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CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 30, ISSUE
4, JULY/AUG 2019
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- Title: Searching the lipidome for
answers to prevent and treat non-communicable
diseases
Authors: Louise van den Berg, Corinna Walsh
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 191-192
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- Title: Ellisras Longitudinal Study 2017: elevated serum levels of carboxymethyl-lysine, an advanced glycation end-product, are associated with higher odds of developing endothelial dysfunction in black South African patients with type 2 diabetes mellitus
(ELS 29)
Authors: Motetelo Alfred Mogale, Catherine Martha Mhlanga, Stanley Sechene Gololo, Agustine Adu
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Pages: 193-197
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DOI Number: 10.5830/CVJA-2018-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-060
Abstract: This case–control study investigated the association between major types of serum advanced glycation end-products (AGEs) and selected serum/plasma markers of endothelial dysfunction in black patients with type 2 diabetes mellitus at Dr George Mukhari Academic Hospital. Serum AGEs were measured using either enzyme-linked immunosorbent assay (ELISA) or spectrofluoremetry. Serum markers of endothelial dysfunction were measured using either ELISA or calometry. The correlation and associations between major types of serum AGEs and markers of endothelial dysfunction were investigated using the Spearman correlation coefficient and bivariate logistic regression analysis, respectively. Although both serum total immunogenic AGEs and serum carboxymethyl-lysine (CML) were moderately and negatively associated with endothelial dysfunction, only serum CML was significantly associated with a higher odds for the development of endothelial dysfunction (low nitric oxide levels) in our diabetic subjects. It can therefore be concluded from this study that high serum levels of CML may predispose to endothelial dysfunction in black South Africans with type 2 diabetes.
- Title: Performance of HAS-BLED and CRUSADE risk scores for the prediction of haemorrhagic events in patients with stable coronary artery disease
Authors: Ersin Yildirim, Okkes Uku, Mehmet Nail Bilen, Ozlem Secen
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 198-202
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DOI Number: 10.5830/CVJA-2019-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-014
Abstract: We aimed to compare the power of the HAS-BLED and CRUSADE risk scores in predicting in-hospital bleeding events in patients with stable coronary artery disease undergoing elective coronary angiography. A total of 405 consecutive patients were included in the study. The mean HAS-BLED score was significantly higher (p < 0.001) in the in-hospital bleeding group. In patients with a HAS-BLED score ≥ 3, the in-hospital bleeding rate was significantly higher than in those with a HAS-BLED score < 3 (p < 0.001). Receiver operating characteristic curve analysis revealed that the HAS-BLED score was superior in predicting in-hospital bleeding events compared to the CRUSADE score [area under the curve (AUC) = 0.684 vs 0.569, respectively, p = 0.002]. Also in the percutaneous coronary intervention subgroup, the HAS-BLED score was superior to the CRUSADE score (AUC = 0.722 vs 0.520, respectively, p = 0.002). We showed that the HAS-BLED and CRUDASE scores are helpful in stable patients undergoing elective coronary angiography. Our results suggest that as a practical, easy-to-implement and more predictive scoring system, the HAS-BLED score was more useful for predicting in-hospital bleeding in patients who did not present with acute coronary syndrome.
- Title: Atherosclerotic plaque in HIV-positive patients presenting with acute coronary syndromes
Authors: Ahmed Vachiat, Keir McCutcheon, Nqoba Tsabedze, Don Zachariah, Pravin Manga
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 203-207
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DOI Number: 10.5830/CVJA-2019-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-016
Aim: This study aimed to characterise the atherosclerotic plaque and plaque burden in HIV-positive patients presenting with acute coronary syndromes (ACS), using intravascular ultrasound (IVUS) and virtual histology (VH).
Methods: This was a prospective study of 20 HIV-positive patients who presented with ACS. IVUS and VH were used to assess plaque burden and plaque characteristics in the culprit and non-culprit coronary arteries.
Results: HIV-positive patients with ACS had a mean age of 51.1 ± 8.1 years. There were 13 (65%) male patients. ST-segment elevation myocardial infarction was the most common presentation of ACS (75%) with the left anterior descending artery being the most common culprit artery (60%). In 60% of patients, the total plaque burden was of moderate degree (40–70% stenosis) while it was of mild degree (< 40% stenosis) in 35%, and in 5% of patients it was severe (> 70% stenosis). A severe degree of total plaque burden was more commonly found in the culprit vessel (30%) than in the non-culprit vessels (5%). Furthermore, the plaque burden was found to be located predominantly in the proximal portion of the coronary arteries. The predominant plaque morphology consisted of fibrous plaque (55.4%) and fibro-fatty plaque (26.6%), while necrotic core was present in 13.3%. Dense calcium was present in only 4.7% of the cohort.
Conclusions: IVUS and VH demonstrated a high burden of atherosclerosis in the left anterior descending artery and proximal vasculature of HIV-positive patients. The atherosclerotic plaque predominantly comprised non-calcified fibrous and fibro-fatty plaque.
- Title: Natural cocoa inhibits maternal hypercholesterolaemia-induced atherogenesis in rabbit pups
Authors: Richard Michael Blay, Saviour Kweku Adjenti, Kevin Kofi Adutwum-Ofosu, Bismarck Afedo Hottor, John Ahenkorah, Benjamin Arko-Boham, Frederick Kwaku Addai
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 208-215
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DOI Number: 10.5830/CVJA-2019-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-019
Abstract: Atherosclerosis begins during foetal development and is enhanced by maternal hypercholesterolaemia during pregnancy. This study assessed the effect of natural cocoa on atherosclerosis in offspring conceived in maternal hypercholesterolaemia. Female rabbits were fed a cholesterol-enriched diet for two weeks and hypercholesterolaemia was confirmed, after which they were crossed with normocholesterolaemic males. One group of hypercholesterolaemic mothers (HCC) received natural cocoapowder (NCP) in their drinking water, whereas the other group (HC) received only water. Histological analysis of three segments of the aorta (arch, thoracic and abdominal) from offspring of both groups was compared with a control group (NC). Intima–media thickness of the aortic arch in offspring born to hypercholesterolaemic rabbits (HC: 146 μm) was higher compared to HCC (99 μm) and control rabbits (58.5 μm). All the sections from the aortic arch of the HC group had atherosclerotic lesions while none of the sections of the aortic arch from the NC and HCC groups had lesions present. Inferentially, regular and voluntary consumption of NCP during pregnancy may inhibit aortic atherogenesis in offspring of hypercholesterolaemic mothers.
- Title: Unmasking right ventricular dysfunction in chronic rheumatic mitral regurgitation
Authors: Ruchika Meel, Ferande Peters, Elena Libhaber, Mohammed R Essop
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 216-221
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DOI Number: 10.5830/CVJA-2019-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-020
Aims: Right ventricular (RV) systolic function is an important predictor of mortality but has been poorly studied in chronic rheumatic mitral regurgitation (CRMR). We studied RV systolic function using speckle-tracking echocardiography (STE) in patients with CRMR.
Methods: Seventy-seven patients with CRMR and 40 healthy controls were enrolled in a cross-sectional study at Chris Hani Baragwanath Hospital between January and October 2014. RV peak systolic strain (PSS) and left ventricular (LV) global longitudinal strain (GLS) were measured using Philips Qlab 9 STE software.
Results: RVPSS was lower in CRMR patients compared to the controls (–16.8 ± 4.5 vs –19.2 ± 3.4%, p = 0.003) with no difference in conventional RV systolic function parameters (p = 0.39). RVPSS was lower in severe CRMR compared to moderate CRMR patients (–14.3 ± 4.23 vs –18 ± 4.18%, p < 0.0001). CRMR patients with LV systolic dysfunction had a greater reduction in RVPSS and LVGLS compared to those with preserved LV systolic function (p = 0.001). LVGLS and significant tricuspid regurgitation (TR) were independent predictors of RVPSS (p < 0.001).
Conclusion: In CRMR patients, RVPSS was a more sensitive marker for detecting earlier RV systolic dysfunction than traditional RV functional parameters.
- Title: The effect of perindopril on echocardiographic parameters, NYHA functional class and serum NT-proBNP values in patients with diastolic heart failure
Authors: Umit Yuksek, Levent Cerit, Nihan Kahya Eren, Oktay Ergene
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 222-227
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DOI Number: 10.5830/CVJA-2019-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-022
Introduction: Growing evidence has demonstrated that diastolic heart failure occurs in about half of heart failure (HF) patients. We investigated the effects of perindopril on echocardiographic parameters, New York Heart Association (NYHA) functional class and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in patients with diastolic heart failure.
Methods: In total, 108 diastolic heart failure patients aged ≥ 50 years, who had diastolic dysfunction with an ejection fraction ≥ 50%, were enrolled and randomised to one of the two study groups. Perindopril was initiated in the study group and the control group was given standard therapy. Echocardiographic parameters, NT-proBNP levels and NYHA classes were recorded. The patients were followed for 11 (three to 16) months. Eighty-eight patients completed the study.
Results: Although diastolic parameters were not changed, A′ (septal) velocity (10.8 vs 9.9 cm/s) and Sm (septal) velocity (8.5 vs 7.6 cm/s) were significantly increased in the perindopril compared to the control group. A significant increase in A′ (septal) velocity (+0.61 vs –0.28 cm/s, p = 0.04) and a slight increase in Sm (septal) velocity (+0.99 vs 0.36 cm/s, p = 0.054) were noted in the perindopril group.
Conclusions: Tissue Doppler septal late diastolic velocities and septal systolic myocardial velocities increased in the perindopril group but NT-proBNP levels, and and NYHA class was not changed in this study population.
- Title: Plasma phospholipid fatty acid patterns are associated with adiposity and the metabolic syndrome in black South Africans: a cross-sectional study
Authors: Alice Achieng Ojwang, Herculina Salome Kruger, Manja Zec, Cristian Ricci, Marlien Pieters, Iolanthé Marike Kruger, Edelweiss Wentzel-Viljoen, Cornelius Mattheus Smuts
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 228-238
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DOI Number: 10.5830/CVJA-2019-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-026
Background: Diets rich in n-6 polyunsaturated fatty acids (PUFAs) and saturated fatty acids (SFA) have been associated with increased risk of obesity and the metabolic syndrome (MetS), but the evidence is inconsistent, whereas diets high in n-3 long-chain (LC)-PUFAs are associated with lower risk. There is limited information about the association of plasma phospholipid fatty acids (FAs) with obesity and the MetSamong black South Africans.
Objective: To investigate the association of dietary FAs and plasma phospholipid FA patterns, respectively, with measures of adiposity (body mass index, waist circumference, waist-toheight ratio) and the MetS in black South Africans.
Methods: Factor analysis was used to identify FA patterns from 11 dietary FAs and 26 individual plasma phospholipid FAs. Cross-sectional association of the identified patterns with measures of adiposity and the MetS was investigated. A random sample of 711 black South African adults aged 30 to 70 years (273 men, 438 women) from the North West Province was selected from the South African leg of the Prospective Urban and Rural Epidemiology (PURE) study. Sequential regression models adjusted for confounders were applied to investigate the association between dietary FAs and plasma phospholipid FA
patterns with measures of adiposity and the MetS.
Results: Two patterns were derived from dietary FAs and six patterns from plasma phospholipid FAs that explained the cumulative variance of 89 and 73%, respectively. The association of FA patterns with adiposity and the MetS was weaker for dietary FA patterns than for plasma phospholipid FA patterns. The plasma phospholipid FA pattern with high loadings of saturated FAs (high-Satfat) and another with high loadings of n-3 very-long-chain PUFAs (n-3 VLC-PUFAs) were positively associated with measures of adiposity and the MetS, while patterns with positive loadings of LC mono-unsaturated fatty
acids (n-9 LC-MUFA) and a positive loading of n-3 essential FAs (n-3 EFA) showed inverse associations with the MetS and some measures of adiposity.
Conclusions: The n-9 LC-MUFA and n-3 EFA patterns seemed to provide possible protective associations with adiposity and the MetS, whereas the high-Satfat and n-3 VLC-PUFA patterns were associated with adiposity and the MetS in our study participants. The results are reflective of the metabolic difference between overweight and obese compared to lean individuals.
- Title: The role of echocardiography in acute viral myocarditis
Authors: Mamotabo R Matshela
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: 239-244
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DOI Number: 10.5830/CVJA-2019-069
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-069
Abstract: The diagnosis of acute viral myocarditis can be very challenging during the initial evaluation, warranting multiple diagnostic tests to be performed, including a full echocardiographic evaluation to exclude other aetiologies that might present similarly. Acute myocarditis may masquerade as acute myocardial infarction in older patients or as any form of cardiomyopathy in young patients. As a result, all these patients need a thorough evaluation and to be managed at a high cardiac-care setting from the very outset. A wide range of diagnostic tests may be warranted, including conventional echocardiography, to exclude other underlying cardiac diseases, to evaluate cardiac chamber size, wall thickness, ventricular function and the presence of pericardial collections, and to assist in guiding further management. Although left ventricular dysfunction tends to be described more often, right ventricular dysfunction has been reported as the most likely cause of unfavourable outcomes, compared with left ventricular dysfunction. Therefore it is important to thoroughly evaluate and report all echocardiographic parameters for both ventricles and to determine the prognosis.
- Title: Case Report: Wellens’ syndrome: a life-saving diagnosis
Authors: Yan ming Chen, Kang xing Song
From: Cardiovascular Journal of Africa, Vol 30, Issue 4 July/August 2019
Published: 2019
Pages: e1–e3
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DOI Number: 10.5830/CVJA-2019-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-010
Abstract: Wellens’ syndrome is a relatively common clinical entity; however, it is often missed, especially in young patients. Without prompt diagnosis and aggressive intervention, patients with Wellens’ syndrome may rapidly go on to develop extensive anterior wall myocardial infarction and possibly sudden death. In this case report, we present a 33-year-old male patient with atypical chest pain, and discuss the significance of a prompt recognition of Wellens’ syndrome.
