CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 16, ISSUE 1, FEB 2005
- Title: From the Editor's Desk
Authors: Brink, Andries
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.3
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- Title: Reflections on the withdrawal
of rofecoxib : editorial
Authors: Dalby, Anthony J.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.5-6
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- Title: Clinical experience with the
S-Flex coronary stent : cardiovascular topic
Authors: Levetan, Basil N.; Park, Kenneth S.; Conway, Damian J.; Dessai, Anusha
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.9-14
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Abstract: Objective: Restenosis and the risk of sub-acute thrombosis still compromise the advantages of coronary stenting. This report aims to present a clinical audit of the first 100 patients to receive the South African-developed 'low injury' S-Flex coronary stent at Groote Schuur Hospital.
Methods: From September 1999 to March 2001, 102 patients received one or more S-Flex stents. There were no special criteria for the use of the S-Flex and the stents were used routinely with stents from other manufacturers. Procedural and patient demographic information was obtained through a retrospective examination of patient records. All but two patients were followed up through clinical interview or telephone contact six months or more after the procedure. The primary endpoint was clinical restenosis, defined as angiographic restenosis (> 50% diameter narrowing), or recurrence of significant symptoms of ischaemic heart disease or target lesion revascularisation (TLR) after discharge from the hospital, unless shown angiographically that the S-Flex was not implicated.
Results: Device success was achieved in all cases. There were five cases of in-hospital major adverse cardiac events (MACE), including the deaths of two patients who had initially presented with cardiogenic shock. The six-month MACE rate was 7.9%, the six-month TLR rate was 3.0% and the total six-month mortality was 4.0%. The clinical restenosis rate after six months was 7.1% and the total event-free survival (i.e. survival without MACE or clinical restenosis) at six months was 86.1%.
Conclusion: The S-Flex stent has a low clinical restenosis rate in a non-selective population undergoing stenting for coronary artery disease.
- Title: Carotid stenosis and carotid
plaque analysis relevant to carotid
endarterectomy and stentassisted angioplasty :
cardiovascular topic
Authors: Du Toit, D.F.; Saaiman, J.A.; Vorster, W.; Labuschagne, B.C.J.; Van Beek, F.J.; Boden, B.H.; Muller, C.J.F.; Geldenhuys, K.M.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.15-20
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Abstract: The primary objective of this cadaveric study was to review the morphological variations of the anatomy of the human carotid artery bifurcation relevant to carotid endarterectomy (CEA) and carotid artery stentsupported angioplasty (CSSA). We quantify carotid bifurcation plaque morphology. Results showed that the angle of deviation at the origin of the internal carotid artery (ICA), in relation to the common carotid artery (CCA), measured a mean of 21.8 degrees with a range from seven to 45 degrees. This anatomical finding is important for the interventionalist concerned with insertion of a carotid stent. The angle of the ICA origin may be an independent risk factor for early atherosclerotic changes at the ICA bulb. Carotid bifurcation plaque was observed in a small, random cohort of seven out of 13 cadavers, and contributed to a mean stenosis of 15.2% (range 5.0-34.8%). Plaque morphology (n = 7) showed haemorrhage (29%), superficial thrombosis (57%), calcification (71%), areas of focal necrosis (71%), neovascularisation (14%) and infiltrates (29%). Ulcerations were not detected. Although four out of 13 patients (31%) died of a cerebrovascular accident, the cause of cerebral apoplexy was thought not to be associated with the carotid bifurcation pathology. 'Re-boring' of occluding plaque, as in CEA, offers potential volumetric anatomical advantage over CSSA within the carotid bifurcation and bulb. In conclusion, precise and applied knowledge of carotid bifurcation anatomy is critical to reduce technical complications during CEA or CSSA. This information may reduce potential dangers of iatrogenic thrombo-embolism and ensuing neurologic deficits. Patients with low-grade carotid stenosis, evidence of focal plaque necrosis, are at risk of spontaneous plaque cap rupture, distal thromboembolism and stroke.
- Title: The William Nelson ECG quiz
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.20, 35
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- Title: Proposed mechanisms for the
anabolic steroid-induced increase in myocardial
susceptibility to ischaemia / reperfusion injury
: cardiovascular topic
Authors: Du Toit, E.F.; Rossouw, E.; Van Rooyen, J.; Lochner, A.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.21-28
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Abstract: Androgenic anabolic steroids (AAS) are often used by athletes to enhance athletic performance but are strongly associated with detrimental cardiovascular effects including sudden cardiac death.
Hypothesis: AAS use increases myocardial susceptibility to ischaemia / reperfusion injury.
Methods: Rats were trained (swimming) with or without intramuscular injection of nandrolone laurate (0.375 mg/kg). Untrained rats with or without nandrolone served as controls. Hearts were mounted on the Langendorff perfusion apparatus and mechanical function was measured before and after 20-min normothermic global ischaemia. Myocardial tissue samples were collected for determination of tissue cyclic nucleotide and TNFa concentrations.
Results: Anabolic steroids decreased the rate pressure product (RPP) of the exercise-trained rat heart [34 582 + 1 778 mmHg/min vs 28 868 + 2 446 mmHg/min for exercise-trained steroid-treated hearts (p < 0.05)]. Reperfusion RPP was lower in both the sedentary, and the exercise-trained, steroid-treated hearts than in their concurrent vehicle-treated controls (18 276 + 2 026 mmHg/min vs 12 018 + 1 725 mmHg/min for sedentary steroid-treated hearts and, 21 892 + 2 912 mmHg vs 12 838 + 1 536 mmHg/min for exercise-trained steroidtreated hearts). Myocardial TNFa [267.75 + 44.25 pg/g vs 190.00 + 15.75 pg/g (p < 0.05)] and cAMP concentrations [406.04 + 18.41 pmol/g vs 235.6 + 43.26 pmol/g (p < 0.05)] were elevated in the steroid-treated hearts when compared with their untreated counterparts.
Conclusions: Supraphysiological doses of anabolic steroids, whether taken during exercise training or under sedentary conditions increase myocardial susceptibility to ischaemia / reperfusion injury in our model. This increased susceptibility may be related to steroid-induced increases in the pre-ischaemic myocardial cAMP concentrations and / or increases in both pre-ischaemic and reperfusion TNFa concentrations.
- Title: Predictors of the successful
outcome of one year survivors of coronary artery
bypass surgery : cardiovascular topic
Authors: Eales, C.J.; Noakes, T.D.; Stewart, A.V.; Becker, P.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.29-35
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Abstract: This study was conducted on a South African cohort to establish the factors that may predict the successful outcome of coronary artery bypass surgery when assessed in terms of improved quality of life one year after the surgery. Information was sought on the socio-economic status of patients, their risk-factor profiles and clinical history. From the patient files, information was recorded on left ventricular ejection fraction, number of vessels bypassed, bypass time, and aortic cross-clamp time. The characteristics that were predictive of a successful outcome one year after surgery were identified. Patients in this study represented a high-risk population with multiple risk factors (obese, heavy smokers, hypertensive, hypercholesterolaemic, inactive, family history of heart disease, diabetes, and regular intake of alcohol).
Measured medical parameters could not distinguish between the group with an improved quality of life and the group who did not have improved quality of life. One year after CABG all patients with an improved quality of life were men. The additional identified predictor variables for a successful outcome were: being married, patients' height, the knowledge that smoking affects the cardiovascular system, number of years that sporting activities were stopped prior to CABG surgery, a betterquality sex life after the operation, acceptance of selfresponsibility for rehabilitation, and the spouse knowing the diet the patient should follow. The predictors of a successful outcome at the time of the operation were: being married (OR = 22.6; p = 0.02); taller than 170 cm (OR = 15.5; p = 0.01); stopped all sporting activities for a period less than 20 years prior to their surgery (OR 11.4; p = 0.01).
We concluded that the outcome of coronary artery bypass surgery could not be predicted on the basis of a medical model that considers exclusively the extent of the patient's disease and associated co-morbidities. Patients should be carefully selected and an intensive post-operative educational intervention should be provided to patients and their spouses / caregivers.
- Title: Endovascular aortic aneurysm
repair by a multidisciplinary team : lessons
learned and six-year clinical update :
cardiovascular topic
Authors: Du Toit, D.F.; Saaiman, J.A.; Carpenter, J.P.; Geldenhuys, K.M.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.36-47
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Abstract: Background: Endovascular aneurysm repair (EVAR) (using an Federal Drug Association-approved AneuRx(R) device) compared to conventional surgical repair of abdom inal aortic aneurysm (AAA) previously rendered favourable outcomes regarding post-operative pain, avoidence of laparotomy, and rapid rehabilitation and hospital discharge in high-risk patients, including octagenarians.
Objectives: To assess the safety, reduction in aneurysmrelated deaths, and interim survival data up to 72 months after AAA exclusion by endoluminal endografts (EVAR).
Design: We carried out an open, controlled, prospective, multidisciplinary EVAR study for the period 1998 to 2003 (six years). In the earlier part of the study, EVAR was compared with previously published results of conventional open aneurysmectomy surgery.
Setting: Heart Unit, Panorama Medi-Clinic, Parow, South Africa.
Participants: We recruited adult male and female patients presenting with AAA and fulfilling the inclusion criteria for endovascular repair, as recommended by the consensus 2003 meeting of the Vascular Association of South Africa (VASSA). All patients were offered open surgery as an alternative and were entered into the VASSA EVAR trial registry. Pre-operatively, AAA anatomy was assessed by spiral-computed tomography (CT), and selectively with conventional angiography and intravascular ultrasound (IVUS). Informed consent was obtained in accordance with the recommendations of the Senate of Surgery Paper 2, Ethical Guidelines, Great Britain and Ireland. Patients underwent EVAR by a multidisciplinary interventional team.
Interventions: Two hundred and seven adult patients with AAA were assessed. Forty-four of the 207 (21.2%) were excluded from EVAR because of irreversible comorbid factors and complex aneurysm morphology. One hundred and sixty-three patients (78%), with a mean age of 70.7 years (range 60-91 years), underwent EVAR (1998-2003). Five patients were lost to follow-up (3%). Median AAA diameter was 56.9 mm and ASA ratings were I, 1.2%; II, 15.9%; III, 57%; IV, 22.6%; and V, 2.4%. EVAR was performed in high- and low-risk categories of both sexes. Most patients were in ASA groups III and IV.
Devices deployed: EVAR was performed using a selection of endografts over 72 months - AneuRx(R) (Medtronic) 47; Talent(R) (Medtronic) 49; Vanguard(R) three; Zenith(R) (Cook) one; Powerlink(R) (Endologix) 62; and other, one.
Results: Thirty-day outcome: successful deployment 99%, primary stent patency 97%, surgical conversion 0.6%, procedural or intra-operative mortality 1.2%, 30-day mortality 4.3%, endoleaks 1.84%, and secondary intraprocedural endovascular interventions 24.5%. Perioperative mortality was 3.1% (one aneurysm related). One patient had suspected endograft infection. Late mortality was 21.4% (35 patients due to co-morbidities, and one was aneurysm related). Follow-up was a median of 28.3 months (range 1-69 months). In 163 patients, two persisting endoleaks (1.2%) were detected. Endotension was detected in 3/163 (1.8%) with average sac increase of 0.8 cm. Conversion to open surgery was needed in one patient (0.6%). Co-morbidities that contributed to late mortality included multi-organ failure, ischaemic heart disease (IHD), cardiomyopathy, renal failure, stroke and cancer. One procedural rupture was fatal (0.6%). Two late ruptures occurred; one was successfully endostented and the other patient died after a failed surgical intervention (0.6%).
Endovascular repair of AAA is more expensive than conventional surgery. Introduction of the Endologix stent has reduced operative time from 120 to 60 minutes in un complicated patients. Newer-generation aortic stents allow better control of negative remodeling and stent migration.
Conclusion: A multidisciplinary team can safely perform EVAR, with a low 30-day mortality rate in selected patients graded ASA II-IV and with favourable aortic aneurysm morphology. About 22% of patients with AAA are not suited for EVAR. Persisting late endoleaks occurred in 1.2% of the cohort study and were not device specific. Life-long follow-up post EVAR is a prerequisite to detect late device failure, endoleaks and aneurysm-sac enlargement, and to assure the durability of these midterm results. Short-term aneurysm rupture prevention is a predictable outcome in high-risk groups.
- Title: South African Heart
Association: Executive Committee 2004 / 2005
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.47
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- Title: Demographic data and outcome
of acute coronary syndrome in the South African
Asian Indian population : cardiovascular topic
Authors: Ranjith, N.; Pegoraro, R.J.; Naidoo, D.P.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.48-54
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Abstract: Significant differences in the prevalence of coronary heart disease (CHD) exist with respect to gender, age and ethnicity. The disease has been reported to be higher in Indian populations that have emigrated from the Indian subcontinent. The aim of this study was to examine differences in major cardiovascular risk factors and clinical outcome in South African Asian Indians of different age groups and gender, who presented with acute coronary syndromes (ACS).
The study cohort consisted of 2 290 consecutive patients, admitted between 1996 and 2002, who were divided into three age subgroups: young (< 45 years; 20%), middle age (> 45 to < 65 years; 59%), and old age (> 65 years; 21%). All three age groups were predominantly male, but this was more evident in the younger (88%) and middle age groups (71%), and became less striking as the proportion of females increased with age.
Smoking was more common in young men compared with young women (p < 0.01). Diabetes mellitus (21%) and hypertension (18%) were seen less frequently in young patients but this was confined to men only. Total cholesterol was elevated in 65 to 70% of all patients while high-density lipoprotein (HDL) levels were significantly lower in men compared with women for all age subsets. Hospital mortality was extremely low in young (1%) and middle-aged patients (2%), but was expectedly higher in older patients (8%; p < 0.0001).
A family history of CHD was the most common familial vascular disease seen. Young patients were more often subjected to diagnostic and therapeutic interventions. They had more aggressive disease, with 48% of those subjected to angiographic studies having triple vessel disease (TVD), and 14% undergoing coronary artery bypass grafting (CABG). Triple vessel disease was also detected most commonly in middle-aged (64%) and old patients (75%).
In conclusion, significant differences in risk factor status were found in South African Indians between genders and for different age groups. Also, young Indians in this study differed markedly from other young population groups with CHD, in that they frequently had premature atherosclerosis with diffuse and aggressive disease.
- Title: Ventricular tachycardia as an
adverse effect of the African potato (Hypoxis
sp.) : letter to the editor
Authors: Ker, James
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.55
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- Title: Eprosartan (Teveten) offers
new opportunities to prevent a second stroke :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.56
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- Title: Interpreting the ACTION study
- benefits in patients with stable angina and
raised blood pressure : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.58-60
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- Title: Pre-hospital use of aspirin
in emergency setting - seldom with adverse
events : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.60
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- Title: New amlodipine (Amloc(R) )
product available in South Africa : drug trends
in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.61
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- Title: ARBITER-2 : evidence that
targeting HDL cholesterol slows atherosclerosis
: drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.61
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- Title: Valsartan - first angiotensin
II receptor blocker licensed for post-MI use :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.62
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- Title: Major trial shows
cardiovascular benefits using new drug
combination with perindopril : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.62
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- Title: Achieving synergy and
improvements in cholesterol lowering : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.63-64
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- Title: Renewed interest in
lovastatin following launch of Lovachol : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.67
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- Title: Prevention of
microalbuminuria in type 2 diabetics : drug
trends in cardiology
Authors: Maritz, Frans J.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.68, 70
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- Title: PEACE - an important yet
neutral study of low-risk patients with CAD :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.70-71
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- Title: Cardio news
From: Cardiovascular Journal of South Africa, Vol 16, Issue 1, Jan / Feb
Published: 2005
Pages: p.72
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