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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S24
Efficacy and safety of different dosages of Rosuvastatin in Bangladeshi patients: A multi-centre real-world study
Abdullah Al Shafi Majumder*, Toufiqur Rahman
#
, A.K.M. Monwarul Islam
†
, Mohammad Ullah
‡
and Alimur Reza
◊
*Popular Medical College and Hospital, Dhaka, Bangladesh.
#
Colonel Malek Medical College, Manikganj, Bangladesh.
†
National Institute of Cardiovascular
Diseases, Dhaka, Bangladesh.
‡
Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh.
◊
Beximco Pharmaceuticals Ltd, Dhaka, Bangladesh
Introduction:
Dyslipidemia, a risk factor for ischaemic heart disease and stroke, is a major contributing cause to the disease burden in Bangladesh.
Rosuvastatin is one of the most potent statins available for reducing low-density lipoprotein cholesterol (LDL-C) levels. It is widely prescribed and well
accepted by the patients in Bangladesh. The cost of Rosuvastatin is similar to that of other statins used in Bangladesh. However, the effectiveness of
Rosuvastatin in Bangladesh has not been adequately studied. Therefore, this study was conducted in an effort to understand the efficacy and safety of
Rosuvastatin in a real-world setting in Bangladesh.
Methods:
This was a single-arm, non-intervention, multi-centre, real-world study conducted in Bangladesh. Adult patients prescribed Rosuvastatin
(5, 10 or 20mg) were enrolled in the study. The patients were observed with the objective of assessing the percentage change from baseline in serum lipid
profile and assessing the proportion of patients reaching the LDL-C target goal of <100mg/dL after 12 weeks of therapy.
Results:
A total of 280 patients were enrolled, with mean age 51.56 years, mean body mass index (BMI) 26.43kg/m
2
, mean baseline LDL-C 155.35mg/dL.
Overall, the mean LDL-C levels declined by 32.1% (49.9mg/dL) from baseline to end-of-study, while the mean TC levels declined by 24.8% (58.8mg/dL) and
the mean HDL-C level increased by 16.71% (5.7mg/dL). The proportion of patients who attained the LDL-C goal (LDL-C
<100mg/dL) in 5, 10 and 20mg dosage group was 24%, 49.21% and 65.71%, respectively. On logistic regression analysis, higher BMI and use of clopidogrel
reduced the odds of attaining LDL-C goal. Overall, 10.4% of all patients reported an adverse event (AE) at the end of the study. Most AEs were reported in the
muscle (6.5%) and GI categories (6.8%).
Conclusion:
This study demonstrates that all dosages of Rosuvastatin was effective in lowering TG and raising HDL-C in addition to lowering its primary
target LDL-C in Bangladesh. High dosages of Rosuvastatin have no significant safety risk in Bangladeshi patients.
Chronic stress phenotype and brain-heart injury
Leone Malan, Faans Steyn and Pieter van Vuuren
North-West University, Mahikeng, Vanderbijlpark, South Africa
Introduction:
Ongoing ischaemia activates calcium-binding protein B (S100B) release from astrocytes in the brain, retinal ganglion cells and myocardium.
S100B elevations were associated with depression, brain injury, optic nerve axon damage and glaucoma risk in rodent models. Whether S100B release will
reflect these changes in the human brain-heart axis when stress is evident is not known and thus assessed in this study.
Methods:
A clinical diagnostic instrument was validated to phenotype chronic emotional stress (STRESS). A prospective bi-ethnic sex cohort (n=359; aged
46 ± 9 years) with similar socio-economic status was stratified into STRESS cases and controls. Three-year changes (∆) were obtained for ambulatory 24-hour
BP, fasting serum S100B and high-sensitive cardiac troponin T (cTnT). Serum was analysed by electrochemiluminescence immuno-assays. At 3-year follow-up,
retinopathy was quantified from digital images in the mydriatic eye and diastolic-ocular-perfusion-pressure, indicative of perfusion deficits and glaucoma risk,
was measured.
Results:
Irrespective of race, STRESS cases (n=236; men=64%) showed increased risk (p≤0.001) with prevalence exceeding established cut-points for chronic
24-hour hypertension (≥130 and/or 80mmHg: 90% vs. 10%), S100B (≥0.1 μg: 67% vs. 33%) and cTnT (≥4.2 ng/L: 77% vs. 23%) compared to controls (n=123).
STRESS cases presented increased retinopathy (71% vs. 29%) and diastolic-ocular-perfusion-pressure levels (p≤0.001) compared to controls at 3-year follow-
up. Consistent higher S100B [odds ratio 1.13 (95% CI 1.0 - 1.2), p=0.02] and diastolic-ocular-perfusion-pressure [odds ratio 1.21 (95% CI 1.1 - 1.11), p≤0.001]
levels were associated with STRESS. Controls demonstrated values within established reference ranges and no associations with risk markers.
Conclusion:
Novel data are presented where a chronic stress phenotype was associated with perfusion deficits in the human brain-heart axis. Homeostatic
reflexes may facilitate blood pressure increases to alleviate perfusion deficits and explain the strong interdependency of STRESS on hypertension prevalence.
Early screening for STRESS and diastolic-ocular-perfusion-pressure may lessen susceptibility of brain-heart injury and glaucoma risk.
Pulmonary atresia with intact ventricular septum: A review of 2 cases that underwent attempted radiofrequency perforation
at Chris Hani Baragwanath Academic Hospital
Vijay Mammen and Antoinette Cilliers
Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
Introduction:
Pulmonary valve atresia with intact interventricular septum (PA-IVS) is defined by a membranous or muscular atresia of the right ventricular
outflow tract and an intact ventricular septum. Early establishment of antegrade flow through the atretic pulmonary valve (PV) should be considered,
if the anatomy is favourable. This gives the right ventricle the maximum opportunity to increase in size. This can be done with catheter valvotomy using
radiofrequency perforation of the PV or surgery. Radiofrequency perforation of the PV is the current standard of care in suitable patients.
Methods:
Two cases of PA-IVS that underwent attempted radiofrequency perforation of the PV in 2018 at Chris Hani Baragwanath Academic Hospital
(CHBAH) were reviewed.
Results:
Case 1 was a 10-day-old female (3.5kg) with a tripartite right ventricle (RV), well developed infundibulum, tricuspid valve (TV) z-score of -2.9, TV to
mitral valve (MV) ratio of 0.6:1, membranous PV plate diameter of 5mm - 6mm (-3.7 - -2.5 z-score) and no RV-dependent coronary circulation. We performed
radiofrequency perforation and subsequent balloon dilatation of the PV that was successful. The patient is currently 8 months old and doing well. Case 2 was
a 2-month-old female (3.8kg) with a small bipartite RV, underdeveloped infundibulum, TV z-score of -1.7, TV:MV ratio of 0.56:1, membranous PV plate diameter
3.5mm - 5 mm (-6.6 - -4.1 z-score) and no RV-dependent coronary circulation. She also had an Ebstenoid-like TV and moderate to severe TV regurgitation. The
procedure was unsuccessful. We also had the added complication of an inadvertent perforation of the right ventricular outflow tract which caused a small
pericardial effusion that subsequently resolved. The patient was awaiting a BT-shunt procedure but subsequently demised before surgery due to sepsis.
Conclusion:
PA-IVS can safely be managed with radiofrequency perforation of the PV, if the anatomy is favourable. However, patient selection is an important
step to acquiring a successful result.