Title: Mitochondrial oxidative phosphorylation and mitophagy in myocardial ischaemia/reperfusion: effects of chloroquine
Authors: K Dhanabalan, B Huisamen, A Lochner
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages:
169-179
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DOI Number: 10.5830/CVJA-2019-067
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2019-067 Aim: The aim of this study was
to evaluate the temporal relationship between
mitochondrial oxidative phosphorylation and
mitophagy in at hearts subjected to
ischaemia/reperfusion. Measurements were made at
specific points during the experimental protocol
(snapshot pproach) and by assessments of
mitophagic flux, using chloroquine
pre-treatment. Methods: Isolated working rat
hearts were subjected to 25 or 30 minutes of
global ischaemia/10 minutes of reperfusion. Half
of each group received chloroquine (10 mg/kg,
intraperitoneally) one hour before
experimentation. Mitochondria were isolated
after stabilisation, ischaemia and reperfusion,
and oxidative phosphorylation was measured
polarographically. Mitochondrial mitophagy
markers were detected by Western blot analysis.
Results: Mitochondrial oxygen
uptake (state 3) and oxidative phosphorylation
rate were reduced by ischaemia and increased by
reperfusion. Chloroquine pre-treatment increased
both parameters. Using a snapshot approach,
exposure to ischaemia ± reperfusion had little
effect on mitochondrial PINK1, Parkin and
p62/SQSTM1 expression. Ischaemia reduced Rab9
expression, and reperfusion upregulated the
phospho DRP1, phospho/total DRP1 ratio and Rab9
levels. Chloroquine significantly reduced PINK1,
p62/SQSTM1, Rab9 and particularly Parkin
expression during reperfusion, without an effect
on mitochondrial total and phospho DRP1 levels.
Conclusion:
Ischaemia/reperfusion-induced changes in
mitochondrial oxidative phosphorylation function
occurred concomitantly with changes in
mitophagic flux. Pre-treatment with chloroquine
profoundly affected mitochondrial function as
well as the pattern of mitophagy during
ischaemia/reperfusion.
Title: Family screening in black
patients with isolated left ventricular
non-compaction: the Chris Hani Baragwanath
experience
Authors: Anneen L Basson, Mohammed R Essop,
Elena Libhaber, Ferande Peters
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages:
180-184
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DOI Number: 10.5830/CVJA-2020-003
DOI Citation Reference Link:
ddx.doi.org/10.5830/CVJA-2020-003 Background: Isolated left
ventricular non-compaction (ILVNC), dilated
cardiomyopathy (DCMO) and hypertrophic
cardiomyopathy (HCM) are diseases that may be
present in family members of patients with
ILVNC. The primary aim of this study was to
identify the prevalence and spectrum of
cardiomyopathy in first-degree relatives of
patients with ILVNC. A secondary aim was to
compare a strategy of clinical screening,
utilising only a clinical assessment and
electrocardiogram (ECG), compared to one that
included echocardiography for screening of
family members of patients with ILVNC. Methods: Eighty-three close
relatives of 38 unrelated patients from the
ILVNC clinic at the Chris Hani Baragwanath
Hospital underwent a detailed clinical history,
physical examination, ECG and echocardiogram.
Results: Echocardiographic
screening revealed unexplained left ventricular
(LV) dysfunction in 10 (12.05%) relatives. Nine
out of the 10 individuals satisfied the criteria
for diagnosis of DCMO. No cases of HCM or LVNC
were identified. A strategy of clinical
assessment and ECG had a sensitivity of 76% and
a specificity of 42% versus the gold standard of
echocardiographic screening. Conclusion: Echocardiographic
screening detected DCMO in 10.8% of subjects. A
strategy of clinical screening that included
electrocardiography was sub-optimal as a
screening strategy compared to echocardiographic
screening.
Title: Incidence and risk factors
for thromboembolism and major bleeding in
patients with mechanical heart valves: a
tertiary hospital-based study in Botswana
Authors: Elizabeth Botsile, Julius Chacha Mwita
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages: 185-189
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DOI Number: 10.5830/CVJA-2020-006
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2020-006 Introduction: Mechanical heart
valve (MHV) prostheses increase the risk of
thromboembolic complications. While warfarin
anticoagulation reduces this risk, its use
increases the risk of bleeding. We sought to
estimate the rate of thromboembolic and bleeding
complications among patients with MHVs at a
tertiary hospital in Botswana. Factors
associated with bleeding and thromboembolic
complications are also described. Methods: This retrospective
cohort study involved a cohort of patients with
MHV at Princess Marina Hospital who were
operated on before September 2017. The study
documented bleeding and thromboembolic events
since the valve replacement, patients’
demographic information, co-existing medical
conditions, drug history and details of valve
replacement. Using the recent international
normalised ratio (INR) results, each patient’s
time in therapeutic range (TTR) was calculated
to assess the level of anticoagulation control.
Results: The study enrolled 142
patients with a mean (SD) age of 42 (12) years
and a median (IQR) duration since valve
replacement of four years (1.8–10.0). The median
(IQR) TTR was 29.8% (14.1–51.0) and only 14.8%
of the patients had an optimal anticoagulation
control. The rates of major bleeding and
thromboembolic complications were 1.5 per 100
personyears and 2.80 per 100 person-years,
respectively. A longer duration of warfarin use
was associated with an increased risk of both
bleeding (p = 0.008) and thromboembolic
complications (p = 0.01). Conclusion: Bleeding and
thromboembolic complications were common in MHV
prosthesis patients in this study. Long duration
of anticoagulation, albeit sub-optimal control,
was a risk factor for bleeding and
thromboembolic complications in these patients.
Therefore, long-term efforts are necessary to
address these complications and possibly improve
the quality of life of these patients.
Title: Patterns of cardiovascular
risk and disease in HIV-positive adults on
anti-retroviral therapy in Mozambique
Authors: I Dobe, N Manafe, N Majid, I Zimba, B
Manuel, A Mocumbi
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages: 190-195
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DOI Number: 10.5830/CVJA-2020-007
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2020-007 Introduction: With improved
access to anti-retroviral therapy (ART) the
focus of HIV treatment is changing to reducing
chronic co-morbidities and their effects, but
guidelines for HIV care in many African
countries do not include screening for cardiac
disease. Our study aimed to determine the
pattern of cardiac abnormalities in HIV-positive
patients on ART. Methods: We implemented a
prospective, observational study for 24 months
on a random sample of adult patients seen at a
dedicated HIV clinic in Mozambique. Demographic,
clinical and full cardiovascular evaluations
were performed on all participants. Results: We enrolled 264
HIV-positive patients (mean age 39.3 years; 186
female, 70.5%). The mean time on ART was 46 (SD
36) months and most had low viral load (174,
65%). Obesity (45, 17%), overweight (65, 24.6%),
hypertension (54, 20.5%) and severe anaemia (21,
8.3%) were frequent. Diabetes was present in
four patients (1.5%). The most important
conditions in 252 patients submitted to
echocardiography (88, 34.9% had cardiac
abnormalities) were: severe rheumatic heart
valve disease (six), severe dilated
cardiomyopathy (five), aortic degenerative
disease and congenital heart disease (in three
patients each). At 24-month follow up, six of
the 252 patients had died; of the 196 reviewed
on echocardiography 29 had progressed and two
had improved ventricular systolic function. Conclusions: This young cohort
of HIV-positive patients on ART showed lower
occurrence of tuberculous pericarditis and
dilated cardiomyopathy but high cardiovascular
risk, as assessed by the presence of obesity,
hypertension and anaemia. Cardiac abnormalities
needing multidisciplinary care were also found.
There is a need for tailored cardiovascular risk
stratification and screening for cardiovascular
disease in HIV-positive patients on ART in
Africa.
Title: Short-term efficacy and
safety of levosimendan in patients with chronic
systolic heart failure
Authors: Xiao-Ran Cui, Xiao-Hong Yang, Rui-Bin
Li, Dong Wang, Min Jia, Long Bai, Ji-Dong Zhang
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages: 196-200
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DOI Number: 10.5830/CVJA-2020-008
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2020-008 Abstract: The objective was to
investigate and evaluate the short-term efficacy
and safety of levosimendan in patients with
chronic systolic heart failure. Forty-nine
patients with chronic systolic heart failure
during acute decompensation were randomly
divided into a levosimendan group (26 cases) and
a control group (23 cases). The control group
received only routine treatment, while the
levosimendan group received a levosimendan bolus
with a load of 12 μg/kg, in addition to the same
routine treatment as the control group. After 48
hours of treatment, N-terminal pro B-type
natriuretic peptide (NT-proBNP) levels in the
levosimendan group were significantly lower than
those in the control group. In addition, the
left ventricular ejection fraction (LVEF) and
New York Heart Association (NYHA) cardiac
function scores of the levosimendan group were
significantly higher and more improved than
those of the control group seven days after
treatment, but there was no significant
difference in the left ventricular end-diastolic
diameter between the two groups. Furthermore, 48
hours after treatment, there were no significant
differences in potassium, haemoglobin,
haematocrit and creatinine levels between the
levosimendan and control groups. During the
whole hospitalisation, there was one case of
sudden death in the control group and one case
of palpitations in the levosimendan group, and
no hypotension or severe hypokalaemia occurred
in either group. Levosimendan significantly
improved NT-proBNP and LVEF in patients with
chronic systolic heart failure, and improved
NYHA cardiac function classification without
significant cardiovascular events. Levosimendan
is therefore effective and safe in the
short-term treatment of chronic systolic heart
failure.
Title: Primary PCI in the management
of STEMI in sub-Saharan Africa: insights from
Abidjan Heart Institute catheterisation
laboratory
Authors: Arnaud Ekou, Hermann Yao, Isabelle
Kouamé, Rolande Yao Boni, Esther Ehouman, Roland
N’Guetta
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages:
201-204
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DOI Number: 10.5830/CVJA-2020-012
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2020-012 Background: Implementation of
primary percutaneous coronary intervention (PCI)
in sub-Saharan Africa remains a challenging
issue. The aim of this study was to report the
results of primary PCI and outcomes in the
catheterisation laboratory of the Abidjan Heart
Institute. Methods: Between April 2010 and
March 2019, all patients aged 18 years
presenting to the Abidjan Heart Institute for
ST-segment elevation myocardial infarction
(STEMI) over the study period and who underwent
primary PCI were included. We considered primary
PCI when it was performed within 48 hours of the
onset of symptoms. Baseline data, PCI
characteristics and outcomes were analysed.
Results: Among a total of 780
patients hospitalised for STEMI, 471 were
admitted within 48 hours of the onset of
symptoms. One-hundred and sixty six patients
underwent primary PCI, with a ratio of primary
PCI/STEMI of up to 21.3%. One hundred and six
patients (63.9%) were admitted within 12 hours
of the onset of symptoms. The femoral approach
was the most commonly used (78.3%). Primary PCI
was performed with stent implantation in 84.3%
of patients. Drug-eluting stents (DES) were used
in 42.1% of patients. In most cases,
angiographic success was observed (157/166,
94.6%). Non-fatal complications were mainly
haematomas (3.6%). Peri-procedural mortality
rate was 1.2%. Conclusion: Primary PCI can be
performed safely in some small-volume centres in
sub-Saharan Africa. Healthcare policies and
regional networks must be encouraged in order to
improve management of STEMI patients.
Title: Cardiac surgery-associated
acute kidney injury: pathophysiology and
diagnostic modalities and management
Authors: Gontse Leballo, Palesa Motshabi Chakane
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages:
205-212
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DOI Number: 10.5830/CVJA-2019-069
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2019-069 Abstract: Acute kidney injury
is a disease spectrum that can present with from
mild renal dysfunction to complete renal failure
that would require renal replacement therapy.
Cardiac surgery-associated acute kidney injury
is a complication that carries a grave disease
burden. Risk factors are identified as being
either modifiable or non-modifiable. This
literature review aims to define the
pathophysiology of cardiac surgeryassociated
acute kidney injury, the current definition and
classification of acute kidney injury and the
available diagnostic modalities, especially the
use of biomarkers.
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 4 July/August 2020
Pages: 213-215
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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.
Title: In Memoriam - Prof Solomon
Elias Levin
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages:
216-217
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Full text: Click here to read via Sabinet » (Login Required) Abstract: It was with deep
sadness that I learnt of the passing of Prof
Solly Levin a mere 11 days after his wife
Cynthia had also passed on. Prof, as he was
fondly referred to, was a legend in his time,
recognised internationally in the field of
paediatric cardiology and paediatrics. He was a
giant of a man, a gentleman and a gentle man who
influenced countless students, registrars and
fellows over a career which spanned close to 70
years.
Title: Tricuspid valve vegetation
related to leaflet injury: a unique problem of
catheter malposition
Authors: Yan Chen, Hongxia Wang, Yun Mou,
Shenjiang Hu
From: Cardiovascular Journal of Africa, Vol 31,
Issue 4 July/August 2020
Pages:
217-220
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DOI Number: 10.5830/CVJA-2020-005
DOI Citation Reference Link:
dx.doi.org/10.5830/CVJA-2020-005 Abstract: The use of
peripherally inserted central catheters (PICCs)
has expanded substantially for drug delivery in
clinical practice in recent years. However, PICC
lines expose patients to potential complications
associated with an increasing incidence of
infective endocarditis. We herein report a case
of a 57-yearold woman who was diagnosed with
tricuspid valve endocarditis by
echocardiography. The most probable cause was
direct injury to the tricuspid valve by the tip
of a PICC line with excessive length in the
right heart. The vegetation disappeared with
conservative treatment after removal of the PICC
line. Clinicians must maintain vigilance against
any suspected PICC-related infection in febrile
patients with a PICC line. For
echocardiographers, precise evaluation of the
position of the PICC tip and the detection of
endocarditis is important to devise the optimal
clinical strategy.