CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE 3, APRIL 2012
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- Title: Electronic innovation and
readership : from the editor's desk
Authors: Brink, A.J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 125
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Abstract: The Cardiovascular Journal of Africa (CVJAfrica) has updated its electronic presence with a modern website to provide for quick and easy access to the Journal's contents and services. Importantly, for narrow-band users in developing regions, the Journal has ensured that access to its articles is direct to text in compact PDFs.
- Title: The design and development of
a stented tissue mitral and aortic heart valve
replacement for human implantation :
cardiovascular topics
Authors: Legg, Murray; Mathews, Edward; Pelzer, Ruaan
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 126-130
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DOI Number: 10.5830/CVJA-2010-065
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2010-065
Abstract: A study was conducted into the development of a mitral and aortic heart valve replacement that caters for patients having suffered valve damage due to stenosis or rheumatic fever. The appeal of the valve is that it is constituted from a solid frame housing pericardial tissue leaflets, and allows the patient freedom from post-operative blood-thinning medication. The valve is designed to appeal to patients in developing areas of the world, as it features a clip-in mechanism to secure the valve assembly into the sewing ring, which is stitched in independently of the frame and leaflets. Re-operative valve replacement would then be made possible when the pericardial leaflets began to calcify. Novel aspects of the design added value to the science of heart valve replacements, through the use of sintered chrome cobalt in the valve components, the insights gained into mechanical testing of pericardium, and the patient benefits offered by the complete design. Further work is planned to fatigue test the assembly, undergo animal trials and make the valve available for commercial use.
- Title: Diabetes congress diary
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 130
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Abstract: Diabetes congress diary
- Title: Prognostic role of
Helicobacter pylori infection in acute coronary
syndrome : a prospective cohort study :
cardiovascular topics
Authors: R Eskandarian, R Ghorbani, M Shiyasi, B Momeni, K Hajifathalian, M Madani
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 131-135
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DOI Number: 10.5830/CVJA-2011-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-016
Abstract: In a prospective cohort study, we evaluated the effect of Helicobacter pylori seropositivity on the risk of future adverse cardiovascular outcomes among patients with acute coronary syndrome (ACS). In 433 patients, IgA and IgG antibodies to H pylori, along with classic risk factors, including hypertension, diabetes, hyperlipidaemia, smoking and family history of coronary artery disease (CAD) were determined. Short- and long-term follow-up information on adverse outcomes, defined as recurrence of unstable angina, myocardial infarction, coronary angioplasty, coronary artery bypass graft surgery, and sudden cardiac death was obtained. None of the classic CAD risk factors correlated with incidence of either short- or long-term outcomes. Seropositivity for H pylori was significantly associated with risk of short-term adverse outcomes, and independently predicted their incidence in multivariate regression (R = 3.05, p < 0.001). Results failed to show such an association between H pylori seropositivity and long-term adverse outcomes. H pylori infection may affect short-term prognosis in patients with ACS. Randomised trials are needed to evaluate the role of H pylori eradication in these patients.
- Title: The clinical,
electrocardiographic and echocardiographic
characteristics and long-term outcome of
patients with tachycardia-induced cardiomyopathy
: cardiovascular topics
Authors: Chin, Ashley; Badri, Motasim; Ntusi, N.B.; Okreglicki, Andrzej
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 136-142
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DOI Number: 10.5830/CVJA-2011-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-019
Abstract: Introduction : The clinical, electrocardiographic and echocardiographic features and long-term outcome of patients with tachycardia-induced cardiomyopathy (TIC) have not been well described in the past.
Methods : A retrospective study was performed at our institution of patients with a diagnosis of TIC.
Results : Thirty-three patients with pure TIC and 12 patients with impure TIC were identified. Compared to patients with dilated cardiomyopathy (DCMO), pure TIC patients were less symptomatic, as judged by NYHA class (p = 0.02), they had fewer clinical signs of heart failure (p = 0.007) and were more likely to report palpitations (p = 0.007) at presentation. Electrocardiographically, pure TIC patients had fewer Q waves (p = 0.002), less left ventricular hypertrophy (LVH) (p = 0.004) and repolarisation abnormalities (p = 0.048), and shorter QRS durations (p = 0.024). Echocardiographically, pure TIC patients had significantly smaller left ventricular internal diameter in diastole (LVIDd) (p < 0.001), ventricular internal diameter in systole (LVIDs) (p = 0.001) and left atrial dimensions (p = 0.048) at presentation compared to DCMO patients. Patients with pure TIC had a trend towards increased residual LVIDd dimensions compared to a control group with normal echocardiograms, indicating a persistence of adverse LV remodelling late after control of the causative tachycardia (p = 0.06). Recurrent tachycardia occurred in three patients, which resulted in a precipitous decline in left ventricular ejection fraction (LVEF).
Conclusions : This study is the first to compare features of pure and impure TIC. Patients with pure TIC had shorter QRS durations, fewer Q waves, and less LVH and repolarisation abnormalities at presentation compared to DCMO patients. TIC patients tended to have smaller LVIDd dimensions at presentation and have persistence of adverse LV remodelling, as characterised by persistent enlargement of LVIDd dimensions, at late follow up.
- Title: The value of serum tumour
markers in the prediction of aetiology and
follow up of patients with pericardial effusion
: cardiovascular topics
Authors: Bildirici, U.; Celikyurt, U.; Acar, E.; Bulut, O.; Sahin, T.; Kozdag, G.; Ural, D.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 143-146
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DOI Number: 10.5830/CVJA-2011-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-029
Abstract: Background : The aim of this study was to evaluate the value of tumour markers in the differential diagnosis of pericardial effusions and to assess their changing levels during follow up.
Methods : Sixty-nine patients who were admitted to hospital with a diagnosis of pericardial effusion were included in the study. Serum tumour markers were measured on admission and after a mean of 18 ± 7 months' follow up. An aetiological diagnosis was made on clinical evaluation, imaging techniques and biochemical, microbiological and pathological analysis. The patients were divided into five groups according to the aetiology of their pericardial effusions.
Results : Carbohydrate antigen (CA) 12-5 and CA 15-3, and carcinoembryonic antigen (CEA) levels were significantly higher in patients with malignancies than in those with viral/idiopathic pericarditis. With multivariate analysis, CA 15-3 levels were found to be the most significant determinant (p = 0.027). In the ROC curve analysis, CA 15-3 values above 25 U/ml predicted a malignancy with 71% sensitivity and 78% specificity.
Conclusion : Tumour markers, particularly CA 15-3, may be useful in the differential diagnosis and prediction of malignancies in patients with pericardial effusion. In patients with viral/idiopathic aetiology, these serum tumour markers were slightly elevated in the acute phase, but after a mean of one year of follow up, their levels returned to normal, contrary to those with malignancies.
- Title: Prevalence of residual left
ventricular structural changes after one year of
antihypertensive treatment in patients of
African descent : role of 24-hour pulse pressure
: cardiovascular topics
Authors: Libhaber, Elena N.; Norton, Gavin R.; Libhaber, Carlos D.; Woodiwiss, Angela J.; Candy, Geoffrey P.; Essop, Mohammed R.; Sareli, Pinhas
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 147-152
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DOI Number: 10.5830/CVJA-2012-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-001
Abstract: Objectives : One year of antihypertensive therapy may normalise left ventricular (LV) structure in 51% of hypertensive patients of European descent. Whether similar effects can be achieved in patients of African descent, who have a high prevalence of concentric LV hypertrophy (LVH) and remodelling, is unknown.
Methods : In 103 hypertensive patients in the Baragwanath Hypertension study we evaluated the prevalence of residual LV structural changes (echocardiography) after four and 13 months of stepwise antihypertensive therapy.
Results : After 13 months of therapy, 24-hour blood pressure control was achieved in 47% of patients. At baseline, 51.5% of patients had concentric LVH, 19% eccentric LVH and 12% concentric LV remodelling. Despite changes in LV mass index (p < 0.01) and relative wall thickness (p < 0.05) with treatment, the proportion of patients with a normal LV mass or geometry increased only from 17.5 to 25% (p > 0.05), while 26% remained with concentric LVH (p < 0.001 compared to baseline), 25% with eccentric LVH and 23% with concentric LV remodelling (p < 0.05 compared to baseline). Residual structural changes were associated with 24-hour pulse pressure (p = 0.02), but not with 24-hour systolic or diastolic blood pressure or clinic blood pressure.
Conclusions : Even after a year of antihypertensive therapy, a high proportion (74%) of hypertensives of African ancestry retained residual LV structural changes, an effect that was associated with 24-hour pulse pressure but not systolic or diastolic blood pressures or clinic blood pressure in this ethnic group.
- Title: The role of angiogenic, anti-angiogenic
and vasoactive factors in pre-eclamptic African
women : early- versus late-onset pre-eclampsia :
cardiovascular topics
Authors: Govender, Lucinda; Mackraj, Irene; Gathiram, Prem; Moodley, Jack
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 153-159
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DOI Number: 10.5830/CVJA-2012-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-003
Abstract: The pathogenesis and aetiology of pre-eclampsia (PE) is still unclear. We investigated the role of angiogenic, anti-angiogenic and vasoactive factors in black South African women with early- and late-onset PE. Serum soluble fms-like tyrosine kinase 1 (sFlt-1), soluble vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) levels were determined using the ELISA technique, and placental mRNA expression levels of sFlt-1, VEGF, PlGF and AT1 receptors were determined using real-time PCR.
Serum sFlt-1 levels were significantly elevated and PlGF significantly reduced in early-onset PE compared to the normotensive group. Placental VEGF mRNA expression levels were significantly reduced in the late-onset pre-eclamptic group compared with the normotensives. The placental mRNA expression of AT1 receptor in the late-onset pre-eclamptic group was relatively raised compared to the normotensives, suggesting hypersensitivity to pressor agents.
We believe that the excess of serum sFlt-1 and reduced VEGF and PlGF levels favour an anti-angiogenic state and endothelial dysfunction leading to PE, and that the aetiology and pathogenesis of early- and late-onset PE differ.
- Title: Cardiac surgery
risk-stratification models : review article
Authors: Prins, Carla; De Villiers Jonker, I.; Botes, Lizelle; Smit, Francis E.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 160-164
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DOI Number: 10.5830/CVJA-2011-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-047
Abstract: Risk models are widely used to predict outcomes after cardiac surgery. Not only is risk modelling applied in the assessment of the relative impact of specific risk factors on surgical outcomes, but also in patient counselling, the selection of treatment options, comparison of postoperative results, and quality-improvement programmes. At least 19 risk-stratification models exist for open-heart surgery. The focus of risk models was originally on pre-operative prediction of mortality. However, major morbidity is in general more common than mortality and the ability to predict only operative mortality is not an adequate method of determining surgical outcome. Multiple intra- and post-operative variables have been excluded in the majority of models and the possible effect of their future inclusion remains to be seen. The unique patient population of sub-Saharan Africa requires a unique risk model that reflects the patient population and levels of care.
- Title: Cardiovascular congress diary
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 164
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Abstract: Cardiovascular congress diary
- Title: The challenges of cardiac
surgery for African children : review article
Authors: Mocumbi, Ana O.H.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 165-167
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DOI Number: 10.5830/CVJA-2012-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-013
Abstract: In Africa the specific pattern of cardiovascular diseases and lack of adequate measures for disease prevention and control result in the frequent need for open-heart surgery for the management of complications of cardiomyopathies in children. Several strategies and innovative ways of providing cardiovascular surgical care in African countries have been used, from agreements to send patients overseas, to programmes for the creation of local services to provide comprehensive care locally.
This article attempts to outline the challenges faced by underdeveloped countries in Africa wanting to embark on programmes of cardiac surgery and the need for several sectors of society to play a role in the process. It discusses issues related to the establishment of centres performing cardiac surgery in Africa, describes the treatment of congenital heart disease, and reviews the aspects of management of conditions highly prevalent in or mostly confined to this continent, such as rheumatic heart valve disease and endomyocardial fibrosis.
- Title: New anticoagulants offer
consistent stroke-reduction benefit in atrial
fibrillation : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 168
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Abstract: 'All the new anticoagulants, dabigatran, rivaroxaban and apixaban are non-inferior to warfarin in the prevention of stroke and embolic events in atrial fibrillation (AF), offering an approximate relative reduction in risk (RRR) of 10% per year when compared to current warfarin therapy', Dr Louis van Zijl, physician and clinical trial investigator, based in Worcester, Western Cape noted in his presentation at the SA Hypertension congress. 'While we envisage that warfarin therapy will still be the control arm for randomised clinical trials for years to come, we need to face up to our failure to use this agent properly during the past 50 years', he noted.
- Title: Coenzyme Q10, an anti-oxidant
of value to reduce oxidative stress; also useful
to reduce statin-induced myalgia : your life and
your heart
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 170
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Abstract: Complementary medicine is frequently used by patients, particularly those with chronic diseases such as at-risk cardiovascular and diabetes patients. A recent survey in Australia showed that almost 50% of diabetic patients are accessing products such as cinnamon and coenzyme Q10 to complete their oral antidiabetic therapy.
- Title: From the ACC congress, 24-27
March 2012 : drug trends in cardiology
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 171
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Abstract: The addition of ivabradine to optimal medical care for those patients with heart failure and a normal ejection fraction (HFNEF) resulted in an improvement in both diastolic function and exercise capacity. This study was presented at the recent American College of Cardiology meeting in Chicago and is important to clinical practice because 50% of all congestive heart failure (CHF) patients have a normal ejection fraction, and to date there is no evidence of an effective treatment for improving outcome in these patients.
- Title: South African Hypertension
Society 2012 congress report : drug trends in
cardiology
Authors: Aalbers, J.; Hardy, G.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 172, 175-176, 179-180
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Abstract: Optimal combination therapy for hypertension - Prof Neil Poulter
Getting to the root of diabetes and the effect of GLP-1 on the cardiovascular system - Prof Wolfgang Schmidt
Difficult-to-control blood pressure - Prof Henry Krum
News from 2012 ACC congress
The young hypertensive - Prof Brian Rayner
- Title: Recruitment of pulmonary
hypertension patients for PATENT trial with
RIOCIQUAT completed, Cardiovascular Journal of
Africa 23(2) 2012, pp. 120 : erratum
Authors: Aalbers, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: 180 Full text: Click here to order »
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Abstract: Recruitment of pulmonary hypertension patients for PATENT trial with RIOCIQUAT completed, Cardiovascular Journal of Africa 23(2) 2012, pp. 120 : erratum
- Title: Iatrogenic
hydropneumopericardium : case report - online
article
Authors: Peters, F.; Patel, A.; Essop, R.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: e1-e2 Pages: 180
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DOI Number: 10.5830/CVJA-2011-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-014
Abstract: We report a case of iatrogenic hydropneumopericardium in a patient with diffuse scleroderma. The transthoracic echocardiogram revealed classical features of this condition. This case resolved spontaneously after five days using only 60% oxygen, which may have augmented resolution in this instance.
- Title: Spontaneous coronary artery
dissection associated with Leriche syndrome :
case report - online article
Authors: Karabay, C.Y.; Can, M.M.; Tanboga, I.H.; Aung, S.M.; Kalayci, A.; Gecmen, C.; Kirma, C.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: e3-e5
Pages: 180 Full text: Click here to order »
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DOI Number: 10.5830/CVJA-2011-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-012
Abstract: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients; those with coronary atherosclerosis, women in the peripartum period, and those with an idiopathic cause. SCAD may also be associated with other conditions. Herein, we present a 44-year-old man who developed SCAD concomitant with Leriche syndrome.
- Title: Multiple gene polymorphisms
predisposing to the prothrombotic state in an
adolescent with acute myocardial infarction :
case report - online article
Authors: Dogan, A.; Icli, A.; Varol, E.; Erdogan, D.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: e6-e8
Pages: 180 Full text: Click here to order »
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DOI Number: 10.5830/CVJA-2011-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-025
Abstract: Acute myocardial infarction with ST-segment elevation (STEMI) is rare in adolescents and its pathogenesis is unclear. Growing evidence shows an association between the prothrombotic state and acute STEMI. Prothrombotic genetic factors may be involved in the pathogenesis of STEMI. We present a case of an adolescent with acute STEMI who had multiple prothrombotic gene polymorphisms: in the beta fibrinogen, methylenetetrahydrofolate reductase and cholesteryl ester transfer protein genes, as well as genotypes in plasminogen activator inhibitor-1 and human platelet antigen type-1. He had normal coronary arteries with catheter-induced spasm and was treated with a calcium antagonist and aspirin.
- Title: Very late thrombosis of a
paclitaxel-eluting stent after 72 months in a
patient on dual anti-platelet therapy : case
report - online article
Authors: Subban, V.; Kalidoss, L.; Sankardas, M.A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: e9-e11
Pages: 180 Full text: Click here to order »
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DOI Number: 10.5830/CVJA-2011-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-022
Abstract: Very late thrombosis continues to be a major cause of concern in the era of drug-eluting stents. The duration of vulnerability to this complication remains undefined. A 62-year-old diabetic male underwent primary percutaneous coronary intervention with a Taxus Express stent (Boston Scientific, Natick, Mass) implantation in 2003 for anterior wall myocardial infarction (AWMI). The patient was on dual anti-platelet treatment. He was asymptomatic and his stress test was negative in 2008. After 72 months, the patient was admitted with acute AWMI resulting from stent thrombosis, which was treated successfully. This case underscores the importance of realising that very late stent thrombosis may occur when patients present with angina symptoms.
- Title: Post-infarction myocardial
rupture : a case of pericardial tamponade
salvaged by auto-blood transfusion : case report
- online article
Authors: Khaledi, A.K.; Larti, F.; Safari, S.
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: e12-e13
Pages: 180 Full text: Click here to order »
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DOI Number: 10.5830/CVJA-2011-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-026
Abstract: Left ventricular free-wall rupture (LVFWR) is a serious and lethal complication of acute myocardial infarction. Although this complication is not common, the fatality rate is high due to haemodynamic collapse in the setting of cardiac tamponade. We report a case of LVFWR in a patient with a rare blood group, who survived because of an innovative technique for pericardiocentesis and simultaneous transfusion of the aspirated blood into the femoral sheath. A video of the patient's ventriculography is provided.
- Title: Heart failure and cardiogenic
shock associated with the TB-immune
reconstitution inflammatory syndrome : case
report - online article
Authors: Kenyon, Chris; Schrueder, Neshaad; Ntsekhe, Mpiko; Meintjes, Graeme
From: Cardiovascular Journal of Africa, Vol 23, Issue 3, Apr
Published: 2012
Pages: e14-e17
Pages: 180
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DOI Number: 10.5830/CVJA-2011-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-062
Abstract: Heart failure has not been described in the setting of TB-immune reconstitution inflammatory syndrome (IRIS). We describe a case of cardiogenic shock in the setting of TB-IRIS four weeks after commencement of antiretroviral therapy. Possible aetiologies and pathophysiology as well as suggested diagnostic and therapeutic approaches to this problem are discussed.
