CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 33, ISSUE
5, SEPTEMBER/OCTOBER 2022
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- From the Editor’s Desk
Author: P Commerford
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Page: 167-168
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- Title: PRELP promotes myocardial fibrosis and ventricular remodelling after acute myocardial infarction by the wnt/β–catenin signalling pathway
Authors: Yu Zhang, Chunli Fu, Shaohua Zhao, Honglei Jiang, Wei Li, Xiangju Liu
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 228–233
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DOI Number: 10.5830/CVJA-2022-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-001
Objectives: Proline/arginine-rich end leucine-rich repeat protein (PRELP) has been reported to contribute to the remodelling of cardiovascular tissues in the ischaemia–reperfusion injury model. However, research is lacking on the role of PRELP in myocardial fibrosis and ventricular remodelling, and the mechanism through which PRELP brings about these changes is not clear. This study aimed to evaluate the role of PRELP in ventricular remodelling and myocardial fibrosis following acute myocardial infarction (AMI) and to explore the underlying mechanism.
Methods: In this study, we established AMI mouse and cellculture models in an oxygen–glucose deprivation environment.
Results: We found that over-expression of PRELP increased the infarct size and interstitial fibrotic area. Expression of the wnt/β–catenin pathway molecules, which are downstream of PRELP, increased more in the PRELP over-expression group than in the AMI group.
Conclusions: Our results showed that PRELP, through the wnt/β–catenin signalling pathway, led to myocardial fibrosis and ventricular remodelling following AMI.
- Title: Association of microalbuminuria with serum lipids and inflammatory markers in an adult population in the Dikgale Health and Demographic Surveillance System site, South Africa
Authors: Thabo Magwai, Perpetua Modjadji, Solomon Choma
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 234–242
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DOI Number: 10.5830/CVJA-2021-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-055
Background: There is evidence that microalbuminuria (urinary albumin excretion) is an early sign of vascular damage and an established risk factor for cardiovascular morbidity and mortality. This study investigated the magnitude of microalbuminuria and its association with serum lipids and inflammatory markers among a rural black population residing in the Dikgale Health and Demographic Surveillance System site, South Africa.
Methods: Data were collected from 602 presumably healthy participants (225 men and 377 women) aged ≥ 18 years. Biochemical data collection included serum lipids, glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), urine albumin and creatinine. Anthropometry and blood pressure were also measured. Microalbuminuria was diagnosed with an albumin–creatinine ratio of ≥ 2.5 mg/mmol in men and ≥ 3.5 mg/mmol in women. Data were analysed using SPSS version 22.0.
Results: The mean age of participants was 48.63 ± 20.89 years. High percentages of microalbuminaria (35.7%), high levels of interleukin 6 (17.8%), hs-CRP (32.9%), triglycerides (TG) (26.1%), low-density lipoprotein cholesterol (52.2%) and total cholesterol (32.0%), and low levels of high-density lipoprotein cholesterol (29.1%) were observed in the population. Increased glucose levels (32.8%), insulin resistance (27.6%), hypertension (45.8%), overweight (26.8%) and obesity (25.4%) were also prevalent. Microalbuminuria was associated with high hs-CRP and TG levels in the men (adjusted odds ratios = 9.434, 95% confidence interval: 1.753 – 50.778, p = 0.01).
Conclusion: High prevalence of microalbuminuria, hypertension, insulin resistance, overweight and obesity, as well as abnormal levels of serum lipids and inflammatory markers were observed in the population. Microalbuminuria was associated with high hs-CRP and TG levels among men.
- Title: Identifying the optimal monopolar electrocautery output power in pedicular internal thoracic artery harvesting: 20 or 40 watts?
Authors: Emin Can Ata, Gözde Erkanli Şentürk, Halil Ibrahim Saygi, Mustafa Özer Ulukan, Murat Uğurlucan, Korhan Erkanli, Metin Onur Beyaz, Erkan Yildiz
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 243–247
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DOI Number: 10.5830/CVJA-2022-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-005
Background: Monopolar electrocautery is an important tool for harvesting the pedicular internal thoracic artery (ITA) in cardiac surgery. The different power outputs of cautery may affect graft integrity and long-term patency. This study aimed to identify the optimal threshold of electrocautery power for ITA harvest.
Methods: This prospective study included 30 patients who underwent elective coronary artery bypass surgery at the Medipol Mega University Hospital. The ITA was harvested by monopolar electrocautery after a median sternotomy. The output of cautery was adjusted at 20 W in group A and 40 W in group B. Three to 4 cm of a distal ITA sample from each patient was examined under a light microscope by two independent pathologists.
Results: The ITA harvest time was longer in group A (21.2 ± 7.5 vs 10.3 ± 8.1 min, p < 0.001) than in group B. ITA free flow was similar in the two groups (43.6 ± 48.7 vs 51.7 ± 45.0 ml/min, p = 0.762). Mild to moderate injury in the endothelial and sub-endothelial sample was more frequent in the lowcautery group (p = 0.0037).
Conclusion: ITA endothelial integrity was found to be better preserved with 40W electrocautery. Moreover, 20W of monopolar electrocautery may not be safe in pedicular ITA harvesting.
- Title: The use of brachiobasilic arteriovenous fistulae for haemodialysis: a single-centre descriptive study
Authors: Tinus du Toit, Kenward Chibuye, David Thomson, Kathryn Manning
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 248–253
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DOI Number: 10.5830/CVJA-2022-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-006
Aim: The main aim of the study was to report on our local experience with the use of brachiobasilic arteriovenous fistulae (BBAVF) and to encourage wider local acceptance of the procedure in accordance with international guidelines. The primary aim was to report on access patency. The secondary aims were to report on functional outcomes and complications.
Methods: This was a retrospective, descriptive study of 41 consecutive haemodialysis patients who underwent BBAVF creation.
Results: The primary patency rates at 30 days, and one and three years were 95.1, 48.8 and 19.5%, respectively. Assisted primary patency rates at 30 days, and one and three years were 100, 67.7 and 24.3%, respectively. Secondary patency rates at 30 days, and one and three years were 100, 70.3 and 27%, respectively.
Conclusion: BBAVF creation can successfully be performed in a resource-constrained environment by surgeons with limited prior experience with the technique. However, careful monitoring, well-established referral pathways for dysfunctional fistulae and access to surgical and endovascular revision seem to be key factors in ensuring long-term patency.
- Title: Endovascular treatment of Buerger’s disease in patients with critical limb ischaemia
Authors: Deniz Serefli, Onur Saydam
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 254–259
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DOI Number: 10.5830/CVJA-2022-018
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-018
Objectives: Thromboangitis obliteransis (TAO) is a nonatherosclerotic, inflammatory, occlusive arteritis that affects small and medium-sized arteries, veins and nerves. A large proportion of patients with TAO suffer from claudication, and the ultimate condition is gangrene and limb loss if there is no treatment or the cessation of smoking. Endovascular revascularisations are performed frequently and provide acceptable results in patients who are not suitable for surgery. In this study, we aimed to show our clinical experience in patients with TAO who were treated with endovascular revascularisation.
Methods: Between January 2014 and March 2020, 18 patients with lower-extremity critical limb ischaemia (CLI) underwent endovascular treatment (ET). Technical details and clinical success at follow up were documented.
Results: This study included 18 patients with lower-extremity TAO who presented with CLI and were treated with ET. The mean age of the patients was 38.8 ± 7.3 years. Fifty per cent of patients had pain at rest, 33.7% had minor tissue loss and non-healing ulcers, and 16.7% had major tissue loss on admission. The majority of lesions were located in the peroneal and tibial arteries (n = 13, 72.2%). Two (11.1%) patients had distal superficial femoral artery occlusion concomitant with popliteal artery (PA) lesions, and three (16.7%) had PA occlusion concomitant with peroneal and tibial artery lesions. Re-establishment of antegrade flow in at least one vessel was achieved in 15 (83.3%) patients. Balloon angioplasty was performed in all patients. Plain old balloon angioplasty (POBA) was used in nine (60%) patients and drug-eluting balloon (DEB) angioplasty in six (40%). The mean duration of follow up in 15 patient who had undergone successful ET was 21.5 ± 8.1 months. The primary CLI-free rate at 12 and 24 months was 80% (66.7% in all patients). Secondary CLI-free rates at six, 12 and 24 months were 100, 93.3 and 53.3%, respectively. Patients who were active smokers during their follow up had a higher frequency of out-patient clinic consultations (p = 0.03).
Conclusion: Controversy has continued on the role of ET in the treatment of TAO. This study shows that ET of TAO had promising primary and secondary patency rates with high technical success and limb-salvage rates.
- Title: Out-of-hospital cardiac arrests in the city of Cape Town metropole of the Western Cape province of South Africa: a spatio-temporal analysis
Authors: Willem Stassen, Elzarie Theron, Thomas Slingsby, Craig Wylie
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 260–266
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DOI Number: 10.5830/CVJA-2022-019
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-019
Background: The incidence of out-of-hospital cardiac arrest (OHCA) is expected to increase in sub-Saharan Africa along with the incidence of cardiovascular disease. In low-resource settings (LRS), OHCA carries a negligible survival rate. Interventions to improve OHCA survival might not be cost effective for many LRS, and therefore need to be targeted to areas of high incidence. The aim of this study was to describe the temporal and geographic distribution of OHCA in the City of Cape Town, South Africa, and their proximity to percutaneous coronary intervention (PCI) resources.
Methods: In this retrospective study, OHCA data between 1 January and 31 December 2018 were extracted from public and one private emergency medical services in the Western Cape. For temporal analysis, distribution of OHCA according to time of day, day of the week and month of the year were subjected to chi-squared testing. For geospatial analysis, cluster and outlier, and hotspot analyses were performed. Proximity analysis was employed to determine the driving time from OHCA location to the closest PCI-capable facility.
Results: A total of 929 patients with OHCA received an emergency medical services response in the City of Cape Town, corresponding to an annual prevalence of 23.2 per 100 000 persons. The distribution of OHCA incidence was not explained by month of the year (p = 0.08) or day of the week (p = 0.67). A statistically significant variation in OHCA incidence was explained by time of day (p < 0.01) with 30% (n = 279) of all OHCAs occurring from 05:00 to 09:59. Geospatial analysis yielded a large area of hotspots (99% confidence interval) over the centre of the metropole, Cape Flats and southern suburbs. The median (interquartile range) driving time from the incident to the closest PCI-capable facility was 10:22 (08:05) minutes.
Conclusion: Incidents of OHCA occurred predominantly at home during the mid-morning, with hotspots around the city centre and residential suburbs of Cape Town. While the incidents occurred close to PCI-capable facilities, some areas remained underserved and access to PCI for OHCA victims may be impossible due to socio-economic factors. With an increase in OHCA incidence expected, it is essential that contextual, cost-effective management interventions be developed and implemented.
- Title: 2022 SASCI/SCTSSA joint consensus statement and guideline on transcatheter aortic valve implantation (TAVI) in South Africa
Authors: J Hitzeroth, H Weich, J Scherman
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 267–269
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DOI Number: 10.5830/CVJA-2022-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-049
Abstract: Patients with severe symptomatic aortic stenosis (AS) have traditionally been treated with surgical aortic valve replacement (sAVR). Transcatheter aortic valve implantation is a percutaneous option that has been shown to be at least as effective as sAVR in numerous subgroups of patients with severe AS. This is an update on the previous joint consensus statement and guideline on transcatheter aortic valve implantation (TAVI) in South Africa, published in 2016. It provides guidance on which patients should preferably be offered TAVI over sAVR, with special consideration of the resourceconstrained environment in South Africa.
- Title: Fire at the gate ruins fish: pulmonary embolism caused by right atrial myxoma
Authors: Kang He, Longrong Bian, Weitao Liang, Zhong Wu
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 270–272
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DOI Number: 10.5830/CVJA-2021-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-062
Abstract: Myxoma is the most common benign type of cardiac tumour. Myxomas mainly occur in the left atrium, rarely in the right atrium. Right atrial myxoma (RAM) is therefore associated with few cases of pulmonary embolism (PE). In this study, we explored a case of RAM associated with PE and characterised by loss of consciousness. The patient was treated by surgical excision of the RAM. After the surgery, the patient showed a good recovery and was discharged nine days after the operation.
- Title: Fatal pulmonary oedema associated with severe pre-eclampsia: challenges and lessons
Authors: Nnabuike Chibuoke Ngene, Jagidesa Moodley
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 273–276
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DOI Number: 10.5830/CVJA-2021-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-064
Abstract: Pre-eclampsia complicated by pulmonary oedema, severe hypertension, tachycardia and desaturation is a devastating condition. A comprehensive understanding of the aetio-pathogenesis during such an emergency is challenging in the absence of functional and responsive point-of-care imaging, and laboratory and other critical-care services. An unbooked 26-yearold gravida 3 para 1+1 presented to a primary healthcare clinic with features of pre-eclampsia, severe hypertension and pulmonary oedema. The only available antihypertensive drug, methyldopa, was administered. The patient was transferred to a district hospital and subsequently referred to a tertiary hospital. On arrival, she was booked for caesarean delivery and in the maternity ward a central venous pressure (CVP) line was inserted. The patient developed pneumo-thorax and died in the intensive care unit undelivered. This case highlights many lessons, which are discussed. If CVP monitoring is indicated before caesarean delivery, consideration must be given to line insertion in the operating room to facilitate rapid delivery should the patient’s condition deteriorate.
- Title: A rare endocrine cause of ventricular tachycardia: a case series of two patients and a literature review
Authors: Ming Yu, Lin Sun, Hong-liang Yang, Huan Sun, Chang Wang, Shuai Yao, Ping Yang
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 277–281
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DOI Number: 10.5830/CVJA-2022-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-043
Abstract: Sheehan’s syndrome is a type of hypopituitarism caused by massive uterine bleeding and hypovolaemic shock after or during delivery. Heart involvement has been documented sporadically among the various clinical manifestations of Sheehan’s syndrome but life-threatening arrhythmias are infrequent. Here, we report on two rare cases of ventricular tachycardia caused by Sheehan’s syndrome. Both female patients were diagnosed with Sheehan’s syndrome 30 years previously, due to massive postpartum bleeding. Both of them terminated hormone replacement therapy recently. Both patients presented with torsade de pointes. The electrocardiogram showed prolonged QT interval. In addition to potassium supplementation and anti-arrhythmia therapy, steroids and thyroid hormone replacement therapy were employed, QT-interval prolongation and T-wave inversion were normalised, and implantable cardioverter defibrillator implantation was avoided. One of the patients was recovering well at the one-year follow up and the other patient was in a coma at the time of this report. We also review the literature for cases of Sheehan’s syndrome presenting with ventricular tachycardia.
- Title: The added value of molecular-based diagnostics in the African forensic medical setting
Authors: Barbara Ströh van Deventer, Musa Aubrey Makhoba, Lorraine du Toit-Prinsloo, Chantal van Niekerk
From: Cardiovascular Journal of Africa, Vol 33, Issue 5 September/October 2022
Pages: 282–286
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DOI Number: 10.5830/CVJA-2022-050
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-050
Abstract: Sudden unexpected infant death (SUDI) is reported to be an extraordinarily high burden in sub-Saharan Africa, with the incidence rate in South Africa among the highest in the world. It is common for the cause of many such infant deaths to remain unexplained even after a full medico-legal death investigation, and then to be categorised as a sudden unexplained infant death (SUID). Fortunately, advances in molecular-based diagnostics allow researchers to identify numerous underlying inherited cardiac arrhythmogenic disorders in many SUDI cases, with a predominance of variants identified in the SCN5A gene. Such cardiac arrhythmogenic-related sudden deaths generally present with no structural alterations of the heart that are macroscopically identifiable at autopsy, therefore highlighting the importance of post mortem genetic testing. We report on a significant genetic finding that was made on a SUDI case in which the cause was ascribed to an acute bacterial pneumonia but it was still subjected to post mortem genetic testing of the SCN5A gene. The literature shows that many SUDI cases diagnosed with inherited cardiac arrhythmogenic disorders have demonstrated a viral prodrome within days of their death. It is therefore not uncommon for these cardiac disorders in infants to be mistaken for flu, viral upper respiratory tract infection or pneumonia, and without the incorporation of post mortem genetic testing, any other contributory causes of these deaths are often disregarded. This study highlights the need for research reporting on the genetics of inherited cardiac disorders in Africa.
