-2017-011
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-011
    Background: Following femur fracture, medullary fat enters the systemic circulation and altered pulmonary haemodynamics may contribute to pulmonary complications. This study evaluated the association between right ventricular (RV) function and pulmonary complications in patients with femur fracture.
    Methods: Patients with a femur fracture who had undergone pre-operative echocardiography that included RV peak global longitudinal strain (RV GLS) were evaluated retrospectively between March 2015 and February 2016. Pulmonary complications were defined as the development of pneumonia or pulmonary thromboembolism during the first postoperative month.
    Results: Among 78 patients, pulmonary complications developed in eight (10.3%). The RV GLS value of all patients was lower than the normal range. In addition, the RV GLS value of patients with pulmonary complications was significantly lower than that of patients without pulmonary complications. Multivariate regression analyses found that worse RV GLS values independently predicted pulmonary complications [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.047–4.151, p = 0.037]. Receiver operating characteristic curve analysis found that a RV GLS value of –14.85% was the best cut-off value to predict pulmonary complications; sensitivity: 75.0%; specificity: 62.9%. Moreover, patients with RV GLS values > –14.85% had significantly lower pulmonary complication-free survival.
    Conclusions: In patients with femur fracture, RV GLS values could help predict pulmonary complications. Therefore, patients with RV GLS values > –14.85 should be monitored closely before and after surgery for femur fracture.

  8. Title: Electrocardiographic abnormalities in treatment-naïve HIV subjects in south-east Nigeria
    Authors: Innocent Chukwuemeka Okoye, Ernest Ndukaife Anyabolu
    From: Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 315-318
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    DOI Number: 10.5830/CVJA-2017-013
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-013
    Background: Cardiac complications of human immunodeficiency virus (HIV) infection are important causes of morbidity and mortality. We set out to determine the electrocardiographic (ECG) abnormalities in treatment-naïve HIV-positive patients in Enugu, south-east Nigeria.
    Methods: This was a cross-sectional study involving 250 HIV-positive and 200 HIV-negative subjects. Demographic and anthropometric data, relevant investigations and ECG results were compared between the groups.
    Results: An abnormal ECG was present in 70% of the HIV-positive patients, sinus bradycardia in 64%, QTC prolongation in 48%, T-wave inversion in 21.6%, Wolf–Parkinson– White syndrome in 0.8%, abnormal P waves in 12.8%, 1st degree heart block in 2.4%, ST depression in 30%, and left-axis deviation in 1.6%. Underweight was associated with ECG abnormalities (p = 0.001). The HIV-positive patients had more ECG abnormalities than the HIV-negative subjects (p = 0.001).
    Conclusion: Electrocardiographic abnormalities were common in treatment-naïve HIV-positive patients in Enugu, Nigeria. The 70% prevalence of ECG abnormalities in treatment-naïve HIV-positive patients was high. There is a need to evaluate HIV-positive patients at onset for cardiac and non-cardiac abnormalities detectable by ECG.

  9. Title: Red cell distribution width is correlated with extensive coronary artery disease in patients with diabetes mellitus
    Authors: Atac Celik, Metin Karayakali, Fatih Altunkas, Kayihan Karaman, Arif Arisoy, Koksal Ceyhan, Hasan Kadi, Fatih Koc
    From: Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: 319-323
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    DOI Number: 10.5830/CVJA-2017-015
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-015
    Introduction: Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM).
    Methods: Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease was diagnosed in the presence of stenosis > 50% in all three coronary artery systems.
    Result: RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all).
    Conclusion: RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.

  10. Title: Prevalence of obesity and body size perceptions in urban and rural Senegal: new insight on the epidemiological transition in West Africa
    Authors: Enguerran Macia, Emmanuel Cohen, Lamine Gueye, Gilles Boetsch, Priscilla Duboz
    From:  Cardiovascular Journal of Africa, Vol 28, Issue  5, September/October
    Published: 2017
    Pages: 324-330
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    DOI Number: 10.5830/CVJA-2017-034
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-034
    Background: The objectives of this study were to assess the prevalence of obesity in Dakar and in Tessekere, a rural municipality in northern Senegal, and to compare ideal body size between these populations.
    Methods: A cross-sectional survey was carried out in 2015 on a representative sample of 1 000 adults, aged 20 years and older in Dakar, and 500 adults of the same age in Tessekere.
    Results: The prevalence of obesity and overweight was higher in Dakar than in Tessekere. However, overweight and obesity rates of young women living in this rural area were close to those of young women in Dakar. At a body mass index of 27.5 kg/m², less than 40% of the men in Dakar and Tessekere found themselves too fat, compared to 50% of urban women and 30% of rural women.
    Conclusion: This study explains how and why obesity is becoming a rural health problem in Senegal.

  11. Title: Anaemia and iron deficiency in heart failure: epidemiological gaps, diagnostic challenges and therapeutic barriers in sub-Saharan Africa
    Authors: Abel Makubi, Johnson Lwakatare, Okechukwu S Ogah, Lars Rydén, Lars H Lund, Julie Makani
    From: Cardiovascular Journal of Africa, Vol 28, Issue  5, September/October
    Published: 2017
    Pages: 331-337
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    DOI Number: 10.5830/CVJA-2017-001
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-001
    Abstract: Anaemia and iron deficiency (ID) are common and of prognostic importance in heart failure (HF). In both conditions the epidemiology, diagnosis and therapies have been extensively studied in high-income countries but are still largely unexplored in sub-Saharan Africa (SSA).
    The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF. From a clinical perspective, less attention is paid by clinicians to screening for anaemia in HF, and as far as interventions are concerned, there are no clinical trials in SSA that provide guidance on the appropriate interventional approach. Therefore studies are needed to provide more insight into the burden and peculiarities of and intervention for anaemia and ID in HF in SSA, where the pathophysiology might be different from that in high-income countries.
    There is increasing appreciation that targeting ID may serve as a useful additional treatment strategy for patients with chronic HF in high-income countries. However, there is limited information on the diagnosis of and therapy for ID in HF in SSA, where infections and malnutrition are more likely to influence the situation. This article reviews the present epidemiological gap in knowledge about anaemia and ID in HF, as well as the diagnostic and therapeutic challenges in SSA.

  12. Title: Congress News: Building and strengthening capacity for cardiovascular research in Africa through technical training workshops: a report of the joint course on health research methods by the Clinical Research Education Networking and Consultancy and the Ivorian Society of Cardiology
    Authors: Bonaventure Suiru Dzekem, Jean Baptiste Anzouan Kacou, Martin Abanda, Euloge Kramoh, Yves Yapobi, Samuel Kingue, Andre Pascal Kengne, Anastase Dzudie
    From:  Cardiovascular Journal of Africa, Vol 28, Issue  5, September/October
    Published: 2017
    Pages: 338-339
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    Abstract: Africa bears a quarter of the global burden of disease but contributes less than 2% of the global research publications on health, partially due to a lack of expertise and skills to carry out scientific research. We report on a short course on research methods organised by the Clinical Research Education Networking and Consultancy (CRENC) during the third international congress of the Ivorian Cardiac Society (SICARD) in Abidjan, Cote d’Ivoire. Results from the pre- and post-test evaluation during this course showed that African researchers could contribute more to scientific research and publications, provided adequate support and investment is geared towards the identification and training of motivated early-career scientists.
  13. Title: Atrial myxoma: a rare cause of hemiplegia in children
    Authors: Uchenna Onubogu, Boma West, Boma Orupabo-Oyan
    From:  Cardiovascular Journal of Africa, Vol 28, Issue 5, September/October
    Published: 2017
    Pages: e1-e3
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    DOI Number: 10.5830/CVJA-2016-093
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-093
    Background: Atrial myxoma is an uncommon cause of hemiplegia in children. However hemiplegia is the commonest manifestation of atrial myxoma in the paediatric age group.
    Case report: An 11-year-old girl presented with left hemiplegia and palpitations. Three months later she had a deepvein thrombosis of the right common iliac vein. MRI of the brain showed a subacute right thalamic infarct, and an ECG showed left atrial and left ventricular hypertrophy. Transthoracic echocardiography revealed a left atrial myxoma impinging on the mitral valve. A diagnosis of left atrial myxoma with multiple thromboembolic events was made. She was placed on anticoagulants until she died while awaiting surgical tumour resection.
    Conclusion: Echocardiography should be done early in children presenting with ischaemic thromboembolic diseases in order to reduce morbidity and mortality rates resulting from cardiac pathology.

  14. Title: Liddle’s syndrome in an African male due to a novel frameshift mutation in the beta-subunit of the epithelial sodium channel gene
    Authors: Robert Freercks, Surita Meldau, Erika Jones, Jason Ensor, Clarise Weimers-Willard, Brian Rayner
    From:  Cardiovascular Journal of Africa, Vol 28, Issue, 5, September/October
    Published: 2017
    Pages:e4-e6
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    DOI Number: 10.5830/CVJA-2017-012
    DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-012
    Abstract: Resistant hypertension is a common clinical problem in South Africa and is frequently associated with low renin and aldosterone levels, especially in black Africans. In South Africa, novel variants in the epithelial sodium channel (ENaC) have been described to be associated with varying degrees of hypokalaemia and hypertension due to primary sodium retention. We report here a case of Liddle’s syndrome due to a novel c.1709del11 (p.Ser570Tyrfs*20) deletion in the beta-subunit of the ENaC in a young black African male. We discuss the likely pathogenesis of hypertension in this setting as well as the treatment options available in South Africa aimed at the ENaC. This case highlights the need for vigilance in detecting and appropriately treating low-renin and low-aldosterone hypertension in view of the frequency of the described variants of the ENaC channel in our country. Specific therapy such as amiloride should be made more widely available.
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Assessment of left atrial function in patients with type 2 diabetes mellitus with a disease duration of six months

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A comparative study on the cardiac morphology and vertical jump height of adolescent black South African male and female amateur competitive footballers

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Effects of age on systemic inflamatory response syndrome and results of coronary bypass surgery

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