CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 34, ISSUE
1, JANUARY/APRIL 2023
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- Editorial
Author: Blanche J Cupido
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Page: 3
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- Title: Changing face of pulmonary embolism with COVID-19
Authors: Bayram Bagırtan, Emine Altuntas, Servan Yasar, Kanber Ocal Karabay
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 4–8
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DOI Number: 10.5830/CVJA-2022-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-011
Aim: This study aimed to describe the baseline characteristics of coronavirus disease 2019 (COVID-19) patients with pulmonary embolism, and to examine the Geneva score, pulmonary embolism severity index (PESI), radiological and biochemical findings.
Methods: From March 2020 to June 2021, the files of 41 COVID-19 patients with pulmonary embolism were accessed.
Results: Mean D-dimer value was 6.04 mg/dl and 61% of the patients received at least one dose of anticoagulant treatment. In patients receiving deep venous thrombosis prophlaxis, an optimal D-dimer cut-off point was calculated as 5.69 mg/dl. The area under the curve was 0.753 (p = 0.007; sensivity 64%; specificity 62.5%). The mean Geneva score was 4.31, mean PESI was 72.48 and mean Qanadli score was 11.29.
Conclusions: According to this study, traditional clinical predictive scores had little discriminatory power in these patients, and a higher D-dimer cut-off value should be considered to better diagnose patients for pulmonary embolism.
- Title: Aortic regurgitation: multimodal assessment of quantification and impact
Authors: Marie-Paule Bernadette N’Cho-Mottoh, Olivier Huttin, Christine Selton-Suty, Soukaina Scadi, Laura Filippetti, Pierre-Yves Marie
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 9–15
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DOI Number: 10.5830/CVJA-2022-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-013
Background: The assessment of severity of aortic regurgitation (AR) by transthoracic echocardiography (TTE) remains challenging in routine practice. Contemporary guidelines recommend cardiovascular magnetic resonance imaging (CMR) in patients with significant disease and suboptimal TTE images. The objective of this study was to assess the role of CMR in the evaluation of severity of AR and to compare both modalities in the quantification of regurgitation and left ventricular volumes.
Methods: Fifty consecutive patients who had isolated chronic AR and who underwent TTE and CMR within an interval of less than three months between May 2009 and June 2020 were included. The main indication for CMR was difficulties in quantifying AR, either because of lack of multiparametric analysis (only one method possible) or because of discrepancies in the different methods by TTE.
Results: In 25 patients, precise grading of AR was not possible by echocardiography. Among them, CMR finally detected seven patients with mild AR, 11 with moderate AR and seven with severe AR. For the 25 patients who had AR quantification by TTE, there was concordance between TTE and CMR in only seven patients (28%), and the AR was re-graded by CMR in 18 patients, including eight patients with severe AR by TTE and moderate AR by CMR. The concordance between TTE and CMR was weakly significant (intraclass correlation coefficient = 0.39, 95% confidence interval: 0.003–0.67, p = 0.02). There was a moderate correlation between left ventricular volumes measured by TTE and by CMR (left ventricular end-diastolic volume: r = 0.57; p = 0.01; left ventricular end-systolic volume: r = 0.47, p = 0.01) but regurgitant volumes were not correlated (r = 0.04; p = 0.8). No TTE parameter of quantification was correlated with regurgitant volume measured by CMR.
Conclusion: The concordance of AR quantification by CMR and TTE was weak. CMR re-graded some patients with severe AR by TTE into moderate AR. This should motivate practitioners to systematically assess all significant AR by CMR in order to improve quantification and optimise clinical management.
- Title: The impact of daily troponin I and D-dimer serum levels on mortality in COVID-19 pneumonia patients
Authors: Berna Stavileci, Emrah Ereren, Emrah Özdemir, Bahar Özdemir, Mahir Cengiz, Rasim Enar
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 16–22
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DOI Number: 10.5830/CVJA-2022-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-017
Background: Coronavirus disease 2019 (COVID-19) is an infection resulting in very high morbidity and mortality rates globally. Limited data are available on the cardiovascular manifestations in these patients. The aim of this study was to analyse the daily troponin I and D-dimer levels and their impact on the need for intensive care and on mortality rates of COVID-19-infected patients.
Methods: Two-hundred and five patients who were hospitalised between 20 March and 5 May 2020, with a diagnosis of moderate-to-severe COVID-19 pneumonia, were analysed retrospectively. Serum troponin I and D-dimer levels were recorded for at least 10 days after admission.
Results: The average age was higher in the group of patients who died compared to the group who were discharged (67.79 ± 14.9 vs 56.87 ± 18.15 years, respectively, p < 0.001). The presence of hypertension, diabetes mellitus, previous coronary bypass surgery, heart failure, chronic renal failure and chronic obstructive pulmonary disease statistically significantly affected mortality rates (p = 0.003, 0.004, 0.045, 0.02, 0.003, 0.007, respectively). The first 10 days of measurements of troponin I and D-dimer were associated with intensive care requirements and mortality (p < 0.001). Both troponin I and D-dimer were higher in the group who died compared to the patients requiring intensive care. Troponin I values of ≥ 16.05 pg/ml on the seventh day were related to the need for intensive care [area under the curve (AUC) 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). Troponin I values ≥ 30.25 pg/ml on the ninth day were related to mortality (AUC 0.920, sensitivity 89.5%, specificity 89.3%, p < 0.001). D-dimer values ≥ 878 hg/ml on the second day were associated with intensive care need (AUC 0.896, sensitivity 78.6%, specificity 78.3%, p < 0.001). D-dimer values ≥ 1 106 hg/ml on the 10th day were associated with mortality (AUC 0.817, sensitivity 68.4%, specificity 65.2%, p < 0.001). It was observed that hospitalisation periods ≥ 9.5 days were associated with mortality (AUC 0.738, sensitivity 68.4%, specificity 65.9%, p < 0.001).
Conclusion: We showed that hospitalisations ≥ 9.5 days in duration were related to increased mortality rates. Troponin I and D-dimer follow-up values in the serum were more effective than other inflammatory markers in predicting mortality and the need for intensive care. A high troponin I value should alert the clinician in terms of clinical deterioration.
- Title: Pre-morbid cardiometabolic risks among South Africans living in informal settlements
Authors: Kebogile Mokwena, Perpetua Modjadji
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 23–29
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DOI Number: 10.5830/CVJA-2022-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-021
Aim: Numerous studies have been conducted on cardiometabolic risk factors in South Africa. However, not much has been done in informal settlement populations faced with their own set of health risks. This study screened for pre-morbid cardiometabolic risks and associated factors among adults living in informal settlements in South Africa.
Methods: A cross-sectional study used the WHO STEPwise questionnaire to collect data on demography, anthropometry, blood pressure, and glucose and cholesterol levels (n = 329). Cardiometabolic risks were based on the criteria considered by the International Diabetes Federation and the National Cholesterol Education Program Adult Treatment Panel III. Data were analysed using STATA 14.
Results: The median age of the participants was 35 (25–42) years. Cardiometabolic risk factors among the participants were hypertension (66%), overweight/obesity (45%), abdominal obesity (46%), and elevated cholesterol (15%) and glucose levels (7%). The metabolic syndrome was found in 17% of the participants, with a high prevalence observed among participants aged 35–59 years (28%) and ≥ 60 years (40%). The metabolic syndrome was significantly associated with gender [males, adjusted odds ratio (AOR) = 0.4, 95% CI: 0.20–0.90] and age, 35–59 years (AOR = 5.07, 95% CI: 2.24–11.23) and ≥ 60 years (AOR = 6.57, 95% CI; 1.57–27.54).
Conclusion: Prevalent cardiometabolic risk factors in informal settlements indicate the need for routine screening for all the components of the metabolic syndrome at the primary healthcare level.
- Title: The non-negligible association between SYNTAX score and anxiety–depressive disorders
Authors: Levent Cerit, Zeynep Cerit, Hamza Duygu
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 30–34
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DOI Number: 10.5830/CVJA-2022-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-022
Objective: Anxiety–depressive disorders are more common in patients with coronary artery disease (CAD) and are strongly associated with higher morbidity and mortality rates. The Hospital Anxiety and Depression Scale (HADS) is a wellvalidated diagnostic tool for screening of anxiety–depression disorders. The SYNTAX score (SS) is the angiographic scoring system and is commonly used to evaluate the severity and complexity of CAD. The aim of this study was to evaluate the association between the HADS and SS.
Methods: The HADS questionnaire was filled in by subjects before the coronary angiography procedure. Biochemical, clinical and echocardiographic parameters, and SS were evaluated in all patients. Patients were assessed using the HADS. The patients were divided into two groups according to the SS [≥ 23: high SYNTAX score group (HSSG), < 23 low].
Results: The HADS scale was significantly higher in HSSG (24.8 ± 10.7 vs 11.3 ± 6.4 p < 0.001). There was no significant difference between the groups regarding laboratory parameters. On multivariate analysis, diabetes mellitus, hyperlipidaemia and the HADS were independent predictors of high SYNTAX score.
Conclusion: In our study, we found that diabetes mellitus, hyperlipidaemia and the HADS were independent predictors of a higher SS.
- Title: SA Heart consensus statement on closure of patent foramen ovale 2021
Authors: J Hitzeroth, P van der Bijl, F Michel, R Meel, BJ Cupido, E Klug
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 35–39
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DOI Number: 10.5830/CVJA-2022-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-009
Abstract: A patent foramen ovale (PFO) is associated with numerous clinical conditions. The most severe of these is cryptogenic stroke. This consensus statement aims to provide a clinical guideline on which patients should be offered PFO closure.
- Title: Resurgence of Shoshin beriberi during the COVID-19 pandemic
Authors: K Govind, GL Gaskin, DP Naidoo
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 40–43
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DOI Number: 10.5830/CVJA-2021-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-051
Abstract: This report describes two patients who presented with severe type B lactic acidosis and shock, initially thought to be due to bowel ischaemia/myocardial infarction and pulmonary sepsis, respectively. This led to a delay in the diagnosis of thiamine deficiency. In both cases there was a dramatic response to intravenous thiamine, confirming the diagnosis of Shoshin beriberi. Both patients admitted to drinking home-brewed alcohol during the time of COVID-19 restrictions on alcohol consumption. These cases highlight the need for early diagnosis and immediate empirical treatment with intravenous thiamine in patients presenting with unexplained severe metabolic acidosis and circulatory shock.
- Title: The optimal diagnosis and treatment of intravenous leimyomatosis
Authors: Hai-Yuan Liu, Jin-Guo Xu, Cheng-Xin Zhang
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 44–47
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DOI Number: 10.5830/CVJA-2022-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-002
Abstract: Intravenous leiomyomatosis (IVL) is a rare form of gynaecological-uterine leiomyoma. Clinically, the diagnosis and treatment are more difficult and challenging due to occult symptoms and clinical presentations, which can be similar to other common diseases. In this report, comprehensive management of a case of IVL is reported and discussed, with the aim of sharing our academic and clinical experience to improve the medical management of IVL.
- Title: Aneurysmal degeneration in the Omniflow II biosynthetic vascular graft
Authors: Ismail Selçuk, Bülent Bariş Güven
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 48–50
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DOI Number: 10.5830/CVJA-2022-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-004
Abstract: Despite advances in endovascular treatments, femoropopliteal bypass is still the best option for the treatment of lower-extremity occlusive artery disease. Omniflow II biosynthetic vascular grafts are often chosen as bypass grafts when autologous vein grafting is not possible. A negative feature of this graft is the tendency towards late biodegeneration with possible formation of graft aneurysms. In this case report, we present a thrombosed non-anastomotic biosynthetic graft aneurysm, which caused only a pulsatile mass in the inguinal region, in a 62-year-old male patient who had undergone a femoropopliteal bypass operation three years earlier. Aneurysm formation in vascular grafts is multifactorial and can cause life-threatening consequences. Therefore, all patients with biosynthetic vascular grafts should remain under lifetime surveillance with duplex ultrasound for aneurysmal graft degeneration and graft thrombosis.
- Title: An unusually large left ventricular thrombus complicating anterior myocardial infarction: the value of multimodality imaging
Authors: Lifa Dhlamini, Ruchika Meel, Mashudu Nethononda
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 51–54
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DOI Number: 10.5830/CVJA-2022-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-007
Abstract: Since the emergence of revascularisation for the treatment of myocardial infarction (MI), the incidence of left ventricular thrombus (LVT) has been declining. However, despite this, it is independently associated with increased morbidity and mortality rates. The mainstay of treatment is vitamin K antagonists, although non-vitamin K antagonists have been shown to be effective. Imaging plays an important role in the surveillance of LVT subsequent to MI. Herein, we emphasise the utility of multimodality imaging of a case of anterior MI complicated by a large LVT, and detail its management.
- Title: Left thoracotomy approach for aortic root surgery
Authors: Roman Komarov, Alisher Ismailbaev, Ashot Simonyan, Inoyat Ermetov, Ivan Ivashov
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 55–58
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DOI Number: 10.5830/CVJA-2022-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-014
Abstract: Marfan syndrome is an autosomal dominant disease of connective tissue affecting approximately one in 5 000 people. However, the majority of patients (60–80%) with Marfan syndrome have some degree of aortic root dilation or thoracic aortic aneurysm that can lead to aortic dissection and rupture, which has long been recognised as the leading cause of death in Marfan syndrome. The funnel breast (pectus excavatum), often seen in patients with Marfan syndrome, radically complicates the access during aortic root or arch interventions, forcing cardiosurgery practitioners to seek alternative approaches. We present a series of clinical observations of two patients with Marfan syndrome and aneurysm of the aortic root and ascending aorta. A left-sided thoracotomy provides the possibility of successful implementation of extensive surgical interventions, decreasing the risks of intra-operative damage to the cardiac structures adjacent to the sternum in this complex cohort of patients.
- Title: Mycotic abdominal aortic aneurysm: two cases caused by Salmonella enterica
Authors: Nehir Tandogar, M Şeyda Velioğlu Öcalmaz
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 59–62
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DOI Number: 10.5830/CVJA-2022-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-024
Abstract: A mycotic abdominal aortic aneurysm was detected on computed tomographic angiography of two male patients who were followed up after reporting symptoms of abdominal pain, malaise and fever of unknown origin. One of the patients’ aneurysm was repaired with a tubular graft and the other patient had endovascular aneurysm repair due to his high co-morbidity. From pre-operative cultures and a pathological examination of the surgical specimens, it was observed that the aneurysms had developed in the abdominal aorta due to Salmonella enterica, and broad-spectrum antibiotic therapy was started. We present these two cases of mycotic aneurysm due to Salmonella. The patients were discharged after the postoperative course of antibiotic treatments were completed.
- Title: Alternative treatment of tricuspid valve vegetations
Authors: Salvatore Lentini
From: Cardiovascular Journal of Africa, Vol 34, Issue 1 January/April 2023
Pages: 63
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DOI Number: 10.5830/CVJA-2022-071
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-071
Abstract: Dear Editor, I read with interest the article of Yan Chen and co-authors: Tricuspid valve vegetation related to leaflet injury: a unique problem of catheter malposition.1 The authors must be commended on the treatment of this particular case and its favourable outcome. They report on the case of a woman with a large tricuspid valve vegetation during infective endocarditis, most probably following trauma caused by malposition of a central venous catheter, inserted to treat myelodysplastic syndrome. The authors treated their patient with a conservative treatment: antibiotic therapy and removal of the central catheter, with the subsequent disappearance of the vegetation.
