ONLINE FIRST ADVANCE PUBLICATION - ePUBLICATION AHEAD OF PRINT
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 and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the Pan-African Pulmonary Hypertension Cohort (PAPUCO) study
    Authors: Irina Balieva, Anastase Dzudie, Friedrich Thienemann, Ana O Mocumbi, Kamilu Karaye, Mahmoud U Sani, Okechukwu S Ogah, Adriaan A Voors, Andre Pascal Kengne, Karen Sliwa
    Full text: Click here to download PDF »
    Submitted 27/5/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-020
    Online Publication Date: 11 October 2017
    Background: Pulmonary hypertension (PH) is prevalent in Africa and is still often diagnosed only at an advanced stage, therefore it is associated with poor quality of life and survival rates. In resource-limited settings, we assessed the diagnostic utility of standard 12-lead electrocardiograms (ECG) to detect abnormalities indicating PH.
    Methods: Sixty-five patients diagnosed with PH were compared with 285 heart disease-free subjects. The prevalence and diagnostic performance of ECG features indicative of PH and right heart strain were calculated.
    Results: Compared to the control group, all abnormalities were more frequent in the PH cohort where no patient had a completely normal ECG. The most prevalent (cases vs control) ECG abnormalities were: pathological Q wave in at least two contiguous peripheral leads (47.7 vs 6.7%), left ventricular hypertrophy (38.5 vs 9.8%) and p-pulmonale (36.9 vs 20.7%) (all p < 0.05). The sensitivity of ECG criteria for right heart strain ranged between 6.2 and 47.7%, while specificity ranged between 79.3 and 100%. Negative predictive value ranged between 81.5 and 88.9% and positive predictive value between 25 and 100%. Positive predictive value was lowest (25%) for right bundle branch block and QRS rightaxis deviation (≥ 100°), and highest (100%) for QRS axis ≥ +100° combined with R/S ratio in V1 ≥ 1 or R in V1 > 7 mm.
    Conclusion: When present, signs of PH on ECG strongly indicated disease, but a normal ECG cannot rule out disease. ECG patterns focusing on the R and S amplitude in V1 and right-axis deviation had good specificity and negative predictive values for PH, and warrant further investigation with echocardiography.
    Keywords: pulmonary hypertension, electrocardiogram, sub- Saharan Africa, screening

  • Title: Unusually aggressive immature neo-intimal hyperplasia causing in-stent restenosis
    Authors: Keir McCutcheon, Andreas S Triantafyllis, Johan Bennett, Tom Adriaenssens
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    Submitted 2/2/17, accepted 19/4/17
    DOI: 10.5830/CVJA-2017-024
    Online Publication Date: 10 October 2017
    Abstract: This image illustrates a very unusual pattern of early and aggressive immature neo-intimal hyperplasia in a 52-year-old man with unstable angina, two months after deployment of a drug-eluting stent in the proximal left anterior descending artery.
    Keywords: in-stent restenosis, neo-intimal hyperplasia, optical coherence tomography

  • Title: The effect of iloprost and sildenafil, alone and in combination, on myocardial ischaemia and nitric oxide and irisin levels
    Authors: Suna Aydin, Tuncay Kuloglu, Suleyman Aydin, Meltem Yardim, Davut Azboy, Zeki Temizturk, Ali Kemal Kalkan, Mehmet Nesimi Eren
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    Submitted 2/11/16, accepted 25/4/17
    DOI: 10.5830/CVJA-2017-025
    Online Publication Date: 31 August 2017
    Aim: Insufficient oxygen supply to organs and tissues due to reduced arterial or venous blood flow results in ischaemia, during which, although ATP production stops, AMP and adenosine continue to be produced from ATP. The fate of irisin, which causes the production of heat instead of ATP during ischaemia, is unknown. Iloprost and sildenafil are two pharmaceutical agents that mediate the resumption of reperfusion (blood supply) via vasodilatation during ischaemic conditions. Our study aimed to explore the effects of iloprost and sildenafil on irisin levels in the heart, liver and kidney tissues and whether these pharmaceutical agents had any impact on serum irisin and nitric oxide levels in rats with induced experimental myocardial ischaemia.
    Methods: The study included adult male Sprague-Dawley rats aged 10 months and weighing between 250 and 280 g. The animals were randomly allocated to eight groups, with five rats in each group. The groups were: sham (control), iloprost (ILO), sildenafil (SIL), ILO + SIL, myocardial ischaemia (MI), MI + ILO, MI + SIL and MI + ILO + SIL. The treatment protocols were implemented before inducing ischaemia, which was done by occluding the left coronary artery with a plastic ligature for 30 minutes. Following the reperfusion procedure, all rats were sacrificed after 24 hours, and their heart, liver and kidney tissues and blood samples were collected for analyses. An immunohistochemical method was used to measure the change in irisin levels, the ELISA method to quantify blood irisin levels, and Griess’ assay to determine nitric oxide (NO) levels in the serum and tissue. Myocardial ischaemia was confirmed based on the results of Masson’s trichrome staining, as well as levels of troponin and creatine kinase MB.
    Results: Irisin levels in biological tissue and serum dropped statistically significantly in the ischaemic group (MI), but were restored with ILO and SIL administration. Individual SIL administration was more potently restorative than individual ILO administration or the combined administration of the two agents. NO level, on the other hand, showed the opposite tendency, reaching the highest level in the MI group, and falling with the use of pharmaceutical agents.
    Conclusions: Individual or combined administration of ILO and SIL reduced myocardial ischaemia and NO levels, and increased irisin levels. Elevated levels of irisin obtained by drug administration could possibly contribute to accelerated wound recovery by local heat production. Sildenafil was more effective than iloprost in eliminating ischaemia and may be the first choice in offsetting the effects of ischaemia in the future.
    Keywords: iloprost, sildenafil, nitric oxide, irisin, myocardial ischaemia–reperfusion

  • Title: Cardiac diastolic function after recovery from pre-eclampsia
    Authors: P Soma-Pillay, MC Louw, AO Adeyemo, J Makin, RC Pattinson
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    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
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    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: The effect of lifestyle interventions on maternal body composition during pregnancy in developing countries: a systematic review
    Authors: Estelle D Watson, Shelley Macaulay, Kim Lamont, Philippe J-L Gradidge, Sandra Pretorius, Nigel J Crowther, Elena Libhaber
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    Submitted 29/9/16, accepted 2/1/17
    DOI: 10.5830/CVJA-2017-003
    Online Publication Date: 24 August 2017
    Abstract: Optimal maternal body composition during pregnancy isa public health priority due to its implications on maternal health and infant development. We therefore aimed to conduct a systematic review of randomised, controlled trials, and case–control and cohort studies using lifestyle interventions to improve body composition in developing countries. Of the 1 708 articles that were searched, seven studies, representing three countries (Brazil, Iran and Argentina), were included in the review. Two articles suggested that intervention with physical activity during pregnancy may significantly reduce maternal weight gain, and five studies were scored as being of poor quality. This systematic review highlights the lack of research within developing countries on lifestyle interventions for the management of excessive weight gain during pregnancy. Similar reviews from developed countries demonstrate the efficacy of such interventions, which should be confirmed using well-designed studies with appropriate intervention methods in resource-limited environments.
    Keywords: diet, physical activity, pregnancy, obesity, gestational weight gain

  • 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
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    Submitted 27/5/16, accepted 8/3/17
    DOI: 10.5830/CVJA-2017-015
    Online Publication Date: 23 August 2017
    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.
    Keywords: red cell distribution width, coronary artery disease, diabetes mellitus, Gensini score

  • Title: A survey of non-communicable diseases and their risk factors among university employees: a single institutional study
    Authors: Emmanuel I Agaba, Maxwell O Akanbi, Patricia A Agaba, Amaka N Ocheke, Zumnan M Gimba, Steve Daniyam, Edith N Okeke
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    Submitted 18/7/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-021
    Online Publication Date: 15 August 2017
    Background: The incidence of non-communicable diseases (NCDs) is rising globally, with its attendant morbidity and mortality, especially in developing countries. This study evaluated the prevalence of NCDs and their risk factors among members of a university community.
    Methods: All employees of the university were invited to the University health clinic for screening, using the World Health Organisation’s STEPwise approach to NCDs.
    Results: A total of 883 (521; 59.0% males) employees with a mean age of 44 ± 10 years were studied. The median (IQR) number of NCD risk factors was three (two to three) per participant. The most common NCD risk factors were inadequate intake of fruit and vegetables (94.6%; 95% CI: 92.8–95.9), physical inactivity (77.8%; 95% CI: 74.9–80.5%) and dyslipidaemia (51.8%; 95% CI: 48.4–51.6%). Others included obesity (26.7%; 95% CI: 23.9–29.8%), alcohol use (24.0%; 95% CI: 21.3–27.0%) and cigarette smoking (2.9%; 95% CI: 2.0–4.3). Hypertension was the most common NCD (48.5%; 95% CI: 45.1–51.8%), followed by chronic kidney disease (13.6%; 95% CI: 11.4–16.1) and diabetes mellitus (8.0%; 95% CI: 6.4–10.1). There was no gender-specific difference in the prevalence of NCDs.
    Conclusion: This study identified that NCDs and their modifiable risk factors are highly prevalent in this community. Workplace policy to support the adoption of healthy living is needed.
    Keywords: diabetes mellitus, hypertension, non-communicable disease, obesity, physical inactivity

  • 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
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    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: Efficacy of cardiac magnetic resonance imaging in a sub-aortic aneurysm case
    Authors: Ruchika Meel, Richard Nethononda, Ferande Peters, Mohammed Essop
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    Submitted 25/1/17, accepted 1/5/17
    DOI: 10.5830/CVJA-2017-027
    Online Publication Date: 29 June 2017
    Abstract: Sub-aortic (SA) aneurysms are a rare entity of variable aetiology. We report the first case of a SA aneurysm assessed using cardiac magnetic resonance imaging (MRI). A 33-year-old female with human immunodeficiency virus and on highly active antiretroviral treatment presented with syncope and dyspnoea. Clinical examination suggested moderate to severe aortic regurgitation (AR) confirmed by transthoracic and transoesophageal echocardiograms. However, echocardiography was suboptimal in defining the precise mechanism and severity of AR. A cardiac MRI was done to elucidate the aetiology, severity and mechanism of regurgitation. It confirmed the presence of a SA aneurysm below the left coronary cusp and its retraction, resulting in an eccentric AR jet. An assessment of moderate AR, based on regurgitant volume, was made. Furthermore, the anatomical relationships of the aneurysm were clearly defined. Cardiac MRI allowed comprehensive assessment of this SA aneurysm.
    Keywords: cardiac magnetic resonance imaging, sub-aortic aneurysm, aortic regurgitation

  • Title: A preliminary review of warfarin toxicity in a tertiary hospital in Cape Town, South Africa
    Authors: Annemarie Jacobs, Fatima Bassa, Eric H Decloedt
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    Submitted 1/3/17, accepted 16/5/17
    DOI: 10.5830/CVJA-2017-029
    Online Publication Date: 21 June 2017
    Aim: Warfarin is a widely used anticoagulant for the prevention and treatment of thromboembolism. We conducted a retrospective review to determine the causes and management of warfarin toxicity of patients admitted to Tygerberg hospital between June 2014 and June 2015.
    Results: We identified and evaluated 126 patients who met the inclusion criteria. The cause of warfarin toxicity was identified and addressed in only 14.3% (18/126) of patients. Where the cause was identified, 56% (10/18) was due to dosing errors and 17% (3/18) drug–drug interaction (DDI). However, 77% (97/126) of patients were retrospectively identified as receiving concomitant medicines known to interact with warfarin at the time of admission. Twenty-eight per cent (35/126) of patients presented with major bleeding, which included seven cases of intracranial haemorrhage. Patients were admitted for a median of eight days at an average treatment cost of R10 578.
    Conclusion: We found that warfarin toxicity carries significant mortality and cost, but little attention is paid to the causes of toxicity.
    Keywords: warfarin, toxicity, bleeding, treatment, cost

  • 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
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    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 the 2001 SCCM/ESICM/ACCP/ATS/ SIS International Sepsis Definitions Conference.
    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

  • Title: Clinical profile, management and outcomes of patients with pulmonary embolism: a retrospective tertiary centre study in Angola
    Authors: Ana Manuel, Adelina Aufico, Rui Africano, Tomáz Peralta, Abel Salas, Adelaide Silva, José Ricardo, Pedro Sabola, Domingas Baião, Carlos Sotolongo, António Dias Neto, Telmo Martins, Vasco Sabino, Joaquim van Dúnem, António Pedro Filipe Júnior
    Full text: Click here to download PDF »
    Submitted 10/4/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-017
    Online Publication Date: 17 May 2017
    Objective: Pulmonary embolism (PE) is a potentially fatal disease. In Angola, few data are available on its occurrence. The aim of the study was to characterise the clinical profile, management and outcomes of patients with PE.
    Methods: A retrospective observational study was conducted at the Girassol Clinic in Luanda, Angola. The medical records of patients admitted to the intensive care unit were analysed from 2011 to 2015.
    Results: Fifty patients were included and the median age was 50.5 ± 17.8 years. Dyspnoea and immobilisation for more than 72 hours were the most frequently seen risk factors at admission; 28% of the patients had massive PE, 36% sub-massive PE, 28% were haemodynamically unstable at admission and 30% had a very high risk of mortality. The in-hospital mortality rate was 20%.
    Conclusions: The clinical characteristics of our patients were similar to those described in the literature. The high prevalence of patients with very high risk at admisson highlights the need to investigate the cause of worst cardiovascular disease outcomes in Africans.
    Keywords: pulmonary embolism, pulmonary CT angiography, anticoagulation, cardiovascular disease, Angola, Africa
     
  • Title: Role of melatonin in glucose uptake by cardiomyocytes from insulin-resistant Wistar rats
    Authors: Frederic Nduhirabandi, Barbara Huisamen, Hans Strijdom, Amanda Lochner
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    Submitted 24/5/16, accepted 4/4/17
    DOI: 10.5830/CVJA-2017-018
    Online Publication Date: 17 May 2017
    Aim: Melatonin supplementation reduces insulin resistance and protects the heart in obese rats. However, its role in myocardial glucose uptake remains unknown. This study investigated the effect of short-term melatonin treatment on glucose uptake by cardiomyocytes isolated from obese and insulin-resistant rats.
    Methods: Cardiomyocytes were isolated from obese rats fed a high-calorie diet for 16 to 23 weeks, their age-matched controls, as well as young control rats aged four to eight weeks. After incubation with melatonin with or without insulin, glucose uptake was initiated by the addition of 2-deoxy-D-[3H] glucose and measured after 30 minutes. Additional control and obese rats received melatonin in the drinking water (4 mg/kg/day) for the last six weeks of feeding (20 weeks) and glucose uptake was determined in isolated cardiomyocytes after incubation with insulin. Intraperitoneal glucose tolerance and biometric parameters were also measured.
    Results: Obese rats (fed for more than 20 weeks) developed glucose intolerance. Cardiomyocytes isolated from these obese rats had a reduced response to insulin-stimulated glucose uptake (ISGU) (p < 0.05). Melatonin administration in vitro had no effect on glucose uptake per se. However, it increased ISGU by cardiomyocytes from the young rats (p < 0.05), while having no effect on ISGU by cardiomyocytes from the older control and obese groups. Melatonin in vivo had no significant effect on glucose tolerance, but it increased basal (p < 0.05) and ISGU by cardiomyocytes from the obese rats (50.1 ± 1.7 vs 32.1 ± 5.1 pmol/mg protein/30 min, p < 0.01).
    Conclusion: These data suggest that short-term melatonin treatment in vivo but not in vitro improved glucose uptake and insulin responsiveness of cardiomyocytes in obesity and insulin-resistance states.
    Keywords: cardiomyocytes, glucose homeostasis, glucose uptake, insulin resistance, melatonin, obesity
     
  • 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
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    Submitted 28/5/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-005
    Online Publication Date: 10 May 2017
    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.
    Keywords: atherosclerosis, Bcl-2 protein, cholesterol, caspase-3, p38 mitogen-activated protein kinase
     
  • Title: Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit
    Authors: Levent Cerit, Zeynep Cerit
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    Submitted 2/6/16, accepted 11/4/17
    DOI: 10.5830/CVJA-2017-023
    Online Publication Date: 26 April 2017
    Background: Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina.
    Methods: The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°.
    Results: The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.
    Conclusion: CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.
    Keywords: coronary angiography, plateletcrit, mean platelet volume
     
  • Title: Electrocardiographic abnormalities in treatment-naïve HIV subjects in south-east Nigeria
    Authors: Innocent Chukwuemeka Okoye, Ernest Ndukaife Anyabolu
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    Submitted 22/6/16, accepted 26/1/17
    DOI: 10.5830/CVJA-2017-013
    Online Publication Date: 24 March 2017
    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.
    Keywords: ECG, cardiac abnormalities, non-cardiac ECG abnormalities, HIV, Enugu, Nigeria
     
  • Title: Medication adherence among cardiac patients in Khartoum State, Sudan: a cross-sectional study
    Authors: Abdelmoneim Awad, Nahid Osman, Siham Altayib
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    Submitted 23/9/16, accepted 8/3/17
    DOI: 10.5830/CVJA-2017-016
    Online Publication Date: 24 March 2017
    Introduction: Non-adherence to medication among cardiac patients is often the major risk factor for poor clinical outcomes, increased mortality rates and higher healthcare costs. The literature evaluating the prevalence of and reasons for non-adherence in resource-poor settings is extremely limited compared to resource-rich settings. There is a scarcity of data about medication adherence in Sudan hence this study was performed to identify prevalence, predictors and barriers of non-adherence to medication among cardiac patients in Khartoum State.
    Methods: A descriptive, cross-sectional survey was performed using a pre-tested, self-administered questionnaire on a sample of 433 randomly selected cardiac patients attending the largest three cardiac centres located in Khartoum State. Descriptive and multivariate logistic regression analyses were used for data analysis.
    Results: The response rate was 89.1%. The mean (± SD) number of chronic diseases among respondents was 2.3 (± 1.3) and that of medication use was 4.2 (± 1.9). The mean (± SD) duration of medication use among participants was 6.4 (± 5.4) years. Optimal adherence was defined as having a score of greater than six on the eight-item Morisky medication adherence scale. Using this cut-off point, 49% (95% CI: 43.9–54.1) of respondents had optimal adherence and 51% (95% CI: 45.9–56.1) had poor adherence. Respondents with a high level of education, low and middle income levels, and those taking five or more medications daily were found to be significantly more non-adherent to medication use than those with low to intermediate education levels (p < 0.001), those with high income levels (p < 0.001), and those taking one to four medications daily (p = 0.039). The top four barriers for poor medication adherence among the study participants were the high cost of drugs, polypharmacy and lack of pharmacist and physician communication with patients about their drug therapy.
    Conclusions: The current findings highlight the need for urgent, multifaceted interventions, given the burden of cardiovascular diseases and the clinical and economic consequencesof medication non-adherence. These interventions include affordable medications, easy-to-use medication regimens with fewer daily doses, ongoing communication between patients and healthcare providers, and improvement of the patient– provider partnership.
    Keywords: non-adherence, adherence, cardiac patients, cardiovascular medications, Khartoum State, Sudan
     
  • 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
    Full text: Click here to download PDF »
    Submitted 21/7/16, accepted 11/1/17
    DOI: 10.5830/CVJA-2017-007
    Online Publication Date: 1 March 2017
    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 datafrom 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.
    Keywords: rheumatic heart disease, rheumatic fever, echocardiography, prevalence, epidemiology
     
  • 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
    Full text: Click here to download PDF »
    Submitted 21/4/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-004
    Online Publication Date: 1 March 2017
    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.
    Keywords: open-heart surgery, thoracic surgery, developing countries
     
  • Title: New World’s old disease: cardiac hydatid disease and surgical principles
    Authors: Omer Tanyeli, Yuksel Dereli, Ilker Mercan, Niyazi Gormus, Tahir Yuksek
    Full text: Click here to download PDF »
    Submitted 10/6/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-006
    Online Publication Date: 20 February 2017
    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.
    Keywords: hydatid cyst, cardiac hydatid cyst, Echinococcus granulosus
     
  • 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
    Full text: Click here to download PDF »
    Submitted 22/8/16, accepted 12/1/17
    DOI: 10.5830/CVJA-2017-011
    Online Publication Date: 01 February 2017
    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.
    Conclusion: 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.
    Keywords: femur fracture, RV peak global longitudinal strain, pneumonia, pulmonary thromboembolism
     
  • Title: Atrial myxoma: a rare cause of hemiplegia in children
    Authors: Uchenna Onubogu, Boma West, Boma Orupabo-Oyan
    Full text: Click here to download PDF »
    Submitted 17/5/16, accepted 30/10/16
    DOI: 10.5830/CVJA-2016-093
    Online Publication Date: 09 Desember 2016
    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.
    Keywords: atrial myxoma, hemiplegia, thromboembolic, cardiac, children
     


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