CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 30, ISSUE
3, MAY/JUN 2019
This journal is now available to be
viewed via our eJournal publication viewer.
- Title: Editorial: Cardiac
rehabilitation delivery in Africa
Authors:Martin Heine, Karam Turk-Adawi, Marta Supervia, Wayne Derman, Francisco Lopez-Jimenez, Pamela Naidoo, Sherry L Grace
From: Cardiovascular Journal of Africa, Vol 30, Issue 3 May/June
Published: 2019
Pages: 133-137
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-011
- Title: The Amsterdam Growth and
Health Longitudinal Study: how important is
physical activity in youth for later health?
(ELS 33)
Authors: Han CG Kemper, Kotsedi Dan Monyeki
From: Cardiovascular Journal of Africa, Vol 30, Issue 3 May/June
Pages: 138-141
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2018-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-057
Background: Three important results came from the Amsterdam Growth and Health Longitudinal Study(AGAHLS). This study followed three birth cohorts (1962, 1963 and 1964) of boys and girls in the Amsterdam region in the Netherlands. The follow-up period was 25 years, with 10 measurements from age 12 to 42 years. The main purpose of the AGAHLS was to detect changes in health and lifestyle over time during the teenage and young adult period.
Methods: In total, 617 subjects were recruited from two secondary schools in Amsterdam and Purmerend. We measured aerobic fitness (VO2 peak), bone mineral density (BMD), obesity from body mass index (BMI) and body fatness from the sum of four skinfolds (S4S). Daily physical activity (DPA) was measured from heart rate, pedometers and an interview. Daily food intake (DFI) was measured by a cross-check dietary history interview.
Results: Longitudinal data analyses revealed that: (1) aerobic fitness, as measured by direct measurement of maximal oxygen uptake (VO2 max), increased more significantly in the physically active percentile (P > 75) of males and females than in the physically inactive percentile (P < 25), (2) BMD, as measured with dual X-ray absorptiometry (DEXA) in the wrist, hip and lumbar region, showed that physical activity in youth with a high mechanical load on the bones (mostly weight bearing) increased bone formation in the hip and lumbar region of males and females in adulthood, (3) the longitudinal relationship between DPA and DFI with the development of overweight and obesity (measured from BMI and S4S) showed that more DPA resulted in significantlylower fat mass, but no relationship could be demonstrated with DFI .
Conclusion: The main conclusion from this 25-year longitudinal research is that the promotion of physical activity (including physical education and sport) in adolescence can potentially be a strong tool to prevent chronic diseases and reduce healthcare costs later in life.
- Title: Ellisras Longitudinal Study
2017: the association of fat patterning with
blood pressure in Polokwane private school
children aged five to 15 years (ELS 22)
Authors: Mbelege Rosina Nkwana, Kotsedi Dan Monyeki, Suzan Mafoloa Monyeki, Tlou Thomas Makata, Judas Mponthseng Lentenne Monyeki
From: Cardiovascular Journal of Africa, Vol 30, Issue 3 May/June
Published: 2019
Pages: 142–145
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2018-058
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-072
Background: Obesity is a risk factor for non-communicable diseases and is a global public health concern. Objectives: The main objectives of this study were to investigate the association of fat patterning and blood pressure among five- to 15-year-old black children attending private schools in Polokwane, South Africa, and to determine the prevalence of obesity and hypertension.
Method: A total of 1 665 subjects (846 boys and 819 girls), aged five to 15 years and attending three private schools in Polokwane, were included in the study. All anthropometric measurements were taken according to standard procedures of the International Society for the Advancement of Kinanthropometry. All data were analysed using SPSS.
Results: Girls showed a higher prevalence of over-fatness (10.2–12.3%) and hypertension (1.4–33.0%) than boys (7.3– 10.3, 3.6–21.3%, respectively). The sum of four skinfolds, trunk skinfolds relative to limb skinfold, and body mass index (BMI) were positively associated with systolic and diastolic blood pressure (p < 0.01). There was a significant positive (p < 0.001) association between over-fatness and hypertension, both unadjusted (OR = 3.11; 95% CI = 2.17–4.46) and adjusted for age and gender (OR = 3.29; 95% CI = 2.22–4.86).
Conclusion: These Polokwane private school children with high body fatness were at risk for developing high blood pressure.
- Title: Ellisras Longitudinal Study 2017: Childhood underweight and
blood pressure status in a rural black population of South Africa (ELS 26)
Authors: Peter M Mphekgwana, Herbert M Makgopa, Kotsedi Dan Monyeki, Johanna M Malatji, Thembinkosi E Mabila
From: Cardiovascular Journal of Africa, Vol 30, Issue 3 May/June
Published: 2019
Pages: 146–150
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2018-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-061
Aim: Childhood underweight is a problem being faced by rural black South African populations but little is known about its risk factors. The aim of this study was to investigate the risk factors related to childhood underweight in rural black South African children within the area known as Ellisras.
Methods: A cross-sectional study was conducted as part of the ongoing Ellisras Longitudinal Study. The current studycomprised a total of 1 811 pre-primary and primary school children (934 males and 877 females) aged between five and 16 years. The chi-squared automatic interaction detection (CHAID) decision tree model was used to identify factors and determine their relationships with childhood underweight.
Results: A total of 1 811 children were involved in the study, of whom about 81% were severely underweight. The CHAID model showed that the variables: nutrition, age group, gender and school level were the four main predicting variables affecting childhood underweight. Hypertension was not significantly associated with childhood underweight.
Conclusions: The prevalence of childhood underweight was found to be high in children aged between five and 16 years. To address this problem, well-thought-out intervention systems are need.
- Title: Effect of time delay of PDA closure on the aortic stiffness
index and its relationship with cardiac function
Authors: Saud M Elsaughier, Ramadan Ghaleb, Hossam Mansour
From: Cardiovascular Journal of Africa, Vol 30, Issue 3 May/June
Published: 2019
Pages: 151–156
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-005
Background: Patent ductus arteriosus (PDA) causes volume overload of the left side of the heart. Stiffening in the larger central arterial system, such as the aortic tree, significantly contributes to cardiovascular diseases in older individuals and is positively associated with systolic hypertension and coronary artery disease. In this study, we evaluated the effect of time delay of PDA closure on aortic stiffness and its relationship with cardiac function before and after transcatheter closure of the PDA.
Methods: Our study population consisted of 60 children who were scheduled for transcatheter closure of the PDA. They were divided into two groups as follows: group A in whom PDA closure was performed before the age of one year, and group B in whom PDA closure was performed after the age of one year.
Results: Before PDA closure, the aortic stiffness index (ASI) was significantly higher in children in group B than in those in group A (p < 0.001), and was it significantly higher in both groups than in the control group (p < 0.001).
Conclusion: Aortic stiffness was significantly elevated in patients with PDA, even small-sized PDAs, and was associated with impairment in cardiac function, particularly if PDA closure was delayed after the age of one year.
- Title: Coronary angiographic
findings in dilated cardiomyopathy in a
sub-Saharan African population
Authors: Roland N’Guetta, Hermann Yao, Esther Ehouman, Arnaud Ekou, Jean-Baptiste Anzouan-Kacou, Iklo oulibaly, Marie-Laure Hauhouot-Attoungbre, Euloge Kramoh, Yves Yapobi, Remi Seka
From: Cardiovascular Journal of Africa, Vol 30, Issue 3, May/june
Published: 2019
Pages: 157–161
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-006
Aim: To describe the coronary angiographic aspects observed in patients with dilated cardiomyopathies (DCM) in a sub- Saharan African country in order to improve their management.
Methods: This was a cross-sectional study conducted from 1 January 2010 to 31 March 2016. All patients aged 18 years and older, presenting with DCM and admitted to Abidjan Heart Institute, who underwent coronary angiography were included. One hundred and eight patients were selected. We analysed and compared the coronary angiographic features observed.
Results: The median age of our patients was 52 years (46–61). There was a male predominance (sex ratio = 3). Hypertension (53.7%) was the major cardiovascular risk factor found. Coronary angiography was abnormal in 37 patients (34.3%). Twenty-three patients (21.3%) had obstructive coronary artery disease (CAD). Patients with CAD were older than those with normal coronary arteries, but with no statistically significant difference (p = 0.06). Hypertension (p < 0.001) and diabetes (p = 0.0003) were statistically significantly more commonly reported in patients with CAD.
Conclusion: Ischaemic heart disease is likely to be underdiagnosed in sub-Saharan Africa. A coronary angiographic assessment of patients receiving treatment for DCM, especially in the presence of cardiovascular risk factors, should help optimise their management and improve prognosis.
- Title: Delayed angioplasty is superior to an emergency strategy in
ST-segment elevation myocardial infarction patients who present late and with
infarct artery spontaneous reperfusion before intervention
Authors: Mingxing Li, Zidi Wu, Yong Yuan, Li Feng, Yi Lao, Zhigang Guo
From: Cardiovascular Journal of Africa, Vol 30, Issue 3, May/June
Published: 2019
Pages: 162-167
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-009
AObjective: The best time to perform percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients presenting 12 to 72 hours after chest pain is unclear. The aim of this study was to explore whether delayed PCI was superior to emergency PCI in STEMI patients who presented 12 to 72 hours after onset of symptoms and with a spontaneous reperfusion infarct-related artery (IRA).
Methods: STEMI patients who presented 12 to 72 hours after symptom onset were enrolled and assigned to either the emergency PCI or delayed PCI group. We compared the rates of procedural success and in-hospital mortality as well as the main adverse cardiac events (MACE) during hospitalisation and after one year of follow up.
Results: We enrolled 159 patients in this retrospective study. Emergency PCI was performed in 73 patients and delayed PCI in 86 patients. A remarkably high rate of procedural success was achieved in the delayed PCI group compared with the emergency PCI group (97.7 vs 86.3%, p = 0.007) due to a lower rate of no re-flow or slow flow (2.3 vs 13.7%, p = 0.007). There was no significant difference in terms of MACE and in-hospital mortality rates (16.4 vs 9.3%, p = 0.133; 1.4 vs 2.3%, p = 0.562). During one year of follow up, the left ventricular ejection fraction was similar in the two groups [median 58% (57–68) in the emergency PCI group vs median 56% (50–62) in the delayed PCI group, p = 0.666]. Although the emergency PCI group had a trend towards a higher rate of MACE, the difference was not statistically significant (12.2 vs 11.6%, HR = 1.067, 95% CI: 0.434–2.627, p = 0. 887).
Conclusion: In STEMI patients who presented late (12–72 hours) after symptom onset and with a spontaneous reperfusion IRA, delayed PCI showed a higher rate of procedural success without increased rates of in-hospital and long-term MACE and mortality.
- Title: Characteristics and 12-month outcome of patients with atrial
fibrillation at a tertiary hospital in Botswana
Authors: Julius Chacha Mwita, Cassandra Ocampo, Onkabetse Julia Molefe-Baikai, Monkgogi Goepamang, Elizabeth Botsile, Jose Gaby Tshikuka
From: Cardiovascular Journal of Africa, Vol 30, Issue, 3, May/June
Published: 2019
Pages: 168–173
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-013
Background: Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia associated with high morbidity and mortality rates. Notwithstanding the scale of the problem, there are sparse data on the characteristics and outcomes of both valvular and non-valvular AF patients in sub-Saharan Africa (SSA).
Objective: This study aimed at describing the clinical features and outcome of AF patients at a tertiary hospital in Botswana. Methods: This prospective study was carried out in the Princess Marina Hospital in Gaborone, Botswana between August 2016 and July 2018. We consecutively enrolled 138 (97.8% black Africans) adult patients with electrocardiographically documented AF. Their baseline clinical and biomedical data were documented, and each patient was followed up for 12 months. The primary study outcome was 12-month all-cause mortality.
Results: The mean [standard deviation (SD)] age of enrolled patients was 66.7 (17.2) years, and 63.8% were females. Common co-morbidities were hypertension (59.4%), rheumatic heart disease (37.7%) and heart failure (35.5%). Stroke/ transient ischaemic attack (TIA) (21.7%) and obesity (34.8%) were also prevalent. Compared to patients with non-valvular AF, those with valvular AF were more likely to be female (82 vs 55%, p = 0.003), younger (60 vs 75 years, p < 0.001), on anticoagulation (88.6 vs 66%, p = 0.005), or have a dilated left atrium (5.3 vs 4.5 cm, p < 0.001). They were also less likely to present with hypertension (33 vs 72%, p < 0.001), stroke/TIA (nine vs 27%, p < 0.017), chronic kidney disease (five vs 20%,p < 0.02), or history of cigarette smoking (two vs 13%, p = 0.049) than non-valvular AF patients. The mean (SD) CHA2DS2- VASc score in non-valvular AF patients was 3.6 (1.5), and the median HAS-BLED score was 2.0 [interquartile range (IQR) 1.0–3.0]. During the 12-month follow up, 20 (14.5%) patients died. Despite differences in baseline characteristics, there was no difference in mortality rate in patients with valvular compared to those with non-valvular AF (13.8 vs 15.9%; p = 0.746).
Conclusion: In this study, hypertension, rheumatic heart disease and heart failure were the most prevalent co-morbidities. AF presented in young people and conferred high mortality rates in both valvular and non-valvular AF patients. Prevention and optimal management of AF and associated co-morbidities are of critical importance.
- Title: Remodelling in atrial
fibrillation: the impact of amiodarone
Authors: Alin Ionut Grosu, Dan Radulescu, Laura Cristina Grosu, Dana Pop
From: Cardiovascular Journal of Africa, Vol 30, Issue, 3, May/June
Published: 2019
Pages: 174–180
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-012
Abstract: Atrial fibrillation (AF) is a common heart rhythm disorder with a prevalence of up to 2.9% in the general population. Its mechanism involves a particular electrophysiological profile as well as structural and biohumoral changes that are often irreversible. With the recent advances in pharmacology, amiodarone remains the cornerstone for the treatment of AF. Although it is one of the most controversial anti-arrhythmic agents due to the multitude of side effects, it is further recognised as the most effective drug available for the conversion and maintenance of sinus rhythm in the case of significant left ventricular dysfunction or severe aortic stenosis. This quality is provided by its multivalent profile, with a complex electrophysiological activity overlapped with an anti-inflammatory and vasodilatory effect. This review aims to outline the main structural and functional changes in AF and the multisite impact of amiodarone on its treatment.
- Title: An integrated model of materno-foetal cardiac dysfunction in
severe pre-eclampsia
Authors: Ismail Bhorat
From: Cardiovascular Journal of Africa, Vol 30, Issue, 3, May/June
Published: 2019
Pages: 181–183
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2018-071
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-073
Abstract: Maternal cardiovascular deterioration in severe pre-eclampsia is due to a combination of factors in the setting of severe trophoblastic ischaemia and the outpouring of maternal cathecolamines, leading to increased left ventricular afterload and increasing ventricular volumes, resulting in increased left ventricular stroke work and demand myocardial ischaemia. This is the substrate for ventricular arrhythmias. Foetal cardiac dysfunction is most likely on the basis of the increased afterload, consequent upon widespread vasoconstriction, due to angiogenic imbalances. In this integrated model, chronic trophoblastic ischaemia is the central role player by releasing vasoactive substances that induce haemodynamic alterations in the maternofoetal complex, augmented and modified by ‘latent’ maternal cardiovascular dysfunction and increased maternal cathecolamine secretion on the one hand, and altered foetal signalling mechanisms on the other, all three components of the materno-placental-foetal complex being in constant interaction with each other. This unified hypothesis may explain the development of both maternal and foetal morbidity and/ or mortality on a unitary basis in severe, complicated preeclampsia.
- Title: South African Hypertension Society commentary on the American
College of Cardiology/American Heart Association hypertension guidelines
Authors: Brian Rayner, Erika Jones, Yusuf Veriava, YK Seedat
From: Cardiovascular Journal of Africa, Vol 30, Issue, 3, May/June
Published: 2019
Pages:184–187
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-025
Abstract: In late 2017, the publication of the new American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines created considerable controversy. The threshold for hypertension was redefined as > 130/80 mmHg and target blood pressure < 130/80 mmHg. The purpose of this commentary is to give clarity on the position of the Southern African Hypertension Society (SAHS). In South Africa more than 90% of hypertensives are not controlled at < 140/90 mmHg. Furthermore, by redefining hypertension to a level of 130/80 mmHg, this will significantly increase the prevalence of hypertension by 43%. The new targets will necessitate greater use of health services for increased health visits to monitor patients, greater use of antihypertensives to achieve the lower target, and increased use of laboratory services to monitor for adverse effects. It is the position of SAHS that the new definition and targets are not relevant to low- and middle-income countries such as South Africa, the threshold for hypertension remains at 140/90 mmHg, and a universal target is < 140/90 mmHg for all categories of hypertension.
- Title: A patient with anomalous origin of the left coronary artery
from the pulmonary artery (ALCAPA syndrome) and 13 live births
Authors: Mustafa Yolcu, Mehmet Salih Bilal, Mustafa Kemal Avsar, Ozgur Yildirim
From: Cardiovascular Journal of Africa, Vol 30, Issue, 3, May/June
Published: 2019
Pages:e1–e2
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-003
Abstract: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) or Bland–White–Garland syndrome is a rarely seen congenital anomaly. Adult and infantile types are defined according to the degree of collateral development between the left coronary artery (LCA) and right coronary artery (RCA). If left untreated, ALCAPA has a 90% mortality rate in the first year of life, primarily due to myocardial ischaemia and heart failure. The degree of collateral development and the related LCA perfusion in ALCAPA syndrome determine the occurence of symptoms. Herein, we present a case of a female patient who had previously, without any symptoms, given live birth to 13 babies. She had been experiencing exertional angina, which started long after the delivery of her 13th child. Since our patient had well-developed collaterals to the LCA, she was asymptomatic and able to give birth to the children via the vaginal route without any problems. Having well-formed collateral vessels between the RCA and LCA may prevent patients from developing symptoms, and even stressful conditions such as pregnancy may be tolerable.
- Title: Second recurrence of familial atrial myxomas: mother and
daughter simultaneously
Authors: Zehra Bayramoglu, Kerem Oral, Mehmet Ezelsoy, Belhhan Akpinar
From: Cardiovascular Journal of Africa, Vol 30, Issue, 3, May/June
Published: 2019
Pages:e3–e6
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2019-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-008
Abstract :Sporadic cardiac myxomas rarely recur, however recurrence rates are higher in patients with a familial aggregation or Carney complex. Carney complex is characterised by multiple mucocutaneous lesions and accounts for up to two-thirds of familial cardiac myxomas. A second recurrence is very rare, even in the case of Carney complex. We report on two cases of recurrent cardiac myxoma, a mother and daughter, who concurrently presented with a second recurrence of atrial myxomas. The time interval between the first and second recurrence following surgery was four years in both. The possibility of repeat recurrence of cardiac myxomas demonstrates the importance of regular echocardiography to detect recurrence and to prevent the potential complications associated with cardiac myxomas. Family screening should be recommended for familial myxomas.
