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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S18
Timing of pericardectomy in tuberculosis-related pericardial constriction
Thadathilankal Jess John, Alfonso Pecoraro, Anton Doubell and Phillip Herbst
Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville,
South Africa.
Introduction:
Constrictive pericarditis (CP) is seen as the final manifestation of a wide range of pericardial pathologies. Tuberculosis remains one of the major
causes of CP in the developing world with various local trials quoting development of CP in tuberculous effusions ranging from <1 to 23.8%. CP is potentially
curable when treated early with pericardectomy. There are, however, no RCTs studying the timing of pericardectomy in tuberculous CP where patients
are often initially identified in the so-called effusive-constrictive phase of the disease. Early surgery before onset of NYHA III or IV symptoms, and prior to
myocardial atrophy ensues, is suggested. Current recommendations, based on expert opinions, suggest waiting 6 - 8 weeks after initiation of anti-TB therapy
to identify patients who have developed CP who would benefit from pericardectomy.
Method:
We describe the clinical evolution of an organised tuberculous effusion in a 52-year-old HIV-positive female.
Results:
A 52-year-old HIV-positive female was diagnosed with an organised pericardial effusion with features supporting a clinical case definition of
tuberculous effusion. Initial echocardiogram revealed effusive-constrictive physiology. On review, 3 months after initiation of anti-tuberculous therapy,
echocardiographic as well as clinical findings were in keeping with constrictive pericarditis and the patient was booked for a pericardectomy. Due to
defaulting follow-up, the patient was re-admitted for surgery at 6 months on completion of anti-tuberculous therapy. On clinical evaluation prior to surgery,
there was complete resolution of failure symptoms with no features of constriction on repeat echocardiogram.
Conclusion:
This case highlights the paucity of data regarding the optimal timing of pericardectomy in tuberculous constrictive pericarditis. It also
encourages further research into the use of novel imaging modalities, including cardiac MRI and/or PET, in identifying patients with persistent pericardial
inflammation who may benefit from anti-inflammatory therapy or a longer period of anti-tuberculous therapy before decisions regarding pericardectomy
are made.
Antiretroviral therapy-naïve HIV-infected patients are predisposed to abdominal obesity and high-density lipoprotein/
apolipoprotein A-1 impairment
Festus Kamau*, Miguel Frias
#
, Sandrine Lecour
†
, Ingrid Webster*, Sabrina Pagano
#
, Nicolas Vuilleumier
#
and Hans Strijdom*
*Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South Africa.
#
Diagnostic
Department, University Hospital of Geneva, Geneva, Switzerland.
†
Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of
Health Sciences, University of Cape Town, Rondebosch, South Africa
Introduction:
Metabolic and cardiovascular-related morbidities pose serious challenges in the management of HIV/AIDS-infected patients, despite the
widespread use of antiretroviral therapy (ART). In sub-Saharan Africa the burden of obesity and its associated cardiovascular risk in these populations remain
poorly characterised. Our aim was to investigate metabolic/cardiovascular risk and endothelial dysfunction in HIV/AIDS-infected patients from the Western
Cape region.
Methods:
Participants were recruited from the Western Cape province (South Africa) from an ongoing cohort study (EndoAfrica) and assigned to 3 groups
(n=50/group): HIV-free [HIV(-)], HIV-infected [HIV(+)] with/without ART (tenofovir, emtricitabine and efavirenz) exposure. Subsequently, patients were
subjected to health screening, anthropometric assessments, biochemical analyses and vascular endothelial structure/function [carotid-intima media thickness
(CIMT) and flow-mediated dilatation (FMD)] assessments.
Results:
The study population was composed of 1:2.2 male:female ratio and mean age of 37.12 ± 8.47 years. No significant differences in the 10-year
Framingham general cardiovascular risk were observed among the 3 groups. However, >75% of HIV(+) ART(-) patients were obese [waist: hip ratio >0.90, in
both male and female participants vs. <0.85 in HIV(-) and HIV(+) ART(+); p=0.001]. Abdominal obesity in ART-naïve HIV-infected patients was associated with
significantly lower, apolipoprotein A-1, and high-density lipoprotein (HDL) levels <1.20 mmol/L compared to >1.20mmol/L in HIV(-) and HIV(+) ART(+) groups;
p=0.03. In addition, circulating interferon-gamma and cell adhesion molecules, ICAM-1 and VCAM-1 levels, were elevated in HIV(+) ART(-) patients. However,
the % FMD and CIMT remained unaltered among the three groups.
Conclusion:
Our findings indicate that before ART exposure, HIV-infected participants were predisposed to the development of abdominal obesity with
associated impairment of HDL concentration/composition. They were also prone to inflammation. These alterations were not present in ART-exposed
participants. However, the 10-year general cardiovascular risk and vascular/endothelial function were altered by neither HIV infection nor by ART use and
approximated that of the general population.
Outcomes of 626 echocardiographically guided pericardiocentesis: A retrospective, single centre, observational cohort study
in a South African tertiary referral centre
Sumanth Karamchand*, Rory Leisegang
#
, Charles Kyriakakis* and Anton Doubell*
*Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville,
South Africa.
#
Department of Pharmacology, Uppsala University, Uppsala, Sweden.
Introduction:
Echocardiographically-guided percutaneous pericardiocentesis (EGPP) is well established as a safe procedure with a low rate of minor and
major complications in high-income countries. There is a paucity of data on its feasibility and safety in resource-limited settings. The primary objective of this
study was to describe and evaluate EGPP outcomes and complications, in a South African tertiary referral centre, and to compare the rate of complications
with the internationally accepted standard. Secondary objectives included evaluating the optimal route of access and identifying potential risk factors for
procedure-related complications.
Methods:
All EGPP performed between 1 January 2008 and 31 October 2018 were included. Pericardiocentesis procedural reports and clinical notes were
evaluated to determine the aetiology of the pericardial effusion, pericardial access site, procedural success, volume of fluid aspirated and procedure related
complications.
Results:
During the 10-year study period, 626 EGPP were performed on 558 patients (mean age ±SD: 40 ± 15 years); survival was assessed in 201 patients.