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, 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
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    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
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    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
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    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 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


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