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CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 31, ISSUE
2, MAR/APR 2020
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- Title: From The Editor’s Desk
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Page: 5
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- Title: Endothelial dysfunction in
HIV-positive patients with acute coronary
syndromes
Authors: Ahmed Vachiat, Therese Dix-Peek, Raquel Duarte, Pravin Manga
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 6-12
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DOI Number: 10.5830/CVJA-2019-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-040
Aim: This study investigated endothelial function in HIV-positive patients with acute coronary syndrome (ACS). Flow-mediated dilatation, pulse-wave velocity, carotid intima– media thickness and endothelial biomarkers were used to non-invasively investigate endothelial dysfunction.
Methods: Twenty HIV-positive patients with ACS (HIV+/ ACS) were compared to 20 HIV-negative patients with ACS (HIV-/ACS) and 20 HIV-positive patients without ACS (HIV+/no ACS).
Results: Endothelial function measured by flow-mediated dilatation (FMD) was similar in both the HIV+/ACS (5.2; IQR 1.4–13.4%) and HIV-/ACS groups (3.7; IQR 2.3–4.4%) (p = 0.78). Arterial stiffness, measured by pulse-wave velocity (PWV) was low in all three cohorts. Carotid intima–media thickness (CIMT) was also low in all three cohorts. The vascular cellular adhesion molecule-1 (VCAM-1) levels in HIV-positive patients with and without ACS were significantly higher than in the HIV-/ACS cohort (p = 0.033 and 0.024, respectively).
Conclusion: Non-invasive investigations such as FMD, CIMT and PWV did not identify patients with HIV who were at high risk of ACS. Endothelial biomarkers may be more useful markers to identify HIV-positive patients who have endothelial dysfunction and increased risk of ACS.
- Title: Does acid reflux precipitate
ischaemia in subjects with acute coronary
syndrome?
Authors: Sunil K George, Boikhutso Tlou, Somalingum Ponnusamy, Datshana P Naidoo
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 13–18
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DOI Number: 10.5830/CVJA-2019-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-048
Aim: It has been postulated that gastro-oesophageal reflux disease (GORD) may trigger coronary ischaemia through viscerocardiac reflex vasoconstriction in subjects with ischaemic heart disease (IHD). Our aim was to estimate the prevalence of GORD in subjects with IHD who present with acute coronary syndrome (ACS) and to determine whether GORD may serve as a trigger for ischaemic events.
Methods: Twenty patients with isolated reflux oesophagitis and 39 with acute coronary syndrome (ACS with concomitant GORD) were studied. Twenty-two subjects comprising normal volunteers and those who were admitted for minor surgical trauma were used as normal controls. All subjects underwent oesophago-gastroduodenal endoscopy (EGD) and acid instillation with hydrochloric acid (0.1 M), as well as nuclear imaging (sestaMIBI) with technetium99. Ischaemia was detected by ST depression using ECG monitoring for one hour during and immediately after EGD.
Results: Of the 111 subjects with ACS, 39 (35.1%) had erosive GORD and comprised the study group. Subjects with ACS had more incidence of diabetes (p = 0.001), hypertension (p = 0.002), a history of smoking (p = 0.006) and elevated serum triglyceride levels (p = 0.008) compared to the GORD group. Risk-factor clustering in the form of the metabolic syndrome was more common in ACS subjects (44 vs 5%; p = 0.008). ST depression was documented in 8/39 (20.5%) patients in the ACS group and 5/20 (25%) in the GORD group (p = 0.958). Reversible perfusion defects on sestaMIBI scan were seen in 35.6% of the ACS subjects.
Conclusion: Although GORD is common in subjects with ACS, we have not been able to show that GORD may serve as a trigger for ischaemia in these subjects.
- Title: Sevoflurane- and
propofol-based regimens show comparable effect
on oxygenation in patients undergoing cardiac
valve replacement with cardiopulmonary bypass
Authors: Zhen Luo, Xiaozhen Wei, Yunxia Zuo, Guizhi Du
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 19–22
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DOI Number: 10.5830/CVJA-2019-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-050
Background: Our study aimed to compare the effects of sevoflurane- and propofol-based anaesthetic regimens on oxygenation during the early period of cardiopulmonary bypass (CPB) in patients undergoing cardiac valve-replacement surgery.
Methods: Patients undergoing mechanical mitral, aortic or double valve replacement were enrolled and randomly divided into two groups: the sevoflurane-based anaesthetic regimen group consisted of patients who received 1–3% sevoflurane inhalation during anaesthesia maintenance and the propofolbased anaesthetic regimen group consisted of patients who received 6–10 mg/kg/h of propofol infusion during anaesthesia maintenance. The partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2), respiratory mechanics and haemodynamics were recorded during CPB.
Results: Forty-two patients met the eligibility criteria for the study. The groups did not differ in terms of clinical and demographic characteristics, and pre- and intra-operative features. Changes in oxygenation were mild (mean PaO2/FiO2 from 358 ± 82 to 471 ± 106 mmHg) within one hour of CPB in our patients. There were no differences in PaO2/FiO2, respiratory mechanics and haemodynamics between the sevoflurane and propofol groups.
Conclusion: In patients undergoing cardiac valve replacement with CPB, lung injury was mild, and sevoflurane- and propofol-based anaesthetic regimens showed similar effect on oxygenation, respiratory mechanics and haemodynamics during the early stage of CPB.
- Title: An easy method for monitoring
patients with pulmonary hypertension: P-wave
dispersion
Authors: Arif Oguzhan Cimen, Samim Emet
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 23–28
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DOI Number: 10.5830/CVJA-2019-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-053
Background: Pulmonary arterial hypertension (PAH) is a haemodynamic and pathophysiological condition with restricted flow through the pulmonary arterial circulation. In pulmonary hypertension, right ventricular hypertrophy and diastolic dysfunction can lead to an increase in atrial strain, fibrosis and dilation, which cause inhomogeneous atrial conduction. Interlead variation in P-wave duration is called P-wave dispersion (PwD), which is an electrocardiographic parameter that can be used to predict atrial arrhythmias. Our aim was to investigate the relationship between PwD, functional capacity, and invasive and non-invasive haemodynamic parameters of patients diagnosed with PAH.
Methods: Between 2015 and 2017 we enrolled 33 patients admitted to our in-patient clinic and diagnosed with PAH, and 32 healthy individuals for the control group. Details of these patients at the time of diagnosis were analysed, including gender, age, physical examination, electrocardiogram (ECG), echocardiography, six-minute walk test distance (6MWD), haemodynamic parameters and blood tests for biochemical markers that are correlated with clinical severity. Statistical analyses were performed using SPSS version 20.0 (SPSS Inc, Chicago, Illinois, USA). Statistical significance was taken as p < 0.05.
Results: In the forward stepwise multiple linear regression analysis, PwD and mean pulmonary artery pressure determined by right heart catheterisation were independently related to the functional capacity tested by the 6MWD (p < 0.02 and p < 0.01, respectively).
Conclusion: PwD can easily be calculated from a surface ECG to indirectly estimate the functional status and prognosis of the patient with PAH.
- Title: Lionel Henry Opie (6 May 1933
– 20 February 2020)
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 28
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- Title: Rooibos (Aspalathus linearis)
protects against nicotineinduced vascular injury
and oxidative stress in Wistar rats
Authors: Michelle Smit-van Schalkwyk, Shantal Windvogel, Hans Strijdom
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 29–38
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DOI Number: 10.5830/CVJA-2019-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-052
Background: Rooibos (Aspalathus linearis) is an indigenous South African plant, traditionally used by the local population as a remedy against several ailments. More recently, rooibos was shown to exhibit potent antioxidant properties, attributed to its polyphenols. We assessed whether treatment with fermented rooibos (RF), unfermented rooibos (RUF) and melatonin (Mel), a well-documented antioxidant included for comparison, could counter the harmful vascular and pro-oxidant effects of nicotine.
Methods: Vascular function, antioxidant enzyme activity and lipid peroxidation were assessed in male adult rats treated with nicotine (5 mg/kg body weight/day) and 2% RF, 2% RUF or 4% Mel co-administration. Nitric oxide (NO) production and cell viability were measured in nicotine-exposed rat aortic endothelial cells (AECs) pre-treated with RF (0.015 mg/ml).
Results: Vascular studies showed that co-administration with RF or Mel exerted anti-contractile and pro-relaxation responses in aortic rings, and increased hepatic superoxide dismutase and catalase activity in nicotine-exposed animals. Co-treatment with Mel additionally decreased lipid peroxidation in nicotine-exposed rats. RUF exerted anti-contractile responses in aortic rings of nicotine-treated animals, while in nicotine-exposed AECs, RF pre-treatment increased intracellular NO levels.
Conclusion: For the first time, we have shown that rooibos co-treatment exerted beneficial vascular effects in nicotineexposed rats, and that this was associated with increased antioxidant enzyme activity.
- Title: Impact of metabolic and
inflammatory changes on glomerular function
beyond conventional risk factors in an urban
South Africa community with prevalent obesity
Authors: Glenda Norman, Angela J Woodiwiss, Vernice Peterson, Monica Gomes, Pinhas Sareli, Gavin R Norton
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 39-50
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DOI Number: 10.5830/CVJA-2019-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-057
Objectives: To determine the extent to which metabolic and inflammatory changes are associated with renal damage beyond conventional risk factors in a community sample with a high prevalence of obesity in urban South Africa.
Methods: This was a cross-sectional, community-based study in 1 010 (n = 872 without diabetes mellitus, DM) randomly selected participants over 16 years of age in an urban, developing community (Soweto, Johannesburg) with a high prevalence of obesity (41.8%). We assessed estimated glomerular filtration rate (eGFR), conventional risk factors including adiposity indices, and metabolic changes and plasma resistin concentrations (ELISA) and the homeostasis model of insulin resistance (HOMA-IR). Relationships independent of haemodynamic loads were confirmed using ambulatory blood pressure and central arterial haemodynamics.
Results: In multivariate regression models conducted in those without DM, HOMA-IR (standardised β-coefficient = –0.13 ± 0.03, p < 0.0001) and plasma resistin concentrations (β-coefficient = –0.10 ± 0.02, p < 0.0001) were second only to age, and at least as strong as systolic blood pressure (β-coefficient = –0.04 ± 0.03, p = 0.19) in the impact on eGFR, while alternative conventional risk factors including adiposity indices and the metabolic syndrome features contributed little to eGFR. Similar results were obtained in relationships with chronic kidney disease (CKD) and in the whole group including those with DM. Adjustments for ambulatory blood pressure or central arterial loads did not influence these relationships.
Conclusions: The impact on glomerular function of insulin resistance and inflammatory changes is well beyond modifiable conventional risk factors, including the metabolic syndrome. Targeting conventional risk factors alone is likely to result in a marked residual risk of renal damage produced by insulin resistance and inflammation.
- Title: PASCAR and WHF Cardiovascular
Diseases Scorecard project
Authors: Anastase Dzudie, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Samuel Kingue
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: 51-58
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DOI Number: 10.5830/CVJA-2020-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-015
Abstract: Data collected by PASCAR for the World Heart Federation’s Cardiovascular Diseases Scorecard project in Africa are presented. We summarise the strengths, threats, weaknesses and priorities identified from the collected data, which need to be considered in conjunction with the associated sections in the accompanying infographic. Data sets that were used include open-source data from the World Bank, World Health Organization and government publications.
- Title: Large left ventricular
non-infectious vegetation in patient with
eosinophilic granulomatosis with polyangiitis
Authors: Yun-Seok Song, Sang-Hoon Seol, Jino Park, Dong-Kie Kim, Yeo-Jeong Song, Seunghwan Kim, Ki-Hun Kim, Doo-Il Kim, Chan-Seon Park, Yeon-Mi Kim
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: e1-e4
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DOI Number: 10.5830/CVJA-2019-065
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-065
Abstract: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare form of systemic vasculitis in which cardiac involvement is relatively common and accounts for half of EGPA-related deaths. Cardiac involvement is more frequent in patients with an absence of anti-neutrophil cytoplasmic antibody and those with higher eosinophil counts. Clinical manifestations are various, including myocarditis, pericarditis, pericardial effusion, heart failure, arrhythmias, valvular insufficiencies and intra-cardiac thrombus formation. The pathology of cardiac involvement in EGPA is usually endomyocardial and pericardial eosinophilic infiltration. Considering the potentially adverse outcomes associated with cardiac involvement in EGPA, early detection is important. We experienced a rare case of EGPA with cardiac involvement presenting with noninfectious vegetations.
- Title: A 31-year-old pericardial
textiloma
Authors: Dong Kyu Kim, Su Kyung Hwang, Sang Cjeol Lee, Yong Jik Lee, Jong Pil Jung, Chang Ryul Park, Gwan Sic Kim
From: Cardiovascular Journal of Africa, Vol 31, Issue 2 March/April 2020
Pages: e5-e8
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DOI Number: 10.5830/CVJA-2019-068
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-068
Abstract: Gossypibomas are uncommon but important complications of surgery. This case report is of a gossypiboma found accidentally 31 years after heart surgery. A 41-year-old man had lost 5 kg in the previous three months and suffered from intermittent epigastric discomfort. A computed tomography scan incidentally revealed a well-defined mass in the right lower anterior mediastinum. Given his history of previous cardiac surgery to repair a ventricular septal defect, the possibility of gossypiboma could not be excluded. Elective excision of the mass was performed through a median sternotomy, and a 5-cm ovoid mass consisting of a thrombus and gauze was removed. The postoperative course was uneventful. The patient’s clinical findings were normal, with no abnormal findings on transthoracic echocardiogram performed one year later.
