CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 16, ISSUE 2, MAR 2005
- Title: Cardiovascular disease and
hormone replacement therapy in post-menopausal
women : editorial
Authors: Rapeport, Naomi
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.76-80
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- Title: The effect of angiotensin
receptor blockers on myocardial infarction :
what are we to believe? : editorial
Authors: Ker, J.A.; Rheeder, P.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.81-82
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- Title: ARBs and mortality in
myocardial infarction : editorial comment
Authors: Opie, Lionel H.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.84
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- Title: Comparison of the effects of
arm position and support on blood pressure in
hypertensive and normotensive subjects :
cardiovascular topic
Authors: Familoni, O.B.; Olunuga, T.O.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.85-88
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Abstract: One hundred and twenty-three hypertensive patients were compared with 120 normotensive subjects, to study the effect of arm position and arm support on blood pressure (BP). The BP tended to increase from the sitting to the standing position in both groups, except when subjects were standing with the arm held out per- pendicular to the body, in which case the BP decreased.
The lowest standing recordings were observed when the elbow was slightly flexed and supported at this position. The highest BP was observed in the standing position with the arm hanging at the side.
Differences in the systolic BP between those with the arm hanging and when it was perpendicular to the torso, or flexed and supported at the elbow were 7.45 mmHg in hypertensives (p = 0.002) and 16.35 mmHg in normotensives (p < 0.0001). Similar figures for diastolic BP were 7.84 mmHg for hypertensives (p < 0.0001) and 9.81 mmHg for normotensives (p < 0.0001). Failure to support the arm at the elbow, even when it was positioned perpendicularly to the torso, led to an increase of 4.87/4.81 mmHg in hypertensives and 7.61/2.83 mmHg in normotensives.
Arm position and arm support affect the accuracy of BP measurements. The effect of arm position is more than that of arm support, although they are additive, and more in normotensives. Healthcare providers should adhere to recommended guidelines for BP measurement
- Title: The William Nelson ECG quiz
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.88, 101
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- Title: Target organ damage and
associated clinical conditions among Nigerians
with treated hypertension : cardiovascular topic
Authors: Ayodele, O.E.; Alebiosu, C.O.; Salako, B.L.; Awodein, O.G.; Adigun, A.D.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.89-93
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Abstract: Aim: Systemic hypertension is the commonest noncommunicable disease in Nigeria. Hypertension is linked with certain target organ damage (TOD) and associated clinical conditions (ACC). This study assessed the extent, pattern and predictors of TOD / ACC in patients with hypertension in Nigeria.
Methods: The study was carried out at the medical outpatient department of a state hospital in Nigeria. Target organ damage was assessed in these patients. Predictors of TOD / ACC were also sought.
Results: A total of 203 patients [73 men (36.0%) and 130 women (64.0%)] constituted the study population. One hundred and twenty-two patients (60.1%) had TOD / ACC . The prevalent TOD / ACC were left ventricular hypertrophy (LVH) (31.0%), chronic kidney disease (18.2%), diabetic nephropathy (18.2%), heart failure (10.8%) and cerebrovascular disease (CVD) (8.9%). There was a statistically significant association between systolic blood pressure and TOD / ACC . Patients with over all blood pressure (BP) control (i.e. BP < 140/90 mmHg) had more TOD compared with those that had overall uncontrolled BP (i.e. BP > 140/90 mmHg) although the difference was not statistically significant (c2 = 1.5, p > 0.05). The association between length of treatment and TOD / ACC approached significance (c2 = 9.35, p = 0.053).
Conclusion: The study showed a high prevalence of TOD / ACC in treated hypertensives. A positive association was shown between systolic BP and TOD / ACC . Early detection of hypertension and strict blood pressure control should help in reducing TOD / ACC in the hypertensive population.
- Title: Miokardiale perfusiebeelding
met Tc-99m MIBI in pasiënte met linker
bondeltakblok : die visuele en kwantitatiewe
beoordeling van anteroseptale perfusie vir die
diagnose van stenose van die linker afdalende
arterie : cardiovascular topic
Authors: Moller, Jacobus; Warwick, James; Bouma, Hymne
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.95-101
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Abstract: Introduction: The non-invasive detection of myocardial ischaemia in patients with left bundle branch block (LBBB) remains a challenge. It is often associated with coronary artery disease or hypertension, but frequently there is no indication of cardiovascular pathology at presentation. Exercise-induced electrocardiographic ST segment changes are non-diagnostic.
Confirming coronary artery disease has obvious implications for management. Several studies have shown greater cardiac mortality in the presence of LBBB. Generally, a good prognosis has been found in patients with LBBB and normal or near-normal myocardial perfusion scintigraphy (MPS).
Various investigators report frequent anteroseptal defects with MPS in patients with LBBB in the absence of significant left anterior descending (LAD) coronary artery disease. Several mechanisms have been proposed to explain this false-positive phenomenon. Various interpretative methods and stress techniques have been evaluated in an attempt to improve the specificity of noninvasive studies for detecting LAD disease.
A number of software packages for quantifying myocardial perfusion are commercially available. Quantification is recommended to improve diagnostic accuracy and intra- and inter-observer reproducibility.
Methods: Patients with LBBB on ECG, who were referred to our institution (February 2002 to September 2003) for myocardial perfusion scintigraphy, were included in the study. Patients with previous myocardial infarction were excluded, unless the location was confirmed to be not anteroseptal before the onset of LBBB. Patients who did not undergo coronary angiography within six months were also excluded, unless a LAD lesion of > 50% was diagnosed more than six months prior to MPS without subsequent intervention, or angiography more than six months later showed a LAD lesion of < 50%.
Treadmill exercise, dipyridamole or dobutamine infusion were used according to standard protocols and imaging commenced 15-60 minutes later. QPSTM quantitative software, used to reconstruct the images and quantify perfusion, is described in detail elsewhere.
Three experienced nuclear physicians interpreted the studies. Stress and rest perfusion, as well as reversibility, to the anteroseptal wall (excluding the apex), anteroseptal wall and apex, and apex only, were graded on a scale of 0 (normal) to 4 (absent perfusion), where 1 represents mild, 2 moderate, and 3 severe impairment of perfusion. A final decision was made by consensus. Using QPSTM, summed stress, rest and difference scores were obtained for the same regions.
Angiographic correlation was obtained by reviewing the patients. records. Stenosis of the LAD or graft vessel to the LAD of = 50% was regarded as significant.
The Kruskal-Wallace non-parametric test was used to compare the groups with and without significant LAD stenosis. A Bonferroni correction was applied to make provision for multiple testing. Receiver operating characteristic (ROC) analysis was utilised to determine the optimal threshold of the significant measurements to distinguish between the two groups; for this threshold, the sensitivity and specificity were calculated.
Results: Nine men and nine women (42.78 years) satisfied the inclusion criteria and were included in the study. Dipyridamole was used in nine patients, exercise in seven, dobutamine in one, and one patient was injected during a period of typical chest pain. Ten patients had a LAD stenosis of < 50% and eight = 50%.
The only measurement that yielded a significant difference between the groups was visual improvement in perfusion to the anteroseptal wall and apex between the stress and rest study (p < 0.0096). Even after applying a Bonferroni correction, the value tended towards significance (p = 0.16). A ROC curve was calculated and an optimal threshold of 0.5 determined, which in turn had a sensitivity of 88% and specificity of 67%.
Discussion: Our findings suggest that visual reversibility in the anteroseptal wall and apex gives an indication of significant LAD stenosis in patients with LBBB.
This finding agrees with that of Mairesse et al. Wackers argues that cardiomyopathic changes cause anteroseptal perfusion defects in LBBB. It is possible that irreversible perfusion defects in the anteroseptal wall and apex are caused by a constant, stress-independent mechanism, whereas reversible defects indicate underlying ischaemia.
Interestingly, quantitative analysis was not helpful in predicting LAD disease. The quantitative software we used is well validated. On the other hand, Svenssson et al. compared three myocardial perfusion quantification software packages and found considerable variation, especially in the presence of perfusion defects.
The state of perfusion to the apex was not helpful to detect significant LAD disease. It is known that the LAD usually supplies the apex. Matzer et al. found that requiring the presence of an apical defect improved specificity. This could not be confirmed by Lebtahi et al. or Vaduganathan et al.
Limitations: A definite limitation of our study was that treadmill stress testing was performed in seven patients. It is currently recommended by most authors that pharmacological stress be performed in patients with LBBB Selection bias is also a limitation because only patients who also had angiography were included in the study (18 out of 91).
Conclusion: A visual improvement in anteroseptal and apical myocardial perfusion between stress and rest with Tc-99m MIBI in patients with LBBB probably indicates significant LAD stenosis. In our hands, quantitative software did not aid in the diagnosis.
A well-designed, prospective study using a standardised stress protocol (probably dipyridamole or adenosine), which specifically evaluates visual reversibility in the anteroseptal wall and apex, will obviate the need for a Bonferroni correction, and could confirm these findings.
- Title: Adherence to cardiovascular
risk factor modification in patients with
hypertension : cardiovascular topic
Authors: Stewart, A.; Noakes, T.; Eales, C.; Shepard, K.; Becker, P.; Veriawa, Y.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.102-107
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Abstract: Aim: The effectiveness of the support of a healthcare practitioner and a family member in producing changes in cardiovascular risk factor modification was tested in a randomised, controlled trial in patients with hypertension.
Methods: The primary outcome measured after the 24-week intervention was blood pressure change. Secondary outcomes included patients' adherence to the programme, their knowledge about hypertension, exercise capacity, body weight, self-reported ability to control stress, adherence to medication and salt restriction, as well as symptoms.
Results: There were no marked improvements in blood pressure regulation in either group. The differences between the experimental and control groups were 3 mmHg (CI -6.18-12.18) for systolic blood pressure and 4 mmHg (CI -1.48-9.48) for diastolic blood pressure. The estimated blood pressure effects were small increases in both diastolic and systolic blood pressure, due to larger changes in the control group. These small changes were of no clinical significance. This intervention was not successful in reducing blood pressure of hypertensive patients who participated in a lifestyle programme. Secondary outcomes did show positive changes as a result of the given intervention. The absolute difference in improvement between the two groups was significantly greater for the experimental group than for the control group for the following variables: 24% better adherence to the programme (p = 0.007); 10% higher mean percentage score of hypertension knowledge and its management (p = 0.04); 20% more patients could control their stress levels (p = 0.05); 26% more patients could control their salt ingestion (p = 0.02); and 20% had better adherence to their given medication regimen (p = 0.05). The experimental group had a statistically significant weight reduction of 1 (± 4) kg relative to the control group (p = 0.03). Both groups increased their exercise capacity during the trial (p = 0.03). On the completion of the intervention, significantly fewer patients in the experimental group than in the control complained of tiredness (p = 0.05). Patients who had a 75% adherence or more to the programme were found to have maintained their knowledge and their exercise capacity, but not their weight loss after a maintenance phase of 12 weeks, during which time there was no intervention.
Conclusion: Patients in a supported environment such as the one in this study were able to modify their cardiovascular risk factors, even though there were non-significant changes in blood pressure reported in this study.
- Title: The role of chest radiography
in diagnosing patients with tuberculous
pericarditis : cardiovascular topic
Authors: Reuter, Helmuth; Burgess, Lesley J.; Doubell, Anton F.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.108-111
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Abstract: Aim: To describe the abnormalities on chest X-ray (CXR) in patients presenting with tuberculous pericardial effusions.
Methods: One hundred and seventy patients presented to Tygerberg Hospital with large pericardial effusions (epi-pericardial separation > 10 mm). All patients had a diagnostic work-up, which included CXR, ECG, two-dimensional echocardiography and HIV serology. Echocardiography was followed by pericardiocentesis and drainage. Pericardial fluid was analysed for adenosine deaminase (ADA), Ziehl Neelsen (ZN) stain, bacterial and mycobacterial cultures. Sputum was sent for ZN stain and mycobacterial cultures. Tuberculous pericardial effusions were diagnosed according to predetermined criteria.
Results: The diagnosis of tuberculous pericarditis was made in 53% (n = 90) of patients with pericardial effusions. Forty-one of the subjects (45.5%) were HIV positive. All patients had an enlarged cardiac silhouette and in the majority of cases, the cardiac shadow was globular with distinct margins. The cardiothoracic ratio (CTR) exceeded 0.55 in all patients. The amount of fluid drained correlated with the radiographic finding of cardiac enlargement.
Conclusion: In developing countries where TB is very prevalent, CXR plays an important role in the identification of large pericardial effusions. Although sonography will still be required for a definite diagnosis, the results of this study show that CXR is a useful screening tool.
- Title: Performance of the
CardioChekTM PA and Cholestech LDX(R)
point-of-care analysers compared to clinical
diagnostic laboratory methods for the
measurement of lipids : cardiovascular topic
Authors: Panz, Vanessa R.; Raal, Frederick J.; Paiker, Janice; Immelman, Ronnie; Miles, Hollis
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.112-116
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Abstract: Point-of-care (POC) blood testing is intended to provide results more rapidly than can be obtained from a central laboratory. Precision and accuracy of the CardioChek PA and Cholestech LDX analysers were compared to clinical diagnostic laboratory methods. In 100 patients, total cho lesterol (TC), triglycerides (TG), HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) levels were measured by both analysers and compared to those analysed by the National Health Laboratory Service (NHLS) laboratory. Data were evaluated for conformance with National Cholesterol Education Program (NCEP) guidelines.
Results were grouped into low, middle and high ranges and were similar to those obtained by the NHLS, except in the high range where TC and LDL-C levels were under-read by both analysers. All analytes measured by both analysers correlated significantly with NHLS (p < 0.0001). With the exception of LDL-C, both analysers showed reasonable compliance with NCEP goals for coefficients of variation and bias measurements. Both analysers met NCEP guidelines for all analytes at two clinical cut-off points.
We concluded that, compared to NHLS methods, performance of the CardioChek PA and Cholestech LDX analysers is acceptable and that they offer healthcare professionals a rapid, POC method for the measurement of lipids.
- Title: C-reactive protein in acute
and delayed preconditioning of the rat heart :
cardiovascular topic
Authors: Valtchanova-Matchouganska, A.; Gondwe, M.; Nadar, A.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.118-123
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Abstract: The involvement of C-reactive protein (CRP) in early (acute) and delayed ischaemic (IPC) and pharmacological (chemical) (CPC) preconditioning in an in vivo model of rat myocardial infarction is presented. Acute IPC was produced by three 5-min occlusion (ischaemia) periods interspersed with 5 min reperfusion, followed by 30-min occlusion of the left coronary artery and 2 h reperfusion injury. Acute CPC was produced by a k-opioid receptor agonist U50488H (5 mg/kg) applied i.v. 15 min before 30-min ischaemia /2-h reperfusion. Delayed preconditioning was produced by 30-min ischaemia /2-h reperfusion, induced 24 h after either ischaemic or pharmacological preconditioning. The myocardial ischaemia / reperfusion injury was evaluated on the basis of total and cardiac creatine kinase isoenzyme activity, functional recovery of the heart (ECG), infarct size (% IS/RA) and mortality at the end of the experiments.
The results obtained showed that:
* The k-opioid receptor agonist U50488H mimics both the acute and delayed IPC in the above experimental protocol.
* Both acute IPC and CPC produce effects by opening of the KATP channels (the effects were blocked by nonspecific ATP-sensitive K channel blocker glybenclamide), and via activation of protein kinase C (a selective protein kinase C inhibitor chelerythrine blocked the effects).
* C-reactive protein was significantly elevated by 54% in non-preconditioned acute ischaemia / reperfusion injury. The elevation was more pronounced (82% increase) 24 h after non-preconditioned ischaemia/ reperfusion injury. It reflected very well the increase in cardiac isoenzymes, infarct size and mortality of the rats, and can be used as a marker of the severity of myocardial injury in this model.
* The increase of CRP was prevented by both IPC and CPC in early, and especially in late preconditioning. This shows the involvement of CRP, not only as a marker, but as a causative factor in cardiac ischaemic / reperfusion injury.
Conclusion: In addition to the established involvement of adenosine, bradykinin, opioid and other receptors, a suppression of myocardial CRP / complement production might be involved in the biological mechanism of preconditioning. This could be a promising perspective in clinical interventions against ischaemia / reperfusion injuries of the heart.
- Title: ASCOT blood pressure-lowering
arm - study of effects of two BP-lowering
regimens in hypertensive patients with
cardiovascular risk factors : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.124, 126-127
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- Title: LIFE echocardiography study
confirms cardiac benefit : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.127
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- Title: Kidney disease as CVD risk
factor : implications for therapy : drug trends
in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.128-129
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- Title: The endothelium - 'man of the
match in the cardiovascular stakes' : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.131
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- Title: Aspirin and anti-lipid agents
show benefit after coronary artery bypass : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.131
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- Title: A closer look at the ACTION
study in the hypertensive sub-group : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.132
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- Title: Cardio news
From: Cardiovascular Journal of South Africa, Vol 16, Issue 2, Mar / Apr
Published: 2005
Pages: p.134-135
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