CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 16, ISSUE 3, MAY 2005
- Title: What do we know about the
burden of cardiovascular disease in South
Africa? : editorial
Authors: Bradshaw, Debbie
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.140-141
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- Title: The William Nelson ECG quiz
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.141, 157
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- Title: Adenosine deaminase activity
- more than a diagnostic tool in tuberculous
pericarditis : cardiovascular topic
Authors: Reuter, Helmuth; Burgess, Lesley J.; Carstens, Machteld E.; Doubell, Anton F.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.143-147
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Abstract: Aim: To improve the understanding of factors that influence adenosine deaminase (ADA) activity in large pericardial effusions.
Methods: A prospective study was carried out at Tygerberg Academic Hospital, South Africa. Patients underwent echocardiographically guided pericardiocentesis. ADA activity, as well as biochemistry, haematology, cytology, and in some cases, histology, were determined. Human immunodeficiency virus (HIV) status was assessed in all patients.
Results: Two hundred and thirty-three patients presented to Tygerberg Hospital with large pericardial effusions requiring pericardiocentesis. Tuberculous pericarditis accounted for 162 effusions (69.5%). An ADA cut-off level of 40 U/l resulted in a test sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic efficiency of 84.0%, 80.0%, 91.0%, 66.0% and 83.0%, respectively. Pericardial exudates with an ADA activity > 40 U/l were associated with increased total leukocyte and neutro - phil counts. Patients with tuberculous pericarditis and ADA > 40 U/l also had increased lymphocyte counts. Pericardial ADA activity < 30 U/l was associated with severe depletion of CD4 cell counts in HIV-positive patients. ADA levels were higher in cases with histological evidence of granulomatous inflammation than in cases with serofibrinous pericarditis.
Conclusions: An ADA cut-off level of 40 U/l results in best diagnostic test results. ADA production appears to be influenced by factors associated with the antituberculous immune response.
- Title: A two-year, single-group
experience with rotational atherectomy :
cardiovascular topic
Authors: Grigorov, V.; Jorgova, J.; Goldberg, L.; Roodt, A.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.148-151
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Abstract: Rotational atherectomy was introduced with a view to approaching percutaneously, cases that were suboptimal or unsuitable for conventional percutaneous transluminal coronary angioplasty (PTCA). In this article we present our findings for a period of two years starting in April 2001, when 60 procedures were performed on 54 patients. We found the procedure to be successful in B2 and C type lesions. It is our opinion that the lower burr-to-artery ratio used in our cases was significantly beneficial in decreasing immediate complications related to the procedure. Complimentary PTCA and stenting improved the angiographic end result. Using this strategy, we have achieved very acceptable clinical results.
- Title: Coagulation gene
polymorphisms as risk factors for myocardial
infarction in young Indian Asians :
cardiovascular topic
Authors: Pegoraro, R.J.; Ranjith, N.; Rom, L.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.152-157
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Abstract: Background: The relationship between pro-coagulant gene polymorphisms, clinical features and the risk of premature coronary heart disease (CHD) in Indian Asian subjects resident in South Africa has been investigated.
Methods: The prevalence of the b-fibrinogen -455G/A and -148C/T, and the factor VII 10bp 5' promoter insertion/deletion and R353Q polymorphisms were examined in 195 unrelated Indian Asian patients (< 45 years) who presented with myocardial infarction (MI). Results were compared with those from 107 unaffected siblings (18-45 years) and 300 healthy age- and race-matched control subjects.
Results: Overall, none of the polymorphisms examined here showed any association with MI. However, when stratified according to obesity, patients with a BMI > 30 kg/m2 had a significantly higher frequency of the b-fibrinogen variant alleles, compared with non-obese patients (19% vs 9%; p = 0.025) and controls (19% vs 9%; p = 0.003). Furthermore, the highest frequency of variant alleles occurred in obese smokers (24%), compared with 4% in non-obese non-smokers (p = 0.003) and 9% in control subjects (p < 0.001). The factor VII R353Q and promoter insertion variants, on the other hand, were associated with higher HDL and lower LDL levels (p = 0.034 and 0.04, respectively).
Conclusion: In young Indian Asians who are both obese and smoke, the b-fibrinogen genetic polymorphisms -455G-->A and -148C-->T, which are in linkage disequilibrium, are significant risk factors for the development of MI. Factor VII genetic variants, namely the 10bp promoter insertion/deletion and R353Q polymorphisms, may possibly play a protective role through their association with elevated HDL and low LDL levels, respectively.
- Title: Correlates of left atrial
size in Nigerian hypertensives : cardiovascular
topic
Authors: Adebiyi, Adewole A.; Aje, Akinyemi; Ogah, Okechukwu S.; Ojji, Dike B.; Oladapo, Olulola O.; Dada, Adekola; Falase, Ayodele O.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.158-161
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Abstract: Aim: Left atrial (LA) enlargement is a common finding in systemic hypertension and is a risk factor for the development of atrial fibrillation and stroke. We determined the correlates of LA enlargement in a Nigerian hypertensive population.
Methods: A total of 361 hypertensives were recruited for echocardiography. Enlarged left atrium was defined as LA diameter > 4.2 cm in men or > 3.8 cm in women.
Results: Enlarged LA was found in 15.8% of the hypertensives (19.2% in females and 12.5% males). Compared with those without dilated LA, subjects with dilated LA had higher age, body mass index, left ventricular end diastolic diameter, left ventricular wall thickness, lower ejection fraction and fractional shortening. In multivariate analysis, body mass index and left ventricular (LV) mass were the major predictors of LA size, whereas dilated LA was related to age, female gender and LV mass or the presence of left ventricular hypertrophy in logistic regression analysis.
Conclusion: Left atrial size in Nigerian hypertensives is influenced by age, female gender, left ventricular mass and body mass index.
- Title: The role of contrast-enhanced
spiral CT imaging versus chest X-rays in
surgical therapeutic concepts and thoracic
aortic injury : a 29-year Swiss retrospective
analysis of aortic surgery : review article
Authors: Exadaktylos, Aristomenis K.; Duwe, Jan; Eckstein, Friedrich; Stoupis, Christoforos; Schoenfeld, Helge; Zimmermann, Heinz; Carrel, Thierry P.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.162-165
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Abstract: Background: Blunt chest trauma accounts for 90% of chest trauma in the civilian population in Europe and the United States and causes 20% of trauma-related deaths. Missed aortic injuries can rupture and lead to subsequent death of the patient.
Materials and methods: This retrospective study compared two different imaging strategies, chest X-rays compared to additional contrast-enhanced spiral CT imaging, in patients suffering from blunt thoracic trauma. The study also questioned whether the additional information obtained from CT scans changed further surgical therapeutic concepts or the decision for immediate surgery.
Results: Between 1971 and 2001, 39 patients were detected with thoracic trauma and aortic lesions. Of the 28 patients who underwent initial CT scanning, 12 (31%) had an emergency thoracotomy (sternotomy) performed on them, which the other 16 did not require. In four (10%) of these 16 patients, the aorta was stabilised and a possible leak was covered with endovascular stenting. In another eight (21%) of them, the concomitant injuries were initially treated and, following regular check-ups, an elective repair of the aortic lesion was performed after a number of months. In four (10%) patients with intramural haematomas or minor leakage, no intervention was necessary. Eleven (28%) patients did not have a chest CT scan on admission and the diagnosis of a contained aortic rupture was missed. They were readmitted to the hospital between four months and 29 years after the initial accident with symptomatic posttraumatic pseudo-aneurysm of the thoracic aorta.
Conclusions: We believe that helical CT evaluation of the mediastinum should be performed in all patients who undergo blunt thoracic trauma, irrespective of chest radiographic findings. Missed diagnoses can occur after angiography or ultrasound alone, and false-positive diagnoses can also be made. Following the current litera ture, we therefore recommend a primary routine chest CT scan in all patients with a history of motor vehicle accident (MVA) at a speed of more than 16 km/h (unrestrained) or 48 km/h (restrained). Furthermore, we recommend a CT scan even if the height fallen was as little as seven metres.
- Title: Should l change to OPCAB? :
review article
Authors: Swart, Marius J.; Joubert, Gina
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.166-170
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Abstract: Much is written about the benefits of off-pump coronary artery bypass surgery (OPCAB). Is it applicable to all practices? Does that mean we all need to change to OPCAB? The surgical literature appears to have flaws with regard to providing answers. In striving for evidence-based medicine, one could integrate clinical data with external best evidence or do proper power calculations to determine study sizes. In a local, retrospective, observational study, 535 patients had a CABG done with the aid of cardiopulmonary bypass and cardiac arrest. Five hundred and seven patients were considered appropriate for analysis. Mortality was seven (1.4%), the prevalence of myocardial infarction four (0.8%), renal dialysis was four (0.8%) and stroke six (1.2%). Eighty (16%) patients required homologous blood transfusions. The median length of hospital stay was five days.
If a local, randomised, controlled study was to be conducted to confirm an improvement with OPCAB, a large number of patients would be needed. For a 12.5% reduction in an event rate presently at 0.8%, 262 000 patients would be necessary. For a 50% reduction in an event rate presently at 4.0%, 2 300 patients should be recruited. The local prevalence rate is very low and the number of patients required for a series is too high. The supremacy of OPCAB for this practice is therefore not established.
- Title: Drugs for the Heart, Lionel
H. Opie, Bernard J. Gersh : book review
Authors: Visagie, G.J.
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.171
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- Title: Identifying high-risk
patients with acute dyspnoea in the emergency
setting : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.172
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- Title: Ezetimibe offers new
opportunity to lower LDL-C to target levels :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.174
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- Title: FDA approves losartan for
stroke prevention in hypertensive patients with
LVH : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.176
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- Title: Plaque composition changes on
rosuvastatin treatment : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.176
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- Title: Phytosterols DT - a natural
option for moderately raised cholesterol : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.178-179
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- Title: Lovastatin - candidate for
non-prescription availability in US market :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.179-180
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- Title: Diovan has EU approval for
the treatment of heart attack survivors : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.180
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- Title: Benefit of clopidogrel in
recent myocardial infarction trials : drug
trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.182-183
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- Title: Aspirin - no effect on
primary prevention of MI or CV death in women :
drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.184
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- Title: Improvement in small artery
function in type 2 diabetes following
candesartan cilexitil treatment : drug trends in
cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.184
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- Title: Moxonidine suitable for
hypertensive menopausal women with metabolic
syndrome : drug trends in cardiology
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.186
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- Title: Cardio news
From: Cardiovascular Journal of South Africa, Vol 16, Issue 3, May / Jun
Published: 2005
Pages: p.188
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