CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 34, ISSUE
2, MAY/JUNE 2023
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- Editorial
Author: P Commerford
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Page: 5
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- Title: Epidemiology and management of heart failure with reduced ejection fraction in a Tunisian university hospital
Authors: Meriem Drissa, Habiba Drissa, Sana Helali, Khalil Oughlani, Amani Farah, Marwa Chebbi
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 68–72
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DOI Number: 10.5830/CVJA-2018-070
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2018-070
Introduction: Despite considerable advances in treatment, heart failure (HF) remains a serious public health problem linked to a high rate of mortality. The aim of this work was to describe the epidemiological, clinical and evolutionary features of HF in a Tunisian university hospital.
Methods: This was a retrospective study including 350 hospitalised patients diagnosed with HF with reduced ejection fraction (≤ 40%) during the period between 2013 and 2017.
Results: The average age was 59 ± 12 years. A male predominance was noted. The main cardiovascular risk factor was the use of tobacco (47%). The electrocardiogram showed atrial fibrillation in 41% of patients and left bundle branch block in 36% of patients. Laboratory results revealed an electrolyte disorder in 30 cases, renal insufficiency in 25% of patients and anaemia in 20%. Echocardiography revealed reduced ejection fraction, with an average of 34 ± 6% (range: 20–40%). The main causes of HF were ischaemic heart disease in 157 patients. The most commonly used medications were diuretics (90% of patients), angiotensin converting enzyme inhibitors (88%), beta-blockers (91%) and mineralocorticoid receptor antagonists (35%). Cardiac resynchronisation therapy was performed on 30 patients and cardioverter defibrillator implantation on 15 patients. The hospital mortality rate was 10% and the average hospital stay was 12 ± 5 days. During six months of follow up, 56 patients died and 126 were re-admitted. Multivariate model predictors of six-month mortality were: age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 21, p = 0.004)
Conclusion: This study illustrates the main characteristics of HF in our population. These include relatively young age, a predominance of males, ischaemic heart disease as the main aetiology, insufficient care strategies and a poor prognosis.
- Title: Role of nuclear factor kappa-B in TNF-induced cytoprotection
Authors: Roisin Kelly-Laubscher, Sarin Somers, Lydia Lacerda, Sandrine Lecour
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 74–80
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DOI Number: 10.5830/CVJA-2022-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-023
Abstract: Ischaemic heart disease (IHD) is a leading cause of death worldwide. Understanding prosurvival signalling pathways that protect against ischaemia–reperfusion injury (IRI) may assist in the development of novel cardioprotective strategies against IHD. In this regard, the transcription factor, nuclear factor kappa-B (NFκB) is activated by tumour necrosis factor (TNF), but its role in TNF-induced cytoprotection is unknown. Therefore, to investigate the role of NFκB in TNF-induced cytoprotection, C2C12 cells were pretreated with TNF (0.5 ng/ml) in the presence and absence of an NFκB inhibitor, pyrrolidine derivative of dithiocarbamate (PDTC; 100 μM). Cells were subjected to simulated IRI and treated with PDTC, either during TNF exposure or at reperfusion. Phosphorylation of IkB was measured after the TNF stimulus. Cytoprotection by TNF in cells subjected to IRI (cell viability: 43.7 ± 8.1% in control vs 70.6 ± 6.1% with TNF, p < 0.001) was abrogated by co-administration of PDTC (40.6 ± 1.9%, p < 0.001 vs TNF) but not by exposure to PDTC at reperfusion (70.7 ± 1.7%). Cytosolic IkB phosphorylation [1.5 ± 0.2 arbitrary units (AU) for TNF vs 1.0 ± 0.0 for untreated, p < 0.01]) was increased after TNF exposure and this increase was abolished by co-administration with PDTC (0.8 ± 0.3 AU, p < 0 01 vs TNF). Our data suggest that NFκB acts as a key component in TNF-induced cytoprotection. These findings may pave the way for the development of novel therapeutic drugs that target TNF/NFκB signalling to protect against IHD.
- Title: Clinical features and outcomes of infective endocarditis: a single-centre experience
Authors: Hoda Abdelgawad, Sahar Azab, Mohamed Ayman Abdel-Hay, Abdallah Almaghraby
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 82–88
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DOI Number: 10.5830/CVJA-2022-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-027
Background: Infective endocarditis (IE) may present with a broad spectrum of symptoms and signs and several tools can be used for diagnosis. Many protocols can be used for in-hospital and out-patient management. The aim of this study was to assess the clinical features, tools used and outcomes of patients diagnosed with IE in one of the tertiarycare university hospitals.
Methods: This study included 90 consecutive patients admitted to the Cardiology Department in a tertiary-care university hospital in Egypt with a diagnosis of IE.
Results: The mean age of the studied population was 36.72 years and 76.67% were males. The most common underlying condition was valvular heart disease (48.89%), followed by intravenous drug use (26.67%) and the most common risk factor was smoking (48.89%). The most common clinical presentation was fever (69.67%), followed by dyspnoea (55.56%), and the mean duration from symptom onset until admission was 13.28 ± 9.29 days. Positive cultures were encountered in 45.56% of patients. Surgery was indicated in 91.11% of the patients but it was performed in only 28.89%. Almost a third of patients (34.44%) died in the hospital. After one year of follow up, a further 8.47% of the patients had died, 11.86% had heart failure and 6.78% had undergone a re-do surgery.
Conclusions: Nowadays IE tends to affect a younger group of patients and valvular heart disease is the main underlying condition. The mortality rate due to IE is high in developing countries and IE does not have only immediate and shortterm complications, its effects extend to a longer period of time.
- Title: Positive impact of training rural health workers in identification and prevention of acute rheumatic fever in eastern Uganda
Authors: Judith Namuyonga, Emma Ndagire, David Okumu, Oluwayomi Olugubuyi, Sulaiman Lubega, John Omagino, Peter Lwabi, Emmy Okello
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 89–92
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DOI Number: 10.5830/CVJA-2022-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-029
Background: Diagnosis of acute rheumatic fever (ARF) is mainly clinical. Delayed or missed diagnosis and failure to administer appropriate and timely treatment of ARF leads to rheumatic heart disease (RHD), which could necessitate expensive treatments such as open-heart surgery. Implementation of preventative guidelines depends on availability of trained healthcare workers. As part of the routine support supervision, the Uganda Heart Institute sent out a team to rural eastern Uganda to evaluate health workers’ knowledge level regarding management of ARF.
Methods: Health workers from selected health facilities in Tororo district, eastern Uganda, were assessed for their knowledge on the clinical features and role of benzathine penicillin G (BPG) in the treatment and prevention of ARF recurrence. Using the RHD Action Needs assessment tool, we generated and administered a pre-test, then conducted training and re-administered a post-test. Eight months later, health workers were again assessed for knowledge retention and change in practices. Statistical analysis was done using Stata version 15.
Results: During the initial phase, 34 of the 109 (31%) health workers passed the pre-test, indicating familiarity with clinical features of ARF. The level of knowledge of BPG use in ARF was very poor in all the health units [25/109 (22.6%)] but improved after training to 80%, as shown by the chi-squared test (χ2 = 0.000). However, retention of this knowledge waned after eight months and was not significantly different compared to pre-training (χ2 ≥ 0.2).
Conclusion: A critical knowledge gap is evident among health workers, both in awareness and treatment of ARF, and calls for repetitive training as a priority strategy in prevention.
- Title: Association between bifurcation angle of the left main coronary artery and severity of stenosis of the proximal left anterior descending artery
Authors: Mohamed Yahia, Walaa Farid, Mohamed Lotfy, Mohamed Osama, Hend Abdo El Deep
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 93–97
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DOI Number: 10.5830/CVJA-2022-031
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-031
Aim: The aim of this study was to evaluate the association between the left main coronary artery (LM) bifurcation angle and the severity of the proximal left anterior descending coronary artery (LAD) stenosis.
Methods: Two hundred patients with suspected coronary artery disease who had coronary angiography were included in this observational study. The severity of coronary artery stenosis was analysed using quantitative coronary angiography software (QCA analysis). The LM–LAD and LAD–left circumflex artery (LCX) angles were measured using software (IC MEASURE) in two-dimensional axial images.
Results: The patients were divided into two groups. The first group included 100 patients with significant proximal LAD stenosis (≥ 50%) and the second, those with LAD stenosis < 50% (100 patients). Patients with significant proximal LAD stenosis were older and had a higher frequency of diabetes mellitus, and higher serum creatinine and low-density lipoprotein levels than those with non-significant LAD stenosis. The LM–LAD and LAD–LCX angles in patients with significant proximal LAD stenosis were wider than in patients with non-significant LAD stenosis (p < 0.001). The cut-off value of 42° of the LM–LAD angle had a sensitivity of 73% and specificity of 70% to predict significant proximal LAD stenosis. The cut-off value of 68° of the LAD–LCX angle had a sensitivity of 68% and specificity of 62% to predict significant proximal LAD disease. In a multivariate logistic regression analysis, LM–LAD and LAD–LCX angles were independent factors for the development of significant proximal LAD stenosis.
Conclusion: Wider LM–LAD and LAD–LCX angles were associated with the severity of proximal LAD disease. Preventative measures and close follow up are needed in such cases to improve their cardiovascular outcome.
- Title: CircRNA-mediated pathology: a new preliminary insight into the mechanism of type II cardio-renal syndrome
Authors: Huan Wang, Yuanhui Hu, Jingjing Shi, Huaqin Wu, Zhiling Qiu, Yanting Geng
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 98–103
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DOI Number: 10.5830/CVJA-2022-033
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-033
Aim: The aim of this research was to investigate the expression of peripheral blood circular RNA (circRNA) in patients with type II cardio-renal syndrome, uncover the potential function and possible mechanisms mediated by circRNAs, and ultimately provide gene target support for the treatment of type II cardio-renal syndrome.
Methods: CircRNAs in the peripheral blood from five healthy individuals and 20 type II cardio-renal syndrome patients were collected for micro-array analysis. Another cohort study consisting of 12 normal cases and 15 type II cardiorenal syndrome patients was conducted to verify the chosen circRNA by quantitative real-time polymerase chain reaction.
Results: A total of 2 884 circRNAs were found to be differentially expressed in the group of patients with type II cardio-renal syndrome. Of these, 1 989 were upregulated and 895 were downregulated. One circRNA was then selected as a candidate biomarker and further validated in the second cohort.
Conclusion: Differentially expressed mRNAs between patients with type II cardio-renal syndrome and healthy controls were enriched in two pathways, including haematopoietic cell lineage and cell adhesion molecules. CircRNA-mediated pathology is indispensable and plays an important role in the progress of type II cardio-renal syndrome. More importantly, hsa_cir_0001763 may be an important character in circRNAmediated pathology.
- Title: Circulatory soluble LOX-1 is a novel predictor for coronary artery disease patients
Authors: Md Sayed Ali Sheikh
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 104–108
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DOI Number: 10.5830/CVJA-2022-038
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-038
Objective: This study investigated the biomarker effect of soluble lectin-like oxidised low-density lipoprotein (sLOX-1) levels for the evaluation of stable and unstable coronary heart disease, correlating it with aging.
Methods: This case–control study was conducted at the Cardiology Department of Xiangya Hospital between June 2015 and September 2018. Stable coronary artery disease (CAD) patients were confirmed by an invasive coronary angiogram, and American College of Cardiology as well as European Cardiology Society clinical protocols were used for the diagnosis of unstable CAD subjects. Plasma sLOX- 1 levels were determined from 226 stable CAD patients, 138 unstable CAD subjects and 75 healthy participants by enzyme-linked immunosorbent assay.
Results: Plasma sLOX-1 expressions were significantly elevated in stable CAD patients (4.5-fold) and unstable CAD patients (5.8-fold) above that of volunteer healthy participants. Moreover, between the stable and unstable patient groups, sLOX-1 concentrations were also statistically significantly different (p < 0.001). Levels of plasma sLOX-1 in the healthy female (30–60 years), and stable and unstable CAD female subjects (61–84 years) were markedly elevated compared with healthy male (30–60 years), as well as stable and unstable CAD male patients (61–84 years) (p < 0.001). Besides, in the female unstable CAD (61–84 years) subjects, circulatory sLOX-1 expressions were much higher than in the younger female unstable CAD (30–60 years) patients (p < 0.001). The stable CAD patients were clearly differentiated from healthy subjects with a high sensitivity of the area under the curve (AUC = 0.895). Unstable CAD patients and healthy subjects were also markedly different with a high sensitivity, as shown by AUC (0.902). Stable and unstable CAD subjects were differentiated with an AUC of 0.867.
Conclusion: Elevated plasma sLOX-1 levels could be regarded as a novel biomarker for detecting CAD patients and there was a significant association with gender and aging.
- Title: Assessment of left atrial morphological and functional differences in professional male football players: a prospective, case–control study
Authors: Sefa Gül, Hasan Güngör
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 109–113
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DOI Number: 10.5830/CVJA-2023-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-010
Background: Intensive physical activity in athletes leads to considerable changes in the morphology and physiology of the left atrium through physiological, exercise-induced remodelling. Aim: This study aimed to assess the mechanical and electrophysiological changes in professional football players using electrocardiographic and echocardiographic assessment tools.
Methods: This prospective, case–control study was performed between February and June 2022. The population consisted of elite male football players (n = 49, group F) as the study group, and healthy male non-athlete individuals of matching age (n = 50, group C) as the control group. All participants underwent electrocardiographic and echocardiographic (two-dimensional and tissue Doppler) examinations. Volumetric and functional assessment of the left atrium was identified as the study’s primary outcome.
Results: There was no significant difference between the groups in terms of demographic and morphometric characteristics (p > 0.05). Maximum and minimum P waves and PR-interval duration were significantly higher in group F than in group C (p = 0.011, p = 0.005 and p < 0.001). Diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes were significantly increased in group F (p < 0.0). Ejection fraction of the left atrium was significantly lower in group F than in group C (p = 0.001). Pulmonary acceleration time and tricuspid annular plane systolic excursion was significantly higher in the football players (p = 0.023 and p < 0.001).
Conclusions: Increased diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes could be demonstrated in the elite football players. The morphological and functional changes in the left atrium might be a physiological consequence of left atrial cardiac remodelling to intensive and chronic training.
- Title: SARS-CoV-2 infection-associated thoraco-abdomino-iliac thrombosis in a patient without cardiac and systemic co-morbidity
Authors: Ferhat Borulu, Bilgehan Erkut, Yahya Unlu
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 114–116
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DOI Number: 10.5830/CVJA-2022-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-025
Abstract: Acute pulmonary damage and vascular coagulopathy occur frequently in patients with severe acute respiratory syndrome coronavirus 2 infection in relation to coronavirus disease (COVID-19). The inflammatory process accompanying the infection and excessive coagulation state is one of the most important causes of patient death. The COVID-19 pandemic remains a major challenge for healthcare systems and millions of patients worldwide. In this report, we present a complicated case of COVID-19 associated with lung disease and aortic thrombosis.
- Title: Diphtheritic myocarditis: a case report, with toxinmediated complications and multi-organ involvement
Authors: Kumari Naidoo, Mpumelelo Msimang, Mignon du Plessis, Datshana Prakesh Naidoo
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 117–120
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DOI Number: 10.5830/CVJA-2022-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-032
Abstract: The re-emergence of diphtheria in South Africa in recent years warns of incomplete vaccination coverage. Recent outbreaks have been associated with a high mortality rate, due to late presentation, limited access to antitoxin and the occurrence of serious systemic complications. Death due to diphtheria is most commonly associated with diphtheritic myocarditis, which presents with heart failure, cardiogenic shock and conduction abnormalities. This case highlights the key clinical features and systemic complications, and examines the reasons for the return of diphtheria in our community.
- Title: Improving cardiovascular outcomes for patients with heart failure in sub-Saharan Africa: conference proceedings of the 2022 Nigerian Cardiovascular Symposium
Authors: Onyedika J Ilonze, Albert Hicks, Bayo Atanda, Mahmoud H Abdou, Chioma Onyekwelu, Ebere Chukwu, Kamilu M Karaye, Ibraheem Katibi, Okechukwu S Ogah, Obi Emerole, Jane N Ajuluchukwu, Mahmoud U Sani, Christopher C Asuzu, Modele O Ogunniyi
From: Cardiovascular Journal of Africa, Vol 34, Issue 2 May/June 2023
Pages: 121–128
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DOI Number: 10.5830/CVJA-2023-016
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-016
Abstract: The Nigerian Cardiovascular Symposium is an annual conference held in partnership with cardiologists in Nigeria and the diaspora to provide updates in cardiovascular medicine and cardiothoracic surgery with the aim of optimising cardiovascular care for the Nigerian population. This virtual conference (due to the COVID-19 pandemic) has created an opportunity for effective capacity building of the Nigerian cardiology workforce. The objective of the conference was for experts to provide updates on current trends, clinical trials and innovations in heart failure, selected cardiomyopathies such as hypertrophic cardiomyopathy and cardiac amyloidosis, pulmonary hypertension, cardiogenic shock, left ventricular assist devices and heart transplantation. Furthermore, the conference aimed to equip the Nigerian cardiovascular workforce with skills and knowledge to optimise the delivery of effective cardiovascular care, with the hope of curbing ‘medical tourism’ and the current ‘brain drain’ in Nigeria. Challenges to optimal cardiovascular care in Nigeria include workforce shortage, limited capacity of intensive care units, and availability of medications. This partnership represents a key first step in addressing these challenges. Future action items include enhanced collaboration between cardiologists in Nigeria and the diaspora, advancing participation and enrollment of African patients in global heart failure clinical trials, and the urgent need to develop heart failure clinical practice guidelines for Nigerian patients.
