CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 35, ISSUE
1, JANUARY/APRIL 2024
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- Editorial
Author: P Commerford
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Page: 3
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- Title: Percutaneous coronary intervention facilities in Nigeria
Authors: Olufemi T Olorunda, Kelechukwu Okoro, Basil Okoh, Tosin Majekodunmi
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 4–6
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DOI Number: 10.5830/CVJA-2022-041
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-041
Background: In Nigeria, the incidence of coronary artery disease has doubled over the last three decades. However, there appears to be a lack of adequate heart catheterisation facilities.
Methods: A list of percutaneous coronary intervention (PCI)- capable facilities was compiled for each state in Nigeria and the federal capital territory. Population estimates for 2019 were obtained from the National Bureau of Statistics and this was utilised to calculate the number of PCI facilities per person in each state and the country.
Results: There are 12 operational PCI facilities in Nigeria, 11 of which are in the private health sector. Overall, there is one PCI facility per 16 761 272 people in Nigeria.
Conclusions: There is a distinct lack of PCI-capable facilities in Nigeria. There needs to be an investment from the government and stakeholders in Nigeria to increase the access to PCI, given the paradigm shift from communicable to noncommunicable diseases.
- Title: Arterial stiffness assessment in obese black South African patients
Authors: TL Rasakanya, E Osuch
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 7–11
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DOI Number: 10.5830/CVJA-2022-064
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-064
Introduction: Increased arterial stiffness is a determinant of cardiovascular mortality and an independent marker of cardiovascular disease. The objective of this study was to asses arterial elasticity by determination of pulse-wave velocity (PWV) and augmentation index (Aix) in obese black patients.
Methods: PWV and Aix were assessed non-invasively using the AtCor SphygmoCor® system (AtCor Medical, Inc, Sydney, Australia). The study participants were divided into four groups; healthy volunteers (HV) (n = 29), patients with concomitant diseases but normal body mass index (Nd) (n = 23), obese patients without concomitant diseases (OB) (n = 29) and obese patients with concomitant diseases (OBd) (n = 29).
Results: The difference in the mean levels of PWV was statistically significant in the obese group with and without concomitant disease. The PWV in the OB group (7.9 ± 2.9 m/s) and in the OBd group (9.2 ± 4.4 m/s) was, respectively, 19.7 and 33.3% higher than in the HV group (6.6 ± 2.1 m/s). PWV was directly correlated with age, glycated haemoglobin level, aortic systolic blood pressure and heart rate. The risk of cardiovascular diseases in the obese patient without additional diseases was increased by 50.7%. The presence of concomitant diseases (type 2 diabetes mellitus and hypertension) in addition to obesity increased arterial stiffness by a further 11.4% and therefore also increased the risk of cardiovascular diseases by a further 35.1%. Aix was increased in the OBd and Nd groups by 8.2 and 16.5%, respectively, however the increase was not statistically significant. Aix was directly correlated with age, heart rate and aortic systolic blood pressure.
Conclusion: The obese black patients had a higher PWV, indicating increase in arterial stiffness and therefore a higher risk for cardiovascular disease. In addition, aging, increased blood pressure and type 2 diabetes mellitus contributed further to arterial stiffening in these obese patients.
- Title: A strategy to improve adherence to guidelinedirected medical therapy (GDMT) and the role of the multidisciplinary team in a heart-failure programme
Authors: Waleed AlHabeeb, Fakhr Alayoubi, Ahmed Hayajneh, Anhar Ullah, Fayez Elshaer
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 12–15
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DOI Number: 10.5830/CVJA-2022-067
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-067
Background: Heart failure (HF) patients place a heavy burden on the healthcare system because of their frequent need for in-patient treatment, emergency room visits and subsequent hospital stays. To provide proper care and effective therapy, practitioners have streamlined delivery techniques such as clinical pathways, checklists and pocket manuals. However, a description of the establishment of a disease-management programme, including a multidisciplinary team of physicians, clinical pharmacists and nurse specialists is required. The aim of this study was to highlight the role of the multidisciplinary team in a heart-failure programme by assessing the improvement in adherence to guideline-directed medical therapy.
Methods: A retrospective, observational research was undertaken on patients with HF at a cardiac centre in Riyadh, to observe the HF patients’ management before (January to December 2014) and after (January to December 2015) the establishment of a programme.
Results: The use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers was 75.59% in 2014 at discharge and 81.17% in2015 (p = 0.249). Beta-blockers use at release increased from 87.83% in 2014 to 94.53% in 2015 (p = 0.021). The flu vaccine was given to 48.24% of patients in 2014 and 75.13% of the patients in 2015 (p < 0.001). The pneumococcal vaccine was administered to 44.22% of patients in 2014 and 75.13% of patients in 2015 (p < 0.001). The ejection fraction improved from 30.21% in the first month to 39.56% in the 12th month (p = 0.001) in patients managed in 2015.
Conclusion: The multidisciplinary heart-failure programme resulted in a positive effect, in the form of improved patient care after including the clinical pharmacist and nurse specialist.
- Title: Characteristics and immediate outcomes of patients who underwent percutaneous balloon mitral valvuloplasty at the Jakaya Kikwete Cardiac Institute, Tanzania
Authors: Reuben K Mutagaywa, Maarten J Cramer, Pilly Chillo, Aileen Barongo, Engerasiya Kifai, Steven Chamuleau, Chete Eze-Nliam, Nelson B Vera, Deogratias Nkya, Alex Loth, Ben Alencherry, Stella Mongella, Henry Mayala, Peter Kisenge, Salehe Mwinchete, Alex B Joseph, Gideon Kwesigabo, Appolinary Kamuhabwa, Mazen Albaghdadi, Joanna Ghobrial, Mohamed Janabi
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 16–26
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DOI Number: 10.5830/CVJA-2022-068
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-068
Background: For rheumatic mitral stenosis (MS), a multidisciplinary evaluation is mandatory to determine the optimal treatment: medical, percutaneous balloon mitral valvuloplasty (PBMV) or valve surgery. Clinical and imaging evaluations are essential for procedural risk assessment and outcomes. PBMV interventions are increasingly available in Africa and are feasible options for selected candidates. Enhancing PBMV training/ skills transfer across most of African countries is possible.
Objectives: The aim of this study was to provide insight into the clinical practice of patients with rheumatic MS evaluated for PBMV in a Tanzanian teaching hospital and to define the role of imaging, and evaluate the heart team and training/skills transfer in PBMV interventions.
Methods: From August 2019 to May 2022, 290 patients with rheumatic MS were recruited consecutively in the Tanzania Mitral Stenosis study. In total, 43 (14.8%) patients were initially evaluated for eligibility for PBMV by a heart team. We carried out the clinical assessment, laboratory investigations, transthoracic/oesophageal echocardiography (TTE/TEE) and electrocardiography.
Results: The median age was 31 years (range 11–68), and twothirds of the patients were female (four diagnosed during pregnancy). Two patients had symptomatic MS at six and eight years. Nine patients had atrial fibrillation with left atrial thrombus in three, and two were detected by TEE. Nine patients in normal sinus rhythm had spontaneous echo contrast. The mean Wilkins score was 8.6 (range 8–12). With re-evaluation by the local and visiting team, 17 patients were found to have unfavourable characteristics: bi-commissural calcification (four), ≥ grade 2/4 mitral regurgitation (six), high scores and left atrial thrombus (three), left atrial thrombus (two), and severe pulmonary hypertension (two). Three patients died before the planned PBMV. Eleven patients were on a waiting list. We performed PBMV in 12 patients, with success in 10 of these, and good short-term outcomes [mean pre-PBMV (16.03 ± 5.52 mmHg) and post-PBMV gradients (3.08 ± 0.44 mmHg, p < 0.001)]. There were no complications.
Conclusions: PBMV had good outcomes for selected candidates. TEE is mandatory in pre-PBMV screening and for procedural guidance. In our cohort, patients with Wilkins score of up to 11 underwent successful PBMV. We encourage PBMV skills expansion in low- and middle-income countries, concentrating on expertise centres.
- Title: Clinical characteristics, diagnostic methods and results of surgically treated histologically benign cardiac myxomas
Authors: Durmuş Alper Görür, Hüseyin Şaşkin
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 27–34
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DOI Number: 10.5830/CVJA-2022-069
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-069
Background: Myxomas are primary cardiac tumours that may be detected incidentally due to embolic events, intracardiac obstructive features or non-specific structural symptoms. The aim of this study was to share our experience of clinical features, diagnostic methods, surgical procedures and postoperative follow up of surgically treated cardiac myxomas.
Methods: Data of 34 patients who underwent surgery for a cardiac myxoma between January 2006 and June 2022 were retrospectively analysed. Group 1 (n = 19) consisted of patients who were symptomatic and group 2 (n = 15) patients were asymptomatic. The medical records of the patients, their clinical status, diagnostic methods, operation information and postoperative course data were collected and recorded.
Results: A total of 34 patients (16 female; mean age 54.5 ± 8.8 years) underwent cardiac myxoma resection with cardiopulmonary bypass. Fifteen (44.1%) patients were diagnosed incidentally with asymptomatic myxoma. An additional cardiac surgical procedure was performed in six patients (17.7%). The 34 cardiac myxomas that were surgically resected were localised in the left atrium in 25 patients (73.5%) and in the right atrium in nine patients (26.5%). Patients’ most common symptoms were dyspnoea (42.1%), palpitations (21.1%), ischaemic stroke (15.8%) and syncope (10.5%). There was no incident of 30-day mortality and no recurrence was observed in any patient during the follow-up period. The duration of surgical intervention in symptomatic patients was significantly shorter than in asymptomatic patients (p = 0.0001), but there was no statistical difference in terms of characteristics.
Conclusion: Myxomas are benign tumours, but they are serious pathologies that require early treatment because of signs of obstruction, embolic complications and confusion, with left atrial thrombus in the differential diagnosis.
- Title: Association between apelin-12 and creatine kinase-MB, depending on success of reperfusion in STEMI patients
Authors: Xhevdet Krasniqi, Josip Vincelj, Masar Gashi, Blerim Berisha, Dardan Kocinaj
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 35–29
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DOI Number: 10.5830/CVJA-2023-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-002
Background: Acute myocardial infarction is characterised by an imbalance in the supply and demand of oxygen in the heart. It requires urgent reperfusion, and poor outcomes are attributed to myocardial ischaemia–reperfusion injury. We aimed to evaluate the association between apelin-12 levels and creatine kinase-MB activity in predicting the effectiveness of reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) patients.
Methods: In this study we included 72 patients with the following criteria: chest pain suggestive of myocardial ischaemia for at least 30 minutes, an electrocardiogram with ST-segment elevation (measured at the J-point) ≥ 2 mm in leads V2–V3 and/or ≥ 1 mm in the other leads, rise of specific biomarkers such as cardiac troponin and the MB fraction of creatine kinase (CK-MB), and those who underwent reperfusion therapy. Blood samples for the measurement of apelin-12 and creatine kinase-MB were collected 12 hours after the reperfusion therapy.
Results: In patients with thrombolysis in myocardial infarction (TIMI) flow grade ≤ 2, the median of the apelin-12 level was 1.80 ng/ml (0.46–9.20), and with TIMI flow 3, it was 5.76 ng/ml (1.14–15.2). Variability was observed in the apelin values (Mann–Whitney test) based on TIMI flow grade (p < 0.001), while no variability was observed for creatine kinase-MB (p < 0.18). The degree of association between apelin-12 and creatine kinase-MB levels was analysed with Pearson’s correlation, enabling us to determine patients with successful reperfusion (determined as TIMI flow 3) (p < 0.004), and those with unsuccessful reperfusion (with TIMI flow ≤ 2) (p = 0.86).
Conclusion: In STEMI patients undergoing reperfusion therapy, apelin-12 level was associated with creatine kinase-MB activity according to the success of the reperfusion.
- Title: Assessment value of the modified early warning score for long-term prognosis of older patients with chronic heart failure
Authors: Yin Yin, Jie Chen, Shijiu Jiang
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 40–43
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DOI Number: 10.5830/CVJA-2023-003
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-003
Aim: The aim of the study was to explore the assessment value of the modified early warning score (MEWS) for the long-term prognosis of older patients with chronic heart failure (CHF).
Methods: A total of 180 CHF patients, treated from January 2016 to January 2018, were divided into a grade I group (n = 28), a grade II group (n = 37), a grade III group (n = 68) and a grade IV group (n = 47) according to the New York Heart Association (NYHA) functional classification. The MEWS was compared on admission and discharge. Based on the clinical outcomes during follow up, the patients were divided into a non-survival group (n = 48) and a survival group (n = 132). Their general clinical data and the MEWS were compared. The predictive values of the MEWS, troponin I (cTnI) and B-type natriuretic (BNP) peptide for long-term prognosis were assessed using receiver operator characteristic (ROC) curves.
Results: The MEWS on patient discharge was significantly lower than that on admission, and it increased with increasing NYHA grade (p < 0.05). The MEWS in the non-survival group was significantly higher than that in the survival group. Different clinical outcomes were positively correlated with NYHA grade, MEWS, six-minute walking distance and left ventricular ejection fraction (r = 0.368, r = 0.471, r = 0.387, r = 0.423, p < 0.05), and negatively correlated with cTnI and BNP (r = –0.411, r = –0.425). The area under the ROC curve of the MEWS was 0.852, indicating higher accuracy. The optimal cut-off value, sensitivity and specificity of the MEWS for determining prognosis were 5.6, 0.854 and 0.797 points, respectively.
Conclusion: The MEWS rose with increasing NYHA grade and reflected the severity of CHF in older patients, which has higher predictive value for long-term prognosis.
- Title: Right atrial strain in a normal adult African population according to age
Authors: Nyange Mushitu, Ruchika Meel
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 44–51
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DOI Number: 10.5830/CVJA-2023-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-004
Background: Right atrial longitudinal strain (RALS) is a useful parameter to define right atrial (RA) subclinical dysfunction prior to changes in RA dimension and volume. We sought to establish normal values for RALS in a sub- Saharan African population.
Methods: This was a retrospective, cross-sectional study from 2017 to 2019 of 100 normal individuals. All echocardiographic measurements were done as per the standard guidelines.
Results: Mean RALS was 32.7 ± 10.5%. The mean RA volume indexed to body surface area was 19.5 ± 5.7 ml/m2. There was a negative correlation between RALS and age but it was not statistically significant (r = –0.15, p = 0.129). Males had a tendency towards higher RA volume indexed and RALS measurements compared to females (20.8 ± 6.3 and 18.7 ± 5.2 ml/m2, p = 0.07; 34.6 ± 9.6 and 31.4 ± 10.9%, p = 0.141, respectively). Body mass index was an independent predictor of RALS (r = –0.43, p = 0.003).
Conclusion: We have provided normative data for RALS in an African population. This study provides a platform for future larger studies on RALS.
- Title: Pre-eclampsia: does cardiac function differ in HIV-positive and -negative women?
Authors: Raeesa Bhorat, Ismail Bhorat, Olive P Khaliq, Jagidesa Moodley
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 52–63
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DOI Number: 10.5830/CVJA-2023-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-005
Abstract: This review aimed to establish the impact of pre-eclampsia and HIV infection on cardiac function. Cardiovascular diseases have been reported to affect pregnancies complicated by both HIV and pre-eclampsia. Pre-eclampsia has been found to be associated with both systolic and diastolic dysfunction. Currently it has been found that there may be a dual, bidirectional pathophysiology, where placenta-mediated factors can influence cardiac function, or pre-existing cardiovascular disease can predispose to pre-eclampsia. Cardiovascular disease, HIV and pre-eclampsia are major health challenges individually and are interrelated with regard to pathophysiology. It has been found that both pre-eclampsia and HIV contribute to cardiac dysfunction as does the impact of antiretroviral therapy. Further research is needed to investigate the link between these diseases for the development of novel therapeutic interventions.
- Title: Calcified right ventricular fibroma in an adult
Authors: Huanhuan Gao, Shuai Yuan, Zhiqiang Hu, Zhelan Zheng, Yanli Wang, Shengjun Wu
From: Cardiovascular Journal of Africa, Vol 35, Issue 1 January/April 2024
Pages: 64–66
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DOI Number: 10.5830/CVJA-2023-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-007
Abstract: Background: Cardiac fibromas are benign tumours of the heart and are composed of fibroblasts and collagen. They are one of the most common cardiac tumours encountered in children and adolescents but are rare in adults. Case report: The patient was a 57-year-old man who presented, complaining of a two-year history of chest tightness at rest. Transthoracic echocardiography revealed a severely calcified mass protruding from the anterior wall of the right ventricle near the apex. The patient was referred for tumour resection. Postoperative histopathological examination identified the calcified mass to be a cardiac fibroma. The patient’s postoperative recovery was unremarkable and he was discharged eight days after surgery. During follow up, he has been free from any troublesome symptoms. Conclusions: Pre-operative diagnosis using various imaging modalities and early surgery are key to optimising the prognosis of patients with a cardiac fibroma.
