CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 29, ISSUE
4, JULY/AUG 2018
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- Title: The changing face of
percutaneous closure of the patent ductus
arteriosus: advances over the last few years
Authors: Adele Greyling
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 203
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- Title: The African context of the
Cape Town Declaration
Authors: Peter Zilla, Liesl Zühlke, Karen Sliwa, Patrick Commerford
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 204-205
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- Title: Obituary: Bongani Mayosi, a hero remembered
Authors: Mpiko Ntsekhe, Patrick Commerford, Paul Brink, Salim Yusuf
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 206-207
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- Title: Pulmonary hypertension as
seen in a rural area in sub-Saharan Africa: high
prevalence, late clinical presentation and a
high short-term mortality rate during follow up
Authors: Anastase Dzudie, Bonaventure Suiru Dzekem, Cabral Tantchou Tchoumi, Leopold Ndemnge Aminde, Ana O Mocumbi, Martin Abanda, Friedrich Thienemann, Andre Pascal Kengne, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 208–212
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DOI Number: 10.5830/CVJA-2018-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-007
Introduction: The epidemiology of pulmonary hypertension (PH) in low- to middle-income countries is poorly characterised. We assessed the prevalence, baseline characteristics and mortality rate in patients with echocardiographically diagnosed PH at a rural cardiac centre in Cameroon.
Methods: We conducted a prospective cohort study in a subsample of 150 participants, aged 18 years and older, diagnosed with PH [defined as right ventricular systolic pressure (RVSP) ≥ 35 mmHg in the absence of pulmonary stenosis and right heart failure]. PH was classified as mild (RVSP: 35–50 mmHg), moderate (RVSP: 51–60 mmHg) and severe (RVSP: > 60 mmHg).
Results: Of 2 194 patients screened via echocardiograms, 343 (crude prevalence 15.6%) had PH. The sub-sample of 150 patients followed up (54.7% women, mean age of 62.7 ± 18.7 years) had a mean RVSP of 68.6 mmHg. They included 7.3% mild, 29.3% moderate and 63.4% severe PH cases. Co-morbidities included log smoke (80.7%), hypertension (52.0%), family history of cardiovascular disease (50.0%), diabetes (31.3%), alcohol abuse (21.3%) and HIV infection (8.7%). Main clinical features were dyspnoea (78.7%), fatigue (76.7%), palpitations (57.3%), cough (56.7%), jugular venous distension (68%) and peripheral oedema (66.7%). Overall, 70% presented in World Health Organisation functional class III/IV. PH due to left heart disease (PHLHD) was the commonest (64.7%), and rheumatic valvular disease accounted for 36.1%. The six-month mortality rate was 28%.
Conclusion: PH, dominated by PHLHD, was common among adults attending this rural centre and was associated with a high mortality rate. Related co-morbidities and late clinical presentation reflect the poor socio-economic context. Improved awareness of PH among physicians could promote early diagnosis and management.
- Title: Does the use of N-butyl-2
cyanoacrylate in the treatment of lower
extremity superficial varicose veins cause acute
systemic inflammation and allergic reactions?
Authors: Özge Korkmaz, Sabahattin Göksel, Müslim Gül, Hasan Başçil, Yavuz Yildir, Öcal Berkan
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 213–217
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DOI Number: 10.5830/CVJA-2018-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-012
Introduction: In this study we used N-butyl-2 cyanoacrylate (NBCA), including dimethyl sulfoxide (DMSO), via the endovenous route, for mechanochemical ablation in the treatment of superficial venous insufficiency, in an attempt to establish whether an early systemic inflammatory response and an allergic reaction occurred in the patients.
Methods: A total of 102 patients were treated with endovenous medical ablation in two centres between October 2015 and February 2016. This study was a two-centre, retrospective, non-randomised investigational study. Ablation treatment with endovenous NBCA was used in patients with C3 to C4b grade superficial venous insufficiency, according to the CEAP (clinical, aetiology, anatomy and pathophysiology) clinical classification, with sapheno-femoral junctional insufficiency and a reflux of 0.5 seconds and longer on duplex ultrasonography. Pre-operative whole blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level and blood chemistry were studied in all patients on admission to the clinic, and repeated in the second hour post-intervention.
Results: All patients were treated successfully. Pre-operative white blood cell count (WBC) was 6.82 ± 1.67 × 109 cells/μl, and post intervention it was 6.57 ± 1.49 × 109 cells/μl; the difference was not statistically significant (p = 0.68). The neutrophil count before the intervention was 4.09 ± 1.33 × 109 cells/μl, while afterwards, it was 4.09 ± 1.33 × 109 cells/μl, with no statistically significant difference (p = 0.833). Pre-intervention eosinophil count was 0.64 ± 1.51 × 109 cells/μl, while it was 0.76 ± 1.65 × 109 cells/μl after the intervention, and the difference was statistically significant. Pre-intervention ESR and CRP values were 18.92 ± 9.77 mm/h and 1.71 ± 1.54 mg/dl, respectively. Postoperative ESR and CRP values were 19.78 ± 15.90 mm/h and 1.73 ± 1.59 mg/dl, respectively, but the differences were not statistically significant. When the parameters were analysed by gender, the differences between pre- and postoperative WBC and eosinophil count, ESR and CRP in women were not statistically significant. On the other hand, although the change in WBC count and CRP value were not statistically significant in males, the differences in eosinophil count and ESR were statistically significant.
Conclusion: Cyanoacrylate has been used in the endovenous medical ablation of varicose veins and superficial venous insufficiency over the last few years without the use of thermal energy and tumescent anaesthesia, which represents the greatest advantage of this method. In addition, since it causes no systemic allergic or acute inflammatory reaction, it appears to be safe to use.
- Title: Hypertension among newly diagnosed diabetic patients at
Mulago National Referral Hospital in Uganda: a cross sectional study
Authors: Martin Muddu, Edrisa Mutebi, Isaac Ssinabulya, Samuel Kizito, Charles Kiiza Mondo
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 218–224
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DOI Number: 10.5830/CVJA-2018-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-015
Background: The prevalence of hypertension in patients with diabetes is approximately two-fold higher than in age-matched subjects without the disease and, conversely, individuals with hypertension are at increased risk of developing diabetes compared with normotensive persons. Up to 75% of cases of cardiovascular disease (CVD) in patients with diabetes are attributed to hypertension. Diabetics who have hypertension are more likely to develop complications and die, and appropriate blood pressure control in these individuals reduces the risk. This study sought to determine the prevalence and factors associated with hypertension among newly diagnosed adult diabetic patients in a national referral hospital in Uganda.
Methods: In this cross-sectional study, conducted between June 2014 and January 2015, we recruited 201 newly diagnosed adult diabetic patients. Information on patients’ socio-demographics was obtained using a pre-tested questionnaire, while biophysical profile, blood pressure measurement, biochemical testing and echocardiographic findings were obtained by the research team for all the participants. Bivariate and multivariate logistic regression analyses were used to investigate the association of several factors with hypertension
Results: Of the 201 patients recruited, 102 were male (50.8%) and the mean age was 46 ± 15 years. The majority of patients (159) had type 2 diabetes mellitus (DM) (79.1%) with a mean HbA1c level of 13.9 ± 5.3%. The prevalence of hypertension was 61.9% (95% CI: 54.8–68.6%). Knowledge of hypertension status was at 56 (27.7%) patients, 24 (44.4%) hypertensives were on treatment, and 19 (33.9%) were using ACE inhibitors/ angiotensin receptor blockers. The independent factors associated with hypertension were being employed (OR 0.37, 95% CI: 0.16–0.90, p = 0.029) and being overweight or obese (OR 11.6, 95% CI: 4.29–31.2, p < 0.0001).
Conclusion: The prevalence of hypertension was high in this population of newly diagnosed diabetics, few patients had knowledge of their hypertension status and few were on appropriate treatment. Both modifiable and non-modifiable risk factors were associated with hypertension in this group. Therefore routine assessment, treatment and control of hypertension among diabetics is necessary to prevent cardiovascular complications and death. There is also a need to address the modifiable risk factors.
- Title: Presentation, management and outcomes of acute coronary
syndrome: a registry study from Kenyatta National Hospital in Nairobi, Kenya
Authors: Ehete Bahiru, Tecla Temu, Bernard Gitura, Carey Farquhar, Mark D Huffman, Frederick Bukachi
From: Cardiovascular Journal of Africa, Vol 29, Issue 4 July/August
Published: 2018
Pages: 225–230
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DOI Number: 10.5830/CVJA-2018-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-017
Background: Acute coronary syndrome (ACS) is understudied in sub-Saharan Africa despite its increasing disease burden. We sought to create an ACS registry at Kenyatta National Hospital to evaluate the presentation, management and outcomes of ACS patients.
Methods: From November 2016 to April 2017, we conducted a retrospective review of ACS cases managed at Kenyatta National Hospital between 2013 and 2016, with a primary discharge diagnosis of ACS, based on International Classification of Diseases (ICD) 10 coding (I20-I24). We compared the presentation, management and outcomes by ACS subtype using analysis of variance testing. We created multivariable logistic regression models using the Global Registry of Acute Coronary Events (GRACE) risk score to evaluate the association between clinical variables, including guideline-directed medical therapy and in-hospital outcomes.
Results: Among 196 ACS admissions, the majority (65%) was male, and the median age was 58 years. Most (57%) ACS admissions were for ST-segment-elevation myocardial infarction (STEMI). In-hospital dual antiplatelet (> 85%), beta-blockade (72%) and anticoagulant (72%) therapy was common. A minority (33%) of patients with STEMI was eligible for reperfusion therapy but only 5% received reperfusion. In-hospital mortality rate was 17%, and highest among individuals presenting with STEMI (21%). After multivariable adjustment, higher serum creatinine level was associated with higher odds of in-hospital death (OR = 1.84, 95% CI: 1.21– 2.78), and STEMI and Killip class > 1 were associated with in-hospital composite of death, re-infarction, stroke, major bleeding or cardiac arrest (STEMI: OR = 8.70, 95% CI: 2.52–29.93; Killip > 1: OR = 10.7, 95% CI: 3.34–34.6).
Conclusions: We describe the largest ACS registry at Kenyatta National Hospital to date and identify potential areas for improved ACS care related to diagnostics and management to optimise in-hospital outcomes.
- Title: Left ventricular twist before
and after haemodialysis: an analysis using
speckle-tracking echocardiography
Authors: Anthony Yip, Saraladevi Naicker, Ferande Peters, Elena Libhaber, Nirvathi Maharaj, Mduduzi Mashabane, Mohammed Rafique Essop
From: Cardiovascular Journal of Africa, Vol 29, Issue 4, July/August
Published: 2018
Pages: 231–236
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DOI Number: 10.5830/CVJA-2018-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-019
Background: The most commonly used parameter of cardiac function in the chronic kidney disease (CKD) patient is ejection fraction (EF), using transthoracic echocardiography (TTE). EF is a highly load-dependent measurement, which varies considerably in CKD patients undergoing haemodialysis. The aim of this pilot study was to evaluate a novel measure of myocardial function, left ventricular twist, which is defined as the ‘wringing action of the heart’, using speckletracking echocardiography in CKD patients before and after haemodialysis.
Methods: Twenty-six patients were recruited from the Chris Hani Baragwanath Hospital haemodialysis unit. TTE was performed according to a detailed standardised protocol before and after a single haemodialysis session. Echocardiography was also performed on 26 age- and gendermatched healthy subjects.
Results: The mean age of the control versus CKD group was 44 ± 11.4 and 43.4 ± 12.2 years, respectively; 46% were male. Apical rotation was diminished in CKD patients compared to controls (4.83 ± 2.3 vs 6.31 ± 1.6 °; p = 0.01) despite no difference in EF (61.7 ± 6.2 vs 58.8 ± 13; p = 0.68). There were no differences in the components of twist: apical rotation, basal rotation and net twist before and after dialysis, despite an increase in EF (58.8 ± 13.7 vs 61.2 ± 13.6; p = 0.02) following dialysis.
Conclusion: Unlike EF, the components of twist are relatively independent of changes in haemodynamic load seen during dialysis. The decrease in apical rotation may represent an early marker of cardiac pathology in the late-stage CKD patient.
- Title: Management of stable angina pectoris in private healthcare
settings in South Africa
Authors: Pride Tlhakudi, Lehlohonolo John Mathibe
From: Cardiovascular Journal of Africa, Vol 29, Issue 4, July/August
Published: 2018
Pages: 237–240
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DOI Number: 10.5830/CVJA-2018-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-020
Aim: Angina pectoris continues to affect multitudes of people around the world. In this study the management of stable angina pectoris in private healthcare settings in South Africa (SA) was investigated. In particular, we reviewed the frequency of medical versus surgical interventions when used as first-line therapy.
Methods: This was a retrospective inferential study carried out using records of patients in private healthcare settings. All cases that were authorised for reimbursement by medical aid schemes for revascularisation between 2009 and 2014 were retrieved and a database was created. Data were analysed using Microsoft® Excel and GraphPad Prism® version 5. The differences (where applicable) were considered statistically significant if the p-value was ≤ 0.05.
Results: Nine hundred and twenty-two patients, consisting of 585 males (average age 64.7 years; SD 12.9) and 337 females (average age 65.5 years; SD 14.3), met the inclusion criteria. One hundred and seventy-eighty or 54%, 156 (43%) and 86 (63%) patients with hypertension, hyperlipidaemia and diabetes, respectively, were treated with surgery only. For these patients, percutaneous coronary interventions (PCIs) were significantly (p < 0.0001) preferred first-line interventions over optimal medical therapy (OMT). Four hundred and thirty-six or 47% of all patients studied were managed with surgery only, while only 25% (227) were managed with OMT. It took 60 months (five years) for patients who were treated with OMT before their first surgical intervention(s) to require the second revascularisation. About 71% of patients who received medical therapy were placed on only one drug, the so called sub-optimal medical therapy (SOMT).
Conclusion: The management of stable angina pectoris in private healthcare settings in SA is skewed towards surgical interventions as opposed to OMT. This is contrary to what consistent scientific evidence and international treatment guidelines suggest.
- Title: Short-term results of flanged Bentall de Bono and
valvesparing David V procedures for the treatment of aortic root aneurysms
Authors: Servet Ergün, Mehmet Dedemoğlu, Murat Bülent RabuŞ, Baburhan Özbek, Mustafa Mert Özgür, Mehmet Altuğ Tuncer, Mehmet Balkanay, Mehmet Kaan Kırali
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages: 241–245
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DOI Number: 10.5830/CVJA-2018-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-021
Aim: Even though the Bentall de Bono procedure is widely used for the treatment of aortic root aneurysms, the procedure is under scrutiny nowadays because of complications due to mechanical prosthetic valves and the need for life-long anticoagulation. Due to these complications, aortic valvesparing operations are being researched. In this study we compared the short-term morbidity and mortality rates of both Bentall de Bono and valve-sparing David V procedures.
Methods: We retrospectively evaluated data from 70 patients who had undergone surgery for aortic root aneurysm between April 2009 and June 2013. We had performed the Bentall de Bono procedure on 46 patients and the David V procedure on 24 patients. Mortality rates, cardpulmonary bypass (CPB) and aortic cross-clamp durations, postoperative arrhythmias, and prolonged intensive care unit (ICU) and hospital stays were compared in this study.
Results: There was no statistical difference for mortality rate (p = 0.57), while the CPB time and cross-clamp duration were shorter in the Bentall group. When we compared the length of ICU and hospital stay, we observed that the David group stayed longer in ICU (p = 0.003) but the duration of hospital stay was shorter (p = 0.007).
Conclusion: Despite Bentall de Bono being the most commonly used procedure, the short-, mid- and long-term results of both procedures were similar. Spared native aortic valve and lack of anticoagulation usage are notable advantages of the David V procedure.
- Title: Letter to the Editor: Tribute to Professor Bongani Mawethu
Mayosi
Authors: Dr OS Ogah
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages:245
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- Title: Transcatheter closure of the
patent ductus arteriosus at a public sector
hospital in Soweto, South Africa: a review of
patient outcomes over 15 years
Authors: Paul Ernest Adams, Matthew Francis Chersich, Antoinette Cilliers
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages: 246–251
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DOI Number: 10.5830/CVJA-2018-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-028
Background: Methods of closing patent ductus arteriosus (PDA) have evolved over time. We review this development in our setting.
Methods: This was a retrospective analysis of children who had transcatheter PDA closure at Chris Hani Baragwanath Hospital between 1993 and 2008.
Results: Over 15 years, 1 254 PDAs were diagnosed, of which 293 required intervention; 139 patients had transcatheter closure, the median age was 1.8 years (interquartile range = 1–4.5 years) and 66% were female (92/139). Mean PDA diameter was 3.2 mm (standard deviation = 1.6 mm), with an average 2:1 shunt. Transcatheter closure was performed using COOK® Flipper coils (n = 93) or Amplatzer™ devices (n = 46). Early occlusion rates for coils were 52% (39/75) and late occlusion occurred in 91% (68/75) of patients. For Amplatzer devices, early occlusion rates were 94% (33/35) and late occlusion was 100%. Amplatzer™ devices, available since 2003, were overwhelmingly used in the later years.
Conclusion: Transcatheter PDA closure was safe and effective in this setting, with outcomes similar to reports elsewhere.
- Title: The challenge in diagnosing coarctation of the aorta
Authors: Julien IE Hoffman
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages: 252–255
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DOI Number: 10.5830/CVJA-2017-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-053
Abstract: Critical coarctation of the aorta in neonates is a common cause of shock and death. It may be the most difficult of all forms of critical congenital heart disease to diagnose because the obstruction from the coarctation does not appear until several days after birth (and after discharge from the hospital), and because there are no characteristic murmurs. Some of these patients may be detected by neonatal screening by pulse oximetry, but only a minority is so diagnosed. Older patients are usually asymptomatic but, although clinical diagnosis is easy, they are frequently undiagnosed.
- Title: The Cape Town Declaration on Access to Cardiac Surgery in the
Developing World
Authors: Peter Zilla, R Morton Bolman, Magdi H Yacoub, Friedhelm Beyersdorf, Karen Sliwa, Liesl Zühlke, Robert SD Higgins, Bongani Mayosi, Alain Carpentier, David Williams
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages: 256–259
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DOI Number: 10.5830/CVJA-2018-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-046
Mission: to urge all relevant entities within the international cardiac surgery, industry and government sectors to commit to develop and implement an effective strategy to address the scourge of rheumatic heart disease in the developing world through increased access to life-saving cardiac surgery.
- Title: Multivessel disease in STEMI patients: a perspective from
limited-resource settings
Authors: Ahmed Ali Ahmed Suliman, Nauman Naseer, Bernard Gersh
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages:260–261
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DOI Number: 10.5830/CVJA-2018-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-034
- Title: Feasibility of south–south collaboration in Africa: the
Uganda–Mozambique perspective
Authors: Judith Namuyonga, Peter Solomon Lwabi, John Omagino, Magdi Yacoub, Ana Olga Mocumbi
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages: 262-263
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DOI Number: 10.5830/CVJA-2018-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-030
- Title: Cases in a series of
carcinoid syndrome and carcinoid heart disease
Authors:Mamotabo R Matshela
From: Cardiovascular Journal of Africa, Vol 29, Issue, 4, July/August
Published: 2018
Pages:e1–e7
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DOI Number: 10.5830/CVJA-2018-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-040
Abstract: Although carcinoid syndrome is regarded as a rare entity, carcinoid patients with evidence of cardiac involvement show a markedly reduced survival time. Patients with advanced signs of right-sided heart failure represent a subgroup at particularly high risk. Echocardiography remains the gold standard to diagnose or confirm structural cardiac involvement in patients with underlying carcinoid disease. This is the notion that propelled us to report on cases of carcinoid syndrome with cardiac involvement. We also review carcinoid syndrome and carcinoid heart disease, and challenges regarding the diagnosis and management of carcinoid heart disease.
