CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 32, ISSUE
6, NOVEMBER/DECEMBER 2021
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- Editorial: From the Editor’s Desk
Author: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Page: 291
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- Title: Assessment of P- to
delta-wave interval and its relationship with
accessory pathway properties in patients with
pre-excitation
Authors: Osman Can Yontar, Ahmet Yanik, Gokhan Aksan
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 292–296
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DOI Number: 10.5830/CVJA-2020-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-057
Background: The first clinical manifestation of the Wolff– Parkinson–White syndrome in previously asymptomatic individuals may be sudden cardiac death. The options for non-invasive risk stratification are limited in the current era beyond ambulatory rhythm monitoring and an exercise stress test. In our study, we sought to investigate whether there was a relationship between the shortest measured P- to delta-wave time interval (PDI) on the conduction properties of surface electrocardiogram and accessory pathways expressed as ante grade effective refractory period (APERP).
Methods: Demographic data, symptom status, electrocardio grams (ECG) and intra-cardiac recordings of invasive electro physiology testing of 103 patients who underwent accessory pathway ablation procedures were collected. Exclusion crite ria were: (1) intermittently occurring pre-excitation, which was detected in previous ECGs, (2) delta-wave resolution on treadmill test, (3) presence of multiple accessory pathways, and (4) accessory pathway locations other than the septum. The PDI was measured as the time interval from the begin ning of the P wave to the earliest upstroke or downstroke of the delta wave on V1 and V2 derivations of the surface ECG, and the shortest measurement was recorded.
Results: Patients were grouped into two groups: group I, if APERP was < 240 ms and group II if APERP was ≥ 240 ms. PDI was significantly shorter in group II. By correlation anal ysis, a positive and moderate correlation between PDI and APERP (r = 0.598, p < 0.001) and PDI and age (r = 0.800, p < 0.001) was found, and a negative and moderate correlation between PDI and inducible AF (r = –492, p < 0.001). The best cut-off value for PDI to predict APERP ≥ 240 was 90.5 ms with a sensitivity of 80% and a specificity of 83%.
Conclusion: Our results demonstrate that there was a strong correlation between the P- to delta-wave interval and univer sally accepted risk factors, such as low age, low APERP and atrial fibrillation inducibility. Further studies with larger patient groups and follow-up data are needed to appraise its predictive value.
- Title: Cardiac manifestation of
corona virus disease 2019: a preliminary report
Authors: GT Lasisi, AO Duro-Emanuel, TE Akintomide, JO Ologunja, OE Amah
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 297–300
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DOI Number: 10.5830/CVJA-2020-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-061
Background: Corona virus disease 2019 (COVID-19) is a multi-systemic illness that can present with cardiac complications. This report describes the preliminary findings of cardiac manifestations seen in patients managed in three centres in Lagos, Nigeria.
Methods: Ten patients, part of an ongoing study of patients admitted in three centres in Lagos, Nigeria, with COVID-19 diagnosed with reverse transcriptase polymerase chain reaction (RT-PCR) or serology were retrospectively studied for cardiac manifestations.
Results: The mean (SD) age was 52.5 ± 18.79 years (with a minimum of 17 years and maximum of 79 years). Six patients were female and four were male. Hypertension was seen in 70%, diabetes in 50% and obesity in 60% of patients. All had elevated inflammatory markers. Only four patients had bilateral pneumonia. The rest had only cardiac manifestations. Six patients presented with de novo heart failure and one had decompensated heart failure. A set of three patients had individually fulminant myocarditis, probable pulmonary embolism and stress cardiomyopathy, respectively.
Conclusion: This study shows that co-morbidities are common in patients with COVID-19 and cardiac complications. The array of cardiac complications is large, with the commonest being heart failure.
- Title: Pregnancy in women with
cardiac disease: a one-year retrospective review
of management and maternal and neonatal outcomes
in a tertiary hospital in Johannesburg, South
Africa
Authors: Irina Balieva, Lawrence Chauke, Amy Wise, Adriaan A Voors, Elise Schapkaitz, Hendrik Lombaard, Haroun A Rhemtula
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 301–307
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DOI Number: 10.5830/CVJA-2020-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-062
Introduction: In South Africa, cardiac disease continues to be the most important non-obstetric cause of maternal death.
Methods: A record review of 74 pregnant women with cardiac disease was performed to determine the prevalence and outcomes of cardiac disease at Charlotte Maxeke Johannesburg Academic Hospital between January and December 2017.
Results: Rheumatic heart disease was the most common cardiac diagnosis (n = 21, 28.4%), followed by pulmonary hypertension (n = 13, 17.6%) and congenital heart disease (n = 12, 16.2%). There were one (1.4%) maternal and two (2.7%) perinatal deaths. Neonatal complications included pre-term delivery (n = 20, 32.3%) and small-for-gestational-age infants (n = 10, 16.1%). Cardiac complications (n = 30, 40.5%) included heart failure (n = 15, 20.3%), pulmonary hypertension (n = 11, 14.9%) and blood transfusions (n = 8, 10.8%).
Conclusion: Cardiac disease in pregnancy was associated with a high risk of maternal and neonatal complications. Pre-conceptual counselling and managing pregnant women at a dedicated centre by a multidisciplinary team could, however, improve outcomes.
- Title: Factors associated with acute
kidney injury and mortality during cardiac
surgery
Authors: Gontse Leballo, Hlamatsi Jacob Moutlana, Michel Kasongo Muteba, Palesa Motshabi Chakane
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 308–313
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DOI Number: 10.5830/CVJA-2020-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-063
Background: Cardiac surgery with cardiopulmonary bypass (CPB) is known to contribute towards the incidence of acute kidney injury (AKI) and peri-operative morbidity and mortality. There are several patient, anaesthetic and surgical factors that contribute to its occurrence. It is imperative to know the profile of a patient who is likely to develop this complication to mitigate for modifiable risks. This study aimed at describing a profile of AKI in an adult patient (over the age of 18 years) following cardiac surgery on CPB. Factors associated with the development of cardiac surgery-associated acute kidney injury (CSA-AKI) are described, as well as the relationship between CSA-AKI and in-hospital mortality.
Methods: This was a contextual, descriptive and retrospective single-centre study with data of 476 adult patients admitted post cardiac surgery between January 2016 and December 2017. Data were collected from Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa. All adult patients who presented for elective cardiac surgery (coronary artery bypass graft), valvular, aortic and other cardiac surgery on CPB were included. Peri-operative factors such as patient demographics, baseline renal function, co-morbid factors, length of CPB and aortic cross-clamp time, degree of hypothermia, use of assist devices, and post-operative serum creatinine (SCr) levels were collected. Incomplete essential peri-operative data and data for patients who presented on renal replacement therapy (RRT) already were excluded. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria.
Results: One hundred and thirty-five (28%) patients developed CSA-AKI and 20, 5 and 3% were in KDIGO 1, 2 and 3, respectively. Older age (p = 0.024), female gender (p = 0.015), higher serum creatinine level (p = 0.025), and lower estimated glomerular filtration rate (eGFR) (p = 0.025) were associated with the development of CSA-AKI, while a history of hypertension was predictive. Forty-six of the 476 patients died. Mortality rates were significantly higher in those with AKI compared to those without [28 (21%) vs 18 (5%), respectively (p = 0.001)]. The incidence was significantly worse in those with severe kidney injury, as evidenced by mortality rates of 44 versus 5% between KDIGO 3 and KDIGO 1 (p < 0.001). Pre-operative eGFR and CSA-AKI requiring RRT were significantly associated with mortality, while pre-operative eGFR was an independent predictor of mortality (hazard ratio 0.99, 95% confidence interval: 0.97–0.99, p = 0.019).
Conclusion: A history of hypertension was predictive of the development of CSA-AKI, and pre-operative eGFR was an independent predictor of mortality in this cohort. Both factors are modifiable.
- Title: Relationship between P-wave
dispersion, left ventricular mass index and
function in Nigerian hypertensive patients
Authors: Francisca O Inofomoh, Oluranti B Familoni, Casmir E Amadi
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 314–319
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DOI Number: 10.5830/CVJA-2021-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-003
Abstract: Hypertension is the most prevalent cardiovascular disorder in the world. It is associated with target-organ damage in various organs and ECG changes. P-wave dispersion (PWD), which represents inhomogeneous atrial conduction and discontinuation of impulses, has been observed, when prolonged, to predict atrial fibrillation, particularly in the setting of hypertension. This study of PWD in 150 hypertensive patients and controls sought to determine the prevalence of PWD in Nigerian hypertensives and its relationship to left ventricular mass index and left ventricular function. Mean PWD in normal subjects was 32.14 ± 4.72 ms and was significantly shorter than that in hypertensive patients at 38.29 ± 8.02 ms. In the total population, 51.3% had prolonged PWD (> 33.46 ms); 70% in the hypertensives and 32.7% of controls. The only significant difference in hypertensives with prolonged and normal PWD was the waist circumference. There was a negative correlation between PWD and ejection fraction (r = –0.17, p = 0.03), but not with diastolic function.
- Title: Clinical and
echocardiographic findings in a crosssectional
study of HIV-infected adults in Enugu, Nigeria
Authors: Paschal O Njoku, Emmanuel C Ejim, Benedict C Anisiuba, Samuel O Ike, Basden JC Onwubere
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 320–326
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DOI Number: 10.5830/CVJA-2020-065
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-065
Background: Human immunodeficiency virus (HIV) infection and highly active antiretroviral therapy (HAART) are implicated in cardiovascular diseases. The objective of this study was to evaluate the clinical and echocardiographic findings in HIV-infected adults.
Methods: One hundred HIV subjects on HAART, 100 HAART-naïve patients and 100 controls were recruited in this cross-sectional study.
Results: Mean CD4 cell count was significantly higher in the HAART-exposed (408.43 ± 221.62) than the HAART-naïve groups (250.06 ± 154.26) (p < 0.001). Weight loss (49%), skin lesions (14%), body weakness (24%), oral thrush (10%) and lymphadenopathy (10%) were more prevalent in HAARTnaïve patients (p < 0.05). Dimensions of aortic root (2.71 cm), left atrium (3.27 cm) and left ventricular mass index (79.95) were significantly higher in HIV-positive subjects on HAART (p < 0.05).
Conclusion: Clinical features of HIV and the CD4 nadir were more prevalent in the HIV-positive, HAART-naïve subjects. Dimensions of the aortic root, left atrium and left ventricle were relatively larger in the HAART-exposed patients while wall thickness and ejection fraction were higher in the HAART-naïve subjects.
- Title: Efficacy of amiodarone for
the prevention of atrial fibrillation recurrence
after cardioversion
Authors: Sabina Istratoaie, Octavia Sabin, Ștefan C Vesa, Gabriel Cismaru, Valer I Donca, Anca D Buzoianu
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 327–338
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DOI Number: 10.5830/CVJA-2020-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-060
Abstract: The restoration and maintenance of sinus rhythm is a desirable strategy for many patients with atrial fibrillation (AF) since it has been associated with improvement in symptoms and a better quality of life. Sinus rhythm can be achieved by pharmacological or electrical cardioversion or after catheter ablation of AF. Despite high rates of successful cardioversion, AF recurrence remains a major challenge. Anti-arrhythmic drug therapy currently plays a significant role in maintaining sinus rhythm after cardioversion. Amiodarone is the most commonly prescribed anti-arrhythmic drug for patients with AF. This is due to its particular electrophysiological properties and superior anti-arrhythmic effects in comparison with other anti-arrhythmic drugs. Understanding the cardiac electrophysiology and arrhythmogenesis mechanisms may result in identification of new targets for anti-arrhythmic therapy. The aim of this article was to review amiodarone’s clinical pharmacology and evaluate evidence supporting amiodarone for treatment and prevention of AF recurrence after cardioversion.
- Title: Repetitive use of
levosimendan in clinical practice: a case series
Authors: Michał Wawrzyniak, Jacek Migaj, Ewa Straburzyńska-Migaj, Magdalena Dudek, Marta Kałużna-Oleksy
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 339–342
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DOI Number: 10.5830/CVJA-2020-058
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-058
Abstract: Levosimendan was developed as a treatment for acute decompensation of severe heart failure (HF). Its use has evolved during recent years, and new HF treatment strategies in different settings have been developed. This case series aimed to show indications for the use of levosimendan and to discuss the treatment response in various settings. Repetitive levosimendan infusions were found to be safe and effective. They seemed to prolong the time of clinical stability, although they did not alter the eventual natural history of HF, with increasing frequency of hospitalisations and rising natriuretic peptide levels.
- Title: Peri-operative
echocardiography for lung transplantation in a
critical patient with COVID-19
Authors: Yan Chen, Hongxia Wang, Yun Mou, Zhelan Zheng
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 343–345
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DOI Number: 10.5830/CVJA-2020-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-064
Abstract: Critical patients with coronavirus disease 2019 (COVID-19) suffer from severe illness and have a high mortality rate. Lung transplantation may be the final option for a subset of these patients. Herein we report the important role of peri-operative echocardiography in a COVID-19 patient who underwent bilateral lung transplantation because of severe respiratory failure. The precise evaluation provided by echocardiography enabled the prevention of anastomotic complications and the successful management of haemodynamic instability. Echocardiographers should be familiar with the complications of lung transplantation and the haemodynamics under extracorporeal membrane oxygenation support to achieve a more accurate interpretation of cardiac parameters.
- Title: Challenging paediatric
coarctation cases treated with a hybrid
approach: five-year follow up
Authors: Sonia El-Saiedi, Hossam Hassanein, Ashraf Abdel-Rahim, Mohamed Maher, Ahmed Abdel-Wahed, Wael Attia
From: Cardiovascular Journal of Africa, Vol 32, Issue 6 November/December 2021
Pages: 346–349
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DOI Number: 10.5830/CVJA-2021-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-006
Abstract: Two paediatric patients suffering from recurrent coarctation after native coarctation surgery were scheduled for cardiac catheterisation in a hybrid setting by the age of two and three years. Through a right anterior mini-thoracotomy, unmounted stents were successfully placed in the coarctant segment. One-year follow up did not show echocardiographic improvement but the patients were controlled on medical therapy. Five-year follow up showed stent breakage in the first case, while the second showed stent stenosis that needed balloon dilatation.
