CARDIOVASCULAR JOURNAL OF AFRICA:
VOLUME 22, ISSUE 2, MARCH 2011
This journal is now available to be
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- Title: Left ventricular dysfunction
in sickle cell disease : the value of an
electrocardiographic marker of increased risk of
arrhythmia : editorial
Authors: Oguanobi, I.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 59-60, 66
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Abstract: Sickle cell disease is one of the most prevalent genetic diseases worldwide; affecting 1/400 individuals of African descent as well as people of Arab, Indian and Hispanic descents. Abnormalities of cardiovascular function have increasingly been documented in sickle cell disease patients. Reports from several clinical studies in recent times have drawn attention to some 'emerging' cardiac pathologies in sickle cell disease and their potentially negative impact on cardiovascular function in these patients. Among these include myocardial infarction without coronary artery disease, pulmonary hypertension and cor pulmonale. Moreover, sudden unexpected death has become increasingly recognised as an important clinical feature of both the homozygous and heterozygous sickling syndromes; although the exact nature and its cause has remained unexplained.
- Title: From the editor's desk
Authors: Brink, Andries
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 60
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Abstract: The Cardiocascular Journal of Africa (CVJA) is making great strides but faces considerable challenges. It is now well accredited in all of the major databases in the world and is widely read. The increase in readership over the past year was 33% and 3 000 articles are downloaded monthly via Pubmed LinkOut. This reflects usage of only four years of the CVJA, which has a dataset of 400 full-text articles in Pubmed.
- Title: Occurrence and pattern of
congenital heart diseases in a rural area of
sub-Saharan Africa : cardiovascular topics
Authors: Tantchou Tchoumi, J.C.; Butera, G.; Giamberti, A.; Ambassa, J.C.; Sadeu, J.C.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 63-66
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DOI: 10.5830/CVJA-2010-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-046
Abstract: The extent of congenital heart disease in Cameroon remains largely unknown. The aim of this study was to determine the occurrence and pattern of congenital heart diseases in the Cardiac Centre of St Elizabeth Catholic General Hospital, situated in a rural area of Cameroon.
Methods : Between November 2002 and November 2008, a population of 2 123 patients with suspected cardiac pathologies were consulted at St Elizabeth Catholic General Hospital referral cardiac centre. Of these patients, 292 subjects were recruited for the study, based on detection of (1) precordial murmurs and/or cardiomegaly on chest X-ray examination, or (2) congenital heart diseases on transthoracic Doppler echocardiography examination.
Results : Congenital heart diseases and inorganic murmurs were found in 95.5 and 4.5% of the patients, respectively. Congenital heart diseases included tetralogy of Fallot (26.1%), isolated ventricular septal defect (38.8%), atrioventricular cushion defect (7.3%), isolated atrial septal defect (2.8%), arterial duct cases (12.4%), common arterial trunk (1.3%), isolated stenosis of the pulmonary artery (2.6%), coarctation of the aorta (1.1%), congenital mitral valve regurgitation (1.2%), atresia of the triscupid valve (1.6%), double-outlet right ventricle (2.1%), anomalous pulmonary venous return (1.5%) and left isomerism (1.2%).
Conclusion : Our data show that there is a high occurrence of congenital heart disease in this hospital in a rural zone of sub-Saharan Africa and that isolated ventricular septal defect is the predominant pathology. Post-surgical follow up remains very challenging as many parents cannot afford their children's medical treatment or are generally not well educated.
- Title: Efficacy of intramuscular
methyl prednisolone in preventing restenosis
after coronary artery stenting with bare-metal
stainless steel stent : a double-blind,
randomised, controlled clinical trial :
cardiovascular topics
Authors: Namdari, M.; Ghafarzadeh, M.; Nikoo, M.A.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 67-69
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DOI: 10.5830/CVJA-2010-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-039
Abstract: The aim of this study was to compare the mid-term outcome of patients receiving intramuscular methyl prednisolone before and after the procedure of coronary artery stenting. The study was conducted during 2007 and 2008 and compared the two arms of the study for the rate of restenosis six months after stenting. The control arm (100 patients) received only the usual preventive measures but the glucocorticoid arm (100 patients) received two doses of intramuscular methyl prednisolone (40 mg) at two-week intervals, the first at the time of the procedure. They also received the usual preventive measures
There was no statistically significant difference between the two arms for the rate of restenosis. When separately analysing for three vessels and for gender, there was no statistically significant difference either.
Lowering the dose of corticosteroid would greatly reduce the efficacy for preventing restenosis after coronary artery stenting. Therefore, if we are to achieve acceptable effectiveness with intramuscular prednisolone, we should administer increased doses at shorter intervals, which could be the target of further studies. However, there would be more chance of side effects with increased frequency of dosing.
- Title: Cardiovascular and
electrocardiographic changes in Nigerians with a
normal pregnancy : cardiovascular topics
Authors: Akinwusi, P.O.; Oboro, V.O.; Adebayo, R.A.; Akintunde, A.A.; Adeniji, A.O.; Isawumi, I.A.; Balogun, M.O.; Ogungbamigbe, T.O.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 71-75
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DOI: 10.5830/CVJA-2010-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-043
Abstract: Introduction : Pregnancy is associated with major haemodynamic and cardiac changes, which can mimic or precipitate cardiac diseases. There is a paucity of this kind of data among pregnant Nigerian women. This study was aimed at describing the cardiovascular and electrocardiographic changes found among healthy pregnant Nigerian women.
Methods : This was an age-matched control study of 69 consecutive normal pregnant and 70 healthy non-pregnant controls. The study protocol included history, physical examination and 12-lead electrocardiography.
Results : Diastolic blood pressure < 60 mmHg was significantly commoner among pregnant subjects than controls (64.7 vs 24.3%, respectively, p < 0.005). Mean heart rate was higher among pregnant women (88.34 ± 11.46 bpm) than the controls (75.16 ± 12.22 bpm, p = 0.020). Pregnant subjects also had a higher proportion of left ventricular hypertrophy (LVH) (10.2 vs 0%, p < 0.05) than non-pregnant controls. Abnormal cardiac findings included a loud second heart sound (P2), missed beats and systolic murmurs (41.2% in pregnant subjects vs 12.9% in non-pregnant controls, p < 0.05). Negroid-pattern ST-segment elevation was commoner among controls (24.3%) than pregnant subjects (2.9%, p < 0.005). Arrhythmias were rare among the study participants.
Conclusion : Significant findings on examination were low diastolic blood pressure and a systolic ejection murmur. However, ECG changes showed a normal frontal-plane QRS axis, normal PR interval, significantly rare normal Negroid-pattern ST elevation, significant LVH based on Araoye RI > 12 mm and a rarity of all forms of arrhythmias. These data may help resolve some cardiac diagnostic difficulties during pregnancy.
- Title: Diary for 2011 cardiovascular
congresses
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 75
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Abstract: Diary for 2011 cardiovascular congresses
- Title: P-wave dispersion :
relationship to left ventricular function in
sickle cell anaemia : cardiovascular topics
Authors: Oguanobi, N.I.; Onwubere, B.J.C.; Ike, S.O.; Anisiuba, B.C.; Ejim, E.C.; Ibegbulam, O.G.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 76-78
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DOI: 10.5830/CVJA-2010-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-047
Abstract: Background : The prognostic implications of P-wave dispersion in patients with a variety of cardiac disease conditions are increasingly being recognised. The relationship between P-wave dispersion and left ventricular function in sickle cell anaemia is unknown.
Objective : This study was aimed at evaluating the relationship between P-wave dispersion and left ventricular function in adult Nigerian sickle cell anaemia patients.
Methods : Between February and August 2007, a total of 62 sickle cell anaemia patients (aged 18-44 years; mean 28.27 ± 5.58) enrolled in the study. These were drawn from patients attending the adult sickle cell clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu. An equal number of age- and gender-matched normal subjects served as controls. All the participants were evaluated with electrocardiography and echocardiography. P-wave dispersion was defined as the difference between the maximum and minimum P-wave duration measured in a 12-lead electrocardiogram.
Results : P-wave duration and P-wave dispersion were significantly higher in patients than in controls. Significant correlation was demonstrated between P-wave dispersion and age in the patients (r = 0.387; p = 0.031). A comparison of subsets of sickle cell anaemia patients and controls with comparable haematocrit values (30-35%) showed significantly higher P-wave duration and P-wave dispersion in the patients than in the controls. The P-wave duration in patients and controls, respectively, was 111.10 ± 14.53 ms and 89.14 ± 16.45 ms (t = 3.141; p = 0.006). P-wave dispersion was 64.44 ± 15.86 ms in the patients and 36.43 ± 10.35 ms in the controls (t = 2.752; p = 0.013). Significant negative correlation was found between P-wave dispersion and left ventricular transmitral E/A ratio (r = -0.289; p = 0.023).
Conclusion : These findings suggest that P-wave dispersion could be useful in the evaluation of sickle cell patients with left ventricular diastolic dysfunction. Further prospective studies are recommended to evaluate its prognostic implication on the long-term disease outcome in sickle cell disease patients.
- Title: Achieving blood preSsure
goals sTudy in uncontrolled hypeRtensive
pAtients treated with a fixed-dose combination
of ramipriL / hydrochlorothiazide : the ASTRAL
study : cardiovascular topics
Authors: Okpechi, I.G.; Schoeman, H.S.; Longo-Mbenza, B.; Oke, D.A.; Kingue, S.; Nkoua, J.L.; Rayner, B.L.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 79-84
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DOI: 10.5830/CVJA-2010-086
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-086
Abstract: Background : Hypertension is a common cardiovascular disease, affecting adults worldwide and it accounts for up to 30% of all deaths. The need for better control of arterial hypertension justifies observational studies designed to better understand the real-life management of hypertensive patients. The ASTRAL study was primarily designed to evaluate the percentage of hypertensive patients achieving blood pressure goals after eight weeks of treatment with a fixed-dose combination of ramipril / hydrochlorothiazide (HCTZ).
Methods : The study was a multi-centre, non-comparative, open-label, observational study conducted in 36 centres in five sub-Saharan African countries, namely Cameroon, Congo Brazzaville, Democratic Republic of Congo (DRC), Madagascar and Nigeria. Four hundred and forty-nine men and women 18 years of age or older with hypertension not controlled by an ACE inhibitor, a diuretic or any other monotherapy or anti-hypertensive combination not containing a diuretic in a fixed dose were considered eligible for inclusion in this eight-week study. The study consisted of three visits, visit one (V1) at baseline, visit two (V2) after four weeks and visit three (V3) after eight weeks.
Results : The mean age of the patients was 54.7 ± 11.7 years (20-90 years) and most were categorised by the WHO criteria as either overweight or obese (71.6%). After four and eight weeks of treatment with the study drug, systolic and diastolic blood pressures significantly changed from baseline : -24.7 / -14.2 mmHg (p < 0.001) and -31.7 / -17.9 mmHg (p < 0.001), respectively. There were 60.2% of the non-diabetics on prior monotherapy who, at eight weeks, fulfilled the primary blood pressure goal for SBP and DBP, versus 26.5% of the diabetic patients, also on monotherapy. Few adverse events were reported, with facial oedema and dry cough recurring twice in two patients.
Conclusion : Fixed-dose combination of ramipril / HCTZ is therefore effective, tolerable and has a good safety profile for blood pressure control in black Africans.
- Title: Serum high-sensitivity
C-reactive protein, amyloid-associated protein
and N-terminal proBNP levels do not predict
reversible myocardial ischaemia : cardiovascular
topics
Authors: Baskurt, M.; Akturk, F.; Keskin, K.; Canbolat, P.; Karadag, B.; Kaya, A.; Yildiz, A.; Coskun, U.; Kilickesmez, K.; Esen, O.; Muniboglu, S.K.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 85-89
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DOI: 10.5830/CVJA-2010-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-041
Abstract: Aim : The aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia.
Methods : Ninety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group.
Results : There was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups.
Conclusion : Serum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.
- Title: Isolated left ventricular
non-compaction with normal ejection fraction :
case report
Authors: Peters, F.; Dos Santos, C.; Essop, R.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 90-93
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DOI: 10.5830/CVJA-2010-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-035
Abstract: Isolated left ventricular non-compaction (LVNC) is a genetic disease that is being increasingly recognised in patients presenting with heart failure of unknown origin. In this case report, we describe a patient with classic LVNC without clinical heart failure and with normal left ventricular ejection fraction.
- Title: Reversible myocardial
stunning due to carbon monoxide exposure : case
report
Authors: Fotbolcu, H.; Incedere, O.; Bakal, R.B.; Tanalp, A.C.; Astarcioglu, M.A.; Dindar, I.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 93-95
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DOI: 10.5830/CVJA-2010-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-040
Abstract: We report on a 37-year-old patient who suffered from myocardial stunning after exposure to carbon monoxide, despite having normal coronary arteries. As myocardial ischaemia may be asymptomatic in these patients, close monitoring with serial electrocardiography and of serum cardiac enzymes and troponins is recommended.
- Title: Secondary intracardiac
Burkitt-like lymphoma in the absence of HIV
infection : case report
Authors: Mocumbi, A.O.; Paul, L.; Maciel, L.; Silva, P.; Ferreira, M.B.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 96-97
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Abstract: Malignant lymphoma can involve the cardiac cavity or myocardium as a mass. Since clinical symptoms of its cardiac involvement are usually absent or non-specific, they may be undetected during life. Burkitt-like lymphoma (BLL) is a highly aggressive B-cell lymphoma with a high proliferative rate. Histopathological characteristics are considered borderline between those of classic Burkitt lymphoma and diffuse large B-cell lymphoma. Extensive cardiac involvement of BLL is rare and poorly documented in the literature.
We report the case of a child with BLL, presenting with extensive infiltration of the heart in the absence of HIV infection, and with right-sided heart failure and positional dyspnoea as the major clinical problems. We highlight the challenges for diagnosis and adequate treatment in poor settings like ours.
- Title: Affordable hypertension
therapy for diabetic patients : opinions in
hypertension management
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 98
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Abstract: Type 2 diabetes is one of the most expensive chronic diseases to treat, and in South Africa, with prescribed minimum benefits (PMB) applying to this disease, both private and public-sector funders are on the alert for cost-benefit issues. Perhaps one of the cost-benefit issues funders have missed is the current and future savings that can be made with effective anti-hypertension therapy from the outset at diabetes diagnosis.
- Title: Simultaneous treatment of
blood pressure and cholesterol beats the 'SILO'
approach in lowering cardiovascular risk :
results of the CRUCIAL study : opinions in
hypertension management
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 101
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Abstract: The so-called 'SILO' treatment approach based on the visualisation of individual cardiovascular risk factors and resulting in one-at-a-time risk-factor treatment is less effective than the simultaneous targeting of the two major risk factors, blood pressure and cholesterol.
- Title: Primary prevention with
statins is more cost-effective : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 102
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Abstract: Atherosclerosis is asymptomatic and both patients and clinicians would prefer to identify the condition early in order to prevent cardiovascular events later.
Reflecting on the Canadian experience, Dr Peter Lin of the Toronto Heart Centre noted that the Canadian health authorities have supported the concept of primary prevention using powerful statins such as atorvastatin and rosuvastatin. 'Their philosophy has been to provide benefit with statins as quickly as possible so as to avoid the first cardiovascular event', he noted.
- Title: New Dean at Stellenbosch
University
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 102
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Abstract: Prof Jimmy Volmink has taken office as the seventh dean of the Faculty of Health Sciences.
- Title: Stroke prevention in atrial
fibrillation : drug trends in cardiology
Authors: Wagenaar, P.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 105
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Abstract: When it comes to the prevention of thrombo-embolism, the entire picture is changing, thanks to the advent of new agents such as the direct thrombin inhibitors, notably dabigatran. 'They are going to have a huge impact and in future we will see less use of warfarin and antiplatelet agents such as aspirin and clopidogrel', says Prof Michael Ezekowitz. He was in South Africa recently at the invitation of Boehringer Ingelheim.
- Title: Stroke risk reduction : focus
of the new ESC guidelines : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 106
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Abstract: CHADS2 risk scoring is an easy off-top-of-the-head method to measure stroke risk in atrial fibrillation (AF) patients, but misses true predictive value and should be replaced by CHADS plus vascular risk (CHA2DS2-VASC). This expansion to the CHADS risk score is advocated in the new expert ESC guidelines for the management of atrial fibrillation.
- Title: Prasugrel offers consistent
platelet control in appropriate patients
requiring treatment - Lilly launches prasugrel
(Efient) in South Africa : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 107, 109
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Abstract: Prasugrel represents a major breakthrough in anti-platelet therapy for patients with acute myocardial infarction (AMI), offering significant benefits over the past decade's mainstay therapy of clopidogrel and aspirin in percutaneous coronary interventions (PCI).
- Title: Substantial evidence for
colorectal cancer reduction with daily low-dose
aspirin : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 110
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Abstract: High-dose aspirin (≥ 500 mg daily) taken for a period of five years has been shown in long-term follow-up studies to reduce the risk of colorectal cancer in the next decades of the patient's life. However, the greater risk of bleeding complications at this high dose reduces aspirin's potential in primary prevention of cancers.
- Title: Cardiovascular care products
From: Cardiovascular Journal of Africa, Vol 22, Issue 2, Mar / Apr
Published: 2011
Pages: 112
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Abstract: Beat colds and 'flu
Lilly launches Efient
