CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 31, ISSUE
3, MAY/JUNE 2020
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- Title: Editorial - Cardiovascular
care in sub-Saharan Africa during the COVID-19
crisis: lessons from the global experience
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Page: 113-115
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- Title: The effects of aquatic and
land exercise on resting blood pressure and
post-exercise hypotension response in elderly
hypertensives
Authors: Francisco ADM Júnior, Samuel G Gomes, Fernando F da Silva, Perciliany M Souza, Emerson C Oliveira, Daniel B Coelho, Raimundo M Nascimento-Neto, Wanderson Lima, Lenice K Becker
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 116-122
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DOI Number: 10.5830/CVJA-2019-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-051
Objective: This study compared resting blood pressure (BP) using ambulatory BP monitoring (ABPM) responses in two groups of subjects trained in land exercise (LE) and aquatic exercise (AE), and assessed post-exercise hypotension (PEH) using ABPM, after land- and aquatic-based exercises.
Methods: ABPM (24 hours) was used to measure the baseline BP in elderly hypertensive women trained in LE and AE and the PEH induced by exercise. For this, 40 subjects were evaluated at rest and after a land- or aquatic-based exercise session (aerobic: 75% of reserve heart rate combined with resistance exercise).
Results: The daytime BP was lower for AE [systolic BP (SBP) 124 ± 1.0 mmHg, diastolic BP (DBP) 70 ± 1.5 mmHg] than for LE (SBP 134 ± 0.9 mmHg, DBP 76 ± 0.9 mmHg), but there were no differences at night-time. The aquatic exerciseinduced PEH in the second hour was maintained at the 24th hour post-exercise. For land exercise-induced PEH, it was maintained at the 12th hour post-exercise. The SBP and DBP were lower at the 24th hour for AE than for LE.
Conclusion: Elderly hypertensive people trained in AE had lower baseline BP during the daytime. SBP and DBP values were lower for individuals trained in AE, and their PEH was more rapid and longer lasting after AE.
- Title: Cardiovascular assessment
after treatment for retinopathy of prematurity:
a comparative study between anti-VEGF agent
(aflibercept) and laser
Authors: Erman Cilsal, Emine Alyamac Sukgen
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 123-129
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DOI Number: 10.5830/CVJA-2019-058
DOI Citation Reference Link: ddx.doi.org/10.5830/CVJA-2019-058
Objective: The aim of this study was to compare the cardiac effects and aortic arterial indices following intravitreal aflibercept treatment or diode laser photocoagulation for the treatment of retinopathy of prematurity (ROP) in infants.
Methods: This single-centre, retrospective study was conducted in infants who were administered laser photocoagulation (LPC) or intravitreal aflibercept (IVA) treatment as initial treatment and had completed at least one year of corrected age. The patients were evaluated in terms of aortic elastic parameters, right and left ventricular systolic and diastolic function using conventional, pulsed Doppler and tissue Doppler imaging (TDI) echocardiographic parameters.
Results: Fifteen infants were in the LPC group, 16 in the IVA group, and 20 in the control group. Although there were some statistically significant differences in terms of pulsed and TDI echocardiographic parameters between the treatment and control groups, these values could not clearly be adopted as a diastolic dysfunction and myocardial performance indices were not influenced. The aortic elastic parameters were impaired in both LPC and IVA groups compared to the control group. Consequently, we observed only minor differences between the treatment groups, which may suggest subtle changes due to the anti-angiogenic treatment.
Conclusion: Although favourable and promising outcomes were obtained with intravitreal injection of anti-vascular endothelial growth factor agents for the treatment of ROP, concerns have been raised about potential systemic side effects, including potential cardiovascular side effects caused by these agents. The small reduction in right ventricular Doppler velocities could probably be explained by the use of anti-angiogenic or laser treatment in infants.
- Title: A primary aldosteronism-like
phenotype identified with the
aldosterone-to-angiotensin II ratio in black
men: the SABPA study
Authors: Johannes M van Rooyen, Marko Poglitsch, Hugo W Huisman, Lebo F Gafane-Matemane, Yolandi Breet, Leonè Malan
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 130-135
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DOI Number: 10.5830/CVJA-2019-059
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-059
Introduction: Black populations may be more likely to have primary aldosteronism (PA) due to adrenal hyperplasia or other forms of adrenal hyperactivity, with suppressed renin levels and high levels of aldosterone, which may contribute to the development of hypertension.
Methods: This sub-study involved 35 black men matched for age, gender and race, and aged 20–65 years, living in the North West Province of South Africa. RAAS triple-A analysis was carried out with LC-MS/MS quantification. Blood pressure, electrocardiography and other variables were determined with known methods.
Results: Hypertensive subjects with higher aldosterone levels showed an increased aldosterone–angiotensin II ratio (AA2 ratio) compared to the hypertensive subjects with low aldosterone levels (10.2 vs 3.0 pmol/l; p = 0.003). The serum potassium concentration was significantly lower in the high-aldosterone group and the serum sodium–potassium ratio was significantly higher compared to the low-aldosterone group (3.9 vs 4.5, p = 0.016, 34.8 vs 31.8, p = 0.032, respectively). Furthermore, aldosterone was positively associated with both left ventricular hypertrophy (Cornell product) (Spearman R = 0.560; p = 0.037) and kidney function [albumin-to-creatinine ratio (ACR)] (Spearman R = 0.589, p = 0.021) in the hypertensive high-serum aldosterone group.
Conclusions: The AA2 ratio, a novel screening test that is currently being validated for PA case detection, was used to identify a PA-like phenotype in black men. Excess aldosterone was associated with endothelial dysfunction and left ventricular hypertrophy, independent of blood pressure.
- Title: The effect of beta-blockers
on foetal birth weight in pregnancies in women
with structural heart disease: a prospective
cohort study
Authors: Johann Baard, Feriel Azibani, Ayesha Osman, Wentzel Dowling, Brian Rayner, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 136-141
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DOI Number: 10.5830/CVJA-2019-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-061
Objective: To examine whether treatment with beta-blockers (BBs) in pregnant women with structural heart disease (SHD) resulted in a decrease in foetal birth weight (FBW) in a South African cohort.
Methods: This was a prospective cohort study conducted in a tertiary-level hospital in Cape Town from 2010 to 2016. Of the 178 pregnant women with SHD, 24.2% received BBs for a minimum of two weeks. Adverse foetal outcomes and mean FBW were compared between the BB groups and subgroups (congenital, valvular, cardiomyopathy and other). Adverse foetal outcome was defined as: low birth weight (LBW) < 2 500 g, Apgar score < 7, premature birth (< 37 weeks) and small for gestational age (SGA).
Results: BB exposure during pregnancy was found to be associated with a non-significant increased FBW (2 912 vs 2 807 g, p = 0.347). A significant decrease (p = 0.009) was noted in FBW for valvular SHD pregnancies using BBs, while a significant increase (p = 0.049) was observed for the same outcome in the cardiomyopathy subgroup using BBs. A significant increase was observed for SGA (p = 0.010) and LBW (p = 0.003) pregnancies within the valvular subgroup when exposed to BBs.
Conclusion: BB use in pregnant women with SHD in a South African cohort showed no association with a decrease in FBW or an increase in adverse foetal outcomes when compared to non-BB usage.
- Title: Prevalence of hypertension
and selected cardiovascular risk factors among
adolescents in selected rural and urban
secondary schools in Botswana
Authors: Matshidiso Mokgwathi, Julius Chacha Mwita
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 142-146
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DOI Number: 10.5830/CVJA-2019-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-062
Background: Adolescent hypertension and other cardiovascular risk factors tend to track into adulthood. Consequently, there is a need to determine the prevalence of hypertension and pre-hypertension, and its co-existence with glycaemia, obesity, tobacco and alcohol use among senior secondary school students in Botswana.
Methods: A cross-sectional study was undertaken between December 2015 and March 2016 among students in selected rural and urban senior secondary schools in Botswana. Data were collected through a self-administered questionnaire, measurements and fasting blood glucose testing. Participants were asked about cigarette smoking, alcohol use and levels of physical activity. Body weight, height, waist circumference, blood pressure and fasting blood glucose levels were measured. Hypertension, pre-hypertension, overweight and obesity were defined based on gender, age and height from normative tables.
Results: A total of 252 students with a mean age (standard deviation) of 17.1 (0.9) years participated in the study. Rural students were older than urban students (17.5 vs 16.7 years; p < 0.001). The prevalence of hypertension and prehypertension were 13.1 and 15.5%, respectively. Physical inactivity (37.7%), overweight/obesity (10.3%) and alcohol intake (9.1%) were also prevalent. Cigarette smoking was rare (2.0%). Impaired fasting glucose levels were found in 1.6% of participants, and none had diabetes mellitus. Hypertension (p < 0.001) and cigarette smoking (p = 0.019) were more prevalent among male than female participants. Female students were more likely to be overweight or obese than male students (p < 0.001). There were no urban–rural differences in hypertension, pre-hypertension and smoking. Urban students were more likely to drink alcohol than rural students (p = 0.008).
Conclusion: Hypertension, overweight/obesity and alcohol intake were common among these adolescents in Botswana. Strategies to reduce the risk factors of cardiovascular diseases should be urgently developed and implemented to prevent cardiovascular disease-related morbidity and mortality in the future.
- Title: Association between
galectin-3 levels and isolated coronary artery
ectasia
Authors: Gonul Aciksari, Turgut Uygun, Adem Atici, Kurtulus Aciksari, Aybala Erek Toprak, Imran Onur, Yusuf Yılmaz, Muhammed Esad Cekin, Emre Yalçınkaya, Ebuzer Aydin, Mustafa Caliskan
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 147-152
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DOI Number: 10.5830/CVJA-2019-070
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-070
Background: Coronary artery ectasia (CAE) is a well-recognised disorder characterised by abnormal dilation of the coronary arteries. Underlying mechanisms associated with abnormal luminal dilation in CAE remain to be elucidated. However, histopathological features resemble those of coronary atherosclerosis. Galectin-3 (Gal-3) is a valuable biomarker for both progression and destabilisation of atherosclerotic lesions. To the best of our knowledge, there is no study in the literature examining serum Gal-3 levels in patients with isolated CAE. In the present study, therefore, we aimed to investigate the possible relationship between serum Gal-3 levels and isolated CAE.
Methods: Between March 2016 and March 2017 this prospective, case-controlled study included a total of 49 consecutive isolated CAE patients (31 males, 18 females) diagnosed with CAE by coronary angiography at the catheter laboratory of Medeniyet University, Goztepe Training and Research Hospital, and 43 individuals (19 males, 24 females) with normal coronary arteries. Physical examination, medical history history, blood biochemistry and transthoracic echocardiography were performed in both groups. Serum concentrations of Gal-3 were measured using blood samples.
Results: Median Gal-3 levels were significantly higher in isolated CAE patients than in the controls [23.2 (23.9 ± 7.1) vs 16.8 ng/ml (17.8 ± 7.3); p < 0.001]. According to the Markis classification, the extent of CAE was not correlated with Gal-3 levels (p = 0.41). Multivariate regression analysis revealed that Gal-3 concentration was an independent predictor of isolated CAE.
Conclusion: Our study results suggest that Gal-3 serum concentrations significantly increased in patients with isolated CAE, indicating that Gal-3 may be involved in the pathogenesis of isolated CAE.
- Title: Treatment of atrial
fibrillation: a comprehensive review and
practice guide
Authors: Jianhua Li, Mei Gao, Minwei Zhang, Donglu Liu, Zhan Li, Juanjuan Du, Yinglong Hou
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 153-158
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DOI Number: 10.5830/CVJA-2019-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-064
Abstract: Atrial fibrillation (AF) is an ectopic rhythm originating in the atrium. AF is the most common sustained cardiac arrhythmia in clinical practice and it is an enormous burden worldwide because of the high rates of morbidity, disability and mortality. Treatment of AF has become a hot spot in the field of cardiovascular medicine. Recently, increasing evidence and advancements in medical technology have helped us gain a better understanding of AF. As a result, management of AF has evolved in the past few years, so that we can better prevent and control AF. Current therapy for AF mainly includes drug therapy, catheter ablation, cryoballoon ablation, left atrial appendage closure and the maze procedure. The goal of this article is to update current treatment options for AF. We hope that this article will help deliver good care to AF patients based on the current state-of-the-art evidence.
- Title: The acute coronary syndrome
revisited: effects and therapeutic modulation of
excess metabolic fuel supply
Authors: M Faadiel Essop, Lionel H Opie
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 159-161
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Abstract: Our proposal is that that metabolic perturbations occurring during and after the onset of the acute coronary syndrome (ACS) require careful management from the moment patients with this diagnosis are admitted to the intensive care unit (ICU). We advocate that insulin treatment should be initiated when blood glucose levels rise to above 11 mM (or 200 mg/dl), thereby providing additional therapeutic benefits. The reasons are as follows.
- Title: The inaugural meeting of the
Africa Heart Rhythm Association (AFHRA)
Authors: Mohamed Jeilan, Joselyn Rwebembera, Hassan Aden, Loreen Akinyi, Olujimi A Ajijola, Ashley Chin, Bundhoo Kaviraj, Kamilu M Karaye, Amam Mbakwem, Beatrice Murage, Marcus Ngatcha, Mohamed Salim, Cabral Tantchou, George Nel, Aimé Bonny, Muzahir Tayebjee
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: 162-164
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DOI Number: 10.5830/CVJA-2020-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-019
Abstract: Cardiorhythm Africa, the inaugural conference of AFHRA, was conceived during the biennial PASCAR congress held in Johannesburg in November 2019, with the ambition to be the largest ever pan-African conference focused purely on arrhythmia. Significant aims were to (1) bring together arrhythmia specialists from across Africa and from the diaspora; and (2) announce the newly formed African Heart Rhythm Association (AFHRA), an affiliate organisation of PASCAR formed from the amalgamation of the Cardiac Pacing and Arrhythmias taskforces. The meeting held in Nairobi (29–31 January 2020) was organised to provide a focus on resource-constrained arrhythmia management within the African context and novel/advanced and potentially home-grown solutions. There was full representation from all five PASCAR regions (North, East, West, Central and Southern Africa). This report summarises the scope and perspective of the first Cardiorhythm Africa meeting and presents the future directions for this annual meeting.
- Title: Early Supera stent fracture
in the femoropopliteal artery
Authors: Hun-Tae Kim, Jeong-Hwan Cho, Jung-Hee Lee, Ung Kim
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: e1-e3
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DOI Number: 10.5830/CVJA-2020-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-004
Abstract: The Supera peripheral stent has been designed to resist stent fracture, which can develop from the torsion and compressive forces in the femoropopliteal artery. We report on a case of Supera peripheral stent fracture in the early period after the index procedure in a patient with femoropopliteal artery disease. An individualised approach, considering the lesion location, patient’s age and exercise capacity is important for the treatment of femoropopliteal artery disease.
- Title: Feasibility and effect of
community health worker support and home
monitoring for blood pressure control in
Nigeria: a randomised pilot trial
Authors: Dike B Ojji, Abigail S Baldridge, Anthony I Orji, Lamkur G Shedul, Olubunmi I Ojji, Nonye B Egenti, Ada M Nwankwo, Mark D Huffman
From: Cardiovascular Journal of Africa, Vol 31, Issue 3 May/June 2020
Pages: e4-e6
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DOI Number: 10.5830/CVJA-2019-066
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-066
Abstract: In a three-arm, randomised, controlled trial among 60 Nigerian adults with hypertension, community health worker support and home blood pressure monitoring led to greater reductions in systolic blood pressure at four weeks compared to the usual care.
