The Cardiovascular Journal of Africa has launched an Online First Advance Publication (ePublication ahead of print) with full text availability via PubMed and this website which is accessible via Google and other search engines. 

This facility is also known internationally as e-publication ahead of print and offers authors the opportunity to publish their research articles sooner for an international audience.
  • Title: Prevalence of cardiometabolic risk factors among professional male long-distance bus drivers in Lagos, south-west Nigeria: a cross-sectional study
    Authors: Casmir E Amadi, Tim P Grove, Amam C Mbakwem, Obianuju B Ozoh, Oyewole A Kushimo, David A Wood, Michael Akinkunmi
    Full text: Click here to download PDF »
    Submitted 26/5/17, accepted 14/1/18
    DOI: 10.5830/CVJA-2018-006
    Online Publication Date: 19 February 2018
    Background: Professional drivers are known to be at high risk of cardiovascular disease (CVD). This study was carried out to highlight these risk factors and their predictors among male long-distance professional bus drivers in Lagos, southwest Nigeria, with a view to improving health awareness in this group.
    Methods: Socio-demographic data, anthropometric indices, blood pressure, fasting plasma blood glucose levels and lipid and physical activity profiles of 293 drivers were measured.
    Results: Mean age of the study population was 48 ± 9.7 years; 71.0 and 19.5% of the drivers used alcohol and were smokers, respectively; and 50.9% were physically inactive. The prevalence of overweight and obesity was 41.7 and 21.1%, respectively, while 39.7 and 13.9% were hypertensive and diabetic, respectively. Ninety (31.3%) subjects had impaired fasting glucose levels while 56.3% had dyslipidaemia. Predictors of hypertension were age and body mass index (BMI). BMI only was a predictor of abnormal glucose profile.
    Conclusion: Professional male long-distance bus drivers in this study showed a high prevalence of a cluster of risk factors for CVD.
    Keywords: cardiovascular disease, risk factors, long-distance drivers

  • Title: Percutaneous transmitral balloon commissurotomy using a single balloon with arteriovenous loop stabilisation: an alternative when there is no Inoue balloon
    Authors: Endale Tefera, Mohamed Leye, Patrick Garceau, Denis Bouchard, Joaquim Miró
    Full text: Click here to download PDF »
    Submitted 9/12/16, accepted 29/1/18
    DOI: 10.5830/CVJA-2018-010
    Online Publication Date: 19 February 2018
    Background: The Inoue balloon technique is the standard technique for mitral valve balloon commissurotomy at this stage. However, the hardware for this technique is expensive and may not always be available in resource-limited settings.
    Objectives: This article reports our experience with percutaneous transmitral balloon commissurotomy using a single balloon (Nucleus) with arteriovenous loop stabilisation.
    Methods: Eleven young patients, aged 12–26 years and weighing 23–48 kg, underwent transmitral balloon commissurotomy using the described technique at our centre from April to May 2014.
    Results: Mean fluoroscopy time was 22.6 ± 6.4 min (18.5–30.0). Mean transmitral gradient decreased from 24.1 ± 5.9 (16–35) to 6.6 ± 3.8 (3–14) mmHg, as measured on transoesophageal echocardiography. Mean mitral valve area increased from 0.69 ± 0.13 cm2 (range 0.5–0.9) before dilation to 1.44 ± 0.25 cm2 (1.1–1.9) after dilation (p < 0.001). Mean estimated pulmonary artery systolic pressure decreased from 110.0 ± 35 mmHg (75–170) before dilation to 28.0 ± 14.4 mmHg (range 10–60) after dilation.
    Conclusion: Our modified Nucleus balloon technique for mitral valve dilation in young patients with mitral stenosis is effective and safe. The technique differs from other over-thewire techniques in that it avoids placing stiff wire in the left ventricle. It also offers better balloon stability and control owing to the arteriovenous loop. This technique may be easier for use by paediatric interventionists who might not be familiar with the Inoue balloon technique.
    Keywords: arteriovenous loop stabilisation, balloon mitral commissurotomy, modified Nucleus balloon technique, mitral valvotomy in resource-limited settings

  • Title: Obesity masks the relationship between dietary salt intake and blood pressure in people of African ancestry: the impact of obesity on the relationship between sodium and blood pressure
    Authors: Muzi Maseko, Mercy Mashao, Abdulraheem Bawa-Allah, Edgar Phukubje, Bongubuhle Mlambo, Thamsanqa Nyundu
    Full text: Click here to download PDF »
    Submitted 24/3/17, accepted 29/1/18
    DOI: 10.5830/CVJA-2018-011
    Online Publication Date: 12 February 2018
    Abstract: Previous studies conducted to investigate the relationship between sodium intake and blood pressure in our African population have yielded contradictory results. With the high prevalence of obesity in this population, it is possible that these contradictory findings are due to the masking effects of obesity on this relationship. We measured 24-hour ambulatory blood pressure and 24-hour urine excretion on 547 South Africans of African ancestry. A multivariate regression analysis revealed no independent relationship between 24-hour sodium excretion and blood pressure in the total population sample, but when participants were stratified according to body mass index (BMI) status, there was a significant association between 24-hour sodium excretion and blood pressure in the normal-BMI participants but not in the overweight/obese participants. We concluded that dietary salt intake, indexed by 24-hour urinary sodium excretion, was associated with increased ambulatory blood pressure but this relationship was masked because of a high proportion of overweight/obese individuals in this population.
    Keywords: dietary salt intake, obesity, hypertension, salt retention, body mass index

  • Title: Levitronix bilateral ventricular assist device, a bridge to recovery in a patient with acute fulminant myocarditis and concomitant cerebellar infarction
    Authors: Yi-Fan Huang, Po-Shun Hsu, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Hong-Yan Ke, Yi-Chang Lin, Hsiang-Yu Yang
    Full text: Click here to download PDF »
    Submitted 1/1/17, accepted 22/1/18
    DOI: 10.5830/CVJA-2018-009
    Online Publication Date: 7 February 2018
    Abstract: We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix® bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix® haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.
    Keywords: ventricular assist device, acute myocarditis, cerebellar infarction

  • Title: Assessment of myocardial fibrosis by late gadolinium enhancement imaging and biomarkers of collagen metabolism in chronic rheumatic mitral regurgitation
    Authors: Ruchika Meel, Richard Nethononda, Elena Libhaber, Therese Dix-Peek, Ferande Peters, Mohammed Essop
    Full text: Click here to download PDF »
    Submitted 21/1/17, accepted 19/12/17
    DOI: 10.5830/CVJA-2018-002
    Online Publication Date: 6 February 2018
    Background: In chronic rheumatic mitral regurgitation (CRMR), involvement of the myocardium in the rheumatic process has been controversial. Therefore, we sought to study the presence of fibrosis using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) and biomarkers of collagen turnover in CRMR.
    Methods: Twenty-two patients with CRMR underwent CMR and echocardiography. Serum concentrations of matrix metalloproteinase- 1 (MMP-1), tissue inhibitor of MMP-1 (TIMP- 1), MMP-1-to-TIMP-1 ratio, procollagen III N-terminal pro-peptide (PIIINP) and procollagen type IC peptide (PIP) were measured.
    Results: Four patients had fibrosis on LGE-CMR. PICP and PIIINP concentrations were similar to those of the controls, however MMP-1 concentration was increased compared to that of the controls (log MMP-1 3.5 ± 0.7 vs 2.7 ± 0.9, p = 0.02). There was increased MMP-1 activity as the MMP-1-to- TIMP-1 ratio was higher in CRMR patients compared to the controls (–1.2 ± 0.6 vs –2.1 ± 0.89, p = 0.002).
    Conclusion: Myocardial fibrosis was rare in CRMR patients. CRMR is likely a disease characterised by the predominance of collagen degradation rather than increased synthesis and myocardial fibrosis.
    Keywords: chronic rheumatic mitral regurgitation, cardiac magnetic resonance, late gadolinium enhancement, biomarkers

  • Title: Coronary stent restenosis and the association with allergy to metal content of 316L stainless steel
    Authors: D Slodownik, C Danenberg, D Merkin, F Swaid, S Moshe, A Ingber, H Lotan, R Durst
    Full text: Click here to download PDF »
    Submitted 14/2/17, accepted 13/7/17
    DOI: 10.5830/CVJA-2017-036
    Online Publication Date: 24 January 2018
    Background: Most intra-coronary stents in use are made of 316 L stainless steel, which contains nickel, chromate and molybdenum. Whether inflammatory and allergic reactions to metals contribute to in-stent restenosis is still a matter of debate.
    Aim: The aim of this study was to ascertain the relationship between metal allergy and the occurrence of in-stent restenosis.
    Methods: Ninety-nine adult patients who underwent two cardiac catheterisations, up to two years apart, were included in the study. Seventy patients had patent stents at the second angiogram (patent stent group) and 29 were found to have in-stent restenosis (restenosis group). All patients underwent patch testing with the relevant metals and the 316L stainless steel plate.
    Results: Twenty-eight (28.3%) patients were found to have an allergy to at least one metal. There was no significant difference in the prevalence of metal allergy between the patent stent group and the restenosis group (28.6 and 27.6%, respectively; p = 0.921).
    Conclusion: Our data do not support the theory that contact allergy plays a role in the pathogenesis of in-stent restenosis.
    Keywords: stent restenosis, metal allergy, stainless steel

  • Title: Reinforcement of suture lines with aortic eversion in aortic replacement
    Authors: Erhan Kaya
    Full text: Click here to download PDF »
    Submitted 25/11/16, accepted 7/11/17
    DOI: 10.5830/CVJA-2017-008
    Online Publication Date: 16 January 2018
    Background: In this study, we describe the technique of eversion of the native aortic tissue to prevent suture line complications, and report on our results with this technique..
    Methods: A total of 42 patients who were operated on due to aortic aneurysm were retrospectively assessed. In all patients, an aortic segment of approximately 2 cm, which was left both distally and proximally, was everted to form a doublelayer lumen and the grafts were anastomosed. Postoperative outcomes and long-term follow-up results were assessed.
    Results: Aortic root replacement was done in 14 cases and eight subjects underwent concurrent coronary artery bypass surgery. Postoperatively, the average volume of the drainage was 375 ± 75 ml, and there were no re-operations. Twentyseven patients required blood transfusion.
    Conclusion: Reinforcement of the anastomosis line via eversion of the native aortic tissue reduced peri-operative blood loss and pseudo-aneurysm and infection, with the advantage of using viable tissue.
    Keywords: suture technique, ascending aortic aneurysms, dissection, pledgetted

  • Title: Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia among adults in Dande municipality, Angola
    Authors: João M Pedro, Miguel Brito, Henrique Barros
    Full text: Click here to download PDF »
    Submitted 25/11/16, accepted 7/11/17
    DOI: 10.5830/CVJA-2017-047
    Online Publication Date: 14 December 2017
    Objectives: To estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia in an Angolan population aged 15 to 64 years and to determine relationships with sociodemographic, behavioural and anthropometric characteristics.
    Methods: A total of 2 354 individuals were assessed for behavioural, sociodemographic and physical characteristics in a cross-sectional, community-based survey. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios for each variable related to the conditions were calculated using logistic regression models.
    Results: Overall, the prevalence of hypertension was 18.0%, diabetes 9.2% and hypercholesterolaemia 4.0%. Among hypertensive individuals, the awareness rate was 48.5%; 15.8% were on treatment and 9.1% had their blood pressure controlled. Only 10.8% were aware they had diabetes, 4.5% were on treatment and 2.7% were controlled. The awareness level for hypercholesterolaemia was 4.2%, with 1.4% individuals on treatment and 1.4% controlled.
    Conclusions: The prevalence levels of hypertension and diabetes, which were higher than previous findings for the region, together with the observed low rates of awareness, treatment and control of all conditions studied, constitute an additional challenge to the regional health structures, which must rapidly adapt to the epidemiological shift occurring in this population.
    Keywords: epidemiology, hypertension, diabetes, hypercholesterolaemia, sub-Saharan Africa

  • Title: Double trouble: psoriasis and cardiometabolic disorders
    Authors: Nasrin Goolam Mahyoodeen, Nigel J Crowther, Mohammed Tikly
    Full text: Click here to download PDF »
    Submitted 26/6/17, accepted 6/12/17
    DOI: 10.5830/CVJA-2017-055
    Online Publication Date: 12 December 2017
    Abstract: Psoriasis (PsO) is a chronic immune-mediated inflammatory skin disorder associated with numerous co-morbidities. This descriptive review focuses on the cardiometabolic co-morbidities of PsO with reference to the epidemiology and pathogenetic mechanisms linking PsO and cardiometabolic disease (CMD). Registry-based studies have shown PsO to be associated with an increased risk of cardiovascular morbidity and mortality. Factors linking PsO and CMD include: chronic inflammation, obesity, classic cardiovascular risk factors, and the effects of systemic therapy used to treat PsO. Chronic inflammation is associated with PsO itself, and with obesity. Adipose tissue is responsible for the secretion of various adipokines, which together with pro-inflammatory cytokines arising from the psoriatic plaque, contribute to the proinflammatory and pro-atherogenic environment. Systemic therapy aimed at decreasing inflammation has been shown to improve CMD in PsO. Screening for and treating CMD and initiating lifestyle modifications will remain the most important interventions until further data emerge regarding the effect of systemic therapy on CMD progression.
    Keywords: psoriasis, cardiovascular disease, cardiometabolic disease, co-morbidities, metabolic syndrome, obesity

  • Title: Atherosclerotic disease is the predominant aetiology of acute coronary syndrome in young adults
    Authors: AK Pillay, DP Naidoo
    Full text: Click here to download PDF »
    Submitted 21/1/17, accepted 13/7/17
    DOI: 10.5830/CVJA-2017-035
    Online Publication Date: 12 December 2017
    Objectives: Few studies have evaluated young adults in their third and fourth decades with coronary artery disease (CAD). This study evaluated the clinical and angiographic profile of young adults (< 35 years) with CAD.
    Methods: A 10-year (2003–2012) retrospective chart review was performed on patients less than 35 years diagnosed with CAD at Inkosi Albert Luthuli Central Hospital, Durban.
    Results: Of the 100 patients who met the study criteria, the majority were male (90%), of Indian ethnicity (79%), and presented with acute coronary syndrome (93%). Smoking (82%), dyslipidaemia (79%) and dysglycaemia (75%) were the most prevalent risk factors. Almost half of the subjects (48%) met criteria for the metabolic syndrome. Angiographic findings revealed multi-vessel (42%), single-vessel (36%) and non-occlusive disease (20%); only two subjects had normal epicardial vessels. Disease severity was influenced by dyslipidaemia (p = 0.002) and positive family history (p = 0.002). Non-coronary aetiologies were identified in 19% of subjects.
    Conclusions: Atherosclerotic disease associated with risk-factor clustering was highly prevalent in young adults with CAD.
    Keywords: coronary artery disease, young adults, risk factors, metabolic syndrome

  • Title: The challenge in diagnosing coarctation of the aorta
    Authors: Julien IE Hoffman
    Full text: Click here to download PDF »
    Submitted 14/7/17, accepted 19/11/17
    DOI: 10.5830/CVJA-2017-053
    Online Publication Date: 11 December 2017
    Abstract: Critical coarctation of the aorta in neonates is a common cause of shock and death. It may be the most difficult of all forms of critical congenital heart disease to diagnose because the obstruction from the coarctation does not appear until several days after birth (and after discharge from the hospital), and because there are no characteristic murmurs. Some of these patients may be detected by neonatal screening by pulse oximetry, but only a minority is so diagnosed. Older patients are usually asymptomatic but, although clinical diagnosis is easy, they are frequently undiagnosed.
    Keywords: patent ductus arteriosus, left ventricular failure, pulse oximetry, balloon dilatation, stent

  • Title: Upper limb ischaemia: a South African single-centre experience
    Authors: Tinus du Toit, Kathryn Manning, Nadraj G Naidoo
    Full text: Click here to download PDF »
    Submitted 11/7/17, accepted 7/11/17
    DOI: 10.5830/CVJA-2017-049
    Online Publication Date: 8 December 2017
    Objective: The aims of this study were to report on our experience with upper limb ischaemia (ULI), to define the pattern and distribution of disease, describe key demographic features and report on conventional clinical outcomes.
    Methods: This was a single-centre, retrospective, descriptive study. All patients (n = 64) who underwent a surgical intervention for ULI over a 12-year study period were included. Findings were analysed and compared with the current literature.
    Results: A male:female ratio of 0.60 was reported. Two major subgroups of patients were identified. The patients in the thrombo-embolic subgroup (n = 30) were notably younger than expected (mean age 55 years) compared to those in the atherosclerotic occlusive disease subgroup (n = 12, mean age 57 years). Presentation overall was generally late, with 8.6% of acute ULI and 48.3% of chronic ULI patients presenting with irreversible ischaemia and tissue loss, respectively. Thrombo-embolism was the dominant vascular pathology reported in this case series (47%). Ninety-five procedures were performed in 64 patients (89 open, six endovascular). Peri-operative (30-day) mortality rate was 7.8%. Systemic and procedure-related complications were observed in 13 and 23%, respectively. The overall major amputation rate was 10.9%. Adherence to follow up was poor (51% at six months).
    Conclusion: Although few firm conclusions could be drawn, this review has expanded our overall perspective of ULI,specific to the population we serve. Collaboration between African vascular units should be encouraged in an attempt to further define the pattern of ULI by identifying distinct geographical confounders.
    Keywords: upper limb, acute ischaemia, chronic ischaemia, revascularisation, non-traumatic

  • Title: Comparison of carotid intima–media thickness and coronary artery calcium score for estimating subclinical atherosclerosis in patients with fatty liver disease
    Authors: Hyun-Jin Kim, Hyung-Bok Park, Yongsung Suh, Yoon-Hyeong Cho, Eui-Seok Hwang, Deok-Kyu Cho, Tae-Young Choi
    Full text: Click here to download PDF »
    Submitted 3/3/17, accepted 19/11/17
    DOI: 10.5830/CVJA-2017-052
    Online Publication Date: 8 December 2017
    Introduction: Fatty liver disease (FLD) is correlated with cardiovascular disease. Carotid intima–media thickness (CIMT) and coronary artery calcium score (CACS) can noninvasively identify subclinical atherosclerosis and predict risk for cardiovascular events. This study evaluated CIMT and CACS measurements to detect subclinical atherosclerosis in patients with and without FLD.
    Methods: Patients who underwent carotid and abdominal ultrasounds as well as cardiac computed tomography (CT) scans were evaluated retrospectively. The differences between the mean CIMT value and CACS measurements in patients with FLD and those with normal livers were estimated.
    Results: Among 819 patients (average age of 53.3 ± 11.2 years), 330 had FLD. The CIMT was greater in patients with FLD compared to the controls (0.79 ± 0.17 vs 0.76 ± 0.17 mm, p = 0.012), and carotid plaques were more commonly seen in patients with FLD. The incidence of a composite of larger CIMT (≥ 75th percentile) plus plaque presence was higher in FLD patients (43.3 vs 36.0%, p = 0.041). Particularly among young patients (≤ 50), the CIMT was larger in patients with FLD than in the controls. FLD increased the risk of a composite of large CIMT plus plaque presence in young patients (odds ratio 1.92, 95% confidence interval 1.05–3.49, p = 0.034). However, patients with FLD had no greater incidence of CACS of over 100 than the controls.
    Conclusion: CIMT was a better marker of underlying subclinicalatherosclerotic risk among patients with FLD than CACS. FLD particularly, increases the risk of subclinical atherosclerosis in patients younger than 50 years of age. These patients should undergo screening CIMT to detect atherosclerosis and modify risk factors.
    Keywords: atherosclerosis, carotid intima–media thickness, coronary artery calcium score, fatty liver

  • Title: Assessment of left atrial function in patients with type 2 diabetes mellitus with a disease duration of six months
    Authors: Oyku Gulmez, Hulya Parildar, Ozlem Cigerli, Nilgun Demirağ
    Full text: Click here to download PDF »
    Submitted 25/5/17, accepted 7/11/17
    DOI: 10.5830/CVJA-2017-048
    Online Publication Date: 30 November 2017
    Introduction: Changes in left atrial (LA) size and function are associated with adverse clinical events. Recently, duration of diabetes mellitus (DM2) has been found to be positively associated with increased LA volume and impaired LA function. This study was performed, using two-dimensional echocardiograpy, to evaluate the changes in LA volume and function in patients with DM2 with a disease duration of six months, and to assess the parameters that affect LA volume and function.
    Methods: Fifty-six patients (28 male, age: 52.6 ± 6.5 years) with DM2 and 56 controls (24 male; age: 50.1 ± 7.0 years) were enrolled in the study. Each subject underwent conventional two-dimensional echocardiography to assess LA volume (indexed maximal LA volume: Vmax, pre-atrial contraction volume: Volp, minimal LA volume: Vmin) and LA function [passive emptying volume – passive emptying fraction (PEV – PEF), active emptying volume – active emptying fraction (AEV – AEF), total emptying volume – total emptying fraction (TEV – TEF)].
    Results: LA diameter, indexed Vmax, Volp, Vmin, AEV and TEV were found to be significantly higher in the DM2 group compared with the controls (p < 0.05). Indexed Vmax, Volp and Vmin were significantly correlated with HbA1c level, body mass index (BMI), high-sensitivity C-reactive protein and uric acid levels, mitral A wave, E/E′ ratio and A′ wave. According to multivariate analysis, age and BMI had a statistically significant effect on LA volume.
    Conclusion: Impaired LA function may be present in patients with newly diagnosed DM2. BMI and increasing age caused LA enlargement and LA volumes that were independent of the effects of hypertension and DM2.
    Keywords: aortic dissection, acute chest pain, hypertension, outcome, case report

  • Title: Acute type A aortic dissection involving the iliac and left renal arteries, misdiagnosed as myocardial infarction
    Authors: Paul Nkemtendong Tolefac, Anastase Dzudie, Sidick Mouliom, Leopold Aminde, Romuald Hentchoya, Martin H Abanda, Charles Mve Mvondo, Vanina D Wanko, Henry N Luma
    Full text: Click here to download PDF »
    Submitted 3/10/16, accepted 2/10/17
    DOI: 10.5830/CVJA-2017-042
    Online Publication Date: 03 November 2017
    Abstract: Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality.
    Keywords: aortic dissection, acute chest pain, hypertension, outcome, case report

  • Title: Cardiac diastolic function after recovery from pre-eclampsia
    Authors: P Soma-Pillay, MC Louw, AO Adeyemo, J Makin, RC Pattinson
    Full text: Click here to download PDF »
    Additional Data: Click here to download Excel version for Table 2 »
    Submitted 23/3/17, accepted 10/7/17
    DOI: 10.5830/CVJA-2017-031
    Online Publication Date: 31 August 2017
    Background: Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery.
    Aims: The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk.
    Methods: This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum.
    Results: At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks’ gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11–10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not.
    Conclusion: Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.
    Keywords: pre-eclampsia, diastolic function, left ventricular remodelling, pregnancy

  • Title: The aetiology of cardiovascular disease: a role for mitochondrial DNA?
    Authors: Marianne Venter, Francois H van der Westhuizen, Joanna L Elson
    Full text: Click here to download PDF »
    Additional Data: Click here to download Excel version for Table 2 »
    Submitted 7/11/16, accepted 31/7/17
    DOI: 10.5830/CVJA-2017-037
    Online Publication Date: 24 August 2017
    Abstract: Cardiovascular disease (CVD) is a world-wide cause of mortality in humans and its incidence is on the rise in Africa. In this review, we discuss the putative role of mitochondrial dysfunction in the aetiology of CVD and consequently identify mitochondrial DNA (mtDNA) variation as a viable genetic risk factor to be considered. We then describe the contribution and pitfalls of several current approaches used when investigating mtDNA in relation to complex disease. We also propose an alternative approach, the adjusted mutational load hypothesis, which would have greater statistical power with cohorts of moderate size, and is less likely to be affected by population stratification. We therefore address some of the shortcomings of the current haplogroup association approach. Finally, we discuss the unique challenges faced by studies done on African populations, and recommend the most viable methods to use when investigating mtDNA variation in CVD and other common complex disease.
    Keywords: mitochondrial DNA, cardiovascular disease, MutPred, mutational load, African

  • Title: A comparative study on the cardiac morphology and vertical jump height of adolescent black South African male and female amateur competitive footballers
    Authors: Philippe Jean-Luc Gradidge, Demitri Constantinou
    Full text: Click here to download PDF »
    Submitted 25/7/16, accepted 13/7/17
    DOI: 10.5830/CVJA-2017-032
    Online Publication Date: 15 August 2017
    Objective: The aim of this comparative study was to determine the gender differences in cardiac morphology and performance in adolescent black South African footballers.
    Methods: Anthropometry, electrocardiography and echocardiography data were measured in 167 (85 males and 82 females) adolescent black South African footballers (mean age: 14.8 ± 1.3 years). Vertical jump height was used as a performance measure of explosive lower-limb power.
    Results: The males had less body fat compared with the females (12.1 ± 3.6 vs 16.8 ± 4.1%, p < 0.05), while females had higher left ventricular end-diastolic diameters compared with males (48.7 ± 3.7 vs 40.7 ± 8.1, p < 0.05). Vertical jump height was higher in males (37.2 ± 10.3) compared with females (31.2 ± 8) and was inversely associated with body fat (β = –0.2, p < 0.05) and positively associated with lean mass (β = 0.5, p < 0.05).
    Conclusion: The findings showed that adolescent black South African male footballers had a performance advantage over females for explosive lower-limb power, which was explained by differences in body composition and not cardiac morphology.
    Keywords: adolescent, black South African, footballers, cardiac morphology, vertical jump height

  • Title: Effects of age on systemic inflamatory response syndrome and results of coronary bypass surgery
    Authors: Orhan Gokalp, Nihan Karakas Yesilkaya, Sahin Bozok, Yuksel Besir, Hasan Iner, Huseyin Durmaz, Yasar Gokkurt, Banu Lafci, Gamze Gokalp, Levent Yilik, Ali Gurbuz
    Full text: Click here to download PDF »
    Submitted 21/3/17, accepted 16/5/17
    DOI: 10.5830/CVJA-2017-030
    Online Publication Date: 23 May 2017
    Background: Coronary artery bypass (CAB) surgery triggers systemic inflammatory response syndrome (SIRS) via several mechanisms. Moreover, age is directly correlated with SIRS. We evaluated the effect of age on SIRS and postoperative outcome after CAB surgery.
    Methods: We retrospectively reviewed the records of 229 patients who had undergone CAB surgery. The patients were divided into three groups according to age: group 1, < 40 years (n = 61); group 2, 40–75 years (n = 83); and group 3, > 75 years old (n = 85). Pre- and peri-operative data were assessed in all patients. SIRS was diagnosed according to the criteria established by Boehme.
    Results: The average pre-operative EuroSCORE value in group 3 was higher than in the other groups and body surface areas were significantly lower in group 3 than in the other groups (p < 0.05). The postoperative SIRS rates were 68.9% in group 1, 84.3% in group 2 and 91.8% in group 3 (group 1 vs group 3; p < 0.05). Mortality rates were not significantly different between the groups (p > 0.05). The predictive factors for SIRS were age, EuroSCORE rate, on-pump CAB surgery and intra-aortic balloon pump use.
    Conclusion: Age was an important risk factor for SIRS during the postoperative period after CAB.
    Keywords: systemic, inflammation, coronary, bypass


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