CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 32, ISSUE
2, MARCH/APRIL 2021
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- Editorial: Atrial high-rates episodes: fact or fiction?
Author: P Mkoko, A Chin
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Page: 59-61
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- Title: The spectrum of rheumatic mitral valve regurgitation presenting to Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, over a 10-year period
Authors: The spectrum of rheumatic mitral valve regurgitation presenting to Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, over a 10-year period
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 62-69
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DOI Number: 10.5830/CVJA-2020-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-029
Background: Recent evidence suggests that there is a change in the profile of rheumatic mitral regurgitation (MR) in South Africa to a pattern of chronic fibrotic valvular disease. Objective: This study describes the clinical profile of patients with rheumatic MR in the province of KwaZulu-Natal (KZN).
Methods: A retrospective chart review was performed on patients seven years and older with moderate to severe rheumatic MR referred to Inkosi Albert Luthuli Central Hospital from 2006 to 2015.
Results: There were 320 patients meeting the study criteria (mean age 22.2 ± 15.8 years, male:female 1:2). Severe dyspnoea was present in 45.9% of patients, heart failure in 117 (36.6%) and atrial fibrillation in 13.8%. Three patients were diagnosed with active carditis at initial presentation and a further 31 had evidence of carditis during follow up. Of the 216 patients who underwent surgery, over one-third (37%) had prolapse of the anterior mitral leaflet, which was due to chordal elongation (n = 63, 29.2%) and/or ruptured chordae (n = 41, 19%). There were 32 deaths (10%) and of these, 27 (8.4%) patients died prior to surgery.
Conclusion: Rheumatic MR in KZN predominantly affects the young, with concomitant carditis resulting in high morbidity and mortality rates.
- Title: The effect of lifestyle modification on depression among myocardial infarction patients after revascularisation
Authors: Aminu Arzet, Wilbert Sibanda, DP Naidoo, Ponnusamy Somalingum
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 70-77
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DOI Number: 10.5830/CVJA-2020-030
DOI Citation Reference Link: ddx.doi.org/10.5830/CVJA-2020-030
Background: Patients with coronary artery disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention [(coronary artery bypass graft surgery (CABG) versus percutaneous coronary intervention (PCI)] influences the outcome. Objectives: We examined the prevalence of depression among myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression in patients who underwent CABG versus PCI.
Methods: We evaluated the risk-factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularisation over a 15-month period (January 2017 to May 2018). The Beck depression inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA).
Results: One hundred patients were recruited (mean age: males 60.73 ± 4.52 years, females 60.29 ± 3.64 years) but five dropped out, leaving 95 patients for complete analysis. Most of the patients were low-income earners [53 (53.0%)], and 21 (21.0%) had tertiary-level education. The majority had multiple CAD risk factors and co-morbidities (79.0%). Prior to the LSM programme, 51 patients (51.0%) had depression and depressive traits [CABG 34 (66.7%) vs PCI 17 (33.3%), p = 0.047]. After LSM the overall prevalence of depression and depressive traits fell to 33 patients (34.7%) [PCI eight (23.0%) vs CABG 25 patients (72.0%), p = 0.001]. The mean depression scores also fell from 21.11 ± 7.75 to 14.98 ± 9.61 (p = 0.002). At baseline, PCI patients were more physically active compared to CABG patients [three (60.0%) vs two patients (40.0%), respectively, p = 0.715]. After LSM, more PCI patients undertook PA compared to CABG subjects [24 (60.0%) vs 14 patients (35.0%), respectively, p = 0.012]. The PA score was also higher among the PCI group compared to the CABG group [14.16 ± 9.73 vs 9.40 ± 10.94, respectively, p = 0.024]. In fully compliant subjects, the benefit derived was similar regardless of the mode of intervention [OR 1.10, 95% CI: 0.78–4.23, p = 0.191]. Using multivariate analysis, the main predictors of depression and depressive traits were female gender (OR 3.29, 95% CI: 1.51–11.03, p = 0.008), CABG (OR 1.86, 95% CI: 1.68–5.77, p = 0.003), heart failure (OR 2.65, 95% CI: 5.87–13.62, p = 0.000), kidney failure (OR 1.41, 95% CI: 1.30–5.23, p = 0.041), atrial fibrillation (OR 1.60, 95% CI: 1.40–4.77, p = 0.023), low PA (OR 1.97, 95%, CI: 11.23–33.20, p = 0.000), previous history of depression (OR 8.99, 95% CI: 1.90–7.89, p = 0.002) and low income (OR 2.21, 95% CI: 1.40–2.85, p = 0.000).
Conclusions: Depression and depressive traits are common among subjects undergoing coronary revascularisation, more so among CABG than PCI participants. LSM reduced the prevalence of depression and depressive traits, with fully compliant CABG versus PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in incidence of depression was recorded among LSM partly compliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.
- In Memorium: Somalingum Ponnusamy: 1/9/58 to 10/2/21
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 78
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- Title: Cardiovascular view of intermediate and high-risk COVID-19 patients: single-centre experience with low mortality and intensive care hospitalisation rates
Authors: Alpay Medetalibeyoglu, Samim Emet, Naci Senkal, Mehmet Aydogan, Murat Kose, Tufan Tukek
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 79-86
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DOI Number: 10.5830/CVJA-2020-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-041
Aim: The purpose of this article was to report the low rates of intensive care unit admission and mortality in intermediateand high-risk COVID-19 patients, and to share our clinical approach with other colleagues. In addition, we sought to reveal the relationship between myocardial injury and clinical outcomes such as death, intensive care unit uptake and hospital stay, and the relationship between inflammatory parameters and cardiac biomarkers in a cardiovascular perspective.
Methods: Patients admitted to the emergency department in the Department of Internal Medicine, Faculty of Medicine, Istanbul University, with laboratory or clinically and radiologically confirmed COVID-19 were included in this retrospective cross-sectional study, which was conducted from 11 March to 10 April 2020. The demographic (age and gender) and clinical (symptoms, co-morbidities, treatments, complications and outcomes) characteristics, laboratory findings, and results of cardiac examinations (cardiac biomarkers and electrocardiography) of patients during hospitalisation were collected from their medical records by two investigators. Data were analysed using SPSS version 25.0 (IBM). A twosided p < 0.05 was considered statistically significant. Analysis began on 11 April 2020.
Results: Mortality and intensive care unit admission rates were statistically significantly higher in patients with cardiac injury than in those without. There was a positive correlation between levels of high-sensitivity TNT and fibrinogen, D-dimer, ferritin, procalcitonin and C-reactive protein (r = 0.24, p < 0.01; r = 0.37, p < 0.01; r = 0.25, p < 0.01, r = 0.34, p < 0.01; r = 0.31, p < 0.01).
Conclusion: The first general data of our 309 patients regarding low mortality and intensive care admission rates, and particular treatment algorithms specific to our centre should be helpful in determining better treatment strategies in the future. Our study emphasises the importance and frequency of cardiovascular outcomes, and the significance of some cardiac biomarkers in predicting COVID-19 prognosis.
- Title: The modulating effects of green rooibos (Aspalathus linearis) extract on vascular function and antioxidant status in obese Wistar rats
Authors: Zimvo Obasa, Mignon Albertha van Vuuren, Barbara Huisamen, Shantal Lynn Windvogel
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 87-97
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DOI Number: 10.5830/CVJA-2020-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-048
Purpose: Obesity is associated with the development of risk factors for cardiovascular disease (CVD) and polyphenols have been shown to possess ameliorative effects against obesity- induced CVD risk factors. Rooibos (Aspalathus linearis) is rich in polyphenols, therefore we investigated the cardioprotective effects of aspalathin-rich green rooibos (GRT) on obesity-induced CVD risk factors in obese Wistar rats.
Methods: Adult male Wistar rats (n = 20 per group) were fed a control or a high-fat diet (HFD) for 16 weeks and treated with GRT (60 mg/kg/day) for six weeks. Blood pressure was monitored throughout. Vascular reactivity was measured and Western blots of cell-signalling proteins (eNOS, AMPK and PKB) were performed in aortic tissues. Effects on oxidative stress were determined by measuring antioxidant enzyme activity and thiobarbituric reactive substance (TBARS) levels in the liver.
Results: HFD animals had (1) increased blood pressure, (2) impaired vasodilation, (3) attenuated PKB and AMPK expression, (4) decreased antioxidant enzyme activity, (5) increased malondialdehyde (MDA) levels, and (6) increased phosphorylated eNOS levels. Treatment with GRT extract significantly alleviated these obesity-induced CVD risk factors.
Conclusion: Supplementation with GRT extract alleviated cardiovascular risk factors in the HFD animals, suggesting a therapeutic potential for GRT in obesity-induced cardiovascular risk.
- Title: Analysis of the vascular access service for patients on haemodialysis in Livingstone Hospital
Authors: Ian R Grant, Robert J Freercks, Eduard J Honiball, Bhekifa Dube
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Page: 98-101
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DOI Number: 10.5830/CVJA-2020-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-049
Background: Reliable vascular access is key to sustainable haemodialysis treatment. Guidelines recommend an arteriovenous fistula (AVF) as the preferred modality in preference to arteriovenous grafts (AVGs) or central venous catheters (CVCs). There are limited data on vascular access in sub- Saharan Africa. This study aimed to evaluate the vascular access used in a South African tertiary hospital and identify problems with achieving the recommended access goals.
Methods: A cross-sectional analysis was performed of the haemodialysis programme at Livingstone Tertiary Hospital. Current and initial vascular access used, timing until the creation of permanent access, and any complications experienced were recorded.
Results: CVCs were used in 56% of subjects, 38% were using an AVF and 5% were using an AVG. Only 12% of the group had no AVF attempt. The overwhelming majority (95%) had dialysis initiated with a CVC. The rate of pre-emptive AVF creation was low and a delay in AVF creation was seen in 63% of patients. Central venous stenosis or occlusion was present in 26% of patients and likely due to prior or current CVC use.
Conclusions: The prevalence of CVC use was high and there were significant delays to AVF creation. High rates of central venous stenosis compromise future AVF use and are likely due to prolonged CVC use. Changes needed to improve the vascular access service include a multidisciplinary access clinic, dedicated theatre list, vascular access co-ordinator and further data collection to continually evaluate the vascular access service.
- Title: Atrial high-rate episodes: a comprehensive review
Authors: Gelu Simu, Radu Rosu, Gabriel Cismaru, Mihai Puiu, Gabriel Gusetu, Ioan Minciuna, Sabina Istratoaie, Raluca Tomoaia, Dumitru Zdrenghea, Dana Pop
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 102-107
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DOI Number: 10.5830/CVJA-2020-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-052
Abstract: Cardiac electronic implantable devices (CIEDs) have the ability to monitor, store and interpret complex arrhythmias, which has generated a new arrhythmic entity: atrial high-rate episodes (AHRE). AHRE are atrial tachyarrhythmias, detected only by CIEDs. They are widely considered a precursor to atrial fibrillation (AF) but can also be represented by other kinds of supraventricular arrhythmias such as atrial flutter or atrial tachycardia. CIED-detected AHRE are associated with an increased risk of stroke, but the risk is significantly lower than the stroke risk of clinical AF. Moreover, there seems to be no temporal correlation between AHRE and thromboembolic events. Because of the current gaps in evidence, the appropriate management of this arrythmia can be challenging. In this review we take into account the epidemiology behind AHRE, predictive factors, clinical impact and management of this arrhythmia.
- Title: Severe bradycardia caused by diabetic ketoacidosis
Authors: João Ferreira, João Martins, Lino Gonçalves
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 108-110
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DOI Number: 10.5830/CVJA-2020-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-026
Abstract: Atrial standstill is an uncommon but serious clinical entity that is often unrecognised in the clinical setting. Its diagnosis and treatment should be swift as malignant arrhythmias and thromboembolic complications can arise. We present a 79-year-old man brought to our emergency department with acute confusion, heart failure and severe bradycardia in the context of diabetic ketoacidosis, and discuss the diagnosis and management of this arrhythmic condition.
- Title: Melatonin against pulmonary arterial hypertension: is it ready for testing in patients?
Authors: Gerald J Maarman, Sandrine Lecour
From: Cardiovascular Journal of Africa, Vol 32, Issue 2 March/April 2021
Pages: 111-112
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DOI Number: 10.5830/CVJA-2021-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-008
Abstract: Pulmonary arterial hypertension (PAH) is a fatal disease defined as a mean pulmonary artery pressure exceeding 25 mmHg when diagnosed with right heart catheterisation. Its pathophysiology involves multiple molecular pathways, including key components leading to an inflammatory and oxidative stress environment that ultimately causes right ventricular hypertrophy and failure. Compared to the developed world, the overall PAH prevalence is higher in developing countries, including Africa, where it is mostly associated with left heart disease, obstructive/restrictive pulmonary disease, HIV and rheumatic heart disease. Current targeted PAH treatments are expensive, not always available in developing countries, and have a limited impact on PAH progression and mortality rate. Therefore, there is an urgent need for effective and affordable medications that can be used as adjunct therapy against PAH in developing countries. Recently, there have been mounting pre-clinical and clinical data suggesting that melatonin may provide health benefits against PAH.
