CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 32, ISSUE
3, MAY/JUNE 2021
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Author: PA Brink
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Page: 115
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- Title: Analysis of risk factors for
thrombosis of the left atrium/left atrial
appendage in patients with non-valvular atrial
fibrillation
Authors: He Du, Ke Bi, Lisha Xu, Feng Chen, Wenfeng Xiong, Yin Wang
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 116-122
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DOI Number: 10.5830/CVJA-2019-071
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-071
Objectives: Left atrial appendage (LAA) morphology is a powerful predictor of thrombogenesis of the left atrium (LA) in patients with non-valvular atrial fibrillation (NVAF). However, it remains unknown whether LAA morphology is useful for stroke risk stratification in patients with NVAF.
Methods: A total of 555 atrial fibrillation patients were divided into thrombus and non-thrombus groups according to transoesophageal echocardiography. We analysed the correlation between LAA morphology and the CHADS2 score. We determined the L2CHADS2 score and compared the ability to predict LA/LAA thrombosis of the CHADS2, L2CHADS2 and CHA2DS2-VASc scores from the area under the curve (AUC).
Results: The odds ratio of non-chicken wing LAA morphology was 11.48. Non-chicken wing LAA morphology was significantly correlated with LA/LAA thrombosis. We incorporated LAA morphology into the CHADS2 score and named it the L2CHADS2 score. The AUC of the L2CHADS2 score (0.767) in predicting LA /LAA thrombosis was significantly higher than that of the CHADS2 (0.558) or CHA2DS2- VASc scores (0.557). The positive and negative predictive values of the L2CHADS2 score (13.1 and 98.7%) were higher than those of the CHADS2 (8.7 and 94.2%) and CHA2DS2- VASc scores (6.9 and 6.9%).
Conclusions: Non-chicken wing LAA morphology was a powerful predictor of LA/LAA thrombosis in NVAF patients. The AUC, sensitivity and specificity of the L2CHADS2 score were higher than those of the CHADS2 and CHA2DS2-VASc scores.
- Title: Comparison of the improvement
of flow-mediated dilatation in patients with
acute coronary syndrome versus stable angina
after six-month cardiac rehabilitation
Authors: In Hyun Jung, Jongkwon Seo, Gwang Sil Kim, Hye Young Lee, Young Sup Byun, Byung Ok Kim, Kun Joo Rhee, Sung-Jin Hong, Chul Kim
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 123-128
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DOI Number: 10.5830/CVJA-2020-022
DOI Citation Reference Link: ddx.doi.org/10.5830/CVJA-2020-022
Background: We investigated whether the improvement in endothelial function, measured using flow-mediated dilatation (FMD), an important predictor of cardiovascular outcomes, was comparable in acute coronary syndrome (ACS) versus stable angina patients after percutaneous coronary intervention (PCI) and a six-month cardiac rehabilitation (CR) programme.
Methods: We analysed the results from 119 patients who completed a six-month CR programme after successful PCI for stable angina (n = 50) and ACS (n = 69).
Results: After six months of CR, the results of FMD were significantly improved in both groups. There were no significant between-group differences in the FMD results at the six-month follow up.
Conclusion: After successful PCI and a six-month CR programme, FMD values were equally improved in both stable angina and ACS patients. Keywords: coronary disease, exercise training
- Title: A comparison of two different
management plans for patients requiring both
carotid endarterectomy and coronary artery
bypass grafting
Authors: Ata Niyazi Ecevit, Okay Guven Karaca, Mehmet Kalender, Murat Bekmezci, Mehmet Ali Sungur, Osman Tansel Darçın
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 129-132
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DOI Number: 10.5830/CVJA-2020-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-042
Background: Carotid endarterectomy (CEA) is a prophylactic operation that is used to mitigate the risk of stroke caused by embolism of atherosclerotic plaques in the carotid bifurcation. Previously, the large, multicentre, randomised, controlled GALA study found no significant differences in clinical outcomes between patients treated using general or local anaesthesia. While this study provided important insights into disease outcomes based on treatment modalities, it did not answer questions regarding the safety of CEA under local anaesthesia in patients at high risk for cardiovascular complications. Here, we examined the use of two different management plans in patients requiring both carotid endarterectomy and coronary artery bypass grafting (CABG), in terms of their effects on hospital mortality.
Methods: Thirty-four patients consecutively operated on in our cardiovascular department were included in this analysis. The patients were divided into two groups based on the anaesthetic management plan. The first group consisted of patients who underwent CEA and CABG under general anaesthesia in the same session (GA group); the second group consisted of patients who initially underwent CEA under cervical block anaesthesia followed by CABG under general anaesthesia in a separate session (CB-GA group). These two groups were compared in terms of postoperative complications and hospital mortality.
Results: The incidence of postoperative myocardial infarction was higher in the CB-GA group, with four patients experiencing postoperative myocardial infarction, compared to no patients in the GA group.
Conclusion: For patients requiring CEA and CABG, performing both operations under general anaesthesia in the same session was safer than initially performing CEA under cervical block anaesthesia followed by CABG under general anaesthesia.
- Title: Vascular health assessment
with flow-mediated dilatation and retinal image
analysis: a pilot study in an adult population
from Cape Town
Authors: Clara Marincowitz, Ingrid Webster, Corli Westcott, Nandu Goswami, Patrick De Boever, Gerald Seidel, Hans Strijdom
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 133-140
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DOI Number: 10.5830/CVJA-2020-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-046
Aim: Flow-mediated dilatation (FMD) and retinal vascular analysis (RVA) may assist in predicting cardiovascular disease (CVD) but are poorly characterised in South Africa. We recorded baseline FMD and retinal vascular widths in healthy participants, and investigated associations with cardiovascular risk factors.
Methods: Endothelial function (measured with FMD), microvascular structure (evaluated via fundus image analysis) and major CVD risk factors were assessed in 66 participants from Cape Town.
Results: Median FMD% was 9.6%, with higher values in females. Mean retinal arteriolar and venular widths were ~156 and ~250 μm, respectively. FMD was not associated with CVD risk factors. Hypertension was associated with narrower retinal arterioles and venules.
Conclusions: We report novel baseline FMD data in healthy South African adults from the Western Cape, and show that retinal microvascular calibres are associated with blood pressure. Our baseline FMD and RVA data could serve as a reference for future studies in South Africa.
- Title: Improvement of cardiac
ventricular function by magnesium treatment in
chronic streptozotocin-induced diabetic rat
heart
Authors: Hamida Aboalgasm, Morea Petersen, Asfree Gwanyanya
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 141-148
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DOI Number: 10.5830/CVJA-2020-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-054
Objective: Chronic diabetes mellitus is associated with detrimental cardiovascular complications and electrolyte imbalances such as hypomagnesaemia. We investigated the effect of magnesium (Mg2+) on cardiac function and the possible role of histological and electrical alterations in chronic, streptozotocin-induced diabetic rats.
Methods: Wistar rats were treated once intraperitoneally with streptozotocin or citrate, and then daily with MgSO4 or saline for four weeks. Cardiac contractile and electrocardiographic parameters were measured on Langendorff-perfused hearts. Other hearts were histologically stained or immunoblotted for the mitochondrial ATP synthase (ATP5A).
Results: In diabetic hearts, Mg2+ prevented a diabetes-induced decrease in left ventricular developed pressure and improved contractility indices, as well as attenuated the reduction in heart rate and prolongation of QT interval, but not the QT interval corrected for heart rate (QTc). Histologically, there were neither differences in cardiomyocyte width nor interstitial collagen. The expression of ATP5A was not different among the treatment groups.
Conclusion: Mg2+ supplementation improved cardiac contractile activity in chronic diabetic hearts via mechanisms unrelated to electrocardiographic or histologically detectable myocardial alterations.
- Title: Effect of mitral valve
replacement on left ventricular function in
subjects with severe rheumatic mitral
regurgitation
Authors: Sharen Maharaj, Somalingum Ponnusamy, Datshana Naidoo
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 149-155
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DOI Number: 10.5830/CVJA-2020-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-056
Introduction: This study describes the effects of mitral valve replacement (MVR) on left ventricular (LV) function in patients with severe rheumatic mitral regurgitation (MR).
Methods: This was a retrospective analysis over a nine-year period (2005–2013). Clinical and echocardiographic parameters were recorded pre-operatively and at two weeks, six weeks to three months and six months following MVR.
Results: Of the 132 patients included in the study, 66% were in New York Heart Association (NYHA) class III–IV and 38% presented with clinical features of heart failure. Pre-operatively, 28% of subjects had impaired LV function [ejection fraction (EF) < 60%] and the majority had advanced chamber dilatation [left ventricular end-diastolic diameter (LVEDD) 60.7 ± 7.9 mm (n = 132), left ventricular end-systolic diameter (LVESD) 39.9 ± 7.2 mm (n = 118) and left atrial size 61.2 ± 12.6 mm (n = 128)]. Paired analysis of 83 patients revealed that the EF was > 55% in 87% (n = 72) pre-operatively, decreasing to 20% (n = 17) of patients at two weeks postoperatively (p < 0.001); thereafter an EF > 55% was recorded in 60% (n = 50) at the six-month follow-up visit (p < 0.001). On multivariate analysis, only LVESD emerged as a significant predictor of postoperative LV dysfunction.
Conclusion: In this study, most patients with severe MR presented late with significant impairment of LV function and chamber dilatation that often did not recover fully after surgery. This study emphasises early comprehensive evaluation of severe MR followed by timeous surgery in order to preserve LV function.
- Title: National prevalence of
coronary heart disease and stroke in South
Africa from 1990–2017: a systematic review and
meta-analysis
Authors: Nada Abdelatif, Nasheeta Peer, Samuel OM Manda
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 156-160
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DOI Number: 10.5830/CVJA-2020-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-045
Background: South Africa is experiencing an increasing burden of cardiovascular diseases, including coronary heart disease (CHD) and stroke. We aimed to obtain overall national prevalence estimates of CHD and stroke in South Africa.
Methods: Studies conducted in South Africa were systematically reviewed from PubMed, Scopus and Web of Science from January 1990 to July 2017. Random-effects meta-analyses were conducted on the selected studies to determine the overall prevalence of CHD and stroke.
Results: Out of 2 466 studies, only 12 covering 75 140 participants reported the national prevalence of CHD and stroke. All 12 studies estimated the national prevalence of both diseases based on self-reported disease status. The overall national prevalence was 1.29 (95% CI = 0.83; 1.75) and 4.29 (95% CI = 3.13; 5.45) for CHD and stroke, respectively. Only one study reported incidence rates so we did not perform any meta-analysis of incidence rates.
Conclusions: There are very few studies on national prevalence of CHD and stroke in South Africa. Well-structured registries for CHD and stroke are required to accurately identify the disease burden and enable adequate resources to be allocated for the implementation of appropriate prevention and management programmes.
- Title: PASCAR and WHF Cardiovascular
Diseases Scorecard
project
Authors: Lilian Mbau, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Gladwell Gathecha
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 161-167
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DOI Number: 10.5830/CVJA-2021-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-022
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 noncommunicable diseases in Kenya 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: Exacerbation of severe
constrictive pericarditis after prior inadequate
pericardiectomy
Authors: Yoshinori Kuroda, Tetsuro Uchida, Masahiro Mizumoto, Kentaro Akabane, Mitsuaki Sadahiro
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 168-170
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DOI Number: 10.5830/CVJA-2020-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-027
Abstract: Pericardiectomy is commonly used to treat constrictive pericarditis (CP); however, persistent calcification can complicate recovery. An 82-year-old man presented with CP following an inadequate pericardiectomy at another hospital two years earlier. He was referred to our hospital with a diagnosis of recurrent CP. Pre-operative computed tomography revealed that the pericardium was not calcified on the anterior of the heart, while the inferior, posterior and lateral surfaces exhibited calcification. Notably, calcification along the inferior portion of the heart formed a calcium envelope structure. Pericardiectomy via re-sternotomy without cardiopulmonary bypass was performed. While dissecting the calcium envelope, a paste-like substance was exuded. Cardiac function improved after pericardiectomy, although the postoperative recovery from heart failure was prolonged. Calcified pericardium should be removed to the extent possible to enhance the efficacy of pericardiectomy, which contributes to improved early surgical results and prevents CP recurrence.
- Title: Basal Takotsubo syndrome
induced by pheochromocytoma rupture
Authors: Shanshan Yuan, Tao He, Lijia Yang, Qiang Chu, Weiqing Huang, Hongyan Dai
From: Cardiovascular Journal of Africa, Vol 32, Issue 3 May/June 2021
Pages: 171-174
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DOI Number: 10.5830/CVJA-2020-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-027
Abstract: Takotsubo syndrome (TTS), characterised by transient left ventricular systolic dysfunction, is divided into five types: (1) apical ballooning, (2) mid-ventricular, (3) basal or inverted, (4) and focal wall-motion patterns, and (5) other types, including biventricular type, isolated right ventricular and global type. The common clinical features of TTS are similar to acute coronary syndrome, which makes them indistinguishable in the early stages. TTS has a wide spectrum of emotional or physical triggers. Pheochromocytoma has been widely recognised as a distinct physical trigger of TTS. Alhough reports of pheochromocytoma causing TTS are not uncommon, spontaneous rupture of pheochromocytoma causing TTS is extremely rare because of the low incidence of tumour rupture. Here we report on a case of a 31-year-old man with adrenal pheochromocytoma rupture developing basal TTS.
