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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S9
AFRICA
Identifying risk factors for failure of radial artery access during coronary angiography in a South African population
Rudolf du Toit* and Jacques Doubell
#
*Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South
Africa.
#
Stellenbosch University and Tygerberg Hospital, Bellville, South Africa
Introduction:
Radial artery (RA) access is preferred to femoral access for coronary angiography but it poses a greater technical challenge with unique
complications. It may require multiple puncture attempts, has a higher cannulation failure rate and can be complicated by radial artery spasm (RAS), radial
artery pulsation loss (RAPL) and radial artery occlusion (RAO). Predictors of radial artery access failure include the size of the radial artery with higher failure
rates in small individuals and females.
Methods:
Patients undergoing coronary angiography via RA access at Tygerberg Hospital from April 2017 - July 2018 were recruited. The RA was assessed
by ultrasonography before and after the procedure. All ultrasound assessments were performed with a GE Logiq E (22MHz probe). The RA diameter was
measured 2 - 5cm proximal to the styloid process. During the procedure the number of puncture attempts, cannulation success and RAS were recorded. Post
procedurally the RA was assessed by ultrasound for local complications and patency assessed clinically and by ultrasound.
Results:
A total of 1 156 patients were included. The mean RA diameter prior to cannulation was 2.28mm (+ 0.47mm). The mean number of puncture
attempts was 2.64 (+12.79). Cannulation success was high (95.8%) with low complication rates (RAS 4.4%, RAPL 4.2% and RAO 4.8%). A negative correlation
was found between the pre-procedural RA diameter and the number of puncture attempts (Spearman’s rho -0.173, p<001). Females were found to have a
significantly smaller radial artery diameter than males with a mean of 2.05mm (+0.39mm) in females compared to 2.41mm (+0.46mm) in males (p<0.001).
There were also significantly more radial artery puncture attempts in females compared to males (p=0.001) as well as higher cannulation failure rates in
females (7.3%) when compared to males (2.6%) (p<001). Patients with hypertension had significantly more radial artery puncture attempts (p=0.047).
Diabetes Mellitus (p=0.038) and dyslipidaemia (p=0.35) were also associated with more radial artery puncture attempts.
Conclusion:
RA size in the South African population is similar to that seen in the rest of the world. In experienced centres the success rate for RA access is
high with low complication rates. RA diameter is a predictor to RA cannulation success and should be taken into consideration when performing trans-radial
coronary angiography, particularly in hypertensive, dyslipidaemic and diabetic females.
The South African SHARE-TAVI registry: Incidence and risk factors leading to conduction disturbances requiring permanent
pacemaker implantation
Rudolf du Toit*, Hellmuth Weich*, Anton Doubell* and the SHARE-TAVI contributors Elizabeth Schaafsma
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*Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, South
Africa.
#
SHARE Registry, SA Heart® Association, Tygerberg Hospital, Bellville, South Africa
Introduction:
Transcatheter aortic valve implantation (TAVI) has been implemented successfully in South Africa, the first case performed in 2009. The SHARE-
TAVI registry, established in 2014, monitors VARC-2 (Valve Academic Research Consortium-2) clinical endpoints. One of these endpoints, the most common
complication post TAVI, is the development of heart block requiring permanent pacemaker implantation (PPI). The incidence of PPI in international registries
ranges from 13% - 17.5%. No data from Africa on PPI has been published to date.
Methods:
The aim of this observational study was to report the PPI rate in the SHARE-TAVI registry and determine the clinical, electrocardiographic and
procedural predictors of PPI. This was done by analysing the registry data and performing a folder review, including detailed recording of pre- and post-
procedural electrocardiographic parameters.
Results:
A total of 305 subjects from both the public and private sectors were analysed. The PPI rate was 9%. Third degree atrioventricular block at the time
of implant was the most common indication for PPI. No clinical predictors of PPI were found. Procedurally, self-expanding valves (PPI rate 14% vs. 6% for
balloon-expanding valves, p=0.02) and valve size were correlated with the need for PPI. Baseline ECG predictors of PPI were axis deviation, QRS duration and
conduction delay, most notably a pre-existing right bundle branch block. PPI did not influence functional class, need for repeat hospitalisation or mortality at
30-day and 1-year follow-up.
Conclusion:
A PPI rate lower than that reported in large international registries was found. Predictors of PPI and the influence PPI on outcomes were similar
to those reported in international data.
Association of diabetes and arterial hypertension in an elderly Moroccan population
Monia El Mourid, Zakaria Qechchar, Fatima Ez-zahraa Talhi, El Mehdi Aqli, Leila Azzouzi and Rachida Habbal
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
Introduction:
The combination of hypertension and diabetes is particularly common in elderly people. It is responsible for an increase in cardiovascular risk
and can cause early damage to degenerative diabetes. This study focused on the epidemiological, clinical and biological characteristics of a population of
patients with associated hypertension and diabetes.
Methods:
A prospective and descriptive study of 321 patients, including 120 with a hypertension and diabetes combination, aged 65 years or older,
presenting at the cardiology department of Ibn Rochd University Hospital in Casablanca, from June 2015 - April 2017.
Results:
The mean age of our patients was 68.3 ± 3.1 years, with a clear female predominance (89.3%). The diagnosis of diabetes preceded that of
hypertension in 42.7%. Sixty percent of patients had Grade I hypertension. Mean BMI was 28.1 ± 4.6kg/m2. Dyslipidemia was present in 56.7% of our patients
with mainly hypo HDLemia (82%) and hyper LDLemia (57%). Macrangiopathy was found in 52% of patients dominated by the occurrence of ischaemic
heart disease in 32%. It was significantly more common in patients with LDL-c ≥1g/l and hypoHDLemia. The microangiopathy present in 73% of cases was
significantly related to hyperglycemia, glomerular filtration rate and triglyceride levels.
Conclusion:
The population of hypertensive and diabetic patients is a relatively frequent population exposed to cardiovascular complications, headed
by ischaemic heart disease. Hence the interest in full management from the moment of diagnosis of diabetes and hypertension to the prevention of
cardiovascular risk and specific therapy.