CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 30, ISSUE
1, JAN/FEB 2019
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- Title: Editorial: Right-sided hearts
Authors: C Greig, DG Buys, SC Brown
From: Cardiovascular Journal of Africa, Vol 30, Issue 1 January/February
Published: 2019
Pages: 3
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- Title: A retrospective review of
right-sided hearts at a South African tertiary
hospital
Authors: Nadia Beringer, Antoinette Cilliers
From: Cardiovascular Journal of Africa, Vol 30, Issue 1 January/February
Published: 2019
Pages: 5-8
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DOI Number: 10.5830/CVJA-2018-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-051
OBackground: A right-sided heart (RSH) has three main causes: dextrocardia, dextroposition and dextroversion. It may be associated with cardiac malformation, extra-cardiac abnormalities and adverse patient outcomes. The aim of this study was to determine the prevalence, demographics, associated cardiac malformations (ACM) and outcome of paediatric patients diagnosed with a RSH at a South African tertiary hospital.
Methods: A retrospective review was performed over a 22-year period.
Results: RSH comprised 1% of the paediatric cardiology referrals. Dextrocardia was the most frequent cause (58.1%) and the majority of these patients had ACM (81.5%). More than a third (40.9%) were diagnosed with dextroposition, secondary to extra-cardiac factors. Dextroversion was the least common cause (1.1%). Over a quarter of all patients were confirmed dead at the time of the study; most had been diagnosed with dextrocardia. Two-thirds of the patients were lost to follow up.
Conclusion: A RSH is an unusual occurrence. Dextrocardia, the most common cause, is frequently associated with ACM and extra-cardiac abnormalities. It is therefore important to timeously elucidate the cause of a RSH.
- Title: Clinical and
echocardiographic correlates of pulmonary
hypertension among heart failure patients in
Lagos, south-western Nigeria
Authors: OA Kushimo, AC Mbakwem, JNA Ajuluchukwu, CE Amadi
From: Cardiovascular Journal of Africa, Vol 30, Issue 1 January/February
Published: 2019
Pages: 9-14
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DOI Number: 10.5830/CVJA-2018-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-053
Background: Pulmonary hypertension (PH) is very prevalent among heart failure (HF) subjects and is now recognised as an independent predictor of poor prognosis. There is a paucity of data in our environment about the frequency and correlates of PH in HF. We aimed to determine the frequency of PH in HF patients in an academic hospital and assess its correlates using echocardiography.
Methods: A total of 219 heart failure patients in NYHA functional class II to IV, and without co-morbidities that could cause PH, were consecutively recruited. Demographic, clinical and echocardiographic data were obtained from all subjects.
Results: The frequency of PH was 38.8%, using an estimated pulmonary artery systolic pressure (PASP) cut-off value of > 36 mmHg. HF subjects with PH tended to be male with a worse NYHA functional class compared with subjects without PH. HF subjects with PH also had significantly higher left ventricular (LV) filling pressures (higher left atrial volume index and E/e′ ratio), more severe mitral regurgitation (MR), poorer LV systolic function, and worse parameters of right ventricular (RV) structure and function compared with those without PH. Echocardiographic variables that correlated significantly with PASP include LV filling pressures (p < 0.001 for all), mitral regurgitant volume (r = 0.269, p < 0.001) and LV ejection fraction (r = –0.239, p > 0.001). On multivariate analysis, the left atrial volume index and E/e′ ratio were independently associated with PASP.
Conclusion: PH is common among HF subjects in our environment and is associated with higher LV filling pressure, more severe MR, poorer LV systolic function and worse RV remodelling. Routine screening for PH among HF patients is recommended for better risk stratification and management.
- Title: Management of low-density
lipoprotein cholesterol levels in South Africa:
the International ChoLesterol management
Practice Study (ICLPS)
Authors: Dirk J Blom, Frederick Raal, Aslam Amod, Poobalan Naidoo, Yen-yu (Evelyn) Lai, for the ICLPS SA study group
From: Cardiovascular Journal of Africa, Vol 30, Issue 1 January/February
Published: 2019
Pages: 15-23
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DOI Number: 10.5830/CVJA-2018-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-054
Abstract: The International Cholesterol Management Practice Study (ICLPS) South Africa investigated achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline low-density lipoprotein cholesterol (LDL-C) targets in real-world clinical practice. Demographic data, clinical characteristics, cardiovascular risk factors, lipidmodifying medications, lipid values and investigator’s assessment of cardiovascular risk were recorded for 396 patients on stable lipid-modifying therapy. Most (98.7%) patients received statins; 25.1% of statin-treated patients were receiving highintensity statins. Overall, 41.4% of patients achieved their LDL-C target; among 354 (89.4%) patients in whom cardiovascular disease risk, based on ESC Systematic Coronary Risk Estimation (SCORE) was calculated, achievement rate was 14.3% for moderate-risk (n = 7), 59.3% for high-risk (n = 123) and 32.3% for very high-risk patients (n = 223). Half of Asian (54.7%) and black African (53.2%) patients were at LDL-C target compared with 29.8% of European/Caucasian and 27.3% of ‘other’ patients. Improved guideline adherence and greater use of combination therapy may increase LDL-C goal achievement.
- Title: Ellisras Longitudinal Study 2017: The relationship between
waist circumference, waist-to-hip ratio, skinfolds and blood pressure among
young adults in Ellisras, South Africa (ELS 14)
Authors: RB Sebati, KD Monyeki, MS Monyeki, B Motloutsi, AL Toriola, MJL Monyeki
From: Cardiovascular Journal of Africa, Vol 30, Issue 1 January/February
Published: 2019
Pages: 24-28
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DOI Number: 10.5830/CVJA-2018-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-056
Background: Obesity and hypertension are major risk factors for non-communicable diseases in the world today. The relationship between indicators of obesity and blood pressure needs attention in the rural South African population.
Aim: This study examined the relationship between anthropometric parameters and blood pressure (BP) among young adults in the Ellisras rural area of South Africa.
Methods: A total of 742 (365 females and 377 males) young adults aged 22 to 30 years, who were part of the Ellisras Longitudinal Study (ELS), participated in the research. Anthropometric and BP measurements were taken using the protocol of the International Society for the Advancement of Kinanthropometry (ISAK). Linear regression was used to determine the relationship between anthropometric parameters and BP. The risk of developing hypertension among young Elisras adults was evaluated using logistic regression.
Results: The results indicted a higher but non-significant prevalence of hypertension in men (2.7%) than women (2.4%). Linear regression showed a significant positive (p < 0.05) association between waist circumference and systolic BP (beta = 0.273, 95% CI: 0.160–0.386), even after being adjusted for age and gender (beta = 253, 95% CI: 0.127–0.343). The risk for developing hypertension was significant (p < 0.05) for waist circumference (OR = 2.091, 95% CI: 1.129–3.871) after adjustment for age and gender.
Conclusion: Of all anthropometric parameters, waist circumference was most significantly associated with BP (p < 0.05). Anthropometric indicators of obesity were strong predictors of hypertension among young adults in the Ellisras rural area.
- Title: Outcomes in patients with acute coronary syndrome in a
referral hospital in sub-Saharan Africa
Authors: Mohamed Hasham Varwani, Mohamed Jeilan, Mzee Ngunga, Anders Barasa
From: Cardiovascular Journal of Africa, Vol 30, Issue 1 January/February
Published: 2019
Pages: 29-33
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DOI Number: 10.5830/CVJA-2018-066
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-066
Background: Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub- Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub- Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking.
Methods: A retrospective review of all ACS admissions to the Aga Khan University Hospital, Nairobi (AKUHN) between January 2012 and December 2013 was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events.
Results: A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%.
Conclusion: In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.
- Title: Aldosterone and renin in
relation to surrogate measures of sympathetic
activity: the SABPA study
Authors: Lebo F Gafane-Matemane, Johannes M van Rooyen, Rudolph Schutte, Aletta E Schutte
From: Cardiovascular Journal of Africa, Vol 30, Issue 1, January/February
Published: 2019
Pages: 34–40
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DOI Number: 10.5830/CVJA-2018-065
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-065
Introduction: Hypertension, particularly in black populations, is often accompanied by augmented sympathetic nervous system activity and suppressed renin activity, indicative of possible blood pressure (BP) dysregulation. The potential role of the interrelationship between the renin–angiotensin–aldosterone system (RAAS) and the sympathetic nervous system in the context of low-renin conditions is unclear. We therefore explored whether surrogate measures of sympathetic activity [noradrenaline, 24-hour heart rate (HR) and percentage (%) dipping of night-time HR] relate to renin, aldosterone and aldosterone-to-renin ratio (ARR) in black and white South Africans.
Methods: We included black (n = 127) and white (n = 179) males and females aged 20–63 years. We measured 24-hour BP and HR, and calculated night-time dipping. We determined renin and aldosterone levels in plasma and calculated ARR. Noradrenaline and creatinine levels were determined in urine and the noradrenaline:creatinine ratio was calculated.
Results: More blacks had low renin levels (80.3%) compared to whites (58.7%) (p < 0.001). In univariate and after multivariate analyses the following significant associations were evident in only the black group: HR dipping was associated negatively with aldosterone level (β = –0.18, p = 0.024) and ARR (β = –0.20, p = 0.011), while 24-hour HR was associated positively with renin level (β = 0.20, p = 0.024). Additionally, there was a borderline significant positive association between noradrenaline:creatinine ratio and aldosterone level (β = 0.19, p = 0.051).
Conclusion: The observed associations between surrogate measures of sympathetic nervous system activity and components of the RAAS in the black group suggest that the adverse effects of aldosterone and its ratio to renin on the cardiovascular system may be coupled to the effects of the sympathetic nervous system.
- Title: The value of community outreach for a university: a synthesis
of trends in higher education The case of the University of Limpopo (ELS 45)
Authors: Hlengani Siweya, Kotsedi D Monyeki
From: Cardiovascular Journal of Africa, Vol 30, Issue 1, January/February
Published: 2019
Pages: 41-44
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DOI Number: 10.5830/CVJA-2018-059
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-059
Introduction: Although the implementation of transradial intervention (TRI) has increased over Background: The South African National Development Plan (SANDP) vision for 2030 highlights key recommendations for reducing the prevalence of non-communicable diseases (NCDs) by 28% by 2030. These are mirrored by the World Heart Federation, although it focuses on reducing the NCD prevalence by 25% by 2025. The targeted diseases include, among others, cardiovascular diseases, diabetes, cancer and chronic respiratory diseases.
Objectives: The aim was to contribute to discussion on the social responsibility, public good and community development functions of a university in South Africa, as derived from the Higher Education Act 101 of 1997 (as amended).
Methods: The researcher’s ontology links with this notion of the existence of multiple realities that exist among universities in South Africa, and provides the basis for a social construction epistemology. Different realities exist for the University of Limpopo.
Results: The Dikgale Health and Demographic Surveillance System and the Ellisras Longitudinal Study, which both started in 1996 within the University of Limpopo, provide ample bush university outreach models on social responsibility, public good and community development. Community participation was central to the dissemination of research results.
Conclusion: Social responsibility, public good and community development are core functions for a university, which should be treated as stand-alone roles, such as teaching, learning and research. The University of Limpopo has distinguished itself by being true to its vision of ‘being a leading African university focused on the developmental needs of its communities and epitomising academic excellence and innovativeness’.
- Title: Intracoronary or intravenous abciximab after aspiration
thrombectomy in patients with STEMI undergoing primary percutaneous coronary
intervention
Authors: Ali Bedjaoui, Karima Allal, Mohamed Sofiane Lounes, Chams Eddine Belhadi, Abdelmoumen Mekarnia, Saber Sediki, Maamar Kara, Adel Azaza, Jean-Jacques Monsuez, Salim Benkhedda
From: Cardiovascular Journal of Africa, Vol 30, Issue, 1, January/February
Published: 2019
Pages: 45-51
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DOI Number: 10.5830/CVJA-2018-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-063
Objectives: To test whether aspiration thrombectomy with intracoronary (IC) instead of intravenous (IV) administration of abciximab could reduce the no-reflow phenomenon in patients undergoing primary percutaneous intervention (PCI) for ST-elevation myocardial infarction (STEMI).
Background: Despite recanalisation with PCI, failure to restore microvascular flow may affect the prognosis of patients with STEMI. A combination of aspiration thrombectomy with IC abciximab may improve distal perfusion.
Methods: After aspiration thrombectomy during primary PCI for STEMI, 160 patients were randomly assigned to either an IV or IC abciximab bolus delivered through the aspiration catheter, both followed by a 12-hour IV abciximab infusion.
Results: ST-segment resolution ≥ 70% was achieved in 36 of 78 patients with IC versus 30 of 82 patients with IV abciximab (46.1 vs 36.6%, p = 0.368), and partial resolution in 28 of 78 versus 31 of 82 patients (35.9 vs 37.8%, p = 0.368). Postprocedural myocardial blush grade (MBG) 3 was obtained in 62.8 vs 63.4% (p = 0.235) and MBG ≥ 2 in 89.7 vs 81.7% (p = 0.148) of patients given IC and IV abciximab, respectively. There were three deaths in each group (3.8%). Major adverse cardiac events occurred in six of 78 patients given the IC and seven of 82 patients given the IV abciximab bolus (7.6 vs 8.5%, p = 0.410). One stroke occurred in each group, and two patients in the IC and nine in the IV group developed renal failure (2.5 vs 10.9 %, p = 0.414).
Conclusion: IC versus IV abciximab did not enhance myocardial reperfusion in non-selected patients with STEMI undergoing primary PCI after aspiration thrombectomy had successfully been performed.
- Title: Cardiovascular risk factors
among people living with HIV in rural Kenya: a
clinic-based study
Authors: Kenneth Juma, Roseanne Nyabera, Sylvia Mbugua, George Odinya, James Jowi, Mzee Ngunga, David Zakus, Gerald Yonga
From: Cardiovascular Journal of Africa, Vol 30, Issue, 1, January/February
Published: 2019
Pages: 52-56
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DOI Number: 10.5830/CVJA-2018-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-064
Objectives: To determine the prevalence of cardiovascular risk factors and their association with antiretroviral therapy (ART) among HIV-infected adults in a rural sub-county hospital in Kenya.
Methods: This was a descriptive survey of patient charts characterising cardiovascular risk among adult patients (> 18 years) at Ukwala sub-county hospital between June 2013 and January 2015. Post-stratification survey weights were applied to obtain prevalence levels. Adjusted odds ratios (AOR) for each variable related to cardiovascular risk factors were calculated using logistic regression models.
Results: Overall, the prevalence of diabetes mellitus was 0.4%, 0.3% of patients had had a previous cardiovascular event (heart attack or stroke), 40.4% had pre-hypertension, while 10.4% had stage 1 and 2.9% stage 2 hypertension. Up to 14% of patients had elevated non-fasting total cholesterol levels. Factors associated with hypertension were male gender (AOR 1.59, p = 0.0001), being over 40 years of age (AOR 1.78, p = 0.0001) and having an increased waist circumference (OR 2.56, p = 0.0014). Raised total cholesterol was more likely in those on tenofovir disoproxil fumarate (TDF) (AOR 2.2, p = 0.0042), azidothymidine (AZT) (AOR 2.5, p = 0.0004) and stavudine (D4T)-containing regimens (AOR 3.13, p = 0.0002).
Conclusions: An elevated prevalence of undiagnosed cardiovascular risk factors such as hypertension and raised total cholesterol levels was found among people living with HIV. There was an association between raised total cholesterol and nucleoside reverse-transcriptase inhibitor (NRTI)-based ART regimens. Our findings provide further rationale for integrating routine cardiovascular risk-factor screening into HIV-care services.
- Title: Long-segment patchplasty of diffuse left anterior descending
artery disease on the beating heart
Authors:Erhan Kaya, Omer Isik
From: Cardiovascular Journal of Africa, Vol 30, Issue, 1, January/February
Published: 2019
Pages: 57-60
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DOI Number: 10.5830/CVJA-2018-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-062
Objective: The rate of patients with diffuse left anterior descending artery (LAD) disease being referred for surgery has increased as a result of advances in endovascular techniques. In surgery of diffuse or multisegment LAD disease, surgical procedures with or without endarterectomy can be performed. In this article, we report our results of longsegment onlay patchplasty of the LAD with a left internal thoracic artery (LITA) graft without endarterectomy, on the beating heart, in patients with multisegment LAD disease.
Methods: We retrospectively analysed patients who underwent coronary artery bypass grafting surgery in our hospital between 1 January 2015 and 31 July 2017. We included LITA onlay patchplasty patients with multisegment LAD disease who had been operated on the beating heart. We excluded patients who underwent coronary endarterectomy and were operated on under cardiopulmonary bypass.
Results: In this period, 54 patients with multisegment LAD disease were treated with LITA patchplasty on the beating heart. The mean length of the arteriotomy was 42.8 ± 13.3 mm (25–75 mm). There were two postoperative myocardial infarctions (3.7%) and three deaths (5.5%). In the remaining patients, there was no haemodynamic instability that needed long-term (> 24 hour) inotropic support. Patients were discharged from hospital on postoperative 9.3 ± 7.1 days with dual antiplatalet therapy.
Conclusion: Bypass grafting of the LAD with long-segment LITA onlay patchplasty can safely be performed in patients with multisegment LAD disease, with acceptable early-term results. In this procedure, proximal and distal segments of the diseased LAD are revascularised with LITA grafts, which may improve long-term survival and quality of life.
- Title: A diagnostic algorithm for pulmonary hypertension due to left
heart disease in resource-limited settings: can busy clinicians adopt a simple,
practical approach?
Authors: Anastase Dzudie, Andre Pascal Kengne, Kim Lamont, Bonaventure Suiru Dzekem, Leopold Ndemnge Aminde, Martin Hongieh Abanda, Friedrich Thienemann, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 30, Issue, 1, January/February
Published: 2019
Pages: 61-67
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DOI Number: 10.5830/CVJA-2018-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-042
Abstract: Pulmonary hypertension (PH) has progressively moved from an orphan disease to a significant global health problem with a major disease burden in limited-resource countries, where over 97% of patients live. The aetiologies of PH differ between highand low-income nations, but PH due to left heart disease is credited to be the most frequent contemporary form. Although a straightforward diagnosis of PH requires the use of rightheart catheterisation (RHC), access to equipment for RHC is a deterrent. Furthermore, the risk associated with RHC limits its uptake to a selection of specialised centres. Moreover, the rigour and clinical reasoning for diagnosis in clinical medicine is rapidly changing and revealing that PH can complicate a diverse range of medical conditions needing other explorations. In this article, we provide for the busy clinician, a simplified diagnostic algorithm for PH that is relevant for making a correct early diagnosis and limiting the impact of PH.
- Title: Delayed left ventricular pseudo-aneurysm after postinfarction
repair of ventricular septal defect
Authors: Yun-Seok Song, Sang-Hoon Seol, Seunghwan Kim, Dong-Kie Kim, Ki-Hun Kim, Doo-Il Kim, Hee-Jae Jun
From: Cardiovascular Journal of Africa, Vol 30, Issue, 1, January/February
Published: 2019
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2018-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-049
Abstract: Left ventricular pseudo-aneurysm is a rare complication that usually occurs after myocardial infarction or cardiac surgery. Sometimes it is related to cardiac rupture. We report on surgical management for a left ventricular pseudo-aneurysm that developed four years after surgery for ventricular septal defect in a patient with acute myocardial infarction.
- Title: Pulmonary thromboendarterectomy in a combined thrombophilia
patient
Authors: Hakan Akbayrak, Hayrettin Tekumit
From: Cardiovascular Journal of Africa, Vol 30, Issue, 1, January/February
Published: 2018
Pages: e4-e6
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DOI Number: 10.5830/CVJA-2018-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-052
Abstract: Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially correctable cause of secondary pulmonary hypertension. Surgical treatment remains the primary treatment for patients with CTEPH. Pulmonary thromboendarterectomy (PEA) with deep hypothermic circulatory arrest is the standard and recommended surgical technique for the treatment of these patients. The prevalence of CTEPH after an acute pulmonary thromboembolism (PTE) has been found in various studies to be between 0.6 and 8.8%. Mortality rates in elective PEA cases with CTEPH are reported to be between 1.9 and 4.5%. We report on a 50-year-old female patient with combined inherited thrombophilia, including protein C and protein S deficiencies, who was diagnosed with CTEPH and was successfully treated with pulmonary thromboendarterectomy.
