CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 29, ISSUE
5, SEP/OCT 2018
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- Title: From the Editor’s Desk
Authors: Pat Commerford
From: Cardiovascular Journal of Africa, Vol 29, Issue 5 September/October
Published: 2018
Pages: 267
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- Title: Clinical characteristics and
outcome of lone atrial fibrillation at a tertiary
referral centre: the Groote Schuur Hospital
experience
Authors: Vinod Thomas, Simone Schulein, Robert N Scott Millar, Bongani M Mayosi
From: Cardiovascular Journal of Africa, Vol 29, Issue 5 September/October
Published: 2018
Pages: 268–272
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DOI Number: 10.5830/CVJA-2018-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-005
Introduction: Atrial fibrillation (AF) is a relatively common arrhythmia. When AF represents an electrophysiological phenomenon in structurally normal hearts, it is termed lone AF. This study was a retrospective, case-based analysis of patients attending the Cardiac Clinic at Groote Schuur Hospital (GSH) and describes the clinical characteristics and outcomes of patients classified as having lone atrial fibrillation. To the best of our knowledge there are no such studies reported from Africa.
Methods: This was a retrospective, descriptive study in which 289 medical records of patients with AF at the GSH Cardiac Clinic were reviewed from 1992 to 2006. The clinical data were interrogated to exclude identifiable causes of AF. Information on clinical characteristics and outcomes were entered into a data-entry form. Baseline descriptive statistics were expressed as means and range for continuous variables, and counts with percentages for categorical variables.
Results: Fifteen per cent (n = 42) of patients were identified as having lone AF, with a mean follow-up time of 5.8 years. Males comprised 57% (n = 24) and females 43% (n = 18). Fifty per cent (n = 21) of the patients had paroxysmal AF, 29% (n = 12) had persistent AF, and 12% (n = 5) progressed from paroxysmal to permanent AF. Subsets of lone AF included concomitant atrial flutter (17%) (n = 7) and sick sinus syndrome (21%) (n = 9). Complications were stroke (10%) (n = 4), tachycardia-related cardiomyopathy (17%) (n = 7) and bleeding complications on warfarin (11%) (n = 3).
Conclusion: Lone AF is not an uncommon arrhythmia, with a preponderance in thin, middle-aged males. The symptoms of lone AF can be debilitating. It has associated morbidity, including tachycardia-related cardiomyopathy and thromboembolism. Rate control and appropriate anticoagulation are the cornerstones of patient management.
- Title: Echocardiographic screening
for rheumatic heart disease in 4 515 Sudanese
school children: marked disparity between two
communities
Authors: Sulafa Ali, Sara Domi, Bahja Abbo, Rabab Abbas, Tajudeen Bushari, Khalid Al Awad, Abdelrahman Elhassan, Manar E Abdel-Rahman
From: Cardiovascular Journal of Africa, Vol 29, Issue 5 September/October
Published: 2018
Pages: 273–277
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DOI Number: 10.5830/CVJA-2018-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-022
Introduction: The epidemiology of pulmonary hypertension (PH) in low- to middle-income Introduction: Echocardiographic (echo) screening has unmasked a high prevalence of subclinical rheumatic heart disease (RHD) in many countries, and it can be used as a surveillance tool to control the disease.
Methods: School children of 10 to 15 years of age were selected in two areas of Sudan, Khartoum, the capital, and Niyala in western Sudan. Echo screening using a hand-held echo (HHE) was conducted in Khartoum using a three-view protocol, and in Niyala, a one-view protocol, both modified from the World Heart Federation protocol. Suspected cases were referred for standard echo study. Training of health personnel was conducted and health education sessions were delivered to the public.
Results: In Khartoum, a total of 3 000 school children were screened; seven cases were positive for RHD using HHE and one case was confirmed by standard echocardiography. The prevalence of RHD using echocardiography was 0.3 per 1 000 children. In Niyala, a total of 1 515 school children were screened. Using HHE, 59 cases were positive for RHD; 44 had definite and 15 borderline disease. Out of 34 who underwent standard echocardiography, 29 (85.2%) were found to have RHD; 22 had definite and seven borderline disease. The prevalence using echocardiography was 19 per 1 000 children. A total of 779 health workers were trained in South Darfur and 50 000 posters and pamphlets were distributed.
Conclusion: Using echocardiography, there was a significant disparity in RHD prevalence between the two communities in Sudan. Efforts to control RHD should be directed to this area, and other rural communities should be investigated.
- Title: Comparison of quantitative
and qualitative coronary angiography: computer
versus the eye
Authors: Taner Sen, Celal Kilit, Mehmet Ali Astarcioglu, Lale Dinc Asarcikli, Tolga Aksu, Habibe Kafes, Afsin Parspur, Gokhan Gozubuyuk, Basri Amasyali
From: Cardiovascular Journal of Africa, Vol 29, Issue 5 September/October
Published: 2018
Pages: 278–282
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DOI Number: 10.5830/CVJA-2018-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-024
Objective: Since visual estimation of the extent of vessel stenosis may vary between operators, we aimed in this study to investigate both inter-observer variability and consistency between the estimation of an operator and quantitative coronary analysis (QCA) measurements.
Methods: A total of 147 elective percutaneous coronary intervention patients with 155 lesions between them were consecutively enrolled in the study. These patients were evaluated for visual estimation of lesion severity by three operators. The lesions were also evaluated with QCA by an operator who was blinded to the visual assessments. Reference diameter, minimal lumen diameter, percentage diameter of stenosis, percentage area of stenosis and diameter of lesion length from the proximal lesion-free segment to the distal lesion-free segment were calculated using a computerised QCA software program.
Results: There was a moderate degree of concordance in the categories 70–89% (kappa: 0.406) and 90–99% (κ: 0.5813), whereas in the categories < 50% and 50–69% there was a low degree of concordance between the visual operators (κ: 0.323 and κ: 0.261, respectively). There was a low to moderate grade of concordance between visual estimation and percentage area of stenosis by QCA (κ: 0.30) but there was no concordance between visual estimation and percentage diameter of stenosis by QCA (κ: –0.061). Also, there was a statistically significant difference between QCA parameters of percentage diameter of stenosis and percentage area of stenosis (58.4 ± 14.5 vs 80.6 ± 11.2 %, p < 0.001).
Conclusion: Visual estimation may overestimate a coronary lesion and may lead to unnecessary coronary intervention. There was low concordance in the categories < 50% and 50–69% between the visual operators. Percentage area of stenosis by QCA had a low to moderate grade of concordance with visual estimation. Percentage area of stenosis by QCA more closely reflected the visual estimation of lesion severity than percentage diameter of stenosis.
- Title: Association of microalbuminuria with left ventricular
dysfunction in Nigerian normotensive type 2 diabetes patients
Authors: TT Shogade, IO Essien, UE Ekrikpo, IO Umoh, CT Utin, BC Unadike, JJ Andy
From: Cardiovascular Journal of Africa, Vol 29, Issue 5 September/October
Published: 2018
Pages: 283–288
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DOI Number: 10.5830/CVJA-2018-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-026
Background: Diabetes mellitus (DM) is a risk factor for left ventricular (LV) dysfunction, and microalbuminuria is frequently associated with DM. This study aimed to compare LV function among normotensive type 2 diabetes (T2DM) patients with normoalbuminuria, those with microalbuminuria, and healthy controls.
Methods: This was a cross-sectional study conducted at the diabetes and cardiology clinics of the University of Uyo Teaching Hospital, Uyo, Akwa-Ibom State, Nigeria, from January 2013 to March 2014. Microalbuminuria was tested for using Micral test strips, and echocardiography-derived indices of LV function were compared among the three groups.
Results: Sixty-three normoalbuminuric, 71 microalbuminuric T2DM patients and 59 healthy controls were recruited. Mean age of participants was 50 ± 8 years and the three groups were age and gender matched (p = 0.23, p = 0.36, respectively). LV diastolic dysfunction (LVDD) showed a stepwise increase from the healthy controls to the normoalbuminuric to the microalbuminuric T2DM patients (16.9 vs 61.9 vs 78.9%, respectively) (p < 0.001), while E/A ratio and fractional shortening showed a significant stepwise decrease (both p < 0.001). LV systolic dysfunction was rare among the three groups. Microalbuminuria showed a strong direct association with LVDD (OR 3.58, 95% CI: 1.99–6.82, p < 0.001). Age remained independently associated with LVDD (OR 1.10, 95% CI: 1.03–1.17, p = 0.003).
Conclusions: LV diastolic function was altered in Nigerian normotensive T2DM patients, and the presence of microalbuminuria with DM had additional effects on this abnormality. Early screening for DM and microalbuminuria could identify individuals with high cardiovascular risk and possibly abnormal LV function.
- Title: Haemorrhage and other complications in pregnant women on
anticoagulation for mechanical heart valves: a prospective observational cohort
study
Authors: S Kariv, F Azibani, J Baard, A Osman, P Soma-Pillay, J Anthony, K Sliwa
From: Cardiovascular Journal of Africa, Vol 29, Issue 5 September/October
Published: 2018
Pages: 289–295
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DOI Number: 10.5830/CVJA-2018-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-029
Objective: To document maternal and foetal morbidity and mortality in anticoagulated, pregnant patients with mechanical heart valves until 42 days postpartum.
Methods: In a tertiary single-centre, prospective cohort, 178 consecutive patients at the cardiac-obstetric clinic were screened for warfarin use between 1 July 2010 and 31 December 2015. Of 33 pregnancies identified, 29 were included. Patients received intravenous unfractionated heparin from six to 12 weeks’ gestation and peripartum, and warfarin from 12 to 36 weeks. Maternal outcomes including death, major haemorrhage and thrombosis, and foetal outcomes were documented.
Results: There were two maternal deaths, five returns to theatre post-delivery, eight patients transfused, six major haemorrhages, one case of infective endocarditis and three ischaemic strokes. Ten pregnancies had poor foetal outcomes (six miscarriages, three terminations, one early neonatal death). Twenty patients required more than 30 days’ hospitalisation, and 15 required three or more admissions. HIV positivity was associated with surgical delivery (p = 0.0017).
Conclusions: Complication rates were high despite centralised care.
- Title: The neutrophil-to-lymphocyte
ratio and mean platelet volume can be associated
with severity of valvular involvement in
patients with acute rheumatic carditis
Authors: Serkan F Çelik, Elif Çelik
From: Cardiovascular Journal of Africa, Vol 29, Issue 5, September/October
Published: 2018
Pages: 296–300
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DOI Number: 10.5830/CVJA-2018-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-031
Objectives: The aim of the study was to investigate the association between the severity of acute rheumatic carditis (ARC) and the neutrophil–lymphocyte ratio (NLR) and mean platelet volume (MPV).
Methods: Paediatric patients diagnosed with ARC between 2010 and 2016 and age- and gender-matched controls were retrospectively analysed. At the time of diagnosis, we reviewed the demographic features obtained: echocardiographic data, complete blood count reports, acute-phase reactants, including C-reactive protein, and erythrocyte sedimentation rate values. The patient group was further divided into two subgroups according to the degree of valvular regurgitation, which included those with severe and those with mild-tomoderate valvular regurgitation.
Results: The number of cases with ARC and age- and gendermatched controls were 120 and 50, respectively. The mean age of the patients was 12.25 ± 2.89 (range: 7–18) years. NLR, MPV, anti-streptolysin-O, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haemoglobin level, and white blood cell (WBC) and neutrophil count were significantly higher in patients with acute carditis compared with the controls (p < 0.001). NLR was found to have a significantly positive correlation with CRP (r = 0.177, p = 0.001), ESR (r = 0.81, p = 0.03) and WBC count (r = 0.47, p = 0.001). Moreover, we found a positive correlation between NLR and severity of valvular regurgitation (r = 0.34, p < 0.001), and a negative correlation between MPV and severity of valvular regurgitation (r = –0.38, p < 0.05) in our patients. In multiple linear regression analysis, severe valvular regurgitation was associated with NLR (0.51; 95% CI: 0.32–0.68; p = 0.006) and MPV (–0.78; 95% CI: –0.72 to –0.98; p = 0.008).
Conclusion: NLR and MPV are novel inflammatory markers and simple, rapid and easily accessible prognostic parameters that can be associated with severity of valvular involvement in patients with ARC.
- Title: Ellisras Longitudinal Study 2017: The relationship between
dietary intake and body mass index among young rural adults in South Africa aged
18 to 30 years (ELS 18)
Authors: Julia TM Mashiane, Kotsedi D Monyeki, Andre P Kengne, Nkwana M Rosina, Mafoloa S Monyeki
From: Cardiovascular Journal of Africa, Vol 29, Issue 5,September/October
Published: 2018
Pages: 301–304
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DOI Number: 10.5830/CVJA-2018-033
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-033
Aim: To assess the relationship between dietary intake and adiposity in young rural South African adults.
Methods: A total of 728 young adults participated and dietary intake was assessed using the 24-hour recall method. Linear regression models were used to determine the association between dietary intake and body mass index (BMI) before and after adjustment for age and gender.
Results: Females showed higher mean BMI values than males in all age groups. An age group of 27- to 30-year-old females had a mean value of 28.1 kg/m2 while males had a mean value of 21.9 kg/m2. The distribution of BMI categories (underweight, normal weight, overweight, obese) was 20.5, 61.7, 9.3 and 3.1% in males, and 8.6, 42.5, 23.1 and 25.8% in females (p ≤ 0.05). Cholesterol intake was significantly (p ≤ 0.05) associated with BMI (beta = 0.002, 95% CI: 0.00–0.004) as well as overweight and obesity (odds ratio = 1.734; 95% CI: –1.09–2.75) after adjustment for age and gender.
Conclusion: There was a high prevalence of overweight and obesity among rural Ellisras females. Moreover, increasing cholesterol intake was associated with overweight and obesity in the overall sample.
- Title: The impact of admission cystatin C levels on in-hospital and
three-year mortality rates in acute decompensated heart failure
Authors: Hatice Selcuk, Mehmet Timur Selcuk, Orhan Maden, Kevser Gülcihan Balci, Mustafa Mücahit Balci, Sebahat Tekeli, Elif Hande Çetin, Ahmet Temizhan, Mustafa Balci, Nihal Karabiber
From: Cardiovascular Journal of Africa, Vol 29, Issue, 5, September/October
Published: 2018
Pages: 305–309
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DOI Number: 10.5830/CVJA-2018-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-035
Background: Although tremendous advances have been made in preventative and therapeutic approaches in heart failure (HF), the hospitalisation and mortality rates for patients with HF is high. The aim of this study was to investigate the association between cystatin C and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and in- and out-of-hospital mortality rates in acute decompensated HF (ADHF).
Methods: Between February 2008 and November 2011, 57 consecutive patients who were admitted with ADHF were included in this prospective study. These patients were clinically followed up every three months by means of visits or telephone interviews. The primary clinical endpoint of this study was any death from heart failure rehospitalisation and/or other causes.
Results: The subjects who died during the in-hospital follow up were younger than the survivors (47.4 ± 17.5 vs 60.8 ± 15.8, p = 0.043). There was a notable correlation between plasma cystatin C and NT-proBNP levels (r = 0.324, p = 0.014) and glomerular filtration rate (GFR) (r = –0.638, p < 0.001). Multivariate logistic regression analysis revealed that only cystatin C level [odds ratio (OR): 12.311, 95% confidence interval (CI): 1.616–93.764, p = 0.015] and age [OR: 0.925, 95% CI: 0.866–0.990, p = 0.023] were linked to in-hospital mortality rate. In the multivariate Cox proportional hazard model, only admission sodium level appeared as a significant independent predictor of death during the 36-month follow up [hazard ratio: 0.937, 95% CI: 0.880–0.996, p = 0.037].
Conclusion: Evaluation of admission cystatin C levels may provide a reliable prediction of in-hospital mortality, compared to estimated GFR or NT-proBNP levels among patients with ADHF. However, in this trial, during long-term follow up, only admission sodium level significantly predicted death.
- Title: The clinical prognostic
significance of myocardial performance index
(MPI) in stable placental-mediated disease
Authors: I Bhorat, M Pillay, T Reddy
From: Cardiovascular Journal of Africa, Vol 29, Issue, 5, September/October
Published: 2018
Pages: 310–316
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DOI Number: 10.5830/CVJA-2018-036
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-036
Aim: To determine whether a single elevated myocardial performance index (MPI) value in the third trimester of pregnancy is a marker for later adverse obstetric outcomes in stable placental-mediated disease, defined as well-controlled pre-eclampsia (PE) on a single agent and/or uncompensated intra-uterine growth restriction (IUGR).
Methods: Fifty-five foetuses whose mothers had stable placental- mediated disease, either mild pre-eclampsia controlled on a single agent, and/or uncompensated IUGR in the third trimester, attending the Foetal Unit at Inkosi Albert Luthuli Hospital, Durban, South Africa were prospectively recruited with 55 matched controls. Recorded data for the subjects included demographic data of maternal age and parity, sonographic data of estimated foetal weight (EFW) and amniotic fluid index (AFI), myocardial performance index (MPI), and foetal Doppler data of the umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV).
Results: The mean gestational age in the controls, the IUGR and any PE cases was 31.4, 31.8 and 31.0 weeks, respectively. The distribution of MPI values was significantly lower in the controls compared to all other groups. The highest standardised MPI values were observed in the PE–IUGR group, where a median of 5.62 was observed. The only significant differences observed between the PE and IUGR groups was the UA resistance index (p = 0.01), where the IUGR cases tended to have higher UA values compared to the combined PE group. Borderline statistical significance was observed for the MCA resistance index values (p = 0.05) between these groups. The overall adverse event rate in the cases was 49%. The highest rate was observed in the PE + IUGR group, where eight out of 12 (67%) experienced adverse events. MPI z-scores served as a good marker of adverse events, as evidenced by the total area under the curve (AUC) of 0.90 on the ROC curve. A cutoff value of 4.5 on the MPI z-score conferred a sensitivity of 89% and specificity of 68% for an adverse event later in pregnancy. In univariate logistic regression, MPI z-score, AFI, EFW, UA Doppler, CPR category, DV Doppler and MCA Doppler were assessed separately as potential predictors of adverse outcome. The only significant predictor of adverse outcome was MPI z-score.
Conclusion: A single elevated value of the MPI (z-score > 4.5) in the third trimester in stable placental-mediated disease was a strong indicator of adverse obstetric outcomes later in pregnancy. This has the potential to be incorporated in conjunction with standard monitoring models in stable placental-mediated disease to predict an adverse event later in pregnancy and thus to reduce perinatal morbidity and mortality.
- Title: Rheumatoid arthritis and risk of cardiovascular disease
Authors: Pieter WA Meyer, Ronald Anderson, James A Ker, Mahmood TM Ally
From: Cardiovascular Journal of Africa, Vol 29, Issue, 5, September/October
Published: 2018
Pages: 317–321
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DOI Number: 10.5830/CVJA-2018-018
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-018
Abstract: In developing countries, rheumatoid arthritis (RA) remains a seriously under-prioritised disease, particularly among the underprivileged, often resulting in presentation of patients late in the course of their disease, further complicated by limited therapeutic options and inconsistent follow up. The consequences are often severe with irreversible disability, increased frequency of co-morbidities, especially cardiovascular disease (CVD), and higher mortality rates, relative to developed countries. Despite addressing traditional cardiovascular risk factors, the impact of subclinical or ‘residual’ inflammation from uncontrolled RA needs to be considered. This narrative review explores the prevalence and pathogenesis of CVD in RA, including the impact of tobacco use. It discusses pitfalls in the risk assessment of CVD in patients with RA, and the effect of disease-modifying anti-rheumatic therapy on cardiovascular co-morbidity.
- Title: The role of novel atherosclerosis markers in peripheral
artery disease: is there a gender difference?
Authors: Horațiu Comşa, Dumitru Zdrenghea, Sorin Claudiu Man, Dana Pop
From: Cardiovascular Journal of Africa, Vol 29, Issue, 5, September/October
Published: 2018
Pages: 322–330
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DOI Number: 10.5830/CVJA-2018-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-023
Abstract: Peripheral arterial disease (PAD) represents a major public health problem due to its high and increasing prevalence, worldwide distribution, and significant morbidity and mortality rate. Female gender is a risk factor for PAD globally and especially in low-income countries. In this review, we summarise the present knowledge regarding the role of novel atherosclerosis markers in the development of PAD in women. We discuss inflammatory markers, cytokines, cellular adhesion molecules, markers of oxidative stress and other circulating markers, and their role in the prediction of presence, severity and complications of PAD, with particular emphasis on gender. Although many PAD biomarkers are indicative of PAD in both males and females, some are strongly correlated with the disease in females. These gender differences could be useful for the early identification and management of PAD in women.
- Title: Development of the
certificate course in the management of
hypertension in Africa (CCMH-Africa):
proceedings of the first continental faculty
meeting, Nairobi, Kenya, 25–26 February 2018
Authors: Anastase Dzudie, Dike Ojji, Albertino Damasceno, Mahmoud U Sani, Euloge Kramoh, Jean Baptiste Anzouan Kacou, Benedict Anisiuba, Elijah Ogola, Mohamed Awad, George Nel, Harun Otieno, Ali Ibrahim Toure, Abdoul Kane, Andre Pascal Kengne, Calypse Ngwasiri, Hamadou Ba, Samuel Kingue, Bruno Mipinda, Bertrand Ellenga Mbolla, Amha Weldehana, Fred Bukachi, Bernard Gitura, Brice Kitio, Brian Rayner, Aletta E Shutte, Ana Olga Mocumbi, Bongani Mayosi, Arun Jose, Bhalla Sandeep, Michael Weber, Christian Delles, Francesco Cappuccio, Habib Gamra, Dorairaj Prabhakaran, Neil Poulter, Saad Subhani, on behalf of the PASCAR task force on hypertension
From: Cardiovascular Journal of Africa, Vol 29, Issue, 5, September/October
Published: 2018
Pages:331–334
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DOI Number: 10.5830/CVJA-2018-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-055
Background: In response to the call by the World Health Organisation to reduce premature deaths from non-communicable diseases by 25% by the year 2025 (25×25), the Pan-African Society of Cardiology (PASCAR), in partnership with several organisations, including the World Heart Federation, have developed an urgent 10-point action plan to improve detection, treatment and control of hypertension in Africa. Priority six of this action plan is to promote a task-shifting/task-sharing approach in the management of hypertension.
Aim: This capacity-building initiative aims to enhance the knowledge, skills and core competences of primary healthcare physicians in the management of hypertension and related complications.
Methods: In a collaborative approach with the International Society of Hypertension, the British and Irish Hypertension Society, the Public Health Foundation of India and the Centre for Chronic Disease Control, the PASCAR hypertension taskforce held a continental faculty meeting in Kenya on 25 and 26 February 2018 to review and discuss a process of effective contextualisation and implementation of the Indian hypertension management course on the African continent.
Results: A tailored African course in terms of evidence-based learning, up-to-date curriculum and on-the-job training was developed with a robust monitoring and evaluation strategy. The course will be offered on a modular basis with a judicious mix of case studies, group discussions and contact sessions, with great flexibility to accommodate participants’ queries.
Conclusions: Hypertension affects millions of people in Africa and if left untreated is a major cause of heart disease, kidney disease and stroke. CCMH-Africa will train in the next 10 years, 25 000 certified general physicians and 50 000 nurses, capable of adequately managing uncomplicated hypertension, thereby freeing the few available specialists to focus on severe or complicated cases.
