CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 23, ISSUE 4, MAY 2012
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- Title: Endothelial dysfunction : are
we ready to heed the vasculature's early-warning
signal? : editorial
Authors: Strijdom, Hans
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 184-185
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Abstract: Endothelial dysfunction (ED) refers to a spectrum of pathophysiological changes in the vascular endothelium that ultimately results in a loss of vascular homeostasis. Traditional cardiovascular risk factors (e.g. diabetes mellitus, smoking, dyslipidaemia and hypertension) are all associated with the development of ED via sustained and harmful effects, mediated by circulating stimuli such as pro-inflammatory tumour necrosis factor-alpha (TNF-alpha), oxidised low-density lipoprotein (ox-LDL), asymmetrical dimethyl-arginine (ADMA), angiotensin II and hyperglycaemia.
- Title: Association between troponin
T and ICU mortality, a changing trend :
cardiovascular topics
Authors: Hajsadeghi, S.; Gholami, S.; Gohardehi, G.; Moghadam, N.S.; Sabet, A.S.; Kerman, S.R.J.; Moradi, M.; Mollahoseini, R.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 186-190
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DOI Number: 10.5830/CVJA-2011-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-034
Abstract: Background : Initially elevated levels of troponin predict adverse outcomes in patients admitted to the intensive care unit (ICU). No research team has investigated the changes in concentration of cardiac troponin T (cTnT) during ICU stay and their association with patient outcome.
Objective : We investigated whether the change in cTnT levels during ICU stay could predict outcomes (death or survival).
Methods : In this cohort study, all patients admitted to the medical ICU (10 beds) from January to July 2008 were enrolled. Troponin levels were evaluated within the first 24 hours of ICU admission and on the fourth, seventh and 10th days after admission.
Results : The study population (135 patients) had a mean age of 60.9 ± 21.5 years. The outcome was significantly different with regard to normal or elevated cTnT concentrations on the first and seventh days of follow up (p = 0.03 and 0.023, respectively). This difference was non-significant for cTnT levels on the fourth and 10th days after admission (p = 0.69 and 0.78, respectively). The change in cTnT levels was not significantly different between the deceased and discharged patients (p = 0.4).
Conclusion : Changes in cTnT levels during ICU stay did not show a significant trend (power: 0.26). Patients whose cTnT levels were increased on the first and seventh days of ICU stay had a worse survival, which could be associated with cardiac events on admission or at specific times during the stay in ICU.
- Title: Diabetes congress diary
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 190
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Abstract: Diabetes congress diary
- Title: Nebivolol therapy improves
QTc and QTcd parameters in heart failure
patients : cardiovascular topics
Authors: Aksoy, S.M.; Cay, S.; Cagirci, G.; Sen, N.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 191-193
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DOI Number: 10.5830/CVJA-2011-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-046
Abstract: Aim : It has previously been shown that β-blocker therapy reduces QT dynamics in heart failure patients. The aim of this study was to demonstrate this improvement with the third-generation β-blocker, nebivolol.
Methods : A total of 72 heart failure patients with systolic dysfunction were included in the study. Corrected QT (QTc) and QT dispersion (QTcd) were measured manually by two independent observers at baseline and after nebivolol use (5 mg/day) in the first and third months of follow up.
Results : Both QTc and QTcd were found to be significantly reduced in the first (455.3 ± 26.7 vs 441.2 ± 25.7 ms, p < 0.001 for QTc, and 65.6 ± 5.3 vs 58.2 ± 5.6 ms, p = 0.001 for QTcd) and third months (455.3 ± 26.7 vs 436.0 ± 28.7 ms, p < 0.001 for QTc, and 65.6 ± 5.3 vs 56.0 ± 6.2 ms, p < 0.001 for QTcd) compared with baseline values.
Conclusion : Nebivolol was associated with improved QT dynamics in heart failure patients with systolic dysfunction.
- Title: Can cardiac surgery be
performed safely on patients with haematological
malignancies : cardiovascular topics
Authors: Guler, A.; Sahin, M.A.; Cingoz, F.; Ozal, E.; Demirkilic, U.; Arslan, M.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 194-196
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DOI Number: 10.5830/CVJA-2011-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-053
Abstract: Introduction : Surgical strategy in patients with haematological malignancies must be planned and carried out with the specific aim of decreasing postoperative complications. The aim of this study was to present our experience on patients previously diagnosed with haematological malignancies who subsequently underwent cardiac surgery. We include data to assist other surgeons predict factors affecting postoperative morbidity and mortality in this group of patients.
Methods : Fifteen patients diagnosed with haematological malignancies who had cardiac surgery were retrospectively analysed. Eight patients had chronic lymphocytic leukaemia, six had non-Hodgkin's lymphoma and the rest had chronic myelocytic leukaemia. Coronary artery bypass graft surgery was performed on all of them.
Results : There were no hospital mortalities. The average follow-up period was 35 ± 11 (23-56) months. Three patients required early postoperative re-operation because of excessive bleeding. No mortalities were seen in the early postoperative period. There were five (33%) deaths during the late follow-up period. Three patients were lost due to intracranial bleeding (confirmed by autopsy) in the 16th, 23rd and 38th months after surgery. The remaining two patients had sudden death in the eighth and 55th months from nondetectable causes.
Conclusion : Cardiac surgery can be performed with acceptable early postoperative outcomes in patients with haematological malignancies. Intracranial bleeding is an important factor contributing to late mortality and patient selection and risk stratification are crucial to improving surgical benefits.
- Title: The impact of cardiovascular
risk factors on the site and extent of coronary
artery disease : cardiovascular topics
Authors: Zand Parsa, A.F.; Ziai, H.; Haghighi, L.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 197-199
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DOI Number: 10.5830/CVJA-2011-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-052
Abstract: Background : In patients with coronary artery disease (CAD), the site and extent of coronary artery involvement in terms of proximal versus distal stenosis and multi- versus single-vessel disease have a crucial effect on patients' outcome. This study was designed to evaluate the relationship between cardiovascular risk factors and the site and extent of coronary artery involvement.
Methods : In this study of patients who had undergone coronary angiography in our hospital, 125 with proximal lesions were enrolled as the case group (group 1) and an equal age- and gender-matched number of patients with non-proximal lesions were selected as the control group (group 2). The two groups were compared based on the presence or absence of diabetes mellitus (DM), hypercholesterolaemia, hypertriglyceridaemia, hypertension (HTN) and cigarette smoking.
Results : The frequency of DM was 33.6 and 10.4% in the case and control groups, respectively, which was statistically significant (p < 0.0001). However, the frequency of hypercholesterolaemia in the case and control groups was 30.4 and 29.6% (p = 0.89), respectively; for hypertriglyceridaemia it was 19.2 and 16.8% (p = 0.062), respectively; for HTN it was 33.6 and 28.8% (p = 0.4), respectively; and for cigarette smoking it was 28.8 and 39.2% (p = 0.08), respectively, which were not statistically significant. Diabetic patients compared to non-diabetics had more multi-vessel disease (89.1 vs 61%, p < 0.0001, respectively), which was statistically significant. There was no relationship between hypercholesterolaemia, hypertriglyceridaemia, HTN and cigarette smoking and extent (multi-vessel involvement) of CAD (p = NS).
Conclusion : Proximal and multi-vessel involvement of the coronary arteries in patients with CAD was related to a history of DM but not of hypercholesterolaemia, HTN, cigarette smoking and hypertiglyceridaemia.
- Title: Cardiovascular congress diary
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 199
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Abstract: Cardiovascular congress diary
- Title: The time-course changes of
NT-proBNP and tissue Doppler indices in patients
undergoing mitral valve replacement :
cardiovascular topics
Authors: Prakaschandra, D.R.; Esterhuizen, T.; Naidoo, D.P.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 200-205
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DOI Number: 10.5830/CVJA-2011-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-057
Abstract: Background : In severe mitral regurgitation, a subset of patients who are asymptomatic may develop left ventricular decompensation before changes in echocardiographic parameters become evident. Since N-terminal brain natriuretic peptide (NT-proBNP) is used to detect early heart failure, we hypothesised that NT-proBNP would be activated in patients with mitral regurgitation.
Methods : Patients submitted to surgery were prospectively evaluated over eight months in the Department of Cardiology at Inkosi Albert Luthuli Central Hospital. Control patients with severe mitral regurgitation were obtained from the outpatient clinic. In order to define their value in identifying left ventricular decompensation, NT-proBNP levels and tissue Doppler imaging (TDI) indices were simultaneously measured and compared with conventional echocardiographic indices at baseline and this was repeated at one week and at six weeks after valve replacement.
Results : Mean NT-proBNP levels were markedly elevated pre-operatively in all surgical cases compared to controls (p = 0.0001). The diastolic E-mitral/E-annulus ratio, measured using TDI, was higher in the study group, indicating higher left ventricular filling pressure present in the study group. NT-proBNP levels increased further at one week after surgery and subsided at the six-week follow-up visit to levels similar to the control group. The TDI diastolic ratio also decreased at one week, and increased slightly again at the six-week follow up. These changes were accompanied by significant reduction in left atrium and left ventricular chamber dimensions with an increase in the ejection fraction from one to six weeks.
Conclusion : Marked differences in mean NT-proBNP levels and TDI ratios between the study and control groups suggest that using TDI and NT-proBNP assays may detect covert left ventricular decompensation.
- Title: Cohort studies of
cardiovascular disease in the Seychelles,
Tanzania and Mauritius : letter to the editor
Authors: Bovet, Pascal; Shamlaye, Conrad
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 205, 215
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Abstract: We read with interest the review by Kengne et al. on cohort studies of cardiovascular disease in sub-Sahara Africa. We agree with the authors that cohort studies are important tools to advance our knowledge of cardiovascular disease in the region and inform appropriate clinical and public health responses.
- Title: Presentation pattern and
management of effusive-constrictive pericarditis
in Ibadan : cardiovascular topics
Authors: Salami, M.A.; Adeoye, P.O.; Adegboye, V.O.; Adebo, O.A.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 206-211
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DOI Number: 10.5830/CVJA-2011-066
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-066
Abstract: Background : Effusive-constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease.
Methods : We conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa.
Results : The diagnosis of effusive-constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy.
Conclusion : Effusive-constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.
- Title: Risk factors for the
development of pneumonia post cardiac surgery :
cardio-vascular topics
Authors: Topal, A.E.; Eren, M.N.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 212-215
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DOI Number: 10.5830/CVJA-2012-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-005
Abstract: Objectives : Postoperative pneumonia is a devastating complication after cardiac surgery that increases morbidity and mortality. The objective of this study was to identify potential risk factors for the development of nosocomial pneumonia post cardiac surgery by the way of logistic regression analysis.
Design : Data of the last 162 patients undergoing cardiac surgery before November 2009 were retrospectively collected and analysed.
Results : The mean age of the patients was 65.57 ± 10.48 years and 83 (51%) were male. Postoperative pneumonia was diagnosed in 21 (13%) patients. The mean remaining time in the intensive care unit and mean length of hospitalisation were longer for patients with postoperative pneumonia. Pre-operative heart rate, previous diabetes mellitus, previous chronic obstructive pulmonary disease, postoperative urea, creatinine and potassium levels, extubation time, postoperative atrial fibrillation, and number of units of transfused packed red blood cells (pRBC) and fresh frozen plasma were associated with higher occurrence of postoperative pneumonia on univariate analysis.
Conclusions : On logistic regression analysis, pRBC transfusion, previous chronic obstructive pulmonary disease and postoperative atrial fibrillation remained as independent predictors for the development of postoperative pneumonia.
- Title: An audit of pregnant women
with prosthetic heart valves at a tertiary
hospital in South Africa : a five-year
experience : cardiovascular topics
Authors: Mazibuko, B.; Ramnarain, H.; Moodley, J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 216-221
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DOI Number: 10.5830/CVJA-2012-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2012-022
Abstract: Background : Cardiac disease in pregnancy is a common problem in under-resourced countries and a significant cause of maternal morbidity and mortality. A large proportion of patients with cardiac disease have prosthetic mechanical heart valve replacements, warranting prophylactic anticoagulation.
Aim : To evaluate obstetric outcomes in women with prosthetic heart valves in an under-resourced country.
Methods : A retrospective chart review was performed of 61 pregnant patients with prosthetic valve prostheses referred to our tertiary hospital over a five-year period.
Results : Sixty-one (6%) of 1 021 pregnant women with a diagnosis of cardiac disease had prosthetic heart valves. Fifty-nine had mechanical valves and were on prophylactic anticoagulation therapy, three had stopped their medication prior to pregnancy and two had bioprosthetic valves. There were forty-one (67%) live births, two (3%) early neonatal deaths, 12 (20%) miscarriages and six (10%) stillbirths. Maternal complications included mitral valve thrombosis (n = 4), atrial fibrillation (n = 8), infective endocarditis (n = 6), caesarean section wound haematomas (n = 7), broad ligament haematoma (n = 1) and warfarin embryopathy (n = 4). Haemorrhagic complications occurred in five patients and all five required blood transfusions.
Conclusion : Prophylactic anticoagulation with warfarin in patients with mechanical heart valve prostheses was associated with high rates of maternal and neonatal complications, including significant foetal wastage in the first and early second trimesters of pregnancy. Health professionals providing care for pregnant women with prosthetic heart valves must consistently advise on family planning matters, adherence to anticoagulation regimes and consider the use of prophylactic anticoagulant regimens other than warfarin, particularly during the first trimester of pregnancy.
- Title: Endothelial dysfunction : the
early predictor of atherosclerosis : review
article
Authors: Mudau, Mashudu; Genis, Amanda; Lochner, Amanda; Strijdom, Hans
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 222-231
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DOI Number: 10.5830/CVJA-2011-068
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-068
Abstract: Since the discovery in the 1980s that nitric oxide (NO) is in fact the elusive endothelium-derived relaxing factor, it has become evident that NO is not only a major cardiovascular signalling molecule, but that changes in its bioavailability are crucial in determining whether atherosclerosis will develop or not. Sustained high levels of harmful circulating stimuli associated with cardiovascular risk factors such as diabetes mellitus elicit responses in endothelial cells that appear sequentially, namely endothelial cell activation and endothelial dysfunction (ED).
ED, characterised by reduced NO bioavailability, is now recognised by many as an early, reversible precursor of atherosclerosis. The pathogenesis of ED is multifactorial; however, oxidative stress appears to be the common underlying cellular mechanism in the ensuing loss of vaso-active, inflammatory, haemostatic and redox homeostasis in the body's vascular system. The role of ED as a pathophysiological link between early endothelial cell changes associated with cardiovascular risk factors and the development of ischaemic heart disease is of importance to basic scientists and clinicians alike.
- Title: Expert report on the 22nd
European meeting on hypertension and
cardiovascular protection, London, 26-29 April
2012 : conference report
Authors: Rapeport, Naomi; Middlemost, Shirley
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: 232-234
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Abstract: Following the release of the updated NICE (British Hypertension Society) guidelines last year and the South African guidelines recently, this meeting presented an opportunity to hear opinion leaders analyse, debate and discuss the best way to detect and manage hypertension in the 21st century.
- Title: Non-obstructive membranes of
the left atrial appendage : case report - online
article
Authors: Bordonali, Tania; Saporetti, Alberto; Vizzardi, Enrico; D'Aloia, Antonio; Chiari, Ermanna; Dei Cas, Livio
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: e1-e2
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DOI Number: 10.5830/CVJA-2011-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-020
Abstract: The left atrial appendage (LAA) is a blind-ending, complex structure distinct from the body of the left atrium and is sometimes regarded as a minor extension of the atrium. However, it should routinely be analysed as part of a transoesophageal echocardiographic examination. In this study we describe the presence of a non-obstructive membrane traversing the cavity of the LAA, found incidentally on transoesophageal echocardiography.
- Title: Mobile atheromatous plaque of
the aortic arch diagnosed by transthoracic
echocardiography prior to coronary artery bypass
surgery - which one would you choose :
scepticism or wishful thinking? : case report -
online article
Authors: Hatemi, A.C.; Omay, O.; Baskurt, M.; Kucukoglu, S.; Oz, B.; Suzer, K.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: e3-e5
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DOI Number: 10.5830/CVJA-2011-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-027
Abstract: A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coronary artery bypass operation revealed a mildly dilated mediastinal silhouette, which led the cardiovascular surgery resident to schedule emergency transthoracic echocardiography (TTE), with a special note asking for detailed evaluation of the ascending aorta and aortic arch. TTE revealed a mobile atheroma at the aortic arch, which obliged the cardiac surgery team to modify their strategy to combined hemi-arcus aortae replacement and coronary artery bypass grafting (CABG). Although with transoesophageal echocardiography (TEE) a small portion of the ascending aorta may be obscured by the trachea, TEE provides higher resolution images than TTE. Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment.
- Title: Successful stenting of
catheter-induced unprotected left main coronary
artery dissection : case report - online article
Authors: Ertas, G.; Ural, E.; Van der Giessen, W.J.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: e6-e7
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DOI Number: 10.5830/CVJA-2011-033
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-033
Abstract: Catheter-induced left main coronary artery (LMCA) dissection is a dramatic, although uncommon complication of diagnostic coronary angiography and requires prompt treatment. We describe a case of iatrogenic occlusive dissection of the LMCA during coronary angiography, treated by subsequent percutaneous recanalisation.
- Title: New images in carcinoid heart
disease : case report - online article
Authors: Klobucic, M.; Paar, M.H.; Padovan, R.S.; Vincelj, J.; Fila, B.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: e8-e10
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DOI Number: 10.5830/CVJA-2011-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-038
Abstract: Echocardiography was the main imaging technique in the diagnosis and follow up of carcinoid heart disease but in the last decade magnetic resonance imaging (MRI) has evolved into a new diagnostic modality. Most of the reported MRI features were similar to those observed by echocardiography - tricuspid and/or pulmonary valve thickening and immobility with consequent valvular dysfunction and right heart enlargement. To our knowledge, this is the first report describing endocardial enhancement of the right cardiac chambers, tricuspid valve and subvalvular apparatus, which corresponds with histologically seen fibrous carcinoid plaques.
- Title: Aortic dissection, a
complication during successful angioplasty of
chronic total occlusion of the right coronary
artery, was treated conservatively : case report
- online article
Authors: Chunlai, S.; Stella, P.R.; Belkacemi, A.; Agostoni, P.
From: Cardiovascular Journal of Africa, Vol 23, Issue 4, May
Published: 2012
Pages: e11-e13
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DOI Number: 10.5830/CVJA-2011-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2011-050
Abstract: Aortic dissection is an uncommon but potentially lethal complication that can occur during the engagement of a guiding catheter. We report a case of a 59-year-old woman with acute aortic dissection due to percutaneous coronary intervention. This resulted in a retrograde extension of the dissection into the proximal part of the ascending aorta. With haemodynamic stability, we decided to treat the aortic dissection medically. As a result, a complete resolution of the aortic dissection was documented by coronary angiography and the follow-up computed tomography scan.
