CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 34, ISSUE
3, JULY/AUGUST 2023
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- Editorial
Author: P Commerford
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Page:131
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- Title: Prognostic value of myocardial scar in ischaemic and non-ischaemic cardiomyopathy using cardiac magnetic resonance imaging
Authors: Reem Laymouna, Eman El-Sharkawy, Salah El-Tahan, Mohamed El-Fiky
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 132–139
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DOI Number: 10.5830/CVJA-2022-040
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-040
Aim: The aim of this research was to evaluate the prognostic value of myocardial scar using cardiac magnetic resonance (CMR) imaging in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM).
Methods: One hundred and fifty-four patients with either ICM or NICM underwent CMR with late gadolinium enhancement sequences for assessment of left ventricular ejection fraction (LVEF), and detection and quantification of any myocardial scar using three methods: manual, number of segments involved, and percentage of scarred myocardium. Patients were followed up for at least six months for clinical cardiac events.
Results: Patients were divided into two groups: group I, patients with ICM (58%) and group II, those with NICM (42%). Clinical presentation ranged from eventless (10%) to chest pain (18%), heart failure (15%), hospitalisation (35%), syncope (1%), ventricular tachycardia (< 1%) and cardiac arrest (< 1%). The scar mass was larger in size in group I (17 ± 15%) than in group II (8 ± 13%). A direct relationship was observed between scar size and event severity (p < 0.001). An inverse relationship between LVEF and event severity was found in group I (p < 0.001) but not in group II (p = 0.128).
Conclusion: Myocardial scar size was a strong predictor of clinical outcome in both the ICM and NICM patients. LVEF was less reliable in predicting morbidity in cardiomyopathy patients.
- Title: Trends and outcomes of cardiovascular disease admissions in Lagos, Nigeria: a 16-year review
Authors: Amam C Mbakwem, Casmir Ezenwa Amadi, Jayne N Ajuluchukwu, Oyewole A Kushimo
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 140–148
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DOI Number: 10.5830/CVJA-2022-037
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-037
Background: Cardiovascular disease (CVD)-related admissions are on the increase in Nigeria and the rest of Africa. This study was carried out to highlight the burden, patterns and outcomes of CVD admissions in a tertiary hospital over a 16-year period in Lagos, Nigeria.
Methods: Admissions records of patients admitted into the medical wards within the study period (January 2002 to December 2017) were reviewed and relevant information pertaining to the study objectives was retrieved for analysis.
Results: There were a total of 21 369 medical admissions and 4 456 (20.8%) CVD-related admissions. A total of 3 582 medical deaths were recorded and 1 090 (30.4%) CVD-related deaths. The median age of the patients was 56.6 (46.0–68.0) years and 51.4% of these were males. Stroke, heart failure, hypertensive disease and acute coronary syndrome constituted 51.2, 36.2, 11.3 and 1.6% of all CVD admissions, respectively. There was a cumulative increase in the number of CVD admissions and deaths (p < 0.001, respectively) during the period under review.
Conclusion: CVD admissions are not only common in Nigeria, but there was also a temporal exponential increase in both the admission and death rates, most likely reflecting the epidemiological transition in Nigeria.
- Title: Clinical profile and outcomes of young patients treated with implantable cardioverter defibrillators at a South African tertiary hospital: a review of two decades of implantable cardioverter defibrillator implantation and follow up
Authors: Philasande Mkoko, Kayla Solomon, Ashley Chin
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 150–156
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DOI Number: 10.5830/CVJA-2022-039
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-039
Aim: In young patients without atherosclerotic coronary artery disease, the aetiology of sudden cardiac death (SCD) has been described in Europe and North America. However, there are important regional variations and there are limited data on the aetiology and outcome of SCD in South Africa. The objective of this study was to determine the profile and outcomes of young patients treated with implantable cardioverter defibrillators (ICDs) at a South African tertiary hospital.
Methods: This study was designed as a retrospective review of patients aged 35 years or younger implanted with ICDs at Groote Schuur Hospital.
Results: During the study period, 38 patients younger than 35 years were implanted with ICDs. The mean (standard deviation) age at ICD implantation was 25.1 (7.6) years and 63.2% were male. A secondary-prevention ICD was implanted in 57.9% of the patient population, and primary prevention in the remaining 42.1%. Patients with secondary-prevention ICDs presented with ventricular tachycardia (59.1%), ventricular fibrillation (31.8%) and receipt of cardiopulmonary resuscitation but no recorded electrocardiograms (9.1%). Arrhythmogenic right ventricular cardiomyopathy (ARVC) was the leading cause of SCD in the secondary-prevention patient population (36.4%). Idiopathic dilated cardiomyopathy accounted for 50% of the primary-prevention patient population. After a median (interquartile range) follow up 32 (14–90) months, 7.9% died and 5.2% received a heart transplant; 42.1% of the study population received appropriate ICD shock therapies and 18.4% received inappropriate shock therapies.
Conclusion: In this single-centre study from South Africa, ARVC and repaired congenital heart disease were the leading causes of SCD in patients younger than 35 years treated with secondary-prevention ICDs. Primary-prevention ICDs were frequently implanted for idiopathic dilated cardiomyopathy.
- Title: Prevalence and associated risk factors for elevated blood pressure in young adults in South Africa
Authors: Sanushka Naidoo, June Fabian, Shane A Norris
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 157–163
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DOI Number: 10.5830/CVJA-2022-036
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-036
Background: Sub-Saharan Africa has been shown to have a high prevalence of hypertension (58% in rural black South Africans) with an accelerated course ending in end-stage renal disease. We sought to determine whether the prevalence of elevated blood pressure (EBP) in early adulthood was associated with any risk factors and/or renal target-organ damage in young adulthood, which could prevent development of these cardiorenal sequelae.
Methods: Data including risk factors for hypertension and markers of kidney damage were collected from young adults (n = 933; age 28 years; 52% female) participating in the Birth to Twenty Plus (BT20) cohort in Soweto, South Africa. Blood pressure was measured on one occasion.
Results: Fifty-four per cent of the study sample had EBP with more men affected (62%) than women (47%) (p < 0.001). Body mass index (BMI), hyperuricaemia and albuminuria had significant associations with EBP in men. In women, BMI, hyperuricaemia and a self-reported history of gestational hypertension had significant associations.
Conclusion: Our findings suggest that the pathophysiology of EBP in young adults differs between the genders and highlights a number of modifiable factors in its development.
- Title: Creating blood conservation for a cardiothoracic surgical hospital: when you have to start from scratch!
Authors: Cenk Indelen, Yesim Uygun Kizmaz, Atakan Erkilinc, Adile Ece Altinay, Aryeh Shander, Mehmet Kaan Kirali
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 164–168
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DOI Number: 10.5830/CVJA-2022-044
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-044
Background: This improvement report presents a hospital blood-management programme, a hospital-specific model that differs from patient blood managment and was aimed at improving operational standards of transfusion. We identified the challenges of the transfusion process and suggest practical strategies for improving them. The aim of this article was to investigate the effect of the programme on the transfusion of blood components.
Methods: In January 2019, the programme was started to improve the transfusion process. The data before and after the start of the programme were compared. Frequency distribution was obtained for each variable for statistical analysis and the chi-squared test with continuity correction was used to compare these variables for the years 2018 and 2019.
Results: Transfusion of total blood components decreased by 23.2%, fresh whole blood by 46.7%, fresh frozen plasma by 38.4%, pooled platelets by 14.0% and red blood cells by 9.66%. Autologous transfusion increased 11.7-fold. The emergency department (76.0%) and intensive care unit transfusion rate (9.26%) decreased significantly.
Conclusion: This programme is an example for hospitals where patient blood management cannot be applied. The programme can be considered the first step for blood management and may be applied to blood management in institutions worldwide. The difficulty of blood supply and increased cost will increase the importance of hospital blood-management programmes in the coming years.
- Title: Assessment of papillary muscle free strain in hypertrophic cardiomyopathy and hypertension-induced left ventricular hypertrophy
Authors: Cennet Yildiz, Atilla Koyuncu, Lutfi Ocal, Mustafa Ozan Gursoy, Ersan Oflar, Gokhan Kahveci
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 169–174
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DOI Number: 10.5830/CVJA-2022-070
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-070
Objectives: We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients.
Methods: Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients.
Results: Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E′ were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were –14.52 ± 3.01 and –16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [–14.00% (–22 to –11%) and –15.5% (–24.02 to –10.16%) vs –23.00% (–24.99 to –19.01%) and –22.30% (–26.48 to –15.95%) (p = 0.016 and p = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of –13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of –15.31 and –17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP.
Conclusions: Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.
- Title: Combined systolic velocities using tissue Doppler imaging could predict the severity of cirrhosis: a prospective cohort study
Authors: Ibrahim Dönmez, Emrah Acar
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 175–180
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DOI Number: 10.5830/CVJA-2023-034
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-034
Aim: Recent research has demonstrated that the contractile characteristics of the right ventricular outflow tract (RVOT) play a significant role in right ventricular function. Pulmonary annular motion velocity (PAMVUT) is a reliable marker of RVOT function. Also, combined systolic velocity [PAMVUT added to tricuspid annular systolic velocity (St)] has been revealed as a suitable parameter for right ventricular systolic function. In this study, we examined the association between the severity of the illness in cirrhotic patients and the combined S velocities (CSV).
Methods: Seventy-four patients with cirrhosis went to the echocardiography laboratory of the Cardiology Department in our centre. Traditional echocardiographic measurements, PAMVUT and CSV values were recorded. The Child–Pugh classes of the patients were determined.
Results: Receiver operating characteristic curve analysis demonstrated that a CSV of 23 cm/s constituted the cut-off value for predicting a moderate-to-severe form of cirrhosis with 76% sensitivity and 65.3% specificity (area uder the curve = 0.735, p < 0.001).
Conclusion: CSV values could predict the severity of cirrhosis more precisely than traditional right ventricular systolic function parameters.
- Title: Electric cardioversion in patients treated with oral anticoagulants: embolic material in the left atrial appendage
Authors: Jarosław Karwowski, Jerzy Rekosz, Mateusz Solecki, Renata Mączyńska-Mazuruk, Karol Wrzosek, Joanna Sumińska-Syska, Mirosław Dłużniewski
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 181–188
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DOI Number: 10.5830/CVJA-2022-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-060
Abstract: Atrial fibrillation (AF) remains the most common arrhythmia. The sinus rhythm restoration procedure without adequate anticoagulant preparation may lead to a thromboembolic event in approximately 5–7% of patients. The initiation of oral anticoagulation significantly reduces this risk by inhibiting formation of embolic material in the heart cavities, especially in the left atrial appendage (LAA). However, there is a group of patients who develop embolic material in the LAA despite oral anticoagulation treatment. The best treatment method to dissolve thrombus in the LAA is not clear, due to the lack of studies with adequate power and endpoints that can determine the best management strategy. We present clinical trials comparing the efficacy and safety of oral anticoagulants in patients undergoing AF cardioversion. We evaluate the frequency of LAA thrombus formation in patients with AF on treatment with oral anticoagulants. Furthermore, we discuss the effectiveness of various treatment strategies on LAA thrombus resolution.
- Title: Permanent His bundle pacing using a Biotronik styletdriven lead: feasibility and early outcomes from a single centre
Authors: Brian Vezi, Ajijola Olujimi, Marcus Ngatcha, Aime Bonny, Justin Ragadu
From: Cardiovascular Journal of Africa, Vol 34, Issue 3 July/August 2023
Pages: 190–194
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DOI Number: 10.5830/CVJA-2022-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-026
Abstract: His bundle pacing (HBP) has been shown to be a good alternative to conventional cardiac resynchronisation therapy (CRT) and may theoretically provide an additional benefit where CRT has a response deficit of at least 30%. HBP requires mapping and identification of the His bundle, and to this purpose the lead delivery is challenging. This first-reported case series from Africa shares early experience with different pacing indications (complete heart block and pre-existing right ventricular pacing; heart failure with left bundle branch block) for using a standard 5.6F, Solia S 60, IS-1, ProMRI bipolar pacing lead and an 8.7F Selectra 3D introducer guide, 32–39-cm working length with 40/55/65-mm proximal radii (Biotronik). These cases highlighted the importance of appropriate programming when implanting HBP and of assessing the conduction system to predict patients who might benefit from HBP and additional left ventricular lead implant. The Biotronik Solia lead and delivery guide were found to be feasible and reliable in these cases. The Biotronik conduction system pacing tools were used with good acute outcomes in patients with different pacing indications.
