CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 30, ISSUE
2, MAR/APR 2019
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- Title: Editorial: Target blood
pressure: a South African perspective
Authors:Andrew Black, Andrew G Parrish, Brian Rayner, Trudy D Leong, Vuyokazi Mpongoshe
From: Cardiovascular Journal of Africa, Vol 30, Issue 2 March/April
Published: 2019
Pages: 71-73
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- Title: Letter to the Editor
Authors: Robin H Kinsley, Darshan Reddy, Charles Yankah
From: Cardiovascular Journal of Africa, Vol 30, Issue 2 March/April
Published: 2019
Pages: 74
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- Title: Association between coronary
tortuosity and mitral annular calcification
Authors: Levent Cerit, Zeynep Cerit
From: Cardiovascular Journal of Africa, Vol 30, Issue 2 March/April
Published: 2019
Pages: 75-78
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DOI Number: 10.5830/CVJA-2018-068
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-068
Introduction: Coronary tortuosity (CorT) is a common coronary angiographic finding. The aetiology, clinical implication and long-term prognosis are not well clarified. Mitral annular calcification (MAC) is one of the most common cardiac structural abnormalities on echocardiographic examination. MAC and CorT are associated with atherosclerotic risk factors such as advanced age, hypertension, diabetes mellitus, hypercholesterolaemia, female gender and chronic kidney disease. There are few data on the co-existence of MAC and CorT in the literature. This study was conducted with the aim of evaluating the association between CorT and MAC.
Methods: The medical records of consecutive patients who underwent coronary angiography were retrospectively reviewed. The study group consisted of 2 736 patients. Taking into consideration the inclusion criteria, 392 patients with MAC and 687 patients without MAC (control group) were included in the study. Biochemical, clinical and echocardiographic parameters and CorT were evaluated in all patients. CorT was defined as three fixed bends during both systole and diastole, with the angle of each bend 45° or more
Results: Patients with MAC had a higher prevalence of hypertension, hyperlipidaemia, female gender, MAC and advanced age. On univariate analysis, advanced age, hypertension, female gender, hyperlipidaemia and MAC were associated with CorT. On multivariate analysis MAC, advanced age and hypertension were independent predictors for CorT (OR 2.167, 95% CI: 1.436–4.283, p < 0.001; OR 1.243, 95% CI: 1.243–3.674, p < 0.001; OR 2.358, 95% CI: 1.864–4.681, p < 0.001, respectively).
Conclusion: In our study, we found a significant relationship between MAC and CorT.
- Title: Change in late sodium current
of atrial myocytes in spontaneously hypertensive
rats with allocryptopine treatment
Authors: Ying Dong, Yun Huang, Hong-lin Wu, Jun Ke, Yuan-li Yin, Chao Zhu, Bin Li, Jie Li, Lei Gao, Qiao Xue, Jian-cheng Zhang, Yang Li
From: Cardiovascular Journal of Africa, Vol 30, Issue 2 March/April
Published: 2019
Pages: 79-86
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DOI Number: 10.5830/CVJA-2018-072
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-072
Aim: We aimed to study the effect of allocryptopine (All) on the late sodium current (INa,Late) of atrial myocytes in spontaneously hypertensive rats (SHR).
Methods: The enzyme digestion method was used to separate single atrial myocytes from SHR and Wistar–Kyoto (WKY) rats. INa,Late was recorded using the patch-clamp technique, and the effect of All was evaluated on the current.
Results: Compared with WKY rat cells, an increase in the INa,Late current in SHR myocytes was found. After treatment with 30 μM All, the current densities were markedly decreased; the ratio of INa,Late/INa,peak of SHR was reduced by 30 μM All. All reduced INa,Late by alleviating inactivation of the channel and increasing the window current of the sodium channel. Furthermore, INa,Late densities of three SCN5A mutations declined substantially with 30 μM All in a concentration- dependent manner.
Conclusion: The results clearly show that an increase in INa,Late in SHR atrial myocytes was inhibited by All derived from Chinese herbal medicine.
- Title: The pattern of risk-factor profile in Egyptian patients with
acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk
project
Authors: Ashraf Reda, Mohamed Ashraf, Mahmoud Soliman, Hany Ragy, Ahmed El kersh, Waleed Abdou, Tamer Mostafa, Mohammed Hassan, Elsayed Farag, Hazem Khamis, Moheb Wadie, Atef Elbahry, Sameh Salama, Ghada Kazamel, Mohammed Sadaka, Morsy Mostafa, Akram Abd El-Bary, Osama Sanad, Samir Rafla, Yaser Abd El-Hady, Mohammed Selim, Nabil Farag, Helmy El-Ghawaby, Hosam Hasan-Ali, Sameh Emil, Morad Beshay, Ahmed Shawky, Mahmoud Yusef, Mohammed Abd El-Ghany, Awni Gamal, Yaser Baghdady, Taymour Mostafa, Mohammed Zahran, Khaled Rabat, Ahmed Bendary, Amany El Shorbagy
From: Cardiovascular Journal of Africa, Vol 30, Issue 2 March/April
Published: 2019
Pages: 87-94
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DOI Number: 10.5830/CVJA-2018-074
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-074
Background: Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt.
Methods: From November 2015 to August 2017, data were collected from 1 681 patients with ACS in 30 coronary care centres, covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta and Upper Egypt, with a focus on risk factors and management strategies.
Results: Women constituted 25% of the patients. Premature ACS was common, with 43% of men aged less than 55 years, and 67% of women under 65 years. Most men had ST-elevation myocardial infarction (STEMI) (49%), while a larger percentage of women had unstable angina and non- ST-elevation myocardial infarction (NSTEMI) (32% each; p < 0.001). Central obesity was present in 80% of men and 89% of women, with 32% of men and women having atherogenic dyslipidaemia. Current smoking was reported by 62% of men and by 72% of men under 55 years. A larger proportion of women had type 2 diabetes (53 vs 34% of men), hypertension (69 vs 49%), dyslipidaemia, and obesity (71 vs 41%) (p < 0.001 for all). There were no gender differences in most diagnostic and therapeutic procedures, but among STEMI patients, 51% of men underwent primary percutaneous coronary intervention compared to 46% of women (p = 0.064).
Conclusions: Central obesity and smoking are extremely prevalent in Egypt, contributing to an increased burden of premature ACS, which warrants tailored prevention strategies. The recognised tendency worldwide to treat men more aggressively was less pronounced than expected.
- Title: The cardiovascular effects of Aspalathus linearis
supplementation in male Wistar rats receiving fixed-dose combination first-line
antiretroviral therapy
Authors: I Webster, EG Imperial, C Westcott, H Strijdom
From: Cardiovascular Journal of Africa, Vol 30, Issue 2 March/April
Published: 2019
Pages: 95-102
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DOI Number: 10.5830/CVJA-2018-075
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-075
Abstract: HIV-infected populations receiving antiretroviral therapy (ART) have an increased risk of cardiovascular disease. The beneficial cardiovascular effects of rooibos are well described; however, it is unknown whether rooibos ameliorates harmful ART-induced cardiovascular side effects. We investigated the cardiometabolic effects of rooibos co-treatment in rats receiving ART (efavirenz, emtricitabine, tenofovir) for nine weeks. Rooibos treatment reduced total cholesterol levels; however, triglyceride, phospholipid and thiobarbituric acidreactive substance levels were unaffected by ART, rooibos or combination treatment. In isolated hearts exposed to ischaemia– reperfusion injury, ART resulted in increased infarct sizes compared to controls, which was not observed when co-treated with rooibos. Vascular studies showed reduced aortic relaxation with ART, and improved relaxation when co-treated with rooibos. In conclusion, we show that rooibos treatment reduced total cholesterol levels in control rats, and that rooibos co-treatment ameliorated the harmful ART-induced cardiovascular effects. These findings are novel and warrant further studies into underlying mechanisms and clinical relevance.
- Title: Beta-blocker target dosing
and tolerability in a dedicated heart failure
clinic in Johannesburg
Authors: J Bolon, K McCutcheon, E Klug, D Smith, P Manga
From: Cardiovascular Journal of Africa, Vol 30, Issue 2, March/April
Published: 2019
Pages: 103–107
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DOI Number: 10.5830/CVJA-2019-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-001
Background:: Despite the significant clinical benefits of betablockers in heart failure with reduced ejection fraction (HFrEF), prescription for and adherence to these agents is reported to be poor. There are few data on the use and tolerance of beta-blocker therapy in patients with HFrEF in South Africa and it is unknown whether these patients would benefit from further heart rate-lowering therapy.
Methods: Data from all patients with HFrEF attending the heart failure clinic of Charlotte Maxeke Johannesburg Academic Hospital from January 2000 to December 2014 were retrospectively collected. We first determined the rates of beta-blocker intolerance in this population and then categorised the patients according to their most recent dose of betablocker (low, moderate or target dose) in order to identify factors associated with beta-blocker intolerance. Lastly, we used the data to identify patients who would be suitable for further treatment with heart rate-lowering therapy.
Results: Five hundred patients, with a median follow up of 58.7 months, were identified during the study period. Black South Africans constituted the majority (66.4%) and most patients had HFrEF due to hypertension (32.8%). At the last recorded clinic visit at the end of the study period, 489 patients (97.8%) were taking a beta-blocker with 59.8% prescribed a beta-blocker at target dose. Consistent with previous data, bradycardia was the commonest cause for failing to reach target beta-blocker dose. Only 61 (12%) patients were on no (n = 11) or low (n = 50) dose of beta-blocker at final clinic visit. As per current guidelines, only 10.6% (n = 53) of this cohort of patients would qualify for further treatment with heart rate-lowering therapy.
Conclusions: In a dedicated heart failure clinic in South Africa, beta-blockers were well-tolerated in the treatment of HFrEF. The potential role of specific heart rate-lowering therapy in patients treated adequately with heart failure medication and proper up-titration of beta-blockers is relatively small.
- Title: Effects of acute hypoxic provocation on the autonomic nervous
system in ‘healthy’ young smokers, measured by heart rate variability
Authors: Zdravko Z Taralov, Peter K Dimov, Kiril V Terziyski, Blagoi I Marinov, Mariyan K Topolov, Stefan S Kostianev
From: Cardiovascular Journal of Africa, Vol 30, Issue 2, March/April
Published: 2019
Pages: 108-112
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DOI Number: 10.5830/CVJA-2019-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-007
Aim: The aim of this study was to compare the activity of the autonomic nervous system (ANS) using heart rate variability (HRV) in ‘healthy’ young smokers and non-smokers before, during and after exogenous hypoxic provocation.
Methods: Twenty-one healthy non-smoking males aged 28.0 ± 7.4 years (mean ± SD) and 14 ‘healthy’ smoking males aged 28.1 ± 4.3 years with 9.2 ± 5.6 pack-years were subjected to one-hour hypoxic exposure (FiO2 = 12.3 ± 1.5%) via a hypoxicator. HRV data was derived via Kubios HRV, Finland software by analysing the pre-hypoxic, hypoxic and post-hypoxic periods.
Results: Standard deviation of the intervals between normal beats (SDNN) was higher in the non-smokers in the prehypoxic period (62.0 ± 32.1 vs 40.3 ± 16.2 ms, p = 0.013) but not in the hypoxic period (75.7 ± 34.8 vs 57.9 ± 18.3 ms, p = 0.167). When comparing intra-group HRV changes, shifting from hypoxic to normoxic conditions, there was an increase in the mean square root of successive R-R interval differences (RMSSD) (65.9 ± 40.2 vs 75.1 ± 45.9 ms, p = 0.011), but these changes were observed in only the group of non-smokers.
Conclusions: Smoking probably impairs autonomic regulation in healthy young males and may lead to decreased HRV, even before subjective clinical signs and symptoms appear.
- Title: Assessment of adherence to medication for cardiovascular
diseases: measurement tools
Authors: Bartosz Uchmanowicz, Anna Szymańska-Chabowska, Beata Jankowska-Polańska
From: Cardiovascular Journal of Africa, Vol 30, Issue, 2, March/April
Published: 2019
Pages: 113-119
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DOI Number: 10.5830/CVJA-2018-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-050
Abstract: The effectiveness of treatment and prevention of chronic illnesses can be optimised with adherence to medication treatment. This is very often assessed by means of a self-report. However, the challenge here is to choose the most suitable questionnaire or the one that is best overall in a given situation. The aim of this systematic review was to assess existing self-reported medication adherence scales, which measure adherence to treatment for cardiovascular disease. The review demonstrated that relatively few disease-specific adherence scales exist. Generic questionnaires and those specific to adherence to hypertension treatment are the most numerous. Questionnaires specifically measuring adherence to antihaemorrhage treatment for atrial fibrillation are particularly necessary and noticeably absent. The two most important aspects that need to be taken into account when selecting the most appropriate scale in a given context are the subject of the measurement (what) and the method of validation (how).
- Title: Blood pressure measurement in
pregnancy and in hypertensive disorders of
pregnancy: devices, techniques and challenges
Authors: Nnabuike C Ngene, Jagidesa Moodley
From: Cardiovascular Journal of Africa, Vol 30, Issue, 2, March/April
Published: 2019
Pages: 120-129
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DOI Number: 10.5830/CVJA-2018-067
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-067
Abstract: Measurement of blood pressure is essential for clinical management of patients. To obtain an accurate blood pressure reading, the use of a validated device and an appropriate technique are required. This is of particular importance in pregnancy where the physiological changes affect vessel wall compliance. Moreover, currently it is difficult to predict in early pregnancy (prior to 20 weeks of gestation) which women would develop hypertension or pre-eclampsia. For this reason, blood pressure devices require validation in pregnancy and in hypertensive disorders of pregnancy to ensure that accurate readings are obtained and utilised for clinical decisions, otherwise the safety of the mother or the foetus/ neonate or both may be compromised. The authors provide a narrative review on devices and techniques for blood pressure measurement in pregnancy and hypertensive disorders of pregnancy as well as the associated challenges.
- Title: Acute circulatory failure in two cardiology departments in
Dakar: 44 cases
Authors:ND Gaye, AA Ngaidé, SCT Ndao, I Dongmo, SA Sarr, F Aw, JS Mingou, M Bodian, MB Ndiaye, A Mbaye, M Sarr, M Diao, SA Ba
From: Cardiovascular Journal of Africa, Vol 30, Issue, 2, March/April
Published: 2019
Pages: e1-e6
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DOI Number: 10.5830/CVJA-2018-073
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-073
Introduction: Acute circulatory failure is a life-threatening emergency whose prognosis depends on early management and aetiological diagnosis. The aim of our study was to assess the epidemiological, aetiological, therapeutic and prognostic aspects of acute circulatory failure in two cardiology departments in Dakar.
Methods: This was a longitudinal, multicentre, descriptive study over a period of six months from October 2014 to March 2015. We included all patients with acute circulatory failure (systolic blood pressure < 90 mmHg, oligoanuria, tachycardia, tachypnoea, onset of altered consciousness) either on admission or during hospitalisation during the study period. A long-term survival survey (six months to one year) was conducted on all included patients.
Results: Forty-four patients were enrolled. The average age was 54.9 years, ranging from 20 to 83 years. The gender ratio was 1.1. Acute circulatory failure occurred most often during hospitalisation (63%), with known cardiomyopathy in 47.7% of cases. Consciousness was impaired in 11 patients while oligoanuria was present in 27.3% of cases. Inflammatory syndrome was mostly found in 63.6% of cases and renal insufficiency and acute liver failure were reported in 45.5 and 29.5% of patients, respectively. Left ventricular dysfunction was the most common echocardiographic feature (70%). Acute circulatory failure was cardiogenic in most cases, with a predominance of advanced dilated cardiomyopathy (44.9%). Septic shock was found in 25% of patients, with pulmonary infection as the main location (20%). Nine per cent of patients had hypovolaemic shock. The most used inotropic drug was dobutamine in 79.5% of cases, followed by adrenaline (18.2%) and norepinephrine (4.5%). Intra-hospital mortality rate was high (52.3%) and one-year survival rate was 27.2%. Poor prognostic factors such as advanced age and renal impairment were associated with a higher overall mortality rate of 18 to 90%, with no statistical significance.
Conclusion: Acute circulatory failure is a diagnostic and therapeutic emergency with a high mortality rate.
- Title: Laron syndrome related to homozygous growth hormone receptor
c.784>C mutation in a patient with hypoplastic pulmonary arteries
Authors: Ayşehan Akıncı, Cemşit Karakurt, Vivian Hwa, İsmail Dündar, Emine Çamtosun
From: Cardiovascular Journal of Africa, Vol 30, Issue, 2, March/April
Published: 2019
Pages:e7–e8
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DOI Number: 10.5830/CVJA-2019-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-002
Abstract :Laron syndrome, also known as growth hormone insensitivity, is an autosomal recessive disorder characterised by short stature due to mutations or deletions in the growth hormone receptor (GHR), leading to congenital insulin-like growth factor 1 (IGF1) deficiency. Cardiac abnormalities, such as patent ductus arteriosus or peripheral vascular disease are rare in patients with Laron syndrome, but cardiac hypertrophy has been observed after IGF1 therapy. In this report, we present a 10-year-and-5-month-old girl with severe peripheral- type pulmonary artery hypoplasia and Laron syndrome related to homozygous GHR c.784>C mutation.
