CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 29, ISSUE
3, MAY/JUNE 2018
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- Title: Editorial: Cardiovascular
magnetic resonance imaging in rheumatic heart
disease
Authors: NAB Ntusi
From: Cardiovascular Journal of Africa, Vol 29, Issue 3 May/June
Published: 2018
Pages: 135
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- Title: Prevalence, clinical
characteristics and outcomes of valvular atrial
fibrillation in a cohort of African patients
with acute heart failure: insights from the
THESUS-HF registry
Authors: Mahmoud U Sani, Beth A Davison, Gad Cotter, Bongani M Mayosi, Christopher Edwards, Okechukwu S Ogah, Albertino Damasceno, Dike B Ojji, Anastase Dzudie, Charles Mondo, Charles Kouam Kouam, Ahmed Suliman, Gerald Yonga, Serigne Abdou Ba, Fikru Maru, Bekele Alemayehu, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 29, Issue 3 May/June
Published: 2018
Pages: 139–145
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DOI Number:10.5830/CVJA-2017-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-051
Introduction: Rheumatic heart disease (RHD) is the commonest cause of valvular heart disease and a common cause of heart failure in sub-Saharan Africa (SSA). Atrial fibrillation (AF) complicates RHD, precipitates and worsens heart failure and cause unfavourable outcomes. We set out to describe the prevalence, clinical characteristics and outcomes of valvular atrial fibrillation in cohort of African patients with acute heart failure (AHF).
Methods: The sub-Saharan Africa Survey of Heart Failure (THESUS-HF) was a prospective, observational survey of AHF in nine countries. We collected demographic data, medical history and signs and symptoms of HF. Electrocardiograms (ECGs) were done in a standard fashion. AF was defined as either a history of AF or AF on the admission ECG. Using Cox regression models, we examined the associations of AF with all-cause death over 180 days and a composite endpoint of all-cause death or readmission over 60 days.
Results: There were 1 006 patients in the registry. The mean age was 52.3 years and 50.8% were women. AF was present in 209 (20.8%) cases. Those with AF were older (57.1 vs 51.1 years), more likely to be female (57.4 vs 49.1%), had significantly lower systolic (125 vs 132 mmHg) and diastolic (81 vs 85 mmHg) blood pressure (BP), and higher heart rates (109 vs 102 bpm). Ninety-two (44%) AF patients had valvular heart disease. The presence of AF was not associated with the primary endpoints, but having valvular AF predicted death within 180 days.
Conclusion: AF was present in one-fifth of African patients with AHF. Almost half of the AF patients had valvular disease (RHD) and were significantly younger and at risk of dying within six months. It is important to identify these high-risk patients and prioritise their management, especially in SSA where resources are limited.
- Title: Influence of visceral fat and blood pressure on changes in
blood flow velocity in non-obese individuals
Authors: A Rahman Rasyada, Munirah Sha’ban, Azran Azhim
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2018
Pages: 146–149
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DOI Number:10.5830/CVJA-2018-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-001
Introduction: The aim of this study was to evaluate the impact of different visceral fat (VF) and blood pressure (BP) levels on changes in blood flow velocity (BFV) among non-obese subjects, using a cross-sectional study approach.
Methods: A total of 110 putatively healthy and non-obese subjects were divided into three groups according to their level of VF and BP. Common carotid artery BFV was measured using a developed portable Doppler ultrasound measurement system.
Results: The most pronounced peak systolic velocity (S1) was lower (p < 0.05) in the hypertensive group and the peak diastolic velocity (D) was significantly lower in the pre-hypertensive group than in the normotensive group. There were differences in velocity reflection and resistive indices between the hypertensive and other two BP groups. The higher VF group had significantly lower S1 and D velocities and resistive and vascular elasticity indices. By contrast, the velocity reflection index was larger in the higher VF group.
Conclusion: We confirmed that there were significant differences in the BFV among non-obese subjects who differed in level of VF and BP. This study confirms that a putatively increasing VF and BP level is associated with the development of hypertension.
- Title: Assessment of myocardial
fibrosis by late gadolinium enhancement imaging
and biomarkers of collagen metabolism in chronic
rheumatic mitral regurgitation
Authors: Ruchika Meel, Richard Nethononda, Elena Libhaber, Therese Dix-Peek, Ferande Peters, Mohammed Essop
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2018
Pages: 150–154
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DOI Number: 10.5830/CVJA-2018-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-002
Background: In chronic rheumatic mitral regurgitation (CRMR), involvement of the myocardium in the rheumatic process has been controversial. Therefore, we sought to study the presence of fibrosis using late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) and biomarkers of collagen turnover in CRMR.
Methods: Twenty-two patients with CRMR underwent CMR and echocardiography. Serum concentrations of matrix metalloproteinase- 1 (MMP-1), tissue inhibitor of MMP-1 (TIMP- 1), MMP-1-to-TIMP-1 ratio, procollagen III N-terminal pro-peptide (PIIINP) and procollagen type IC peptide (PIP) were measured.
Results: Four patients had fibrosis on LGE-CMR. PIP and PIIINP concentrations were similar to those of the controls, however MMP-1 concentration was increased compared to that of the controls (log MMP-1 3.5 ± 0.7 vs 2.7 ± 0.9, p = 0.02). There was increased MMP-1 activity as the MMP-1-to- TIMP-1 ratio was higher in CRMR patients compared to the controls (–1.2 ± 0.6 vs –2.1 ± 0.89, p = 0.002).
Conclusion: Myocardial fibrosis was rare in CRMR patients. CRMR is likely a disease characterised by the predominance of collagen degradation rather than increased synthesis and myocardial fibrosis.
- Title: HIV disease is associated
with increased biomarkers of endothelial
dysfunction despite viral suppression on
long-term antiretroviral therapy in Botswana
Authors: Mosepele Mosepele, Terence Mohammed, Lucy Mupfumi, Sikhulile Moyo, Kara Bennett, Shahin Lockman, Linda C Hemphill, Virginia A Triant
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2018
Pages: 155–161
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DOI Number: 10.5830/CVJA-2018-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-003
Background: Untreated HIV infection is associated with increased biomarkers of endothelial dysfunction. However, the predictors and degree of endothelial dysfunction among virally suppressed HIV-infected adults on long-term antiretroviral therapy (ART) have not been well studied in sub- Saharan Africa (SSA).
Methods: We enrolled 112 HIV-infected adults with virological suppression on long-term ART and 84 HIV-uninfected controls in Botswana. We measured plasma levels of markers of endothelial injury [soluble vascular adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1) and E-selectin] and plasma levels of biomarkers of inflammation [interleukin 6 (IL-6)] and monocyte activation (sCD163). Baseline traditional cardiovascular disease (CVD) risk factors and bilateral common carotid intima–media thickness (cIMT) were also available for all participants. We assessed whether HIV status (despite virological suppression on ART) was associated with biomarkers of endothelial dysfunction after controlling for traditional CVD risk factors in linear regression models. We additionally assessed the association between IL-6, sCD163 and cIMT with endothelial dysfunction in separate multivariate linear regression models, controlling for cIMT, among virally suppressed HIV-infected participants only.
Results: In multivariate analysis, HIV infection was significantly associated with increased VCAM-1 (p < 0.01) and ICAM-1 (p = 0.03) but not E-selectin (p = 0.74) levels. Within the HIV-positive group, higher sCD163 levels were associated with decreased ICAM-1 and E-selectin (p < 0.01 and p = 0.01, respectively) but not VCAM-1 (p = 0.13) levels. IL-6 was not associated with any of the biomarkers of endothelial dysfunction.
Conclusion: HIV disease was associated with biomarkers of endothelial dysfunction among virally suppressed adults in Botswana on long-term ART after controlling for traditional CVD risk factors. Future work should explore the clinical impact of persistent endothelial dysfunction following longterm HIV viral suppression on the risk of CVD clinical endpoints among HIV-infected patients in this setting.
- Title: The effects of treatment with atorvastatin versus
rosuvastatin on endothelial dysfunction in patients with hyperlipidaemia
Authors: Vahit Demir, Mehmet Tolga Doğru, Hüseyin Ede, Samet Yılmaz, Cağlar Alp, Yunus Celik, Nesligül Yıldırım
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2017
Pages: 162–166
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DOI Number: 10.5830/CVJA-2018-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-008
Introduction: Statins can reduce cardiovascular events and improve endothelial function. However, differences in the effect of statins on endothelial dysfunction have not been researched sufficiently. Here, we aimed to compare the effects of atorvastatin versus rosuvastatin on endothelial function via flow-mediated and endothelial-independent dilation.
Methods: Hyperlipidaemic subjects on treatment with statins for one year (either 20 mg/day atorvastatin or 10 mg/day rosuvastatin) were enrolled in the study. In accordance with the literature, flow-mediated dilation (FMD) and nitrate-mediated endothelium-independent dilation (EID) were measured by ultrasonography on the right brachial artery of each subject. Baseline and final measurements were compared in each group and between the groups.
Results: One hundred and four subjects (50 atorvastatin and 54 rosuvastatin users) were enrolled in the study. Fifty-eight subjects were female. The groups were statistically similar in terms of age and body mass index, and haemoglobin, creatinine, total cholesterol, triglyceride, high-density lipoprotein and low-density lipoprotein cholesterol levels. In each group, the mean final FMD and EID values were higher compared to their respective baseline values, but the mean changes in FMD and EID were statistically similar in both groups (p = 0.958 for FMD and 0.827 for EID). There was no statistically significant difference between the atorvastatin and rosuvastatin groups in terms of final FMD and EID values (p = 0.122 and 0.115, respectively).
Conclusion: This study demonstrated that both one-year atorvastatin and rosuvastatin treatments significantly improved endothelial function, when assessed with FMD and EID and measured by ultrasonography. However, the amount of improvement in endothelial dysfunction was similar in the two treatments.
- Title: Percutaneous transmitral balloon commissurotomy using a
single balloon with arteriovenous loop stabilisation: an alternative when there
is no Inoue balloon
Authors: Endale Tefera, Mohamed Leye, Patrick Garceau, Denis Bouchard, Joaquim Miró
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2018
Pages: 167–171
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DOI Number: 10.5830/CVJA-2018-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-010
Background: The Inoue balloon technique is the standard technique for mitral valve balloon commissurotomy at this stage. However, the hardware for this technique is expensive and may not always be available in resource-limited settings.
Objectives: This article reports our experience with percutaneous transmitral balloon commissurotomy using a single balloon (Nucleus) with arteriovenous loop stabilisation.
Methods: Eleven young patients, aged 12–26 years and weighing 23–48 kg, underwent transmitral balloon commissurotomy using the described technique at our centre from April to May 2014.
Results: Mean fluoroscopy time was 22.6 ± 6.4 min (18.5– 30.0). Mean transmitral gradient decreased from 24.1 ± 5.9 (16–35) to 6.6 ± 3.8 (3–14) mmHg, as measured on transoesophageal echocardiography. Mean mitral valve area increased from 0.69 ± 0.13 cm2 (range 0.5–0.9) before dilation to 1.44 ± 0.25 cm2 (1.1–1.9) after dilation (p < 0.001). Mean estimated pulmonary artery systolic pressure decreased from 110.0 ± 35 mmHg (75–170) before dilation to 28.0 ± 14.4 mmHg (range 10–60) after dilation.
Conclusion: Our modified Nucleus balloon technique for mitral valve dilation in young patients with mitral stenosis is effective and safe. The technique differs from other over-thewire techniques in that it avoids placing stiff wire in the left ventricle. It also offers better balloon stability and control owing to the arteriovenous loop. This technique may be easier for use by paediatric interventionists who might not be familiar with the Inoue balloon technique.
- Title: Obesity masks the
relationship between dietary salt intake and
blood pressure in people of African ancestry:
the impact of obesity on the relationship
between sodium and blood pressure
Authors: Muzi Maseko, Mercy Mashao, Abdulraheem Bawa-Allah, Edgar Phukubje, Bongubuhle Mlambo, Thamsanqa Nyundu
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2018
Pages: 172–176
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DOI Number: 10.5830/CVJA-2018-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-011
Abstract: Previous studies conducted to investigate the relationship between sodium intake and blood pressure in our African population have yielded contradictory results. With the high prevalence of obesity in this population, it is possible that these contradictory findings are due to the masking effects of obesity on this relationship. We measured 24-hour ambulatory blood pressure and 24-hour urine excretion on 547 South Africans of African ancestry. A multivariate regression analysis revealed no independent relationship between 24-hour sodium excretion and blood pressure in the total population sample, but when participants were stratified according to body mass index (BMI) status, there was a significant association between 24-hour sodium excretion and blood pressure in the normal-BMI participants but not in the overweight/obese participants. We concluded that dietary salt intake, indexed by 24-hour urinary sodium excretion, was associated with increased ambulatory blood pressure but this relationship was masked because of a high proportion of overweight/obese individuals in this population.
- Title: Facilitators, context of and barriers to acute coronary
syndrome care at Kenyatta National Hospital, Nairobi, Kenya: a qualitative
analysis
Authors: Ehete Bahiru, Tecla Temu, Julia Mwanga, Kevin Ndede, Sophie Vusha, Bernard Gitura, Carey Farquhar, Frederick Bukachi, Mark D Huffman
From: Cardiovascular Journal of Africa, Vol 29, Issue 3, May/June
Published: 2018
Pages: 177–182
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DOI Number: 10.5830/CVJA-2018-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-013
Background: The prevalence of ischaemic heart disease and its acute manifestation, acute coronary syndrome (ACS), is growing throughout sub-Saharan Africa, including Kenya. To address this increasing problem, we sought to understand the facilitators, context of and barriers to ACS care at Kenyatta National Hospital, with the aim of improving the quality of care of ACS.
Methods: We conducted in-depth interviews with healthcare providers involved in the management of ACS patients from January to February 2017 at Kenyatta National Hospital in Nairobi, Kenya. We selected an initial sample of key participants for interviewing and used a snowballing technique to identify additional participants until we achieved saturation. After transcription of audio recordings of the interviews, two authors conducted data coding and analysis using a framework approach.
Results: We conducted 16 interviews with healthcare providers. Major themes included the need to improve the diagnostic and therapeutic capabilities of the hospital, including increasing the number of ECG machines and access to thrombolytics. Participants highlighted an overall wide availability of other guideline-directed medical therapies, including antiplatelets, beta-blockers, statins, anticoagulants and ACE inhibitors. All participants also stated the need for and openness to accepting future interventions for improvement of quality of care, including checklists and audits to improve ACS care at Kenyatta National Hospital.
Conclusion: Major barriers to ACS care at Kenyatta National Hospital include inadequate diagnostic and therapeutic capabilities, lack of hospital-wide ACS guidelines, undertraining of healthcare providers and delayed presentation of patients seeking care. We also identified potential targets, including checklists and audits for future improvements in quality of care from the perspective of healthcare providers.
- Title: Association of traditional cardiovascular risk factors with
carotid atherosclerosis among adults at a teaching hospital in south-western
Nigeria
Authors: Adeleye Dorcas Omisore, Olusola Comfort Famurewa, Morenikeji Adeyoyin Komolafe, Christiana Mopelola Asaleye, Michael Bimbola Fawale, Babalola Ishmael Afolabi
From: Cardiovascular Journal of Africa, Vol 29, Issue, 3, May/June
Published: 2018
Pages:183–188
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DOI Number: 10.5830/CVJA-2018-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-014
Background: Traditional cardiovascular risk factors (CVRFs), which include age, gender, hypertension, diabetes mellitus, dyslipidaemia, smoking, alcohol consumption, chronic kidney disease and obesity, have been shown to be associated with atherosclerosis. We aimed to evaluate the impact of traditional CVRFs on carotid atherosclerosis (CA) in a sample of Nigerian adults.
Methods: We examined 162 subjects with traditional CVRFs in a cross-sectional study. Demographic and clinical data, including history of hypertension, diabetes mellitus, smoking, alcohol intake and chronic kidney disease, as well as systolic and diastolic blood pressure, weight and height were collected. Serum creatinine, fasting blood glucose and lipid profiles were also determined. Carotid intima–media thickness (CIMT) and presence of carotid plaque (CP) were evaluated by high-frequency B-mode ultrasound. Chi-squared and regression analyses were carried out to determine associations between variables of CIMT and CVRF.
Results: Increased CIMT was associated with all CVRFs (p < 0.05) except gender (p > 0.05), while CP was associated with older age, obesity, hypertension and dyslipidaemia (p < 0.05). We found prevalence of increased CIMT was 53.7%, while that of CP was 16.1%. The prevalence of CA (increased CIMT and CP) also increased with increasing number of CVRFs in the subjects. Age ≥ 50 years, hypertension, dyslipidaemia, obesity and alcohol intake explained 78.7% of variance in CIMT, while age ≥ 50 years and hypertension explained 38.0% of variance in CP.
Conclusions: CA was associated with presence and increasing number of traditional CVRFs. A significant percentage of variance in CA was, however, unexplained by traditional CVRFs.
- Title: Double trouble: psoriasis and cardiometabolic disorders
Authors: Nasrin Goolam Mahyoodeen, Nigel J Crowther, Mohammed Tikly
From: Cardiovascular Journal of Africa, Vol 29, Issue, 3, May/June
Published: 2018
Pages:189–194
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DOI Number: 10.5830/CVJA-2017-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-055
Abstract: Psoriasis (PsO) is a chronic immune-mediated inflammatory skin disorder associated with numerous co-morbidities. This descriptive review focuses on the cardiometabolic co-morbidities of PsO with reference to the epidemiology and pathogenetic mechanisms linking PsO and cardiometabolic disease (CMD). Registry-based studies have shown PsO to be associated with an increased risk of cardiovascular morbidity and mortality. Factors linking PsO and CMD include: chronic inflammation, obesity, classic cardiovascular risk factors, and the effects of systemic therapy used to treat PsO. Chronic inflammation is associated with PsO itself, and with obesity. Adipose tissue is responsible for the secretion of various adipokines, which together with pro-inflammatory cytokines arising from the psoriatic plaque, contribute to the proinflammatory and pro-atherogenic environment. Systemic therapy aimed at decreasing inflammation has been shown to improve CMD in PsO. Screening for and treating CMD and initiating lifestyle modifications will remain the most important interventions until further data emerge regarding the effect of systemic therapy on CMD progression.
- Title: Irregular, narrow-complex tachycardia
Authors: Julian Hoevelmann, Charle Viljoen, Ashley Chin
From: Cardiovascular Journal of Africa, Vol 29, Issue, 3, May/June
Published: 2018
Pages:195–198
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Abstract: The correct differentiation of an irregular, narrow-complex tachycardia has crucial implications for the therapeutic management of these conditions. In this article we present a differential diagnostic and treatment approach to irregular, narrow-complex tachycardias.
- Title: PASCAR News: Report from Nairobi: towards a 25% reduction in
uncontrolled hypertension in Africa
Authors: Marí Hudson
From: Cardiovascular Journal of Africa, Vol 29, Issue, 3, May/June
Published: 2018
Pages:199-200
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- Title: Levitronix bilateral
ventricular assist device, a bridge to recovery
in a patient with acute fulminant myocarditis
and concomitant cerebellar infarction
Authors: Yi-Fan Huang, Po-Shun Hsu, Chien-Sung Tsai, Yi-Ting Tsai, Chih-Yuan Lin, Hong-Yan Ke, Yi-Chang Lin, Hsiang-Yu Yang
From: Cardiovascular Journal of Africa, Vol 29, Issue, 3, May/June
Published: 2018
Pages:e1–e4
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DOI Number: 10.5830/CVJA-2018-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-009
Abstract: We report on the case of a 27-year-old male who presented to our emergency room with chest tightness, dyspnoea and cold sweats. The 12-lead electrocardiogram showed diffuse ventricular tachycardia with wide QRS complexes. Troponin-I level was elevated to 100 ng/ml. The coronary angiogram showed good patency of all three coronary vessels, and acute fulminant myocarditis was suspected. The patient underwent cardiopulmonary resuscitation in the catheter room and high-dose inotropic support was initiated to stabilise his haemodynamic status. After resuscitation, the patient was in a coma and acute stroke was highly suspected. In addition, deteriorating cardiogenic shock with acute renal failure and pulmonary oedema were also detected. Due to haemodynamic compromise despite high-dose inotropic support, a Levitronix® bilateral ventricular assist device (Bi-VAD) was implanted on an emergency basis for circulatory support. Postoperative brain computed tomography revealed acute left cerebellar infarction. Because the patient had left cerebellar infarction with right hemiplegia, heart transplantation was contraindicated. Eventually, cardiac systolic function recovered well and the patient underwent successful Bi-VAD removal after a total of 18 days on Levitronix® haemodynamic support. He was weaned from the ventilator two weeks later and was discharged 10 days later.
