CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 29, ISSUE
1, JAN/FEB 2018
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- Title: Editorial: Appropriate
strategies for South Africa for the management
of acute myocardial infarction in patients
presenting with ST-segment elevation
Authors: Rhena Delport
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 4-5
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- Title: The proportion of South
Africans living within 60 and 120 minutes of a
percutaneous coronary intervention facility
Authors: Willem Stassen, Lee Wallis, Craig Vincent-Lambert, Maaret Castren, Lisa Kurland
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 6-11
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DOI Number:10.5830/CVJA-2018-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-004
Introduction: Timely reperfusion, preferably via percutaneous coronary intervention (PCI) following myocardial infarction, improves mortality rates. Emergency medical services play a pivotal role in recognising and transporting patients with ST-elevation myocardial infarction directly to a PCI facility to avoid delays to reperfusion. Access to PCI is, in part, dependant on the geographic distribution of patients around PCI facilities. The aim of this study was to determine the proportion of South Africans living within 60 and 120 minutes of a PCI facility.
Methods: PCI facility and population data were subjected to proximity analysis to determine the average drive times from municipal ward centroids to PCI facilities for each province in South Africa. Thereafter, the population of each ward living within 60 and 120 minutes of a PCI facility was extrapolated.
Results: Approximately 53.8 and 71.53% of the South African population live within 60 and 120 minutes of a PCI facility. The median (IQR, range) drive times and distances to a PCI facility are 100 minutes (120.4 min, 0.7–751.8) across 123.6 km (157.6 km, 0.3–940.8).
Conclusion: Based on the proximity of South Africans to PCI facilities, it seems possible that most patients could receive timely PCI within 120 minutes of first medical contact. However, this may be unlikely for some due to a lack of medical insurance, under-developed referral networks or other system delays. Coronary care networks should be developed based on the proximity of communities to 12-lead ECG and reperfusion therapies (such as PCI facilities). Public and private healthcare partnerships should be fortified to allow for patients without medical insurance to have equal accesses to PCI facilities.
- Title: Reinforcement of suture lines with aortic eversion in aortic
replacement
Authors: Erhan Kaya
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 12-15
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DOI Number:10.5830/CVJA-2017-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-008
Background: In this study, we describe the technique of eversion of the native aortic tissue to prevent suture line complications, and report on our results with this technique.
Methods: A total of 42 patients who were operated on due to aortic aneurysm were retrospectively assessed. In all patients, an aortic segment of approximately 2 cm, which was left both distally and proximally, was everted to form a doublelayer lumen and the grafts were anastomosed. Postoperative outcomes and long-term follow-up results were assessed.
Results: Aortic root replacement was done in 14 cases and eight subjects underwent concurrent coronary artery bypass surgery. Postoperatively, the average volume of the drainage was 375 ± 75 ml, and there were no re-operations. Twentyseven patients required blood transfusion.
Conclusion: Reinforcement of the anastomosis line via eversion of the native aortic tissue reduced peri-operative blood loss and pseudo-aneurysm and infection, with the advantage of using viable tissue.
- Title: Value of transluminal
attenuation gradient of stress CCTA for
diagnosis of haemodynamically significant
coronary artery stenosis using wide-area
detector CT in patients with coronary artery
disease: comparison with stress perfusion CMR
Authors: Hee Yeong Kim, Hwan Seok Yong, Eung Ju Kim, Eun-Young Kang, Bo Kyoung Seo
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 16-21
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DOI Number: 10.5830/CVJA-2017-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-026
Introduction: This study aimed to evaluate the value of transluminal attenuation gradient (TAG) of stress coronary computed tomography angiography (CCTA), using a widearea detector CT in patients with coronary artery disease, compared to stress perfusion cardiac magnetic resonance (CMR) imaging.
Methods: This prospective study from May 2012 to January 2015 included 21 patients with moderate coronary stenosis on invasive coronary angiography. All patients underwent adenosine stress single-shot CCTA with a rest CCTA scan using a wide-area detector CT. Coronary artery stenosis was evaluated on both stress and rest CCTA images, and TAG was manually obtained for all vessels. Stress perfusion CMR was used as a reference standard. A TAG cut-off value of –15.1 HU/10 mm was applied for diagnosing haemodynamically significant stenosis. The diagnostic accuracies of TAG and CMR were estimated and compared.
Results: TAG of stress CCTA in all coronary arteries had a sensitivity, specificity, and positive and negative predictive values of 90.5, 90.0, 86.4 and 93.1%, respectively. Corresponding values for TAG of rest CCTA in all coronary arteries were 42.9, 83.3, 64.3 and 67.6%, respectively, whereas those for TAG of coronary arteries with moderate stenosis on stress CCTA were 93.3, 100, 100 and 92.3%, respectively. Mean effective radiation doses for stress and rest CCTA were 10.6 ± 2.6 mSv and 2.3 ± 1.3 mSv, respectively.
Conclusions: TAG of CCTA provided high diagnostic accuracy for detecting haemodynamically significant coronary artery stenosis. TAG of stress CCTA was more diagnostically accurate, especially in coronary arteries with moderate stenosis.
- Title: Effects of age on systemic inflammatory
response syndrome and results of coronary bypass surgery
Authors: Orhan Gokalp, Nihan Karakas Yesilkaya, Sahin Bozok, Yuksel Besir, Hasan Iner, Huseyin Durmaz, Yasar Gokkurt, Banu Lafci, Gamze Gokalp, Levent Yilik, Ali Gurbuz
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/Februaryr
Published: 2018
Pages: 22–25
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DOI Number: 10.5830/CVJA-2017-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-030
Background: Coronary artery bypass (CAB) surgery triggers systemic inflammatory response syndrome (SIRS) via several mechanisms. Moreover, age is directly correlated with SIRS. We evaluated the effect of age on SIRS and postoperative outcome after CAB surgery.
Methods: We retrospectively reviewed the records of 229 patients who had undergone CAB surgery. The patients were divided into three groups according to age: group 1, < 40 years (n = 61); group 2, 40–75 years (n = 83); and group 3, > 75 years old (n = 85). Pre- and peri-operative data were assessed in all patients. SIRS was diagnosed according to the criteria established by Boehme.
Results: The average pre-operative EuroSCORE value in group 3 was higher than in the other groups and body surface areas were significantly lower in group 3 than in the other groups (p < 0.05). The postoperative SIRS rates were 68.9% in group 1, 84.3% in group 2 and 91.8% in group 3 (group 1 vs group 3; p < 0.05). Mortality rates were not significantly different between the groups (p > 0.05). The predictive factors for SIRS were age, EuroSCORE rate, on-pump CAB surgery and intra-aortic balloon pump use.
Conclusion: Age was an important risk factor for SIRS during the postoperative period after CAB.
- Title: Cardiac diastolic function
after recovery from pre-eclampsia
Authors: P Soma-Pillay, MC Louw, AO Adeyemo, J Makin, RC Pattinson
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 26-31
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DOI Number: 10.5830/CVJA-2017-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-031
Background: Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery.
Aims: The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk.
Methods: This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum.
Results: At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks’ gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11–10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not.
Conclusion: Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.
- Title: A survey of non-communicable diseases and their risk factors
among university employees: a single institutional study
Authors: Emmanuel I Agaba, Maxwell O Akanbi, Patricia A Agaba, Amaka N Ocheke, Zumnan M Gimba, Steve Daniyam, Edith N Okeke
From: Cardiovascular Journal of Africa, Vol 28, Issue 6, November/December
Published: 2017
Pages: 377–384
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DOI Number: 10.5830/CVJA-2017-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-021
Background: The incidence of non-communicable diseases (NCDs) is rising globally, with its attendant morbidity and mortality, especially in developing countries. This study evaluated the prevalence of NCDs and their risk factors among members of a university community.
Methods: All employees of the university were invited to the University health clinic for screening, using the World Health Organisation’s STEPwise approach to NCDs.
Results: A total of 883 (521; 59.0% males) employees with a mean age of 44 ± 10 years were studied. The median (IQR) number of NCD risk factors was three (two to three) per participant. The most common NCD risk factors were inadequate intake of fruit and vegetables (94.6%; 95% CI: 92.8–95.9), physical inactivity (77.8%; 95% CI: 74.9–80.5%) and dyslipidaemia (51.8%; 95% CI: 48.4–51.6%). Others included obesity (26.7%; 95% CI: 23.9–29.8%), alcohol use (24.0%; 95% CI: 21.3–27.0%) and cigarette smoking (2.9%; 95% CI: 2.0–4.3). Hypertension was the most common NCD (48.5%; 95% CI: 45.1–51.8%), followed by chronic kidney disease (13.6%; 95% CI: 11.4–16.1) and diabetes mellitus (8.0%; 95% CI: 6.4–10.1). There was no gender-specific difference in the prevalence of NCDs.
Conclusion: This study identified that NCDs and their modifiable risk factors are highly prevalent in this community. Workplace policy to support the adoption of healthy living is needed.
- Title: A comparative study on the cardiac morphology and vertical
jump height of adolescent black South African male and female amateur
competitive footballers
Authors: Philippe Jean-Luc Gradidge, Demitri Constantinou
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 32–35
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DOI Number: 10.5830/CVJA-2017-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-032
Objective: The aim of this comparative study was to determine the gender differences in cardiac morphology and performance in adolescent black South African footballers.
Methods: Anthropometry, electrocardiography and echocardiography data were measured in 167 (85 males and 82 females) adolescent black South African footballers (mean age: 14.8 ± 1.3 years). Vertical jump height was used as a performance measure of explosive lower-limb power.
Results: The males had less body fat compared with the females (12.1 ± 3.6 vs 16.8 ± 4.1%, p < 0.05), while females had higher left ventricular end-diastolic diameters compared with males (48.7 ± 3.7 vs 40.7 ± 8.1, p < 0.05). Vertical jump height was higher in males (37.2 ± 10.3) compared with females (31.2 ± 8) and was inversely associated with body fat (β = –0.2, p < 0.05) and positively associated with lean mass (β = 0.5, p < 0.05).
Conclusion: The findings showed that adolescent black South African male footballers had a performance advantage over females for explosive lower-limb power, which was explained by differences in body composition and not cardiac morphology.
- Title: Atherosclerotic disease is
the predominant aetiology of acute coronary
syndrome in young adults
Authors: AK Pillay, DP Naidoo
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 36–42
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DOI Number: 10.5830/CVJA-2017-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-035
Objectives: Few studies have evaluated young adults in their third and fourth decades with coronary artery disease (CAD). This study evaluated the clinical and angiographic profile of young adults (< 35 years) with CAD.
Methods: A 10-year (2003–2012) retrospective chart review was performed on patients less than 35 years diagnosed with CAD at Inkosi Albert Luthuli Central Hospital, Durban.
Results: Of the 100 patients who met the study criteria, the majority were male (90%), of Indian ethnicity (79%), and presented with acute coronary syndrome (93%). Smoking (82%), dyslipidaemia (79%) and dysglycaemia (75%) were the most prevalent risk factors. Almost half of the subjects (48%) met criteria for the metabolic syndrome. Angiographic findings revealed multi-vessel (42%), single-vessel (36%) and non-occlusive disease (20%); only two subjects had normal epicardial vessels. Disease severity was influenced by dyslipidaemia (p = 0.002) and positive family history (p = 0.002). Non-coronary aetiologies were identified in 19% of subjects.
Conclusions: Atherosclerotic disease associated with risk-factor clustering was highly prevalent in young adults with CAD.
- Title: Coronary stent restenosis and the association with allergy to
metal content of 316L stainless steel
Authors: D Slodownik, C Danenberg, D Merkin, F Swaid, S Moshe, A Ingber, H Lotan, R Durst
From: Cardiovascular Journal of Africa, Vol 29, Issue 1, January/February
Published: 2018
Pages: 43-45
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DOI Number: 10.5830/CVJA-2017-036
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-036
Background: Most intra-coronary stents in use are made of 316 L stainless steel, which contains nickel, chromate and molybdenum. Whether inflammatory and allergic reactions to metals contribute to in-stent restenosis is still a matter of debate.
Aim: The aim of this study was to ascertain the relationship between metal allergy and the occurrence of in-stent restenosis.
Methods: Ninety-nine adult patients who underwent two cardiac catheterisations, up to two years apart, were included in the study. Seventy patients had patent stents at the second angiogram (patent stent group) and 29 were found to have in-stent restenosis (restenosis group). All patients underwent patch testing with the relevant metals and the 316L stainless steel plate.
Results: Twenty-eight (28.3%) patients were found to have an allergy to at least one metal. There was no significant difference in the prevalence of metal allergy between the patent stent group and the restenosis group (28.6 and 27.6%, respectively; p = 0.921).
Conclusion: Our data do not support the theory that contact allergy plays a role in the pathogenesis of in-stent restenosis.
- Title: Drug Trends in Cardiology: Dynaval: new product launch
From: Cardiovascular Journal of Africa, Vol 29, Issue, 1, January/February
Published: 2018
Pages:47
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- Title: Short-term rehospitalisation or death and determinants after
admission for acute heart failure in a cohort of African patients in Port
Harcourt, southern Nigeria
Authors: Maclean R Akpa, Okechukwu Iheji
From: Cardiovascular Journal of Africa, Vol 29, Issue, 1, January/February
Published: 2018
Pages:46–50
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DOI Number: 10.5830/CVJA-2017-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-038
Background: Heart failure (HF) is a major health burden globally and contributes significantly to morbidity and mortality related to cardiovascular disease. The aim of this study was to determine the outcome, and factors determining these outcomes in patients admitted for acute HF and followed up for six months.
Methods: This was a hospital-based, prospective study. Subjects included consecutive patients with a confirmed diagnosis of acute HF admitted to the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) in Nigeria over one year. All had a full physical examination and relevant investigations, including echocardiography. Subjects were followed up for six months and reassessed for outcome/ endpoint, which was rehospitalisation or death. Factors that predicted these outcomes were also determined.
Results: There were 160 subjects, 84 females and 76 males, age range 20 to 87 years, mean age 52.49 ± 13.89 years. Sixteen subjects (10.0%) were lost to follow up, 66 (41.3%) showed clinical improvement, 57 (35.6%) were rehospitalised, while 21 (13.1%) died. Determinants of rehospitalisation were New York Heart Association (NYHA) class, heart failure type, haemoglobin level at presentation and estimated glomerular filtration rate (eGFR). Determinants of mortality were NYHA class and haemoglobin level at presentation.
Conclusion: Heart failure rehospitalisation and mortality rates of 35.6 and 13.1%, respectively, were high compared to developed countries.
- Title: Left ventricular remodelling in chronic primary mitral
regurgitation: implications for medical therapy
Authors: Keir McCutcheon, Pravin Manga
From: Cardiovascular Journal of Africa, Vol 29, Issue, 1, January/February
Published: 2018
Pages:51–65
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DOI Number: 10.5830/CVJA-2017-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-009
Abstract: Surgical repair or replacement of the mitral valve is currently the only recommended therapy for severe primary mitral regurgitation. The chronic elevation of wall stress caused by the resulting volume overload leads to structural remodelling of the muscular, vascular and extracellular matrix components of the myocardium. These changes are initially compensatory but in the long term have detrimental effects, which ultimately result in heart failure. Understanding the changes that occur in the myocardium due to volume overload at the molecular and cellular level may lead to medical interventions, which potentially could delay or prevent the adverse left ventricular remodelling associated with primary mitral regurgitation. The pathophysiological changes involved in left ventricular remodelling in response to chronic primary mitral regurgitation and the evidence for potential medical therapy, in particular beta-adrenergic blockers, are the focus of this review.
- Title: Risk assessment of the occurrence of sudden death related to
hypertrophic cardiomyopathy in Dakar
Authors: Simon Antoine Sarr, Boubacar Dodo, Kana Babaka, Fatou Aw, Malick Bodian, Mouhamadou Bamba Ndiaye, Adama Kane, Maboury Diao, Serigne Abdou Ba
From: Cardiovascular Journal of Africa, Vol 29, Issue, 1, January/February
Published: 2018
Pages:e1-e5
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DOI Number: 10.5830/CVJA-2017-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-010
Aim: The aim of this study was to assess of the risk of sudden death in a population of hypertrophic cardiomyopathy patients in Dakar.
Methods: This was a transverse study at the cardiology clinic of Aristide Le Dantec Hospital from January 2014 to June 2015. We used the European Society of Cardiology risk score to calculate this risk.
Results: The average age of patients was 53 years. Unexplained syncope was found in two patients and two others had a family history of sudden death. The septal hypertrophy average was 20.9 mm. Seven patients had left intraventricular obstruction. One patient had a high risk of sudden death, three had intermediate risk and 13 had low risk. Competitive sport was not allowed, 13 patients were under medical treatment, one had an implantable cardioverter defibrillator and two had no treatment.
Conclusion: Our study highlighted a low and intermediate risk of the occurrence of sudden death at five years. One patient had a high risk of sudden death.
- Title: Coronary artery bypass grafting and paraparesis; is there a
correlation?
Authors: Ilias Samiotis, Nikolaos G Baikoussis, Vasileios Patris, Michalis Argiriou, Panagiotis Dedeilias, Christos Charitos
From: Cardiovascular Journal of Africa, Vol 29, Issue, 1, January/February
Published: 2018
Pages:e6-e8
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DOI Number: 10.5830/CVJA-2017-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-014
Abstract: Adult cardiac surgery is associated with significant perioperative morbidity and mortality rates, mainly in elderly patients with co-morbidities. A series of postoperative complications may arise and delay the recovery of patients undergoing cardiac surgery. Such complications also increase the burden of resource use and may affect late survival rates. Neurological complications appear mainly as stroke of varying degrees, with impairment of mobility and ability of the patient. We describe a rare case of progressive paraparesis after on-pump coronary artery bypass grafting, and review its aetiology, diagnosis and management.
- Title: Acute type A aortic dissection involving the iliac and left
renal arteries, misdiagnosed as myocardial infarction
Authors: Paul Nkemtendong Tolefac, Anastase Dzudie, Sidick Mouliom, Leopold Aminde, Romuald Hentchoya, Martin H Abanda, Charles Mve Mvondo, Vanina D Wanko, Henry N Luma
From: Cardiovascular Journal of Africa, Vol 29, Issue, 1, January/February
Published: 2018
Pages:e9-e13
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DOI Number: 10.5830/CVJA-2017-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-042
Abstract: Acute aortic dissection is the most frequent and deadly presentation of acute aortic syndromes. Its incidence is estimated at three to four cases per 100 000 persons per year. Its clinical presentation may be misleading, with misdiagnosis ranging between 14.1 and 38% in many series. A late diagnosis or absence of early and appropriate management is associated with mortality rates as high as 50 and 80% by the third day and second week, respectively, especially in proximal lesions. We report on the case of a 53-year-old man who presented with type A aortic dissection, misdiagnosed as acute myocardial infarction, who later died on day 12 of hospitalisation. Although a relatively rare condition, poor awareness in Africa probably accounted for the initial misdiagnosis. Thorough investigation of acute chest pain and initiation of clinical registries are potential avenues to curb related morbidity and mortality.
