CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 29, ISSUE
6, NOV/DEC 2018
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- Title: From the Editor’s Desk
Authors: Pat Commerford
From: Cardiovascular Journal of Africa, Vol 29, Issue 6 November/December
Published: 2018
Pages: 337
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- Title: Anatomical and functional changes
after aortic valve replacement with different sizes
of mechanical valves
Authors: Gokhan Ilhan, Sahin Bozok, Berkan Ozpak, Hakan Kara, Serkan Yazman, Serdar Bayrak, Ibrahim Ozsoyler, Ali Gurbuz
From: Cardiovascular Journal of Africa, Vol 29, Issue 6 November/December
Published: 2018
Pages: 338–343
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DOI Number: 10.5830/CVJA-2018-037
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-037
Objective: To date, there is no consensus on the selection of type and size of prosthetic valve for aortic valve replacement (AVR). The aim of this study was to compare anatomical and functional changes occurring in the left ventricle after AVR with different sizes of mechanical valves.
Methods: A total of 92 patients with serious aortic valve stenosis, who underwent AVR between March 2001 and June 2008 using mechanical valves of different sizes, were retrospectively analysed. The sizes of the mechanical valves were 19, 21, 23 and 25 mm. All patients were assessed preoperatively, and at six months and in the first, third and fifth years postoperatively. The left ventricle was assessed with electrocardiography, echocardiography and telecardiography and compared in the four patient groups, constituted according to the mechanical valve size used.
Results: In all groups, left ventricular mass and mass index, transvalvular aortic gradient, thicknesses of the interventricular septum and posterior wall, and left ventricular endsystolic and end-diastolic diameters had decreased significantly post surgery. Left ventricular ejection fraction and exercise capacity had increased significantly (p < 0.001). The most noteworthy anatomical and functional improvements were seen in patients who had received 23- and 25-mm mechanical valves.
Conclusion: Mechanical valve replacement should not be performed with small size valves because of the higher residual gradient.
- Title: Prevalence and
sociodemographic correlates of cardiovascular
risk factors among patients with hypertension in
South African primary care
Authors: JM Ngango, OB Omole
From: Cardiovascular Journal of Africa, Vol 29, Issue 6 November/December
Published: 2018
Pages: 344–351
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DOI Number: 10.5830/CVJA-2018-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-038
Objective: To determine the prevalence and sociodemographic correlates of cardiovascular risk factors among patients with hypertension at Johan Heyns Community Health Centre, Sedibeng district, South Africa.
Methods: A total of 328 participants were systematically sampled. A researcher-administered questionnaire collected information on: socio-demography, presence of diabetes, family history of hypercholesterolaemia, family history of fatal cardiovascular (CV) events, and engagement in physical activities. Other measurements included: blood pressure (BP), weight, height, abdominal circumference and electrocardiography (ECG). Data analysis included descriptive statistics, chi-squared test and regression analysis. Main outcome measures included the proportions of participants with each CV risk and their significant sociodemographic determinants.
Results: Participants’ mean age was 57.7 years. Most participants were black (86.0%), female (79%) and pensioners (43.6%). The mean BP was 139/84 mmHg, and 60.7% had their BP controlled to targets. There was an average of 3.7 CV risk factors per participant and the prevalence of CV risk factors was: abdominal obesity (80.8%), physical inactivity (73.2%), diabetes (30.2%), alcohol use (28.0%), hypercholesterolaemia (26.5%), smoking (11.9%), past family history of fatal CV event (14.9%), and left ventricular hypertrophy (5.2%). Sociodemographic factors significantly associated with each CV risk factor were: obesity and being female (p = 0.00); alcohol use and young age (p = 0.00); smoking, being male and race other than black (p = 0.00 and p = 0.00, respectively); physical inactivity, being a pensioner and male (p = 0.02 and p = 0.02, respectively); diabetes and being male (p = 0.03); hypercholesterolaemia and race other than black (p = 0.03); family history of hypercholesterolaemia and race other than black (p = 0.00); and family history of fatal CV event and race other than black (p = 0.00).
Conclusion: There is a high burden of CV risk factors among patients with hypertension in South African primary care, signifying a substantial risk of cardiovascular disease (CVD) in this setting. Interventions aimed at CVD risk reduction need to take cognisance of the sociodemographic correlates of CV risk factors.
- Title: Usefulness of a titration
algorithm for de novo users of
sacubitril/valsartan in a tertiary centre heart
failure clinic
Authors: Émilie Laflamme, Audrey Vachon, Sylvain Gilbert, Julie Boisvert, Vincent Leclerc, Mathieu Bernier, Pierre Voisine, Mario Sénéchal, Sébastien Bergeron
From: Cardiovascular Journal of Africa, Vol 29, Issue 6 November/December
Published: 2018
Pages: 352-356
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DOI Number: 10.5830/CVJA-2018-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-039
Background: A reduction in the rate of death and hospitalisations in patients with heart failure (HF) with reduced ejection fraction receiving sacubitril/valsartan compared to enalapril was demonstrated in the PARADIGM-HF study. However, tolerability when initiating and optimising sacubitril/valsartan treatment in real clinical practice is unknown.
Methods: We performed a prospective cohort study of clinical and biochemical parameters of the first 100 patients receiving sacubitril/valsartan in a tertiary HF clinic. Patients had titration of the molecule guided by an algorithm developed by pharmacists and cardiologists in the clinic. The objective was to evaluate the proportion of patients reaching the maximal dosage, the time to reach maximal dosage, and the rate of adverse events, as well as the required modification of other HF therapy during the sacubitril/valsartan titration.
Results: Forty-six per cent of patients reached the sacubitril/ valsartan maximal dose of 97/103 mg (200 mg) twice daily and 73% received at least 49/51 mg (100 mg) twice daily. Mean titration time was 30 ± 9 days. Symptomatic hypotension, renal dysfunction (increase in creatinine level > 30%) and hyperkalaemia (potassium level > 5.5 mmol/l) occurred in nine, four and 2% of patients, respectively. Background HF pharmacological treatment remained stable during the sacubitril/valsartan titration but daily dosage of furosemide was reduced by 13% (p = 0.0005).
Conclusions: This algorithm is a safe and easy-to-use tool in daily clinical practice for the introduction and titration of sacubitril/valsartan. Almost half of the patients reached the maximal dose, with a tolerability profile in line with the original study.
- Title: The efficacy of antiplatelet therapies as evaluated by
thrombo-elastography in retired Chinese officersAuthors: Yongzeng Chen,
Xi Wang, Qian Yu, Fan Wang, Haijun Wang, Hongbin Liu
From: Cardiovascular Journal of Africa, Vol 29, Issue 6 November/December
Published: 2018
Pages: 357–361
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DOI Number: 10.5830/CVJA-2018-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-041
Aim: This study evaluated, using thrombo-elastography (TEG), the efficacy of antiplatelet therapies in retired Chinese officers and explored the factors influencing the efficacy of antiplatelet therapies.
Methods: Nine hundred and fifty-five retired male Chinese officers (≥ 60 years old), who had undergone TEG between June and August 2015 at the Chinese People’s Liberation Army General Hospital (PLAGH), were enrolled in this study. The subjects were divided into four groups according to the antiplatelet drug(s) that they were administered: aspirin, clopidogrel, dual drugs (combination of aspirin and clopidogrel) and no antiplatelet drug. TEG was used to evaluate the efficacy of antiplatelet therapy in the four groups.
Results: The inhibition of platelet aggregation induced by arachidonic acid (AA%) was 48.0 ± 19.3% in the aspirin group, and the inhibition induced by adenosine diphosphate (ADP%) was 63.0 ± 18.2% in the clopidogrel group. The AA% and ADP% in the dual-drug group were 51.0 ± 16.5 and 46.0 ± 15.3%, respectively. The total efficacy of antiplatelet therapy was 45.9% in the aspirin group, 51.2% in the clopidogrel group and 81.4% in the dual-drug group. A multivariate logistic regression analysis of the maximum amplitude of ADP-induced platelet–fibrin clot strength (MA-ADP) indicated that in the population with MA-ADP < 31 mm, an increased white blood cell count (OR = 1.262, p < 0.001) was a risk factor, while an increased platelet count (OR = 0.995, p = 0.013) was a protective factor for bleeding. In the population with MA-ADP > 47 mm, increased platelet count (OR = 1.006, p < 0.001), estimated glomerular filtration rate (eGFR, OR = 1.016, p = 0.013) and glycated haemoglobin levels (HbA1c, OR = 1.358, p = 0.011) were risk factors for thrombosis.
Conclusion: This quality-controlled TEG procedure was an efficient method to evaluate the efficacy of antiplatelet therapies in the clinic. White blood cell and platelet counts, and eGFR and HbA1c levels may influence the efficacy of an antiplatelet therapy.
- Title: Evaluation of ventricular arrhythmogenesis in children with
acute rheumatic carditis
Authors: Mehmet Kucuk, Cem Karadeniz, Rahmi Ozdemir, Timur Meşe
From: Cardiovascular Journal of Africa, Vol 29, Issue 6 November/December
Published: 2018
Pages: 362–365
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DOI Number: 10.5830/CVJA-2018-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-043
Background: Recent studies have shown that the Tp-e interval, which on an electrocardiogram (ECG) is the interval between the peak and the end of the T wave, can be used as an index of transmural dispersion of ventricular repolarisation (TDR). Both Tp-e/QT and Tp-e/QTc ratios have also been used in that capacity. However, these novel repolarisation indices have not previously been studied in children with acute rheumatic carditis (ARC).
Methods: A hundred and thirty-nine children who were diagnosed with ARC and 153 age- and gender-matched healthy controls were retrospectively reviewed. Twelve-lead ECGs were used to evaluate P-wave, QT and QTc dispersions, Tp-e interval, and Tp-e/QT and Tp-e/QT ratios.
Results: The mean age of the patients was 10.9 ± 2.4 years. The P-wave, QT and QTc dispersions were significantly higher in patients compared to the healthy control subjects. The Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were also significantly increased in patients compared to the controls. When the patients were compared in terms of either one- or twovalve involvement, we found no difference between the groups regarding P-wave, QTd and QTc dispersions, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios. There was no correlation between acute-phase reactants, white blood cell count and these repolarisation parameters.
Conclusions: This study showed that the new transmural dispersion of ventricular repolarisation parameters, Tp-e interval, Tp-e/QT ratios and QTd were increased in children with ARC. Prolongation of the Tp-e interval and an increased Tp-e/QT ratio might be useful markers for predicting myocardial involvement in children with ARC.
- Title: TCultural coping as a risk
for depression and hypertension: the SABPA
prospective study
Authors: S Le Roux, GA Lotter, HS Steyn, L Malan
From: Cardiovascular Journal of Africa, Vol 29, Issue 6, November/December
Published: 2018
Pages: 366–373
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DOI Number: 10.5830/CVJA-2018-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-045
Objectives: In past studies, a lack of social support has been associated with cardiovascular disease (CVD) risk, particularly in black Africans. However, whether or not coping strategies have beneficial effects on blood pressure (BP) and emotional well-being is not clear. We therefore assessed the relationship between BP levels, depression and coping strategies.
Methods: A prospective bi-ethnic cohort followed 359 black and white South African school teachers (aged 20–65 years) over a three-year period. Data on ambulatory 24-hour blood pressure, depression, coping strategies (defensiveness, social support, avoidance) and culture-specific coping scores (cognitive/ emotional debriefing, spiritual-, collectivistic and ritualcentred) were obtained.
Results: Over three years, chronic depression (38 vs 19%) and hypertension (68 vs 35%) were apparent in blacks (d-values > 0.3) as opposed to whites. In both groups, depression was accompanied by more avoidance (loss-of-control) coping. Consistent spiritual and increasing collectivistic coping were apparent in whites. Over time, increasing defensiveness (OR 1.08, p ≤ 0.05) and ritual coping (OR 1.27, p ≤ 0.01; d-values > 0.5), predicted chronic depression in blacks. The change in their symptoms of depression predicted 24-hour hypertension (OR 1.11, p = 0.04). No similar associations existed in whites.
Conclusions: Blacks showed increasing defensiveness and ritual- and spiritual-centred coping in an attempt to combat chronic depression, which may be costly, as reflected by their chronic hypertensive status. Whites showed consistent spiritual- centred coping while utilising avoidance or loss-of-control coping, with a trend of seeking less social support or isolation as a coping mechanism. During counselling of depressed patients with hypertension, the beneficial effects of social support and spiritual coping may be of great importance.
- Title: Transradial versus transfemoral intervention in non-STsegment
elevation acute coronary syndrome patients undergoing percutaneous coronary
intervention: the Korean transradial intervention registry of 1 285 patients
Authors: Min-Ho Lee, Duk Won Bang, Byung Won Park, Byung-Ryul Cho, Seung-Woon Rha, Myung Ho Jeong, Junghan Yoon, Jon Suh, Kyoo-Rok Han, Min Su Hyon
From: Cardiovascular Journal of Africa, Vol 29, Issue 6,November/December
Published: 2018
Pages: 374–380
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DOI Number: 10.5830/CVJA-2018-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-047
Introduction: Although the implementation of transradial intervention (TRI) has increased over the last few years, there are limited data on the impact of TRI on efficacy and safety in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). We sought to compare one-year clinical outcomes and bleeding complications of TRI with those of transfemoral intervention (TFI) in patients with NSTE-ACS.
Methods: The Korean TRI registry was a cohort of 20 centres from 2012 to 2015. The primary efficacy endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death (CD), non-fatal myocardial infarction (MI) and repeat revascularisation (RR). Among the 1 319 patients with NSTE-ACS, 1 285 were finally analysed after excluding 34 due to lack of follow-up data. The patients were divided into TRI and TFI groups according to the final access site.
Results: At one-year follow up, the TRI group showed a significantly lower rate of MACE, and a marginally significantly lower rate of CD than the TFI group in the crude population. However, in propensity-score matched analysis, the rate of MACE did not differ between the TRI and TFI groups. Regarding bleeding complications, the TRI group was associated with significantly lower rates of major bleeding in both the crude and matched populations. Independent predictors of MACE were chronic kidney disease (CKD) and multi-vessel disease (MVD).
Conclusions: In patients with NSTE-ACS, TRI was associated with favourable one-year clinical outcomes and lower bleeding complications compared to TFI. Independent predictors of MACE were clinical and angiographic profiles (CKD, MVD) rather than vascular access sites.
- Title: Audit of transfusion of blood products in paediatric
congenital heart surgery on cardiopulmonary bypass
Authors: Caroline Tumelo Bayebaye, Michel Kasongo Muteba, Palesa Motshabi Chakane
From: Cardiovascular Journal of Africa, Vol 29, Issue, 6, November/December
Published: 2018
Pages: 381–386
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DOI Number: 10.5830/CVJA-2018-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-048
Background: Cardiac surgery is associated with peri-operative bleeding, which may result in the need for blood transfusion, particularly in paediatric congenital cardiac surgery on cardiopulmonary bypass (CPB). There is a necessity for regular auditing in order to improve practices.
Methods: Retrospective, contextual, descriptive data of 105 patients were collected for the period January to December 2014.
Results: The median age of patients was four (1–6) years, weight was 13 (8.4–20) kg, and mean lowest CPB haemoglobin level was 8.3 (1.5) g/dl. There was a statistically significant difference in median red packed cell (RPC), platelet and cryoprecipitate units per patient transfused across four RACHS (risk-adjusted classification for congenital heart surgery) categories (p = 0.03, p = 0.0013, p = 0.0001, respectively). There was a statistically significant correlation between transfused fresh frozen plasma units with CPB time (r = 0.2634, p = 0.0199) and RPC units (r = –0.4654, p < 0.001).
Conclusion: Although no standardised transfusion guidelines were available, overall transfusion of blood products was comparable to reported practices.
- Title: Pre-eclampsia and the foetus:
a cardiovascular perspective
Authors: Ismail Bhorat
From: Cardiovascular Journal of Africa, Vol 29, Issue, 6, November/December
Published: 2018
Pages: 387–393
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DOI Number: 10.5830/CVJA-2017-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2017-039
Abstract: Pre-eclampsia is the leading cause of perinatal morbidity and mortality. A full understanding of the pathogenesis of this enigmatic condition is essential if we are to develop new prophylactic and therapeutic interventions. Central to our understanding of the pathogenesis of early-onset preeclampsia is absolute utero-placental ischaemia, which is lack of placental vascular transformation in early pregnancy. By contrast, relative utero-placental ischaemia, due to a mismatch between utero-placental blood flow and increased demand for nutrients occurring later in pregnancy, may be central to the development of late-onset pre-eclampsia. These pathogenic mechanisms have advanced our understanding of this condition, leading to better prediction, screening and intervention modalities. Screening for pre-eclampsia in the first and second trimesters by investigating the maternoplacental circulation and placental hormones could identify a high-risk subgroup. The advantage of screening in the first trimester is that a prophylactic intervention is available in the form of low-dose aspirin, if started before 16 weeks’ gestation in the high-risk group, resulting in a substantial reduction in severe early-onset pre-eclampsia, while identification of a high-risk group in the second trimester will lead to focused management in this group. Using a combination of cardiac Doppler, multi-vessel Doppler assessment of the foetal circulation and biomarkers in established pre-eclampsia in the third trimester could predict adverse outcomes and guide clinicians to timeous delivery. Hopefully, advances in our understanding of this enigmatic disease will lead to further prophylactic and new therapeutic interventions.
- Title: The Pan-African Society of Cardiology position paper on
reproductive healthcare for women with rheumatic heart disease
Authors: Ana Olga Mocumbi, Keila KF Jamal, Amam Mbakwem, Maylene Shung-King, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 29, Issue, 6, November/December
Published: 2018
Pages: 394–403
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DOI Number: 10.5830/CVJA-2018-044
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-044
Abstract: This position paper summarises the current knowledge on the epidemiology, diagnosis and management of women of childbearing age with rheumatic heart disease (RHD) in Africa, as well as the available data on their use of reproductive health services. The aim is to provide guidance to health professionals on aspects of sexual and reproductive health in women with RHD. It reviews the diagnosis, management and counselling of women with RHD throughout their reproductive life. Additionally, this publication discusses potential ways of integrating obstetric and cardiovascular care at peripheral levels of the health systems, as a way of improving outcomes and reducing maternal mortality rates related to cardiovascular disease in Africa. Finally, the article proposes responses to fulfill the actual needs for better reproductive health services and improvement in care for women with RHD.
- Title: News from the 2018 Cape Town World Congress of Internal
Medicine
From: Cardiovascular Journal of Africa, Vol 29, Issue, 6, November/December
Published: 2018
Pages: 404
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