CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 28, ISSUE
3, MAY/JUNE 2017
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- Title: Editorial: Radiation safety:
time to act
Authors: SC Brown
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 139-140
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- Title: Resveratrol did not alter
blood pressure in rats with nitric oxide
synthase-inhibited hypertension
Authors: M Aydin, B Gungor, AS Akdur, HE Aksulu, C Sılan, I Susam, AK Cabuk, G Cabuk
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 141-146
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DOI Number:10.5830/CVJA-2016-069
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-069
Background: Inhibition of nitric oxide synthase (NOS) is a well-known experimental model of hypertension (HT). It was shown that oxidative stress contributes to the pathogenesis of HT. Resveratrol is a potent anti-oxidant that is found in red grapes, peanuts and red wine. It improves the NO response and increases endothelial NOS expression, which causes endothelium-dependent vasorelaxation as well as renal vasodilation. We aimed to explore the effects of resveratrol on blood pressure, the water–salt balance and sodium excretion as a reflection of renal function in NOS-inhibited rat models.
Methods: Thirty-five male Sprague-Dawley rats (200–250 g) were used in this study. In order to obtain hypertensionmodels, an NOS inhibitor, N-nitro-L-arginin (L-NNA) was used. The rats were randomly divided into five groups: controls (given water and 0.8% salty diet) and four groups [given L-NNA, resveratrol (RSV) eluent, RSV, and L-NNA + RSV]. Blood pressures were measured indirectly by the tailcuff method on the first, seventh and 10th days. At the end of the study protocol (10th day), fluid balance, glomerular filtration rate, fractional sodium excretion, and blood and urine sodium and creatinine levels were measured.
Results: At the end of the study protocol, blood pressureswere higher in only the L-NNA group (117.8 ± 3.5 vs 149.5 ± 2.1 mmHg; p < 0.05), as expected. Additional applications of RSV with L-NNA could not prevent the increase in blood pressure (122.8 ± 7.3 vs 155.4 ± 4.4 mmHg; p < 0.05). There were no remarkable changes in water–salt balance and renal function with the application of resveratrol.
Conclusion: Resveratrol was unable to prevent or reverse blood pressure increase in NOS-inhibited rats.
- Title: Prevalence of selected cardiometabolic risk factors among
adults in urban and semi-urban hospitals in four sub-Saharan African countries
Authors: S Kingue, S Rakotoarimanana, N Rabearivony, FL Bompera
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 147-153
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DOI Number:10.5830/CVJA-2016-072
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-072
Aim: Cardiovascular diseases (CVDs) are a global challenge but the burden in sub-Saharan African (SSA) countries is less well documented than elsewhere. We aimed to describe the key cardiometabolic risk factors in four SSA countries.
Methods: A cross-sectional, multi-national, hospital-based study was carried out among adults (> 35 years) across four SSA countries from 12 December 2011 to 7 February 2013. Risk factors were defined using the World Health Organisation and International Diabetes Federation guidelines.
Results: Of the 844 adults (57.4% female, mean age 52.6 years), 76.6% were urban residents. The predominant CVD risk factors were hypertension (74.1%), obesity (36.2%) and excessive alcohol consumption (25.6%). Diabetes (17.7 vs10.0%), obesity (42.8 vs 16.8%) and hypercholesterolaemia (25.8 vs 18.0%) were more prevalent among the hypertensive subjects (all p < 0.007) than the normotensives. The metabolic syndrome (39.4%) was more common in women and hypertensive subjects.
Conclusions: Hospital patients in SSA countries present with excessive rates of cardiometabolic risk factors. Focus on their prevention and control is warranted.
- Title: Assessment of myocardial
repolarisation parameters in patients with
familial Mediterranean fever
Authors: K Karaman, M Karayakalı, E Erken, A Demirtaş, M Öztürk, F Altunkaş, A Arısoy, OE Turan, K Ceyhan, A Çelik
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 154-158
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DOI Number: 10.5830/CVJA-2016-074
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-074
Background: Familial Mediterranean fever (FMF) is a chronic, recurrent auto-inflammatory disease characterised by self-terminating attacks of fever and sterile polyserositis. The main cause of death in auto-inflammatory diseasesis cardiovascular events. Additionally, auto-inflammatory diseases have potential effects on the myocardial repolarisation parameters, including the T-wave peak-to-end (Tp-Te) interval, cTp-Te interval (corrected Tp-Te) and the cTp-Te/ QT ratio. The aim of this study was to analyse the efficacy of myocardial repolarisation alterations in anticipation of cardiovascular risks in patients with FMF.
Methods: This study included 66 patients with FMF and 58 healthy control subjects. Tp-Te and cTp-Te intervals and the cTp-Te/QT ratio were measured from the 12-lead electrocardiogram.
Results: In electrocardiographic parameters, analysis of QT, QT dispersion, corrected QT (QTc) and QTc dispersion were similar between the groups. The Tp-Te and cTp-Te intervals and Tp-Te/QT and cTp-Te/QT ratios were significantly prolonged in FMF patients. Multivariate linear regression analyses indicated that erythrocyte sedimentation rate was an independent predictor of a prolonged cTp-Te interval.
Conclusions: Our study revealed that when compared with control subjects, Tp-Te and cTp-Te intervals and cTp-Te/QT ratio were increased in FMF patients.
- Title: Saliva/serum ghrelin, obestatin and homocysteine levels in
patients with ischaemic heart disease
Authors: N Kilic, N Dagli, S Aydin, F Erman, Y Bek, O Akin, SS Kilic, HK Erdemli, H Alacam
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 159-164
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DOI Number: 10.5830/CVJA-2016-075
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-075
Background: We aimed to compare ghrelin, obestatin, homocysteine (Hcy), vitamin B12 and folate levels in the serum and saliva of ischaemic heart disease patients.
Methods: Serum and saliva were collected from 33 ischaemic heart disease (IHD) patients and 28 age- and body mass index-matched healthy individuals. Levels of acylated and desacylated ghrelin, obestatin and Hcy were determined using the ELISA method.
Results: Acylated ghrelin, desacylated ghrelin and obestatin levels in the saliva were found to be higher than those in the serum of the control group, while acylated and desacylated ghrelin levels in the saliva were significantly lower than those in the serum. Obestatin levels were higher in IHD patients (p = 0.001). Saliva and serum vitamin B12 and folate levels in IHD patients were significantly lower than in the control group (p = 0.001).
Conclusions: It was determined that serum ghrelin levels increased in ischaemic heart disease patients, while serum levels of obestatin decreased.
- Title: The effects of treatment in
patients with childhood asthma on the elastic
properties of the aorta
Authors: O Bektaş, ZY Günaydin, A Karagöz, R Akgedik, A Bayramoğlu, A Kaya
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 165-169
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DOI Number: 10.5830/CVJA-2016-076
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-076
Introduction: The study aimed to investigate the effects of treatment in patients with childhood asthma on the elastic properties of the aorta and cardiovascular risk.
Methods: The study was performed in 66 paediatric patients diagnosed with bronchial asthma (BA). All patients were administered the β2 agonist, salbutamol, for seven days, followed by one month of montelukast and six months of inhaled steroid treatment. All patients underwent conventional transthoracic echocardiographic imaging before and after treatment. Aortic elasticity parameters were considered to be the markers of aortic function.
Results: Aortic elasticity parameters, including aortic strain (15.2 ± 4.8 and 18.8 ± 9.5%, p = 0.043), aortic distensibility (7.26 ± 4.71 and 9.53±3.50 cm2/dyn, p = 0.010) and aortic stiffness index (3.2 ± 0.6 and 2.8 ± 0.5, p = 0.045 showed significant post-treatment improvement when compared to pre-treatment values. Tricuspid annular plane systolic excursion (TAPSE) was also observed to improve after treatment (1.81 ± 0.38 and 1.98 ± 0.43, p = 0.049).
Conclusion: The study demonstrated that when provided at appropriate doses, medications used in BA may result in an improvement in aortic stiffness.
- Title: Training community health workers to screen for
cardiovascular disease risk in the community: experiences from Cape Town, South
Africa
Authors: T Puoane, S Abrahams-Gessel, TA Gaziano, N Levitt
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 170-175
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DOI Number: 10.5830/CVJA-2016-077
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-077
Abstract: This article describes a training process to equip community health workers (CHWs) with knowledge and skills to identify individuals at high risk for cardiovascular disease (CVD) in a township in Cape Town.
Methods: CHWs were employed by a non-governmental organisation (NGO) primarily focusing on non-communicable diseases (NCDs). They were trained in the theory of CVD, including physiological changes and related risk factors and in obtaining anthropometric and blood pressure measurements. Pre- and post-training tests assessed learning needs and the effectiveness of imparting knowledge about CVD, respectively.
Results: Training increased knowledge about CVD risk factors. CHWs were able to screen and identify those at risk for CVD and refer them to health professionals for validation of scores. The initial one-week training was too short, given the amount of information covered. Some CHWs had difficulty with English as the primary instruction medium and as the only language in which tests were offered.
Conclusion: Although CHWs could be trained to screen for CVD risk, increased training time was required to impart the knowledge. The language used during training and testing presented challenges for those trainees whose dominant, spoken language was not English.
- Title: Effects of Ramadan intermittent fasting on North African
children’s heart rate and oxy-haemoglobin saturation at rest and during
sub-maximal exercise
Authors: MA Fenneni, I Latiri, A Aloui, S Rouatbi, K Chamari, HB Saad
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 176-181
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DOI Number: 10.5830/CVJA-2016-078
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-078
Aim: To examine the effects of Ramadan intermittent fasting (RIF) on the heart rate (HR) and oxyhaemoglobin saturation levels (oxy-sat) of boys at rest and during a six-minute walking test (6MWT).
Methods: Eighteen boys (age: 11.9 ± 0.8 years, height: 153.00 ± 8.93 cm, body mass: 55.4 ± 18.2 kg), who fasted the entire month of Ramadan in 2012 for the first time in their lives, were included. The experimental protocol comprised four testing phases: two weeks before Ramadan (pre-R), the end of the second week of Ramadan (R-2), the end of the fourth week of Ramadan (R-4), and 10 to 12 days after the end of Ramadan (post-R). During each phase, participants performed the 6MWT at approximately 15:00. HR (expressed as percentage of maximal predicted HR) and oxy-sat (%) were determined at rest and in each minute of the 6MWT.
Results: R-4 HR values were lower than those of (1) pre-R (in the second minute), (2) R-2 (in the first and second minutes),and (3) post-R (in the first, second, fourth, fifth and sixth minutes). R-2 oxy-sat values were higher than those of pre-R (in the third minute) and those of post-R (in the fifth minute). Post-R oxy-sat values were lower than those of pre-R and R-4 in the fifth minute. These oxy-sat changes were not clinically significant since the difference was less than five points.
Conclusion: In non-athletic children, their first RIF influenced their heart rate data but had a minimal effect on oxy-sat values.
- Title: Assessment of indirect inflammatory markers in patients with
myocardial bridging
Authors: Levent Cerit
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/April
Published: 2017
Pages: 182-185
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DOI Number: 10.5830/CVJA-2016-080
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-080
Introduction: Myocardial bridging (MB) is a congenital variant of the coronary artery in which a portion of the epicardial coronary artery takes an intramuscular course. Although it is considered a benign anomaly, it may lead to such complications as myocardial ischaemia, acute coronary syndrome, coronary spasm, exercise-induced dysrhythmias or even sudden death. MB may be related to increased inflammatory and atherosclerotic processes. This study was conducted with the aim of evaluating the relationship between neutrophil/ lymphocyte ratio (NLR) and MB.
Methods: Taking into consideration the inclusion criteria, 86 patients with MB and 88 with normal coronary angiographies (control group) were included in the study. The association between MB and laboratory and other clinical parameters was evaluated.
Results: The platelet distribution width (PDW) (17.3 ± 0.40 vs 16.1 ± 0 .5; p < 0.05), NLR (3.2 ± 1.3 vs 2.2 ± 0.9; p < 0.05) and red cell distribution width (RDW) (14.3 ± 1.3 vs 13.1 ± 1.1; p < 0.05) were significantly higher in the MB group than in the control group.
Conclusions: This study demonstrated that compared to normal coronary arteries, PDW, NLR and RDW were significantly higher in MB patients. Further studies are needed to clarify the increased inflammatory parameters in patients with MB.
- Title: Symptom-to-balloon time and
myocardial blush grade are predictors of left
ventricular remodelling after successful primary
percutaneous coronary intervention
Authors: EM Farag, MM Al-Daydamony
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 186-190
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DOI Number: 10.5830/CVJA-2016-085
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-085
Introduction: In patients with ST-segment elevation myocardial infarction (STEMI), successful primary percutaneous coronary intervention (PCI) was found to be useful in earlier restoration of TIMI flow 3. However, the incidence of left ventricular (LV) dilatation and remodelling after successful primary PCI is still high. We aimed to determine the independent predictors of LV remodelling after successful primary PCI for patients with first STEMI.
Methods: We included 232 STEMI patients treated with primary PCI. Echocardiography was done on the day of PCI and after six months. LV remodelling was defined as ≥ 20% increase in the six-month left ventricular end-diastolic volume (LVEDV).
Results: In patients with remodelling, symptom-to-door andsymptom-to-balloon times were significantly longer (p < 0.00001 for each), initial ejection fraction (EF) was significantly lower (p = 0.044), six-month LVEDV, left ventricular end-systolic volume (LVESV) and LVEDV increase were significantly higher, and EF was significantly lower (p < 0.00001 for each). Mean myocardial blush grade (MBG) was significantly lower in patients with remodelling (p < 0.00001). There was a significant positive correlation between LVEDV increase and both symptom-to-balloon time (r = 0.603, p < 0.00001) and symptom-to-door time (r = 0.564, p < 0.00001), and a significant negative correlation between LVEDV increase and MBG (r = –0.447, p < 0.00001). Logistic regression showed that the independent predictors of LV remodelling were symptom-to-balloon time (p = 0.00068), symptom to door time (p = 0.0013) and MBG (p = 0.0057).
Conclusion: Symptom-to-door time, symptom-to-balloon time and MBG were the only significant predictors of LV remodelling.
- Title: Telmisartan decreases microalbuminuria in patients with type
2 diabetes mellitus following coronary artery bypass grafting
Authors: C Furat, R Dogan, G Ilhan, E Bayar, B Ozpak, H Kara, Ş Bozokr
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 191-195
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DOI Number: 10.5830/CVJA-2016-089
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-089
Objective: This prospective study aimed to investigate the effects of the selective angiotensin receptor antagonist, telmisartan, on microalbuminuria after coronary artery bypass surgery in patients with diabetes mellitus.
Methods: Patients were divided into two groups with block randomisation, using the sealed envelope technique: group T (telmisartan group) consisted of patients who received the angiotensin receptor blocking agent telmisartan 80 mg daily for at least six months in the pre-operative period; group N-T (non-telmisartan group) consisted of patients who received no telmisartan treatment. Clinical and demographic characteristics, operative and postoperative features, microalbuminuria and high-sensitivity C-reactive protein levels were compared.
Results: Forty patients met the eligibility criteria for the study. The groups did not differ with regard to clinical anddemographic characteristics, and operative and postoperative features. Microalbuminuria levels between the groups differed significantly in the pre-operative period, first hour postoperatively and fifth day postoperatively. C-reactive protein levels between the groups differed significantly on the fifth day postoperatively.
Conclusion: Telmisartan was useful for decreasing systemic inflammation and levels of urinary albumin excretion in patients who had type 2 diabetes mellitus and had undergone coronary artery bypass surgery.
- Title: Perceptions of radiation safety training among
interventionalists in South Africa
Authors: A Rose, WID Rae
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 196-200
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DOI Number: 10.5830/CVJA-2017-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-028
Abstract: Exposure to ionising radiation may have deterministic and stochastic health effects, which include skin changes, chromosomal aberrations, cataracts and carcinomas. Formalised training in radiation safety and protection improves knowledge on the subject and facilitates greater compliance in safety practices. This qualitative study included 54 interventionalists (adult and paediatric cardiologists, and interventional radiologists). The participants were purposively selected and interviewed to explore their perceptions about radiation safety. A thematic analysis of the transcripts was done using a deductive and inductive approach. Findings showed participating cardiologists had less knowledge about radiation safety than participating radiologists. Cardiologists reported little or no formal training on radiation safety and did not display a culture of radiation safety. There was no consensus on how the training gap should be addressed. There is a perceived need to change and enhance the radiation safety culture among interventionists, and the participants proffered some ideas. These included the need for re-curricularisation of cardiologists’ training to create awareness of radiation safety practices.
- Title: Xanthine oxidase inhibitors in ischaemic heart disease
Authors: M Zdrenghea, A Sitar-Tǎut, G Cismaru, D Zdrenghea, D Pop
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages: 201-204
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DOI Number: 10.5830/CVJA-2016-068
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-068
Abstract: Increased uric acid levels are correlated with cardiovascular disease, particularly with ischaemic heart disease. Xanthine oxidase inhibitors, especially allopurinol, lower the risk of ischaemic heart disease due to their effects on reactive oxygen species and endothelial function. In chronic stable angina pectoris, allopurinol increases the median time to ST depression, time to chest pain, and total exercise time. On the other hand, it has been reported that allopurinol has a beneficial effect on ischaemic patients referred for angioplasty, but there are insufficient data regarding its effect on acute myocardial infarction patients. Moreover, other important actions of allopurinol are regression of left ventricular hypertrophy and improvement in the results of cardiac rehabilitation. The efficacy of allopurinol has recently been acknowledged by the European Society of Cardiology guidelines for stable angina pectoris, but the particular role of allopurinol in ischaemic heart disease patients is not fully established...
- Title: Persistent left superior vena cava
Authors: KW Tyrak, J Hołda, MK Hołda, M Koziej, K Piątek, W Klimek-Piotrowska
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/June
Published: 2017
Pages:e1-e4
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DOI Number: 10.5830/CVJA-2016-084
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-084
Abstract: Persistent left superior vena cava (PLSVC) is the most common congenital malformation of thoracic venous return and is present in 0.3 to 0.5% of individuals in the general population. This heart specimen was dissected from a 35-yearold male cadaver whose cause of death was determined as non-cardiac. The heart was examined and we found a PLSVC draining into the coronary sinus. The right superior vena cava was present with a small-diameter ostium. An anomalous pulmonary vein pattern was observed; there was a common trunk to the left superior and left inferior pulmonary veins (diameter 17.8 mm) and an additional middle right pulmonary vein (diameter 2.7 mm) with two classic right pulmonary veins. The PLSVC draining into the coronary sinus had led to its enlargement, which could have altered the cardiac haemodynamics by significantly reducing the size of the left atrium and impeding its outflow via the mitral valve.
- Title: A rare cause of early
repolarisation in an adolescent boy with chest
pain: myocardial bridging
Authors: M Deveci, K Babaoğlu, Ö Kayabey
From: Cardiovascular Journal of Africa, Vol 28, Issue 3, May/April
Published: 2017
Pages:e5-e7
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DOI Number: 10.5830/CVJA-2016-088
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2016-088
Abstract: We present the case of a 33-year-old man with middle aortic syndrome. The final diagnosis was established with magnetic resonance imaging. He underwent a successful aorto-aortic bypass. Two-year follow-up imaging showed the new graft was patent, with no abnormalities at the anastomosis sites. At the last follow-up examination he was asymptomatic with no neurological dysfunction.
