CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 33, ISSUE
6, NOVEMBER/DECEMBER 2022
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- Editorial
Author: Blanche J Cupido
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Page: 289-290
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DOI Number: 10.5830/CVJA-2023-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-001
- Title: Effects of intra-operative fluid management under the guidance of stroke volume variability on short-term prognosis after thoracoscopic lobectomy
Authors: Feng Zhu, Shaolin Cheng, Yang Yang, Xuan Li, Zhen Tang
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 291–295
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DOI Number: 10.5830/CVJA-2021-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-049
Aim: We aimed to explore the influence of intra-operative fluid management under the guidance of stroke volume variability (SVV) on the short-term prognosis after thoracoscopic lobectomy.
Methods: A total of 171 eligible patients from April 2017 to April 2019 were selected. All patients received intra-operative fluid management under the guidance of SVV, and were divided into low-, middle- and high-level groups (n = 57) using a random-numbers table. The general data, respiratory function indices at different time points, haemodynamic indices at different time points, use of vasoactive drugs, shortterm prognosis indices and incidence of complications were compared.
Results: There were no significant differences in age, gender, operation time, one-lung ventilation time, amount of bleeding, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, lung compliance and peak airway pressure at different time points, usage amount of anisodamine and incidence rate of complications among the three groups. In the low-level group, the fluid infusion amount and urine volume were significantly larger, the forced expiratory volume in one second (FEV1), percentage of FEV1 in the predicted value (FEV1%pred) and FEV1/forced vital capacity (FEV1/FVC) seven days after operation were higher, and the six-minute walk test (6MWT) distance was longer than those in the other two groups. The usage amount of dopamine, norepinephrine and esmolol was smaller, and the postoperative exhaust time was shorter than those in the other two groups. The low-level group had a smaller usage amount of isosorbide dinitrate injection and shorter length of postoperative hospital stay than the high-level group. Stroke volume had a significant difference at T2 and T3 in the low-level group, central venous pressure (CVP) and stroke volume had significant differences at T2 and T3 in the middle-level group, and heart rate (HR), mean arterial pressure and CVP were significantly different at T2 and T3 in the high-level group.
Conclusion: Fluid management under the guidance of lowlevel SVV (8% ≤ SVV ≤ 9%) was conducive to the maintenance of stable haemodynamics in patients during thoracoscopic lobectomy, thereby improving short-term prognosis.
- Title: The role of inflammatory parameters in the prediction of postoperative delirium in patients undergoing coronary artery bypass grafting
Authors: Hüseyin Şaşkin, Kazim Serhan Özcan, Serhan Yildirim
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 296–303
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DOI Number: 10.5830/CVJA-2022-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-008
Objective: In this study, we aimed to evaluate the association of pre-operative and early postoperative inflammatory parameters with postoperative delirium in patients operated on for coronary artery bypass grafting.
Methods: The data of 1 279 cardiac surgery patients operated on between June 2014 and March 2020 were analysed retrospectively. Among these, 777 (61.2%) patients operated on for isolated coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled. Two groups were formed. The patients who developed postoperative delirium were placed in group 1 (n = 187) and the patients with uneventful postoperative follow up (n = 590) were enrolled in group 2.
Results: Pre- and early postoperative mean platelet volume, C-reactive protein level, erythrocyte sedimentation rate, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were elevated in group 1 (p = 0.0001). The APACHE II score and duration of hospital and intensive care unit stay were significantly elevated in group 1 (p < 0.05). An early-stage neurological event was observed in eight patients (4.3%) in group 1 and 12 patients (2%) in group 2, which was not statistically significantly different between the groups (p = 0.09). In-hospital mortality was observed in three patients (1.6%) in group 1 and five patients (0.8%) in group 2, which did not show a statistically significant difference (p > 0.05). In univariate and multivariate regression analysis, the pre-operative platelet-to-lymphocyte ratio (p = 0.013), mean platelet volume (p = 0.0001) and erythrocyte sedimentation rate (p = 0.002) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Also, the postoperative platelet-to-lymphocyte ratio (p = 0.0001), neutrophil-to-lymphocyte ratio (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were determined as independent risk factors for the occurrence of delirium in the early postoperative period.
Conclusion: Pre-and early postoperative inflammatory parameters were observed to be predictors of postoperative delirium in patients operated on for coronary artery bypass grafting.
- Title: Influence of verapamil on pressure overload-induced ventricular arrhythmias by regulating gene-expression profiles
Authors: Xianfeng Cheng, Xue Xu, Chengwei Zou, Weidong Jiang
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 304–312
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DOI Number: 10.5830/CVJA-2022-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-010
Background: Life-threatening ventricular arrhythmias can lead to sudden cardiac death in patients. This study aimed to investigate the changes in gene profiles involved when verapamil (VRP) affects increased wall stress (pressure overload)-induced ventricular arrhythmias, thus revealing the potential causative molecular mechanisms and therapeutic targets through geneexpression identification and functional analysis.
Methods: Animal models with wall stress-induced ventricular arrhythmias were established. Low (0.5 mg/kg) and high (1 mg/kg) doses of VRP were administered intravenously 10 minutes before transverse aortic constriction, and average ventricular arrhythmia scores were calculated. Next, we evaluated the molecular role of VRP by characterising differential gene-expression profiles between VRP-pretreated (1 mg/kg) and control groups using RNA-sequencing technology. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were used to reveal molecular function. A protein–protein interaction (PPI) network was then developed.
Results: VRP exerted its anti-arrhythmic effects in response to increases in left ventricular (LV) afterload. We detected differentially expressed genes (DEGs), of which 36 were upregulated and 1 397 downregulated, between the VRP-pretreated and model groups during acute increases in LV wall stress. GO analysis demonstrated that the DEGs were associated with cytoskeletal protein binding. KEGG analysis showed that enriched pathways were mainly distributed in adherens junctions, actin cytoskeleton regulation and the MAPK signalling pathway. Centralities analysis of the PPI identified Rac1, Grb2, Rbm8a and Mapk1 as hub genes.
Conclusions: VRP prevented acute pressure overload-induced ventricular arrhythmias, possibly through the hub genes Rac1, Grb2, Rbm8a and Mapk1 as potential targets of VRP.
- Title: Prosthetic vascular graft management in above-knee amputations
Authors: Levent Umur, Ismail Selçuk
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 313–316
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DOI Number: 10.5830/CVJA-2022-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-012
Objective: Critical limb ischaemia (CLI) is the most severe state of peripheral arterial disease and is one of the major causes of lower-limb amputations. One of the treatment choices is prosthetic vascular grafts. Despite treatment, CLI may lead to amputation owing to infection or progressive ischaemia. The aim of this study was to show that multidisciplinary planning and surgery for CLI patients with prosthetic grafts decreased the duration of hospital stay, costs, risk of infection and ascending conversion of the amputation level.
Methods: Forty-two above-knee amputation patients with grafts were retrospectively evaluated. Group A patients (n = 24) had partial excision and group B patients (n = 18) total excision with or without saphenous patch-plasty, according to the patency of the deep femoral artery. Growth in wound culture, antibiotic therapy duration, conversion to hip disarticulation and hospitalisation periods were compared.
Results: Differences in growth of wound culture (p = 0.007), antibiotic duration (p = 0.003), hip disarticulation (p = 0.029) and duration of hospital stay (p = 0.0001) between the two groups were found to be statistically significant (p < 0.05).
Conclusion: Management of CLI patients is a complex process, and a multidisciplinary approach is key to avoiding undesirable outcomes. Meticulous planning, including excision of the total graft, while ensuring the vascular supply, is essential.
- Title: The relationship between gender and systemic immune–inflammation index in patients with new-onset essential hypertension
Authors: Emine Altuntas, Sükrü Cetın, Songül Usalp
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 317–321
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DOI Number: 10.5830/CVJA-2022-030
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-030
Aim: The systemic immune–inflammation index (SII) has been reported to have a prognostic ability in various cardiovascular diseases and tumours. In this study, we aimed to investigate whether there was an association between SII and gender and age in newly diagnosed, treatment-naïve, hypertensive patients.
Methods: A total of 153 participants, of whom 93 were men and 60 were women, were included in this retrospective study. Retrospective evaluation of the patients was performed using electronic medical records. The SII was calculated according to the following formula at admission: SII = platelet × neutrophil/lymphocyte counts
Results: The SII was significantly higher in women compared to men (546.31 vs 385, respectively, p = 0.003) and was positively correlated with age. The receiver operating characteristic curve shows the SII cut-off value predicting new-onset essential hypertension with a sensitivity of 67.6% and a specificity of 67.2% in women.
Conclusion: According to these results, using the SII in cardiovascular diseases may be recommended to increase survival rate in hypertensive women.
- Title: A clinical conundrum: review of anticoagulation in pregnant women with mechanical prosthetic heart valves
Authors: M Jenneker, H Ramnarain, H Sebitloane
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 322–328
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DOI Number: 10.5830/CVJA-2022-028
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-028
Abstract: In South Africa, maternal mortality from cardiovascular disease remains high. The recent Saving Mothers report 2017–2019 from the Confidential Enquiries into Maternal Deaths revealed that indirect maternal death from medical and surgical disorders is the fourth commonest cause of maternal death, accounting for 16.9% of deaths, with cardiac disease accounting for one-third of this. The burden of rheumatic heart disease (RHD) is a significant contributor to maternal morbidity and mortality. The true burden is unknown due to limited data. The natural history of RHD confers additional risk as many cases may remain undiagnosed, with first presentation occurring during pregnancy. This undiagnosed subset of women may be the result of poor accessibility to healthcare facilities and primary healthcare interventions for acute rheumatic fever. RHD causes progressive damage to the heart valves, especially the left-sided valves, which eventually require surgical correction with mechanical prosthetic valves.
- Title: Subacute dual stent thromboses in a COVID-19-positive patient
Authors: Jacques Liebenberg, Thadathilankal-Jess John, Hoosain Khalfey, Ibrahim D’Andrea, Charles Kyriakakis
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 329–332
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DOI Number: 10.5830/CVJA-2022-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-003
Abstract: The hypercoagulable state of COVID-19 is resulting in an increasing number of unexpected venous and arterial thromboses in patients. We report a case of subacute dual coronary stent thrombosis in the setting of COVID-19 and we provide a brief review of current management recommendations.
- Title: PASCAR Seminar: PASCAR Clinical Research Training Task Force Seminar, Cape Heart Institute, University of Cape Town, 14 November 2022
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 333
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Abstract: The inaugural PASCAR Clinical Research Training Task Force one-day seminar was held in Cape Town and facilitated and supported by the Cape Heart Institute and University of Cape Town on 14 November 2022. In-room international faculty included PASCAR Clinical Research Training Task Force co-chair Prof Mahmoud Sani (Bayero University, Kano, Nigeria) and Prof Ana Mocumbi (Eduardo Mondlane University, Mozambique) as well as local expert faculty from the Cape Heart Institute, University of Cape Town and South African MRC, namely PASCAR Clinical Research Training Task Force co-chair Prof Friedrich Thienemann, Prof Karen Sliwa, Prof Liesl Zühlke, Prof Andre Pascal Kengne, Prof Mark Engel, Antoneta Mashinyira and Dr Sandra Mukasa. The seminar accommodated 24 delegates from Namibia, South Africa, Congo, Tanzania, Kenya, Zimbabwe, Nigeria and Mozambique.
- Title: Cardio News: First for Africa: robotic-assisted cardiothoracic surgery comes to South Africa
From: Cardiovascular Journal of Africa, Vol 33, Issue 6 November/December 2022
Pages: 334
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Abstract: In a first for the continent, a cardiothoracic robotic-assisted surgery programme has been established at Netcare Christiaan Barnard Memorial Hospital to provide less-invasive alternatives for procedures involving the chest cavity, including lung cancer and cardiac surgeries, among others.
