CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 31, ISSUE
1, JAN/FEB 2019
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- Title: What cardiology training and cardiac procedural training does Africa need?
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Page: 3
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- Title: Cardiac pacing in sub-Saharan Africa
Authors: Aimé Bonny, Olujimi A Ajijola, Mohamed Jeilan, Mahmoud Sani, Zaheer Yousef, Matthew F Yuyun, Kamilu Karaye, Mervat Aboulmaaty Nahib, Yazid Aoudia, Loreen Akinyi, Marcus Ngantcha, Saad Subahi, Felix Sogade, Ashley Chin
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Pages: 3-4
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DOI Number: 10.5830/CVJA-2020-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-001
- Title: A cross-sectional cohort study with microvascular complications in patients with type 2 diabetes with and without hypothyroidism
Authors: Louise Johnson, Brian Rayner
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 5–8
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DOI Number: 10.5830/CVJA-2019-036
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-036
Objectives: Previous reports have suggested an association between hypothyroidism and macrovascular complications in type 2 diabetes (T2DM) but the association with microvascular complications is not well documented. This study aimed to determine whether there were significant differences in these complications in patients with T2DM with and without hypothyroidism.
Methods: This was a retrospective, cross-sectional, case– control study from a single centre specialising in diabetes in South Africa. T2DM was defined by American Diabetes Association criteria. The cases were all patients treated for hypothyroidism and the controls were clinically and biochemically confirmed euthyroid, who were under follow up between 1 January and 1 July 2016. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) of < 60 ml/min, determined by the CKD-epidemiology collaboration equation (CKD-EPI) and/or albumin/creatinine ratio > 3 mg/mmol. Diabetic retinopathy (DR) was defined as the presence of aneurysms, bleeds, exudates and new vessel formation on the retina examined by an ophthalmologist. Diabetic peripheral neuropathy (DPN) was defined as the presence of symptoms, loss of 128-Hz sensation and abnormal 10-gm monofilament. Cardiovascular disease (CVD) was defined as the presence of major adverse cardiovascular events (MACE).
Results: There were 148 cases and 162 controls. Compared to the controls, the cases were older (65.6 vs 59.4 years, p < 0.00001), more likely to be female (67.6 vs 39.5%, p < 0.0001) and white (89.2 vs 79.6%, p = 0.02), have a lower HbA1c level (7.5 vs 8.2%, p = 0.0001), eGFR (64.4 vs 72.7 ml/min, p = 0.0006) and triglyceride level (2.18 vs 2.55 mmol/l, p = 0.04), have a higher high-density lipoprotein cholesterol level (1.13 vs 1.02 mmol/l, p = 0.001), a longer duration of diabetes (14.8 vs 11.6 years, p = 0.001) and using fewer antidiabetic agents (1.82 vs 2.19, p = 0.001). There was a higher prevalence of CKD (44 vs 57.8%, p = 0.03) and CVD (59.3 vs 45.3, p = 0.06), and a trend towards higher DR (66.7 vs 47.6, p = 0.09). There was no difference in body mass index, hypertension, low-density lipoprotein cholesterol level (all patients received statin therapy), DPN and amputations. After adjusting for confounding factors, there was no association between CKD and DR, and hypothyroidism, but the trend to association with CVD persisted (OR 1.97. p = 0.07).
Conclusions: Hypothyroidism in T2DM was not associated with microvascular disease after adjusting for confounding factors. There was a nearly two-fold risk of CVD. The study is limited by the retrospective and observational design.
- Title: Healthy Heart Africa: a prospective evaluation of programme outcomes on individuals’ hypertension awareness, screening, diagnosis and treatment in rural Kenya at 12 months
Authors: Gerald Yonga, Francis O Okello, Jane L Herr, Ashling Mulvaney, Elijah N Ogola
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 9–15
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DOI Number: 10.5830/CVJA-2019-037
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-037
Objective: To evaluate the impact of Healthy Heart Africa (HHA), a comprehensive hypertension intervention programme, on hypertension awareness, knowledge, screening and diagnosis among rural communities in Kenya.
Methods: Individuals from rural households near intervention and matched control healthcare facilities were randomly surveyed at baseline and the end point (after 12 months). A difference-in-differences analysis estimated the impact of HHA.
Results: This analysis included 838 individuals (intervention, n = 432; control, n = 406) at baseline and 698 (n = 364 and n = 334, respectively) at the end point. At baseline, both groups had high hypertension awareness (> 80%) but poor knowledge. After 12 months, healthcare providers were the primary information source for the intervention group only (p < 0.05). At the end point, respondents’ knowledge of hypertension risk factors, consequences and management trended higher among the intervention versus the control group. Hypertension screening/diagnosis and patient recall of provider recommendations remained unchanged in both groups.
Conclusion: HHA improved hypertension knowledge but screening and diagnosis remained unchanged after 12 months.
- Title: OPCAB surgery with an alternative retraction method: a single-centre experience
Authors: Erdem Cetin, Tolga Can, Celal Selcuk Unal, Aydin Keskin, Emre Kubat
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 16–20
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DOI Number: 10.5830/CVJA-2019-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-038
Background: The off-pump coronary artery bypass (OPCAB) technique, which is used in order to avoid the side effects of cardiopulmonary bypass, is often questioned in terms of its efficacy and safety. Also, in this technique, surgeon experience plays a very important role. In this study, we share the results of our 606 OPCAB cases with an alternative retraction technique.
Methods: This study was a retrospective analysis of OPCAB operations performed between January 2014 and December 2018. Patients were evaluated and operated on by a surgical team led by an experienced OPCAB surgeon with over 200 prior OPCAB surgeries.
Results: The study included 606 OPCAB cases, and 21.8% (132) were female and 78.2% (474) were male. Our mortality rate was 1.7% (n = 10) and only two patients suffered a cerebrovascular incident. A statistically significant difference was found between pre-operative and six-month postoperative left ventricular ejection fraction values (p < 0.01).
Conclusion: The OPCAB technique can be performed with similar results to on-pump surgery when conducted by an experienced surgeon, as in our study.
- Title: Relationship between clot burden in pulmonary computed tomography angiography and different parameters of right cardiac dysfunction in acute pulmonary embolism
Authors: Heba wagih Abdelwahab, Shreif Arafa, Khaled Bondok, Nihal Batouty, Mostafa Bakeer
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 21-24
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DOI Number: 10.5830/CVJA-2019-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-041
Background: Pulmonary computed tomography angiography (CTA) contains a wealth of information regarding the diagnosis and impact of acute pulmonary embolism (PE). Echocardiography remains the recommended examination to detect signs of right ventricular (RV) dysfunction in patients with shock or hypotension following PE.
Objectives: To detect the relationship between clot volume in pulmonary CTA and different parameters of RV dysfunction assessed by echocardiography and pulmonary CTA in patients with acute PE.
Methods: A cross-sectional study was performed on patients with acute PE from June 2017 to June 2018. Enrolled patients were assessed clinically, radiologically and for cardiac dysfunction. The relationship between clot volume and RV dysfunction was assessed using pulmonary CTA and echocardiography. Data were analysed with SPSS version 16. Correlations were studied using the Spearman and Kruskal– Wallis tests.
Results: There was a significant correlation found between clot volume and parameters of RV dysfunction, assessed by pulmonary CTA, including RV diameter (p < 0.001), RV to left ventricular (LV) diameter ratio (p = 0.01), pulmonary artery diameter (p = 0.01), ratio of main pulmonary artery to ascending aorta diameter (p = 0.04), and superior vena cava diameter (p = 0.01). On the other hand, there was no significant correlation between clot volume and parameters of RV dysfunction assessed by echocardiography.
Conclusion: In patients with acute PE, the assessment of RV dysfunction using pulmonary CTA showed good correlation with clot burden, unlike the assessment done with echocardiography.
- Title: Salidroside protects the cardiac function of exhausted rats by inducing Nrf2 expression
Authors: Peng Xu, Yang Wang, Weiwei Sun, Yawei Sun, Wei Lu, Yumei Chang, Zheng Ping, Yang Li, Xuebin Cao
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 25–32
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DOI Number: 10.5830/CVJA-2019-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-043
Objective: To investigate whether salidroside (Sal) protected the rat heart from exhaustive exercise-induced injury by inducing nuclear factor erythroid 2-related factor 2 (Nrf2) expression.
Methods: Forty-eight male Sprague-Dawley rats were divided into four groups (n = 12 rats per group): the control, the exhaustive swimming (ES) group, the low-dose Sal plus acute exhaustive swimming (SLE) group, and the high-dose Sal plus acute exhaustive swimming (SHE) group. In the SLE and SHE groups, 15 and 30 mg/kg Sal were administered, respectively, once a day. The rats in the control and ES groups were administered the same amount of physiological saline, respectively, once a day. On the 14th day, the rats in the ES, SLE and SHE groups underwent exhaustive swimming training once. Then cardiac function parameters and electrocardiograms were recorded. Biomarkers of myocardial injury in the serum and oxidative stress factors in the myocardial tissue were evaluated using ELISA tests. The levels of Nrf2, nuclear Nrf2 and Kelch-like ECH-associated protein 1 (Keap1) messenger RNA and proteins were assessed in the myocardium using q-PCR and Western blotting, respectively.
Results: Compared to the control group, the ES group showed remarkable increases in serum brain natriuretic peptide (BNP), cardiac troponin I (cTnI) and reactive oxygen species levels, but significant decreases in catalase and glutathione levels (p < 0.05). Compared to the ES group, the Sal treatment decreased serum BNP and cTnI levels and alleviated the changes in levels of oxidative stress-related factors. After treatment with Sal, nuclear and intracellular levels of Nrf2 protein were increased in the myocardial cells, while the level of Keap1 protein was decreased (p < 0.05).
Conclusion: Sal protected the heart from exhaustive exerciseinduced injury, and it may improve cardiac function and cardiac bioelectricity in exhausted rats by inducing Nrf2 expression.
- Title: Ductal closure in infants under 6 kg including premature infants using AmplatzerTM duct occluder type two additional sizes: a single-centre experience in South Africa
Authors: Lungile Pepeta, Adele Greyling, Mahlubandile Fintan Nxele, Zongezile Makrexeni, Samkelo Jiyana
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 33-39
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DOI Number: 10.5830/CVJA-2019-044
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-044
Background: This is a report on percutaneous closure of patent ductus arteriosus (PDA) using Amplatzer Duct Occluder type two additional sizes (ADO II AS) in patients under 6 kg.
Methods: Prospective data were collected and a review of patients’ records was conducted. Demographics, and angiographic and clinical outcomes are reported in this article.
Results: During the period June 2011 to June 2017, of the 92 patients who underwent closure of the PDA using the ADO II AS device, 59 were under 6 kg. The median weight of the cohort at closure was 3.6 kg (range: 900 g – 5.8 kg). The median ductal diameter was 1.9 mm (range: 1.0–3.4 mm). Three embolisations in the cohort were all retrieved percutaneously. Two PDAs were closed percutaneously and one surgically. Four premature infants required blood transfusions. The closure rate was 96.6% before discharge.
Conclusion: PDA closure using ADO II AS in small infants is feasible, effective and has few complications.
- Title: Echocardiographic left atrial remodelling and determinants of left atrial size in the early phase of high blood pressure: a comparative cross-sectional study in Douala, Cameroon
Authors: Armelle Corrine Simo Gounoue, Anastase Dzudie Tamdja, Simeon-Pierre Choukem, Hamadou Ba, Sidick Mouliom Aboubakar, Archange Nzali, Marie Patrice Halle, Clovis Nkoke, Benjamin Momo Kadia, Martin Hongieh Abanda, Chris Nadege Nganou, Marcel Kenfack Abzabji, Samuel Kingue
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 40-46
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DOI Number: 10.5830/CVJA-2019-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-046
Background: Left atrial remodelling (LAR) has been described in Western populations with chronic hypertension and is associated with a higher risk of adverse cardiovascular events. Although hypertension tends to occur earlier and is more severe in sub-Saharan Africa than in more developed nations, LAR and its associated factors in these African hypertensive subjects have been poorly elucidated.
Objectives: To assess left atrial structural remodelling in black hypertensive patients and determine factors associated with left atrial size.
Methods: This was a cross-sectional, comparative study carried out in two tertiary hospitals in Douala, Cameroon over a period of three months. Fifty-two patients, either newly diagnosed with hypertension or known hypertensives treated for less than a year, were consecutively recruited. These patients were matched (unpaired matching) for age and gender to 40 randomly selected healthy subjects. The posterior– anterior diameter indexed to body surface area (BSA), volume indexed to BSA, and longitudinal and transverse diameters of the left atrium (LA) were measured using transthoracic echocardiography, in accordance with the American Society of Echocardiography guidelines. LAR was defined as increase in LA size, characterised by LA volume ≥ 34 ml/ m2. Early morning urine was analysed for microalbuminuria using urine strips to obtain spot albumin/creatinine ratio. Data were analysed using SPSS version 23 and statistical significance was set at p < 0.05.
Results: The gender distribution and mean age were similar between the two groups. Hypertensive patients had significantly higher mean body mass index, left ventricular mass and an altered diastolic function. They also had significantly higher LA longitudinal diameter (50.0 vs 47.4 mm; p = 0.045), surface area (17.9 vs 15.5 cm2; p = 0.003) and volume (52.4 vs 43.8 ml; p = 0.002) compared to the non-hypertensive counterparts. Fourteen patients (26.9%) had LA enlargement compared to one (2.5%) in the non-hypertensive group (odds ratio = 9.78, CI: 2.67–35.8, p < 0.0001). Diastolic dysfunction (p = 0.008) was the only independent predictor of LA size in the hypertensive subjects. Microalbuminuria did not significantly correlate with LA size.
Conclusion: Our study shows evidence of LAR in newly diagnosed black African patients with hypertension, characterised by an increase in the LA length, surface area and volume. Future studies are warranted to better elucidate the biological mechanisms underlying the link between the early phase of hypertension and LAR, as well as its prognostic implications in our population.
- Title: Geographical influence on the distribution of the prevalence of hypertension in South Africa: a multilevel analysis
Authors: Muchiri E Wandai, Shane A Norris, Jens Aagaard-Hansen, Samuel OM Manda
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Published: 2019
Pages: 47-54
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DOI Number: 10.5830/CVJA-2019-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-047
Background: As a response to the growing burden of noncommunicable diseases, the South African government has set targets to reduce the prevalence of people with raised blood pressure, through lifestyle changes and medication, by 20% by the year 2020. It has also recognised that the prevalence varies at local administrative level. The study aim was to determine the geographical variation by district of the prevalence of hypertension among South African adults aged 15 years and above.
Methods: Data from all five waves of the National income Dynamics Study, a panel survey, were used for estimation by both design-based and multilevel analysis methods. In the multilevel analysis, a three-level hierarchy was used with panel participants in the first level, repeated measurements on patients in the second level, and districts in the third level.
Results: After accounting for demographic, behavioural, socio-economic and environmental factors, significant variation remained in the prevalence of hypertension at the district level. Districts with higher-than-average prevalence were found mostly in the south-western part of the country, while those with a prevalence below average were found in the northern area. Age, body mass index and race were the individual factors found to have a strong effect on hypertension prevalence for this sample.
Conclusions: There were significant differences in hypertension prevalence between districts and therefore the method of analysis and the results could be useful for more targeted preventative and control programmes.
- Title: A giant aneurysm of the left anterior descending coronary artery in the setting of Behcet’s disease
Authors: Mejdi Ben Messaoud, Nidhal Bouchahda, Ayoub Belfekih, Fadwa Omri, Mezri Maatouk, Walid Mnari, Habib Gamra
From: Cardiovascular Journal of Africa, Vol 31, Issue 1 January/February 2020
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2019-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-031
Abstract: Behcet’s disease is a chronic inflammatory syndrome that can affect arteries and veins of all sizes and is an unusual cause of myocardial infarction. We report a case of a 42-year-old male with no cardiovascular risk factors who was referred to our department for a spontaneously resolving anterior ST-elevation myocardial infarction. Clinical and biological investigations revealed a high probability for Behcet’s disease. The coronary angiogram showed severe left main artery stenosis with a huge coronary aneurysm of the proximal left anterior descending coronary artery, which was treated by aneurysm resection and coronary artery bypass grafting. Inflammatory arteritis should be considered in young patients with low cardiovascular risk presenting with acute coronary syndrome.
