CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 30, ISSUE
5, SEP/OCT 2019
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Supplement to CVJA: Abstracts: PASCAR, SA Heart & Africa PCR Join forces for the 2019 Congress.
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Supplement to CVJA: Abstracts: PASCAR, SA Heart & Africa PCR Join forces for the 2019 Congress.
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- Title: Familial hypercholesterolaemia and its management in South Africa
Authors: AD Marais
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 247-248
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DOI Number: 10.5830/CVJA-2019-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-054
- Title: Renal denervation: bleak
past, brighter future
Authors: Brian Rayner
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 249–250
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DOI Number: 10.5830/CVJA-2019-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-056
- Title: The effects of HIV/AIDS on the clinical profile and outcomes post pericardiectomy of patients with constrictive pericarditis: a retrospective review
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 251–257
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DOI Number: 10.5830/CVJA-2019-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-015
Objective: The clinical profile and surgical outcomes of patients with constrictive pericarditis were compared in HIV-positive and -negative individuals.
Methods: This study was a retrospective analysis of patients diagnosed with constrictive pericarditis at Inkosi Albert Luthuli Central Hospital, Durban, over a 10-year period (2004–2014).
Results: Of 83 patients with constrictive pericarditis, 32 (38.1%) were HIV positive. Except for pericardial calcification, which was more common in HIV-negative subjects (n= 15, 29.4% vs n = 2, 6.3%; p = 0.011), the clinical profile was similar in the two groups. Fourteen patients died preoperatively (16.9%) and three died peri-operatively (5.8%).On multivariable analysis, age (OR 1.17; 95% CI: 1.03–1.34; p = 0.02), serum albumin level (OR 0.63; 95% CI: 0.43–0.92; p = 0.016), gamma glutamyl transferase level (OR 0.97; 95% CI: 0.94–0.1.0; p = 0.034) and pulmonary artery pressure (OR 1.49; 95% CI: 1.07–2.08; p = 0.018) emerged as independent predictors of pre-operative mortality rate. Peri-operative complications occurred more frequently in HIV-positive patients [9 (45%) vs 6 (17.6%); p = 0.030].
Conclusions: Without surgery, tuberculous constrictive pericarditis was associated with a high mortality rate. Although peri-operative complications occurred more frequently, surgery was not associated with increased mortality rates in HIV-positive subjects.
- Title: Ellisras Longitudinal Study
2017: association of hypertension with
increasing levels of adiposity in 10- to
14-year-old boys and girls in the Eastern Cape
(ELS 31)
Authors: A Chungag, CM Tata, CR Sewani-Rusike, W Nel, BN Nkeh-Chungag
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 258–261
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DOI Number: 10.5830/CVJA-2019-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-017
Objectives: Previous studies suggest a strong relationship between obesity and hypertension. This study aimed at evaluating the prevalence of hypertension and pre-hypertension in 10- to 14-year-old boys and girls in the Eastern Cape Province of South Africa and to determine the association between blood pressure parameters and selected measures of adiposity.
Methods: A cross-sectional, school-based study of 540 10-to14-year-old children from seven schools in the Eastern Cape Province was carried out. Anthropometry and blood pressure parameters were determined.
Results: All measures of adiposity and blood pressure were significantly higher in the girls (p < 0.05). The prevalence of hypertension and pre-hypertension was over 20 and 12%, respectively. Systolic blood pressure and pulse pressure were associated (r > 0.27; p < 0.05) with increasing levels of adiposity.
Conclusion: This study highlights the importance of weightcontrol strategies for the prevention of hypertension in these adolescents and later on in life.
- Title: Ellisras Longitudinal Study
2017: patterns of physical activity in an urban
and rural setting among black South African
adults (ELS 23)
Authors: Z Smart Mabweazara, L Lloyd Leach, Mario Smith, Lungiswa Tsolekile, Thandi Puoane
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 262–267
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DOI Number: 10.5830/CVJA-2019-018
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-018
Background: Understanding patterns of physical activity among adults can lead to targeted approaches to improve activity levels in the African population. This study aimed to determine whether age, gender, location and employment status could predict physical activity among rural and urban South African adults, and to determine the participants’ risk of developing cardiovascular disease (CVD).
Methods: A cross-sectional design was conducted on 319 participants of mean age 57 ± 10.43 years. Participants were sampled using a stratified random-sampling procedure from an urban township in Langa, Western Cape Province, and a rural township in Mt Frere, Eastern Cape Province, South Africa. A researcher-generated questionnaire was used to collect sociodemographic and hysical activity data. Linear regression analysis was used to test predictive relationships.
Results: Gender and geographical location were significant predictors (p = 0.001) of physical activity. Rural participants engaged more in physical activity (91.5%) than urban participants (84.2%) and were more likely to meet the physical activity recommendations to promote cardiovascular fitness (p = 0.000). The most frequent physical activities in rural participants were walking (15.4%), household chores (18.8%) and household chores + gardening (15.4%). The most frequent physical activities in urban participants were household chores (34.2%), and household chores + walking (33.7%). In terms of duration of physical activity, rural participants spent longer periods engaging in activities lasting up to two hours (21.4%), compared to 5.9% in urban participants (p = 0.000).
Conclusions: Gender and geographical location were significant predictors of physical activity among black South African adults. Overall, rural adults engaged in more physical activity than urban-dwelling adults. Males also engaged in more physical activity and at a higher intensity than females. Most rural participants met the American College of Sports Medicine recommendations for cardiovascular fitness and therefore were at minimal risk for developing CVD compared to their urban counterparts.
- Title: Effects of atorvastatin on
time-dependent change of fast sodium current in
simulated acute ischaemic ventricular myocytes
Authors: Hongshi Li, Zheng Wan, Xiaolong Li, Tianming Teng, Xin Du, Jing Nie
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 268–274
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DOI Number: 10.5830/CVJA-2019-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-021
Introduction: Our previous experiments showed that the transient sodium current (INa) was abnormally increased in early ischaemia and atorvastatin could inhibit INa. The aim of this study was to observe the time-dependent effects of simulated ischaemia on INa and characterise the direct effects of atorvastatin on ischaemic INa.
Methods: Left ventricular myocytes were isolated from Wistar rats and randomly divided into two groups: a control group (normal to simulated ischaemia) and a statin group (normal to simulated ischaemia with 5 μmol/l atorvastatin). The INa was recorded under normal conditions (as baseline) by wholecell patch clamp and recorded from three to 21 minutes in the next phase of simulated ischaemic conditions.
Results: In the control group, normalised INa (at –40 mV) was increased to the peak (1.15 ± 0.08 mA) at three minutes of ischaemia compared with baseline (0.95 ± 0.04 mA, p < 0.01), it subsequently returned to baseline levels at nine and 11 minutes of ischaemia (0.98 ± 0.12 and 0.92 ± 0.12 mA, respectively), and persistently decreased with prolonged ischaemic time. In the statin group, there were no differences between baseline and the early stages of ischaemia (0.97 ± 0.04 mA at baseline vs 0.92 ± 0.12 mA in ischaemia for three minutes, p > 0.05).
Conclusion: Our results suggest that, in the early stages of ischaemia, changes in INa in ventricular myocytes are time-dependent, showing an initial increase followed by a decrease, while atorvastatin inhibited the transient increase in INa and made the change more gradual.
- Title: Effects of cardiopulmonary
bypass on dialysisdependent patients
Authors: Nursen Tanrıkulu, Baburhan Ozbek
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 275–278
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DOI Number: 10.5830/CVJA-2019-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-023
Background: End-stage renal disease is considered an independent risk factor for early and late survival after coronary artery bypass grafting.
Methods: We retrospectively analysed patients with dialysisdependent renal insufficiency who had undergone coronary artery bypass surgery between 2010 and 2017. Patients who were operated with the assistance of cardiopulmonary bypass (ONCAB) were in group 1 and those operated with off-pump coronary artery bypass surgery (OPCAB) were in group 2. We compared peri-operative morbidity and mortality rates and short-term results of the two groups.
Results: There were 74 patients in group 1 and 36 in group 2. Blood transfusion requirement, drainage, need for intraaortic balloon pump and duration of stay in intensive care unit was statistically significantly higher in group 1 (p < 0.05). Also, postoperative creatine kinase (CK) and creatine kinasemuscle/ brain (CKMB) values were statistically significantly higher in group 1 (p = 0.003).
Conclusion: Coronary artery bypass grafting under ONCAB was a potential risk for morbidity and mortality in patients with end-stage renal disease. Performing OPCAB surgery may improve postoperative outcomes and should be kept in mind as a surgical option.
- Title: Long-term safety and efficacy
of alirocumab in South African patients with
heterozygous familial hypercholesterolaemia: the
ODYSSEY Open-Label Extension study
Authors: Dirk J Blom, Johannes Breedt, Lesley J Burgess, Iftikhar O Ebrahim, Graham Ellis, Prashilla Soma, Eugene van der Walt, Poobalan Naidoo, Alet van Tonder, Frederick J Raal
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 279–284
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DOI Number: 10.5830/CVJA-2019-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-039
Background: Alirocumab reduces low-density lipoprotein cholesterol (LDL-C) levels by up to 61%. The ODYSSEY Open-Label Extension study investigated the effect of alirocumab in patients with heterozygous familial hypercholesterolaemia (HeFH) over 144 weeks.
Methods: Eligible patients with HeFH had completed an earlier double-blind, randomised, placebo-controlled parent study. Patients were initiated on 75 mg alirocumab Q2W subcutaneous (SC) unless baseline LDL-C was > 8.9 mmol/l, in which case they received 150 mg alirocumab Q2W. Dose titration to 150 mg Q2W was at the investigator’s discretion. Results: The study enrolled 167 patients and the parent study mean (± SD) baseline LDL-C level was 3.65 ± 1.9 mmol/l. Mean LDL-C level was reduced by 48.7% at week 144; mean on-treatment LDL-C was 2.30 ± 1.24 mmol/l. Eight patients reported injection-site reactions, with one treatment iscontinuation. Treatment emergent anti-drug antibodies were identified in five patients but these did not affect the efficacy.
Conclusion: Alirocumab effectively and safely reduced LDL-C in these patients.
- Title: Clinical outcome of
intracoronary versus intravenous high-dose bolus
administration of tirofiban in diabetic patients
undergoing primary percutaneous coronary
intervention
Authors: Ahmed A Ghonim, Abdalla Mostafa, Ahmed Emara, Alaa S Algazzar, Mohammed A Qutub
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 285–289
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DOI Number: 10.5830/CVJA-2019-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-027
Background: Previous trials remain inconsistent regarding the advantages and hazards related to intracoronary (IC) compared with intravenous (IV) administration of thrombolytics. We aimed to evaluate the safety and effectiveness of IC versus IV tirofiban administration in diabetic patients (DM) with acute ST-segment elevation myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI).
Methods: This trial included 95 patients who were randomised to high-dose bolus plus a maintenance dose of tirofiban administered either IV or IC. The groups were compared for the incidence of composite major adverse cardiac events (MACE) at 30 days. Levels of cardiac markers were recorded pre- and post-intervention for myocardial perfusion.
Results: The MACE were not different between the groups, but post-procedure myocardial blush grade (MBG) 3 and thrombolysis in myocardial infarction (TIMI) 3 flow were significant in the IC group (p = 0.45, 0.21, respectively), favouring the IC strategy. Peak values of both creatine kinase-muscle/brain (CK-MB) and high-sensitivity troponin T (hs-TnT) were significantly lower in the IC group (155.68 ± 121, 4291 ± 334 ng/dl) versus the IV group (192.4 ± 86, 5342 ± 286 ng/dl) (p = 0.021, p = 0.035, respectively). The peak value was significantly lower in the IC group than the IV group in terms of ST-segment resolution and 30-day left ventricular ejection fraction (LVEF) (p = 0.016 and 0.023, respectively).
Conclusion: Thirty days post PCI, IC tirofiban was more efficient in ameliorating blood flow in the coronary arteries and myocardial tissue perfusion in DM patients after STEMI despite bleeding events, and MACE rates showed no significant difference between the groups. The IC group showed better improvement in LVEF.
- Title: Renal denervation: dark past,
bright future?
Authors: Marshall Heradien, Felix Mahfoud, Doug Hettrick, Paul Brink
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 290–296
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DOI Number: 10.5830/CVJA-2019-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-045
Abstract: The purpose of this review is to update the reader on the relevance of autonomic nervous system imbalance in clinical cardiology. Increased sympathetic tone associates with the metabolic syndrome, hypertension and cardiac arrhythmias. With the kidneys playing a pivotal role in increased peripheral resistance, sodium and water retention and other mechanisms, renal denervation (RD) may theoretically restore autonomic imbalance and improve cardiovascular outcomes. Landmark RD trials and novel uses for RD in cardiac arrhythmia management are discussed.
- Title: Familial
hypercholesterolaemia workshop for leveraging
point-of-care testing and personalised medicine
in association with the Lipid and
Atherosclerosis Society of Southern Africa
Authors: AD Marais, MJ Kotze, FJ Raal, AA Khine, PJ Talmud, SE Humphries
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 297–304
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DOI Number: 10.5830/CVJA-2019-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-055
Abstract: Familial hypercholesterolaemia (FH) is a common autosomal dominantly inherited disorder in which impaired clearance of plasma low-density lipoprotein cholesterol causes premature atherosclerotic vascular disease and tendon xanthomata. This workshop aimed to consolidate information on the diagnosis and management of FH in South Africa. The genetic causes include mutations in the LDL receptor, apolipoprotein B100 and proprotein convertase subtilisin/kexin type 9 (PCSK9). Additionally, the concatenation of multiple gene variants can result in polygenic FH. Therapeutic measures include a healthy lifestyle, statins and cholesterol-absorption inhibitors that will achieve control of the dyslipidaemia in the majority of cases. The recently introduced monoclonal antibodies to PCSK9 can improve achievement of target concentration in severe cases. FH is present in all sectors of the South African population but there is sparse documentation in the indigenous African populations. FH should be actively sought, diagnosed and treated with judicious pharmacotherapy and screening of relatives.
- Title: PASCAR and WHF Cardiovascular
Diseases Scorecard project
Authors: Awad A Mohamed, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Saad Subahi
From: Cardiovascular Journal of Africa, Vol 30, Issue 5 September/October 2019
Published: 2019
Pages: 305–310
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DOI Number: 10.5830/CVJA-2019-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-063
Abstract: On behalf of the World Heart Federation, the Pan-African Society of Cardiology (PASCAR) co-ordinated data collection and reporting for the country-level Cardiovascular Diseases (CVD) Scorecard to be used in Africa. The objective of the scorecard is to create a clear picture of the current state of CVD prevention, control and management per country for 12 African countries. The Sudan Heart Society assisted PASCAR in collating and verifying the data through Drs Awad Mohamed (president, Sudan Heart Society) and Saad Subahi (PASCAR president, based in Sudan). Based on the data collected, we summarise the strengths, threats, weaknesses and priorities identified, which need to be considered in conjunction with the associated sections provided in the infographic published with this report. Data sets used included open-source data from the World Bank, World Health Organisation and government publications.
