CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE
10, NOV 2012
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- Title: Measurement of cardiac troponins
to detect myocardial infarction using
high-sensitivity assays : South African
guidelines : editorial
Authors: Delport, Rhena; Ker, James A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 531-532, 540
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Abstract: With the use of specific cardiac markers with higher sensitivity, new perspectives have emerged on the nature of myocardial necrosis and injury, which are associated with acute coronary syndrome (ACS). The third universal definition of myocardial infarction now classifies myocardial infarction (MI), based on the relevant pathology, clinical presentation, prognosis and treatment strategy, as spontaneous MI (type 1), MI secondary to an ischaemic imbalance (type 2), cardiac death due to sudden fatal MI (type 3), and MI associated with revascularisation procedures (types 4 and 5). What has also become evident is the extent of necrosis and injury that is associated with pathologies of other organs and conditions.
- Title: Prevalence and determinants of
electrocardiographic abnormalities in
sub-Saharan African individuals with type 2
diabetes : cardiovascular topic
Authors: Dzudie, Anastase; Choukem, Simeon-Pierre; Adam, Abdoul K.; Kengne, Andre P.; Gouking, Patricia; Dehayem, Mesmin; Kamdem, Felicite; Doualla, Marie S.; Joko, Henry A.; Lobe, Marielle E.E.; Mbouende, Yves M.; Luma, Henry; Mbanya, Jean-Claude; Kingue, Samuel
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 533-537
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DOI Number: 10.5830/CVJA-2012-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-054
Abstract: Aim : This study assessed the prevalence and determinants of electrocardiographic abnormalities in a group of type 2 diabetes patients recruited from two referral centres in Cameroon.
Methods : A total of 420 patients (49% men) receiving chronic diabetes care at the Douala General and Yaoundé Central hospitals were included. Electrocardiographic abnormalities were investigated, identified and related to potential determinants, with logistic regressions.
Results : The mean age and median duration of diagnosis were 56.7 years and four years, respectively. The main electrocardiographic aberrations (prevalence %) were: T-wave abnormalities (20.9%), Cornell product left ventricular hypertrophy (16.4%), arrhythmia (16.2%), ischaemic heart disease (13.6%), conduction defects (11.9%), QTc prolongation (10.2%) and ectopic beats (4.8%). Blood pressure variables were consistently associated with all electrocardiographic abnormalities. Diabetes-specific factors were associated with some abnormalities only.
Conclusions : Electrocardiographic aberrations in this population were dominated by repolarisation, conduction defects and left ventricular hypertrophy, and were more related to blood pressure than diabetes-specific factors.
- Title: Follow up in a developing country
of patients with complete atrio-ventricular
block : cardiovascular topic
Authors: Tchoumi, J.C. Tantchou; Foresti, Sara; Lupo, Pierpaolo; Cappato, Riccardo; Butera, Gianfranco
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 538-540
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DOI Number: 10.5830/CVJA-2012-059
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-059
Abstract: Aim : The purpose of the study was to assess the incidence and survival rate of patients with complete atrio-ventricular block in the cardiac centre of St Elizabeth Catholic General Hospital, Kumbo, Cameroon.
Methods : Between 2009 and 2011, 26 patients with complete atrio-ventricular block were diagnosed at our institution. Complete atrio-ventricular block was defined as complete heart block, diagnosed by echocardiographic or electrocardiographic documentation of the dissociation between electrical activity of the atria and ventricles. Hospital charts, electrocardiograms (ECG), echocardiography and chest radiography were reviewed.
Results : The triad of symptoms that pointed to the diagnosis of complete atrio-ventricular block was mainly fatigue, shortness of breath on mild physical exertion, and dizziness. The median age at diagnosis was 65 ± 15 years. The escape rhythm showed a narrow QRS complex in 35.2% of patients, whereas wide QRS complexes were seen in 64.8%. In only 15 patients were pacemakers implanted: dual-chamber in 10 and single-chamber in five cases, depending on the availability of the pacemakers. During the observational period, five non-implanted patients died, giving a mortality rate of 45%. We recorded no deaths in patients with pacemakers.
Conclusion : In developing countries, natural selection is observed in patients with complete atrio-ventricular block. Lack of infrastructure and early detection, and financial limitations are the main problems faced in the follow up of these patients. Re-organisation of the public health system, new programmes for the prevention of cardiovascular diseases, and government subsidisation are needed in our milieu.
- Title: QTc prolongation prior to
angiography predicts poor outcome and associates
significantly with lower left ventricular
ejection fractions and higher left ventricular
end-diastolic pressures : cardiovascular topic
Authors: Van der Bijl, Pieter; Heradien, Marshall; Doubell, Anton; Brink, Paul
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 541-545
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DOI Number: 10.5830/CVJA-2012-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-060
Abstract: Background : QT prolongation on the surface ECG is associated with sudden cardiac death. The cause of QT prolongation in ischaemic heart disease (IHD) patients remains unknown, but may be due to a complex interplay between genetic factors and impaired systolic and/or diastolic function through as yet unexplained mechanisms. It was hypothesised that QT prolongation before elective coronary angiography is associated with an increased mortality at six months.
Methods : Complete records of 321 patients who underwent coronary angiography were examined for QT interval corrected for heart rate (QTc), left ventricular ejection fraction (LVEF), left ventricular end-diastolic pressure (LVEDP) and known ischaemic heart disease risk factors. Patients were designated long QTc (LQTc) when they had prolonged QTc intervals or normal QTc (NQTc) when the QTc interval was normal. Patients with atrial fibrillation, bundle branch blocks, no ECG in the 24 hours before angiography, or a creatinine level > 200 µmol/l were excluded. Survival was determined telephonically at six months.
Results : Twenty-eight per cent of the total population had LQTc. During follow up, 15 patients (4.7%) died suddenly, 73% of whom had a LQTc. LQTc was significantly associated with mortality (LQTc 12% vs NQTc 1.7%; p < 0.01), and with lower but normal LVEF (LQTc 52.9 ± 15.4% vs NQTc 61.6 ± 13.6%; p < 0.01), higher LVEDP at LVEF > 45% (LQTc 19.2 ± 9.0 mmHg vs NQTc 15.95 ± 7.5 mmHg; p < 0.05), hypercholesterolaemia and a negative family history of IHD.
Conclusion : In patients with sinus rhythm and normal QRS width, QTc prolongation before coronary angiography predicted increased mortality at six months. QTc also associated strongly with left ventricular systolic and diastolic dysfunction, hypercholesterolaemia and a negative family history of IHD.
- Title: Statistical profiling of hospital
performance using acute coronary syndrome
mortality : cardiovascular topic
Authors: Manda, Samuel O.M.; Gale, Chris P.; Hall, Alistair S.; Gilthorpe, Mark S.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 546-551
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DOI Number: 10.5830/CVJA-2011-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-064
Abstract: Background : In order to improve the quality of care delivered to patients and to enable patient choice, public reports comparing hospital performances are routinely published. Robust systems of hospital 'report cards' on performance monitoring and evaluation are therefore crucial in medical decision-making processes. In particular, such systems should effectively account for and minimise systematic differences with regard to definitions and data quality, care and treatment quality, and 'case mix'.
Methods : Four methods for assessing hospital performance on mortality outcome measures were considered. The methods included combinations of Bayesian fixed- and random-effects models, and risk-adjusted mortality rate, and rank-based profiling techniques. The methods were empirically compared using 30-day mortality in patients admitted with acute coronary syndrome. Agreement was firstly assessed using median estimates between risk-adjusted mortality rates for a hospital and between ranks associated with a hospital's risk-adjusted mortality rates. Secondly, assessment of agreement was based on a classification of hospitals into low, normal or high performing using risk-adjusted mortality rates and ranks.
Results : There was poor agreement between the point estimates of risk-adjusted mortality rates, but better agreement between ranks. However, for categorised performance, the observed agreement between the methods' classification of the hospital performance ranged from 90 to 98%. In only two of the six possible pair-wise comparisons was agreement reasonable, as reflected by a Kappa statistic; it was 0.71 between the methods of identifying outliers with the fixed-effect model and 0.77 with the hierarchical model. In the remaining four pair-wise comparisons, the agreement was, at best, moderate.
Conclusions : Even though the inconsistencies among the studied methods raise questions about which hospitals performed better or worse than others, it seems that the choice of the definition of outlying performance is less critical than that of the statistical approach. Therefore there is a need to find robust systems of 'regulation' or 'performance monitoring' that are meaningful to health service practitioners and providers.
- Title: Cardiomyopathies and myocardial
disorders in Africa : present status and the way
forward : review article
Authors: Falase, Ayodele O.; Ogah, Okechukwu S.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 552-562
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DOI Number: 10.5830/CVJA-2012-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-046
Abstract: A review of heart diseases in Africa shows that the cardiomyopathies continue to be important causes of morbidity and mortality in the population. Hypertension remains the commonest cause of myocardial disease, followed by the cardiomyopathies. Ischaemic heart disease continues to be rare. Of the cardiomyopathies, dilated cardiomyopathy (DCM) is still the commonest. A large proportion of patients diagnosed with DCM in Africa have been shown to be cases of hypertensive heart failure, with varying degrees of myocardial dysfunction. Hypertrophic cardiomyopathy, which in the past was thought to be rare among Africans, has been shown to have the same prevalence as in other parts of the world. Moreover it is now known to be a genetic disorder. Endomyocardial fibrosis has become rare in communities where it used to be common. Its aetiology continues to be elusive. Arrhythmogenic right ventricular cardiomyopathy has been reported among Africans but there are no reports of left ventricular non-compaction or the ion channelopathies from Africa. Lenegre disease and the long-QT syndromes are well-known entities in clinical practice in Africa although long-QT in Africa is associated with potassium deficiency arising from prolonged treatment with diuretics. Left ventricular non-ischaemic aneurysms still occur but are rare. In view of these, a new classification of myocardial disorders was proposed for Africa.
- Title: Telomeres and atherosclerosis :
review article
Authors: Khan, Sajidah; Chuturgoon, Anil A.; Naidoo, Datshana P.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 563-571
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DOI Number: 10.5830/CVJA-2012-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-056
Abstract: In humans and other multicellular organisms that have an extended lifespan, the leading causes of death are atherosclerotic cardiovascular disease and cancer. Experimental and clinical evidence indicates that these age-related disorders are linked through dysregulation of telomere homeostasis. Telomeres are DNA protein structures located at the terminal end of chromosomes and shorten with each cycle of cell replication, thereby reflecting the biological age of an organism. Critically shortened telomeres provoke cellular senescence and apoptosis, impairing the function and viability of a cell. The endothelial cells within atherosclerotic plaques have been shown to display features of cellular senescence. Studies have consistently demonstrated an association between shortened telomere length and coronary artery disease (CAD).
Several of the CAD risk factors and particularly type 2 diabetes are linked to telomere shortening and cellular senescence. Our interest in telomere biology was prompted by the high incidence of premature CAD and diabetes in a subset of our population, and the hypothesis that these conditions are premature-ageing syndromes. The assessment of telomere length may serve as a better predictor of cardiovascular risk and mortality than currently available risk markers, and anti-senescence therapy targeting the telomere complex is emerging as a new strategy in the treatment of atherosclerosis. We review the evidence linking telomere biology to atherosclerosis and discuss methods to preserve telomere length.
- Title: 2nd South Africa-United Kingdom
cardiovascular workshop
Highlighting cardiovascular research in South Africa : meeting report
Authors: Kelly-Laubscher, Roisin; Burger, Gideon; Davies, Neil; Engelbrecht, Anna-Mart; Sliwa, Karen; Lecour, Sandrine; Strijdom, Hans; Hausenloy, Derek
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 572-573
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Abstract: It has been predicted that by the year 2030, the prevalence of death from cardiovascular disease (CVD) will have increased significantly. The perception that CVD is not relevant to developing countries needs to be redressed. In fact, South Africa (SA) is undergoing a more rapid increase in the prevalence of CVD than the developed countries, mainly due to urbanisation and the threatening increase in incidence of obesity and diabetes. Therefore there is a need for cutting-edge research with the potential to produce better therapies for the treatment of CVD in Africa.
- Title: South Africa enters a new era in
stroke prevention : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 573
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Abstract: Boehringer Ingelheim chose World Stroke Day on 29 October to launch its novel anticoagulant, Pradaxa (dabigatran) in South Africa. It promises to revolutionise stroke prevention in patients with atrial fibrillation (AF).
- Title: Simplifying venous thromboembolism
management : a new and safer era : drug trends
in cardiology
Authors: Hardy, G.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 574-575
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Abstract: During the course of October, Bayer hosted a lecture tour in major centres throughout South Africa on venous thromboembolism (VTE) management. Spanning the interests of a healthcare team approach to the management of VTE, lectures were presented by the eminent vascular physician Dr Cohen and our South African counterparts; haematologist Prof Peter Jacobs and specialist vascular surgeon Dr James Tunnicliffe.
- Title: Benefits of dabigatran maintained
for more than two years : drug trends in
cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: 576
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Abstract: Prevention of stroke in patients with non-valvular atrial fibrillation was sustained over more than two years' use of the novel oral anticoagulant drug, dabigatran, according to data from the first long-term study of these new agents. The results from the RE-LY-ABLE (Long-term Multi-centre Extension of Dabigatran Treatment in Patients with Atrial Fibrillation) study were presented at the American Heart Association (AHA) scientific sessions 2012.
- Title: Infections secondary to pacemaker
implantation : a synopsis of six cases : case
report - online article
Authors: Kane, A.D.; Ndiaye, M.B.; Pessinaba, S.; Mbaye, A.; Bodian, M.; Driouch, M.E.D.; Jobe, M.; Diao, M.; Sarr, M.; Kane, A.; Ba, S.A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: e1-e4
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DOI Number: 10.5830/CVJA-2012-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-035
Abstract: Introduction : Permanent cardiac pacing is a technique whose indications have increased in the last 20 years. As with any foreign body, pacemaker implantation is associated with the risk of infection. The objective of this study was to describe the clinical, paraclinical and treatment options of infections secondary to pacemaker implantation at the Cardiology Department of the Aristide le Dantec Teaching Hospital (CHU Aristide le Dantec) in Dakar, Senegal.
Methods : We conducted a retrospective study over a period of three years (from January 2005 to December 2007) during which pacemaker implantation was carried out in 107 patients. All patients with local and/or systemic signs of infection were included in our study.
Results : The prevalence of infection in patients with pacemakers was 5.6% in our series and infection occurred in three women and three men, with a mean age of 66.2 years (range 23-83). The delay time for the onset of clinical signs of infection was 6.6 months, with a range of eight days to 12 months. The clinical signs were externalisation of the pacemaker with suppuration (five cases), fever (one case) and inflammatory signs (one case). Factors favouring the occurrence of infection were co-morbidity (four cases), pre-operative length of stay (average eight days), use of temporary cardiac pacing (three cases), the number of people in the theatre (average 4.5), postoperative haematoma (one case) and repeating the surgical procedure (three cases). Staphylococcus epidermidis (two cases), Staphylococcus aureus (two cases) and Klebsiella pneumoniae (one case) were the organisms isolated at the local site. Transthoracic echocardiography showed no objective signs of endocarditis. The treatment was antibiotic therapy for an average duration of 50.4 days after debridement of the infected site (six cases). We noted four recurrences at six months and one death from sepsis at 12 months.
Conclusion : Infections secondary to pacemaker implantation are rare but serious. Their management is difficult and requires the removal of the implanted material, hence the importance of prevention of infection, or the removal and re-implantation of the pacemaker at another site in cases of infection. This is particularly important in our region where pacemakers are very expensive.
- Title: MRI finding of a papillary muscle
cyst : a differential diagnosis : case report -
online article
Authors: Shayingca, Thandaza; Andronikou, Savvas; Truter, Rene; Reid, Emile
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: e5-e6
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DOI Number: 10.5830/CVJA-2012-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-062
Abstract: Cystic lesions of the papillary muscle in the form of myxoma, hydatid cyst, papillary fibroelastoma, blood-filled cysts and endodermal heterotopia are rare causes of embolic stroke. In view of the potential complications caused by these lesions, surgery is often advocated but there is no consensus on which patients qualify. We examined a differential diagnosis of a papillary muscle cystic lesion in a patient presenting with features of embolic disease and identified the imaging features on MRI that directed management.
- Title: Successful management of
spontaneous aortic dissection type B in the
third trimester of pregnancy : case report -
online article
Authors: Simsek, Yavuz; Colak, Cengiz; Yilmaz, Ercan; Celik, Ebru; Erdil, Nevzat; Celik, Onder
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: e7-e9
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DOI Number: 10.5830/CVJA-2012-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-063
Abstract: Acute aortic dissection is a life-threatining disease that requires immediate surgical intervention. Although aortic dissection is a rare condition during pregnancy, it is of high risk for both mother and foetus. Most cases of aortic dissection during pregnancy have certain risk factors, including Marfan syndrome and congenital heart diseases. In this study, we report on a case of acute aortic dissection developing spontaneously at 32 weeks of gestation. The patient delivered a baby through cesarean section, and medical management of the dissection was commenced. Both mother and neonate survived and recovered well.
- Title: Single-stage repair of adult
aortic coarctation and concomitant coronary
artery disease : an unusual surgical approach
through median sternotomy : case report - online
article
Authors: Ulas, Mahmut Mustafa; Ergun, Kumral; Lafci, Gokhan; Sen, Nihat; Yalcinkaya, Adnan; Irdem, Ahmet; Cagli, Kerim
From: Cardiovascular Journal of Africa, Vol 23, Issue 10, Nov
Published: 2012
Pages: e10-e12
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DOI Number: 10.5830/CVJA-2012-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-061
Abstract: Surgical repair of postductal aortic coarctation associated with severe coronary artery disease is in most cases a difficult decision to make. As staged procedures are associated with a higher rate of morbidity and mortality, simultaneous operative management of both pathologies is desirable. We describe a case of a 51-year-old man who was referred to our department for surgical treatment of postductal aortic coarctation and concomitant coronary artery disease, which we managed with single-stage surgery through median sternotomy.
