CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 19, ISSUE 1, FEB 2008
- Title: Show me the data : editorial
Authors: Rossner, Mike; Van Epps, Heather; Hill, Emma
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 3-4
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Abstract: The integrity of data, and transparency about their acquisition, are vital to science. The impact factor data that are gathered and sold by Thomson Scientific (formerly the Institute of Scientific Information, or ISI) have a strong influence on the scientific community, affecting decisions on where to publish, whom to promote or hire, the success of grant applications, and even salary bonuses. Yet, members of the community seem to have little understanding of how impact factors are determined, and, to our knowledge, no one has independently audited the underlying data to validate their reliability.
- Title: Prevalence and covariates of
electrocardiographic left ventricular
hypertrophy in diabetic patients in Tanzania :
cardiovascular topics
Authors: Lutale, J.J.K.; Thordarson, H.; Gulam-Abbas, Z.; Vetvik, K.; Gerdts, E.
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 8-14
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Abstract: Background: Left ventricular hypertrophy (LVH) has been demonstrated to be a powerful predictor of cardiovascular (CV) morbidity and mortality in diabetic as well as hypertensive patients. However, less is known about the prevalence of electrocardiographic LVH (ECG-LVH) and its relation to other CV risk factors in diabetic patients in sub-Saharan Africa. Therefore, the aim was to assess the prevalence of ECG-LVH in diabetic patients in Dar es Salaam, Tanzania, and its relation to other cardiovascular risk factors.
Methods: Two hundred and thirty-seven consecutive patients attending the Muhimbili diabetic clinic were studied. ECGlvH was diagnosed by Sokolow-Lyon voltage and Cornell voltage-duration product criteria. Q waves, ST-segment deviation, T-wave abnormalities and intraventricular conduction defects were classified by the Minnesota codes. Blood pressure (BP), serum creatinine, cholesterol and triglyceride levels, and HbA1c and urinary albumin and creatinine concentrations were determined.
Results: The prevalence of LVH in patients was 16% by either ECG criteria; 12.2% by Sokolow-Lyon and 5.1% by Cornell product criteria. Patients with LVH had significantly higher systolic and mean BP and pulse pressure, and a higher prevalence of ST-segment abnormalities, T-wave inversion and albuminuria than those without LVH (all p < 0.05). in multivariate logistic regression analysis, systolic BP was the only independent predictor of ECG-LVH. The prevalence of ECG-LVH increased by 15% per 10 mmHg higher systolic BP [OR 1.151 (95% CI 1.00921.314), p < 0.05]. Clustering of cardiovascular risk factors differed significantly between type 1 and type 2 diabetes patients. On average, type 1 patients had 0.8 and type 2 had 2.2 additional CV risk factors.
Conclusion: ECG-LVH was present in 16% of diabetic patients in Tanzania. Systolic BP was the most important predictor of ECG-LVH. Clustering of CV risks was significantly higher in type 2 than in type 1 diabetics, demonstrating the need for systematic multiple risk-factor assessment in these patients.
- Title: The a2CDel322-325 adrenergic
receptor polymorphism is not associated with
heart failure due to idiopathic dilated
cardiomyopathy in black Africans :
cardiovascular topics
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 15-16
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Abstract: Background: A four-amino acid deletion was identified within the a2C-adrenergic receptor (a2CDel322-325) that, when homozygous, increases the risk of heart failure in African-Americans nearly six-fold. We hypothesised that homozygosity for the a2CDel322-325 polymorphism may be a risk factor for heart failure due to idiopathic dilated cardiomyopathy (DCM) in black South Africans.
Methods: The a2CDel322-325 polymorphism was genotyped in 37 patients with heart failure and 34 controls, all of black African ancestry. Genotyping was performed by a size-fractionation assay.
Results: The patients studied ranged in age from 21 to 79 years with a mean age of 50 years, and 62% were male. No significant difference was observed in homozygosity for the a2CDel322-325 polymorphism or in allele and genotype frequencies between patients and controls. The frequency of the allele containing the deletion was 0.54 in cases and 0.53 in controls. The genotype frequencies in the patients were consistent with those of the controls (p = 0.56).
Conclusions: Homozygosity for the a2CDel322-325 polymorphism is not associated with an increased risk for heart failure due to idiopathic DCM in black South Africans.
- Title: Short- and long-term outcomes
of percutaneous coronary intervention in
patients with low, intermediate and high
ejection fraction : cardiovascular topics
Authors: Alidoosti, M.; Salarifar, M.; Zeinali, A.M.H.; Kassaian, S.E.; Dehkordi, M.R.; Fatollahi, M.S.
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 17-21
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Abstract: Background: Reduced ejection fraction (EF) has previously been shown to be a risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). However, with the advent of stents, procedural complications and restenosis rates have reduced dramatically. The aim of this study was to assess the association between left ventricular (LV) ejection fraction and in-hospital and longterm outcomes using a prospective registry.
Methods: After exclusion of patients with acute myocardial infarction (MI) and those with missing data on left ventricular ejection fraction, 2 030 patients undergoing PCI between March 2002 and 2004 remained in our prospective registry. Patients were divided into three categories: group 1: EF < 40% (n = 293), group 2: EF = 41-49% (n = 268) and group 3: EF > 50% (n = 1 469). The frequency of in-hospital and follow-up outcomes between groups was compared using appropriate statistical methods.
Results: Stents were used for over 85% of the patients in each group. The mean EF + SD in the lowest to highest EF groups was 35.8 + 5.4%, 45.5 + 1.6% and 57 + 5.7%, respectively. The angiographic and procedural success rates were 91.8, 92.1 and 94.1%, (p = 0.16); and 91.1, 90.3 and 92.9%, (p = 0.09), respectively. The respective cumulative major adverse cardiac events (MACE) and cardiac death rates at follow-up were 5.8, 2.2 and 3.3% (p = 0.04) and 2, 0.4 and 0.3% (p = 0.02), respectively. The hazards ratio (95% CI) for MACE and cardiac death in the lowest versus highest EF groups were 2.07 (1.03-4.16) and 5.49 (1.29-23.3).
Conclusions: Patients with significant left ventricular dysfunction had higher long-term major adverse cardiac events and cardiac death rates. Even the use of newer techniques such as stenting did not compensate for this.
- Title: Electrocardiographic
abnormalities in patients with heart failure :
cardiovascular topics
Authors: Karaye, Kamilu M .; Sani, Mahmoud U .
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 22-25
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Abstract: Background: The morbidity and mortality from heart failure (HF) differ between patients with reduced (< 50%) and with preserved (> 50%) left ventricular ejection fraction (LVEF) on account of many factors, including abnormalities detected in the electrocardiogram (ECG). The aim of this study was to determine and compare the ECG abnormalities between HF patients with reduced and with preserved LVEF.
Methods: The study was cross-sectional in design and carried out in Aminu Kano teaching hospital and Murtala Mohammed specialist hospital, Kano, Nigeria, from April 2005 to June 2006. We studied the resting electrocardiograms of all HF patients aged 15 years and older who were referred to the two centres for echocardiography.
Results: A total of 113 patients were studied and 98.2% of them had abnormal ECGs. Forty-two patients (37.2%) had preserved LVEF while the remaining 71 (62.8%) had reduced LVEF. Left ventricular hypertrophy ( LVH) was the commonest ECG abnormality, found among 55 patients (77.5%) with reduced LVEF, and 21 patients (50%) with preserved LVEF (p = 0.0026). The commonest arrhythmia was atrial fibrillation, found among 10 patients (14.1%) with reduced LVEF and eight patients (19.1%) with preserved LVEF (p = 0.486). Prolonged corrected QT interval was found among 30 (71.4%) and 56 patients (78.9%) with preserved and reduced LVEF, respectively (p = 0.370).
Conclusion: Most of the patients with heart failure studied in Kano, Nigeria had abnormal electrocardiograms, and the most common abnormality was LVH.
- Title: Primary cardiac angiosarcoma
with right coronary-to-right atrium fistula :
case report
Authors: Yildiz, Ahmet; Yakut, Necmettin; Kurtoglu, Tunay; Okcun, Baris; Kupelioglu, Ali
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 26-27
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Abstract: Primary tumours of the heart are rare. About 25% of all cardiac tumours are malignant and the most common of these is the angiosarcoma. We present a 61-year-old male with a right atrial angiosarcoma that was detected on coronary angiography. The tumour showed marked vascularity and a right coronary-to-right atrium fistula, and the patient underwent surgical resection. Pathological examination of the tumour was consistent with a cardiac angiosacoma and the diagnosis was also confirmed by immuno-histochemistry. He consequently underwent chemotherapy, however the patient died 60 days after the surgery.
- Title: Resolution of a giant atrial
thrombus following anticoagulation therapy :
case report
Authors: Senturk, Tunay; Kaderli, Aysel Aydin; Yesilbursa, Dilek
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 28-30
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Abstract: We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy, repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant therapy.
- Title: William Nelson ECG Quiz
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 30, 38
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Abstract: This is the ECG of an 85-year-old man.
- Title: Pacemaker-mediated
tachycardia induced by left ventriculography
during diagnostic catheterisation : a rare event
: case report
Authors: Jafary, Fahim H.; Shafquat, Azam
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 31-32
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Abstract: Pacemaker-mediated tachycardia (PMT) is an arrhythmia seen in patients implanted with dual-chamber pacemakers. It occurs when ventricular contraction is followed by retrograde conduction to the atrium, which is sensed by the pacemaker, leading to ventricular triggering. A vicious re-entry cycle is set up, leading to incessant tachycardia unless appropriately terminated. A common precipitant is a premature ventricular contraction (PVC). Although PVCs are frequently generated during ventriculography, PMT is an extremely rare event during cardiac catheterisation despite the fact that a large number of patients with implanted pacemakers do undergo the procedure. We report on a case and hope to highlight the possibility of PMT occurring during catheterisation, as well on therapeutic options.
- Title: Takotsubo cardiomyopathy : an
acute and reversible cardiomyopathy mimicking
acute myocardial infarction
Authors: Middlemost, Shirley; Mabin, Thomas
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 33-38
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Abstract: Takotsubo cardiomyopathy is an acute, reversible form of left ventricular dysfunction precipitated by emotional or physical stress. The condition is important to recognise as it mimics acute myocardial infarction and acute coronary syndrome. Most patients are female and postmenopausal. Presenting symptoms include severe chest pain, acute dyspnoea, hypotension or even cardiogenic shock.
The ECG changes are suggestive of an acute coronary syndrome with T-wave inversion with / without ST elevation, most often in the precordial leads. The syndrome is characterised by a sudden onset of transient extensive akinesia of the left ventricle, often involving all three major coronary artery territories, in the absence of significant coronary artery stenosis. The wall motion typically involves the apex of the left ventricle with hyperkinesis of the base of the heart. Variant forms have recently been described where the wall motion abnormality involves the mid-ventricular wall with hyperkinesis of the base and apex, or the base of the heart with hyperkinesis of the apex.
Characteristically, there is only a limited release of cardiac enzymes disproportionate to the extent of regional wall motion abnormality. Transient right ventricular dysfunction may occur and is associated with more complications, longer hospitalisation and worse left ventricular systolic dysfunction. Serial echocardiography is useful to document improvement in cardiac function.
The pathogenesis is unclear. Transient mid-cavity obstruction has been invoked with subsequent myocardial stunning in the akinetic segments. Treatment is supportive. The most effective long-term management remains to be defined. Although the prognosis is good with recovery of ventricular function at about three weeks, some patients have died. The syndrome may recur.
- Title: Electrocardiographic left
ventricular hypertrophy with strain pattern :
prevalence, mechanisms and prognostic
implications : review article
Authors: Ogah, O.S.; Oladapo, O.O.; Adebiyi, A.A.; Adebayo, A.K.; Aje, A.; Ojji, D.B.; Salako, B.L.; Falase, A.O.
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 39-45
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Abstract: Background: Electrocardiographic left ventricular hypertrophy with strain pattern has been documented as a marker for left ventricular hypertrophy. Its presence on the ECG of hypertensive patients is associated with a poor prognosis. This review was undertaken to report the prevalence, mechanism and prognostic implications of this ECG abnormality.
Materials and methods: We conducted a comprehensive search of electronic databases to identify studies relating to the title of this review. The search criteria were related to the title. Two of the reviewers independently screened the searches.
Results: Results were described qualitatively. The data were not pooled because there were no randomised studies on the topic. The prevalence of ECG strain pattern ranged from 2.1 to 36%. The highest prevalence was reported before the era of good antihypertensive therapy. The sensitivity as a measure of left ventricular hypertrophy ranged from 3.8 to 50%, while the specificity was in the range of 89.8 to 100%.
Strain pattern was associated with adverse cardiovascular risk factors as well as increased all-cause and CV morbidity and mortality.
ST-segment depression and T-wave inversion on the ECG was recognised as the strongest marker of morbidity and mortality when ECG-LVH criteria were utilised for risk stratification in hypertensive subjects.
Conclusion: Electrocardiographic strain pattern identifies cardiac patients at higher risk of cardiovascular-related as well as all-cause morbidity and mortality.
- Title: ONTARGET programme of cardio-
and vascular protection - first results are
imminent : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 46, 48
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Abstract: The largest comparison trial ever conducted of the cardio-protective effects of an ARB (telmisartan) alone, compared to and in combination with a well-proven ACE inhibitor (ramipril), the ONTARGET study is expected to yield a wealth of invaluable data relating to high-risk patients and to contribute significantly to the future treatment of cardiovascular disease.
- Title: Extended ASCOT - lipid
lowering (ASCOT-LLA) study shows positive
results of atorvastatin : drug trends in
cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 49, 51
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Abstract: An analysis of the further period of 2.2 years of lipid lowering following the early termination of ASCOT-LLA has shown that the significant reductions in primary cardiovascular events were maintained over the longer period, while the reduction in all-cause mortality (15%) now reached borderline significance.
- Title: Forthcoming events for 2008 :
drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 51
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Abstract: Forthcoming events for 2008
- Title: Controlled off-label use of
recombinant activated factor VII (NovoSeven) can
build evidence base : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 52, 54
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Abstract: The controlled off-label usage of recombinant activated factor VII (rFVIIa) can facilitate appropriate practices and provide evidence to underpin re-imbursement discussions.
- Title: A practical routine regimen
for amiodarone usage to reduce atrial
fibrillation in patients undergoing coronary
bypass surgery : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 55
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Abstract: A new study using a very practical administration of amiodarone on the day of surgery and post-operatively has shown that amiodarone is both effective and cost-effective in avoiding atrial fibrillation events in patients undergoing bypass surgery.
- Title: Managing acutely ill medical
patients to reduce venous thromboembolic events
: drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 57
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Abstract: Prof Sylvia Haas of the Institute for Experimental Oncology and Therapy Research, Munich University explained in her presentation on the need for thromboprophylaxis in medical patients at the recent South African Thrombosis congress.
- Title: SA experts comment on
clopidogrel and aspirin (dual platelet therapy)
use with bare metal and drug-eluting stents :
drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 58
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Abstract: Consensus on dual platelet therapy usage with stenting was evident from expert opinion expressed by South African cardiologists and surgeons at the recent meeting of the South African Society for Thrombosis and Haemostasis in Johannesburg. However there was considerable discussion on the local use of drug-eluting stents in South Africa, particularly in the light of the expense they entail.
- Title: Stop press
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 58
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Abstract: Dr Dalby's views on the longer use of clopidogrel in patients with acute coronary syndromes (ACS) were substantiated at the time of this issue going to press by a retrospective study published in the Journal of the American Medical Association of some 3 000 patients with ACS who experienced an increase in events following clopidogrel withdrawal.
- Title: First head-to-head study
comparing rosuvastatin and atorvastatin effects
on the treatment of atherosclerosis : drug
trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 1, Jan / Feb
Published: 2008
Pages: 60
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Abstract: AstraZeneca has announced the launch of a new clinical trial, SATURN, designed to measure the impact of rosuvastatin (CrestorTM) 40 mg and atorvastatin (Lipitor(R)) 80 mg on the progression of atherosclerosis in high-risk patients. SATURN will compare the effects of these two statins on the ability to decrease the progression or induce regression of atherosclerosis, the main cause of cardiovascular disease, following two years of treatment in patients with coronary artery disease.
