CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 32, ISSUE
1, JANUARY/FEBRUARY 2021
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- From The Editor's Desk: Can we reduce bleeding risk after interventional procedures?
Author: Farrel Hellig
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Page: 3-4
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- Title: Delayed retinal vein recovery responses indicate both non-adaptation to stress as well as increased risk for stroke: the SABPA study
Authors: Leoné Malan, Mark Hamer, Roland von Känel, Konstantin Kotliar, Roelof D van Wyk, Gavin W Lambert, Walthard Vilser, Tjalf Ziemssen, Markus P Schlaich, Wayne Smith, Martin Magnusson, Annemarie Wentzel, Carlien E Myburgh, Hendrik S Steyn, Nico T Malan
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 5-16
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DOI Number: 10.5830/CVJA-2020-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-031
Objectives: Low or high sympatho–adrenal–medullary axis (SAM) and hypothalamic–pituitary–adrenal axis (HPA) dysregulation reflect chronic stress. Retinal vessel dynamics may relate to SAM, HPA activity and stroke risk. Our objectives were therefore to assess the relationships between retinal vessel, SAM and HPA responses, and to determine stroke risk.
Methods: A prospective bi-ethnic gender cohort (n = 275, 45 ± 9 years) was included. Urine/serum/saliva samples for SAM [norepinephrine:creatinine ratio (u-NE)] and HPA [adrenocorticotrophic hormone (ACTH), cortisol] were obtained at baseline, three-year follow up and upon flicker light-induced provocation. Diastolic ocular perfusion pressure was measured as a marker of hypo-perfusion. Retinal arterial narrowing and venous widening calibres were quantified from digital images in the mydriatic eye. A validated stress and stroke risk score was applied.
Results: An interaction term was fitted for venous dilation in u-NE tertiles (p ≤ 0.05) and not in u-NE median/quartiles/ quintiles. Independent of race or gender, tertile 1 (low u-NE) had a 112% increase in u-NE, decreases in cortisol, and no changes in ACTH over three years (positive feedback). Tertile 3 (high u-NE) contradictorily had decreases in u-NE and cortisol, and increases in ACTH (negative feedback). In tertile 1, reduced arterial dilation, and faster arterial vasoconstriction and narrowing were related to higher SAM activity and hypo-perfusion (p ≤ 0.05), whereas delayed venous dilation, recovery and widening were related to cortisol hypo-secretion (p ≤ 0.05). In tertile 1, delayed venous recovery responses predicted stress and stroke risk [odds ratio 4.8 (1.2–19.6); p = 0.03]. These associations were not found in u-NE tertiles 2 and 3.
Conclusions: In response to low norepinephrine, a reflex increase in SAM activity occurred, enhancing arterial vasoconstriction and hypo-perfusion. Concomitant HPA dysregulation attenuated retinal vein vasoactivity and tone, reflecting delayed vein recovery responses and non-adaptation to stress. These constrained vein recovery responses are indicative of increased chronic stress and stroke risk.
- Title: A comparison of AAIR versus DDDR pacing for patients with sinus node dysfunction: a long-term follow-up study
Authors: Reuben Kato Mutagaywa, Basil Tumaini, Ashley Chin
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 17-20
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DOI Number: 10.5830/CVJA-2020-040
DOI Citation Reference Link: ddx.doi.org/10.5830/CVJA-2020-040
Objectives: The aim of the study was to compare the clinical outcomes [atrial fibrillation (AF), atrio-ventricular (AV) block, device sepsis and lead revision] of patients with sinus node dysfunction (SND) between atrial-pacing atrial-sensing inhibited-response rate-adaptive (AAIR) versus dual-chamber rate-adaptive (DDDR) pacing. The choice of AAIR pacing versus DDDR pacing was determined by AV nodal functional testing at implant.
Methods: We conducted a retrospective review of consecutive patients who underwent AAIR and DDDR pacing over a 10-year period.
Results: One hundred and sixteen patients required pacing for symptomatic SND. Fifty-four (46.6%) patients received AAIR pacemakers and 62 (53.4%) received DDDR pacemakers based on AV nodal functional testing at implant. Patients who had AV Wenkebach with atrial pacing at 120 beats per minute received DDDR pacing. Overall the mean age of patients with SND was 65 years and 66.4% were females, 30% were diabetics and 71% were hypertensives. Pre-syncope/ syncope (84%) and dizziness (69%) were the most common symptoms. Sinus pauses and sinus bradycardia were the most common ECG manifestations. Over a median follow up of five (IQR: 2–11) years, four patients (7.4%) developed AF in the AAIR group compared to three (4.8%) in the DDDR group (p = 0.70). AV block occurred in one patient in the AAIR group, who required an upgrade to a DDDR pacemaker. There was no difference in device sepsis or need for lead revision between the two groups.
Conclusion: We found that AV nodal functional testing with atrial pacing at the time of pacemaker implantation was a useful tool to help guide the implanter between AAIR or DDDR pacing. Patients who underwent AAIR pacing had a low risk of AF, AV block or lead revision. In resource-limited settings, AAIR pacing guided by AV nodal functional testing should be considered as an alternative to DDDR pacing.
- Title: Study of congenital heart defects among neonates in Jos, Nigeria: prevalence and spectrum
Authors: Olukemi O Ige, Tolulope O Afolanranmi, Christopher S Yilgwan, Fanen Ayatse, Esin Nkereuwem, Atiene S Sagay, Phyllis Kanki, Fidelia Bode-Thomas
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 21-27
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DOI Number: 10.5830/CVJA-2020-044
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-044
Background: There are few reports of the prevalence of CHD in the neonatal period in sub-Saharan Africa. The only available study in Nigeria was carried out before the widespread availability of echocardiography in the country. We sought to determine the prevalence and spectrum of congenital heart defects (CHD) among neonates in Jos, Nigeria.
Methods: This cross-sectional study enrolled neonates less than one week of age from the two largest hospitals and their immunisation centres. Relevant information was obtained and an echocardiogram was performed on each neonate.
Results: There were 3 857 neonates recruited over a two-year period; male-to-female ratio was 1.1:1. A total of 111 babies had CHD, with a prevalence of 28.8 per 1 000. Sixty-four neonates had mild CHD, with a prevalence of 16.6 per 1 000, while moderate and severe CHD were found in 27 (7.0 per 1 000) and 20 (5.2 per 1 000), respectively.
Conclusion: CHD is prevalent in Nigerian neonates and there is therefore a need for advocacy to improve access to its diagnosis at birth for appropriate management.
- Title: Hybrid rotablation and drug-eluting balloon strategy
Authors: Ahmed Vachiat, Mpiko Ntsekhe, Farrel Hellig
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 28-32
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DOI Number: 10.5830/CVJA-2020-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-050
Aim: The aim was to assess the safety and efficacy of rotational atherectomy followed by drug-eluting balloon (DEB) in patients with a high risk of bleeding.
Methods: A retrospective review was carried out of hospital records of consecutive patients who underwent the hybrid procedure.
Results: The average age of the 23 patients was 74 years. Risk factors for bleeding included renal failure (35%), oral anticoagulation use (26%) and peptic ulcer disease (35%). All patients had procedural success. No bleeding was reported over the 24-month follow-up period. Dual antiplatelet therapy was stopped successfully in six patients (26%) at three months. Two patients had confirmed target-lesion failure (restenosis). Two patients died over the study period but the cause of death was not known to be cardiovascular disease related.
Conclusion: For patients at high risk of bleeding who require rotablation, the use of a drug-eluting balloon may be a safe, effective alternative.
- Title: Nine-year, single-centre experience of left atrial appendage occlusion: patient characteristics, procedural outcomes and long-term follow up
Authors: Mark Abelson, Andre Phillips, Shirley Middlemost
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 33-36
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DOI Number: 10.5830/CVJA-2020-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-051
Abstract: This is a review of 114 patients with atrial fibrillation who had left atrial appendage occlusion with an Amplatzer cardiac plug over a nine-year period done by a single operator. This shows that the procedure can be safely performed with a very low rate of major complications (< 1%) and a zero procedural mortality rate. Long-term follow up over an average of 38.5 months showed a 65% reduction in actual versus predicted stroke rate. This is similar to that seen with oral anti-coagulants and other published trials and registries involving left atrial appendage occlusion.
- Title: Relationship between physical activity and carotid intima–media thickness among teachers in South Africa: the SABPA study
Authors: Tamrin Veldsman, Mariette Swanepoel, Andries Monyeki, Sanette Brits, Leoné Malan
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Page: 36
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DOI Number: 10.5830/CVJA-2020-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-024
In the Abstract, in Methods: Ultrasound CIMT imaging was done using the SonoSite Micromaxx. Physical activity was done over seven consecutive days.
In the Abstract, in Results: The prevalence of obesity according to BMI and sedentary behaviour was above 30%; hypertension was 38.9% and low-grade inflammation (CRP) was 41.1%.
- Title: PASCAR and WHF Cardiovascular Diseases Scorecard project
Authors: Dejuma Yadeta, Wubaye Walelgne, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Mussie Gebremichael
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 37-46
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DOI Number: 10.5830/CVJA-2021-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-001
Abstract: Data collected for the World Heart Federation’s Scorecard project regarding the current state of cardiovascular disease prevention, control and management, along with related non-communicable diseases in Ethiopia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the accompanying infographic. Information was collected using open-source data sets from the World Bank, the World Health Organization, the Institute for Health Metrics and Evaluation, the International Diabetes Federation and relevant government publications.
- Title: PASCAR and WHF Cardiovascular Diseases Scorecard project
Authors: Mpiko Ntsekhe, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 32, Issue 1 January/February 2021
Pages: 47-56
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DOI Number: 10.5830/CVJA-2021-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-002
Abstract: Data collected by the Pan-African Society of Cardiology 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 for South Africa, which need to be considered in conjunction with the associated sections in the accompanying infographic. Data sets that were used include opensource data available online and government publications. In the section on priorities and the way forward, we highlight the multifactorial health challenges with which South Africa has had to deal and the progress that has been made.
