CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 35, ISSUE
2, MAY/AUGUST 2024
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- Editorial
Author: Paul Brink
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Page: 69
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- Title: Effect of different priming fluids on extravascular lung water, cell integrity and oxidative stress in cardiopulmonary bypass surgery
Authors: Halim Ulugöl, Meltem Güner Can, Uğur Aksu, Kübra Vardar, Murat Ökten, Fevzi Toraman
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 70–74
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DOI Number: 10.5830/CVJA-2023-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-006
Background: Discussions continue on the ideal priming fluid in adult cardiac surgery. The purpose of this prospective study was to evaluate the effects of different types of priming fluids on extravascular lung water, cell integrity and oxidative stress status.
Methods: Thirty elective coronary artery bypass surgery patients were randomised prospectively into two groups. The first group received colloid priming fluid, while the second group received crystalloid priming fluid. Extravascular lung water index, advanced oxidative protein products, total thiol, free haemoglobin, ischaemic modified albumin and sialic acid levels were measured. Moreover, intra-operative and postoperative outcomes were reviewed.
Results: There were no significant differences between the groups with regard to extravascular lung water index, oxidative stress parameters or cell integrity (p > 0.05). Similarly, no significant differences were observed between the patients with regard to intra-operative and postoperative outcomes (p > 0.05).
Conclusions: The presumed superiority of colloidal priming for cardiopulmonary bypass could not be confirmed in our study.
- Title: Surgical experience in adults with Ebstein’s anomaly: long-term results
Authors: Ozge Altas, Sabit Sarikaya
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 75–81
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DOI Number: 10.5830/CVJA-2023-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-008
Objective: The aim of this study was to review late results of the surgical treatment of Ebstein’s anomaly with reconstruction and replacement in adults.
Methods: Medical records of 28 consecutive patients operated on between 1991 and 2014 were reviewed retrospectively. Surgical repair was performed in 19 (67.9%) patients (Hardy: two, Danielson: three, modified Danielson: six, Carpentier: three, Kay annuloplasty reinforced with ring: two), whereas tricuspid valve replacement was performed in nine patients (32.1%). Primary long-term outcomes consisted of right ventricular function, survival and freedom from re-operation. We evaluated the additional impacts of residual tricuspid insufficiency and type of surgery on survival.
Results: In-hospital mortality rate was 7.1% (n = 2) due to low cardiac output status and sepsis. Patients showed a significant postoperative decrease in tricuspid regurgitation (p < 0.001), right atrial size (p < 0.001) and pulmonary hypertension (p = 0.002). The mean follow-up time was 140 ± 71.4 months, with a median of 126 months (105–192). Late mortality occurred in two patients and there was no significant difference in terms of survival based on residual tricuspid insufficiency (p = 0.57) and type of surgery (p = 0.094). Overall survival rates were 89.3, 85.4, 85.4 and 68.3% at five, 10, 15 and 20 years, respectively.
Conclusion: Although complex leaflet reconstruction techniques have evolved to achieve a more physiological and durable repair, both approaches can be performed safely on specific patients and can be alternated, with acceptable rates of survival and re-operation.
- Title: Systemic immune–inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome
Authors: Fatma Özpamuk Karadeniz, Yusuf Karadeniz, Emine Altuntaş
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 82–88
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DOI Number: 10.5830/CVJA-2023-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-011
Objective: Inflammatory mechanisms play an important role in the pathogenesis of atherosclerosis and myocardial infarction. The clinical and prognostic importance of inflammatory parameters, such as neutrophil–lymphocyte (NLR) and platelet–lymphocyte ratios (PLR) in complete blood counts in acute myocardial infarction and other cardiovascular diseases has been demonstrated. However, systemic immune–inflammation index (SII) calculated from neutrophils, lymphocytes and platelets in the complete blood cell count has not been studied sufficiently and is thought to provide a better prediction. This study investigated whether haematological parameters such as SII, NLR and PLR were associated with clinical outcomes in acute coronary syndrome (ACS) patients.
Methods: We included 1 103 patients who underwent coronary angiography for ACS between January 2017 and December 2021. The association between major adverse cardiac events (MACE) that developed in hospital and at 50 months of follow up and SII, NLR and PLR was compared. Long-term MACE were defined as mortality, re-infarction and targetvessel revascularisation. SII was calculated using the formula: NLR × total platelet count in the peripheral blood (per mm3).
Results: Of the 1 103 patients, 403 were diagnosed with ST-elevation myocardial infarction and 700 with non-STelevation myocardial infarction. The patients were divided into a MACE and a non-MACE group. In hospital and during the 50-month follow up, 195 MACE were observed. SII, PLR and NLR were found to be statistically significantly higher in the MACE group (p < 0.001). SII, C-reactive protein level, age and white blood cell count were independent predictors of MACE in ACS patients.
Conclusion: SII was found to be a strong independent predictor of poor outcomes in ACS patients. This predictive power was greater than that of PLR and NLR.
- Title: A cross-sectional study of the spectrum, aetiology and clinical characteristics of adult mitral valve disease at Chris Hani Baragwanath Academic Hospital
Authors: Ebrahim Banderker, Geert Roozen, Merika Tsitsi, Ruchika Meel
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 89–94
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DOI Number: 10.5830/CVJA-2023-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-009
Background: Valvular heart disease constitutes a considerable amount of cardiovascular morbidity and mortality worldwide. There is a scarcity of data from Africa.
Methods: In this descriptive, cross-sectional study, we documented the demographic, clinical and echocardiographic features of current patients with adult mitral valve disease (MVD) at Chris Hani Baragwanath Academic Hospital from December 2018 to March 2019.
Results: The study included 134 patients (mean age 50 ± 13.3 years) and 77% were female. The majority were of African ethnicity (96%). Mitral regurgitation (39%), followed by mixed MVD (38%) were the dominant lesions. Mitral stenosis was found in 23% of the patients. The main aetiologies were rheumatic heart disease (80%), mitral valve prolapse (11%), myxomatous degeneration (6%) and infective endocarditis (3%). Hypertension (30%) and HIV (12%) were the main co-morbidities. Heart failure was present in 78% of the patients at index hospitalisation. The main complications were pulmonary hypertension (28%) and atrial fibrillation (14%).
Conclusion: The patients with MVD tended to be older African females with co-morbidities who had predominant rheumatic mitral regurgitation.
- Title: Investigation of left ventricular changes according to valve type in patients with surgical replacement due to isolated aortic stenosis
Authors: Abdullah Güner, Mehmet Işık, Ömer Tanyeli, Serkan Yıldırım, Erdal Ege, Volkan Burak Taban
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 96–101
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DOI Number: 10.5830/CVJA-2023-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-012
Objective: The aim of this study was to investigate postoperative left ventricular changes [left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), patient–prosthesis mismatch (PPM), pulmonary artery pressure (PAP), gradients, and ejection fraction (EF)] according to the valve type used in patients undergoing aortic valve replacement (AVR) due to isolated aortic stenosis.
Methods: A total of 199 patients with isolated AVR due to aortic stenosis between 2010 and 2020 was retrospectively investigated. Four groups were identified according to the valve type used (mechanical, bovine pericardium, porcine and sutureless). Pre-operative and first year postoperative transthoracic echocardiography findings for the patients were compared.
Results: Mean age was 64.4 ± 13.0 years, while the gender distribution was 41.7% women and 58.3% men. Of the valves used in patients, 39.2% were mechanical, 18.1% were porcine, 8.5% were bovine pericardial and 34.2% were sutureless valves. Analysis independent of the valve groups observed LVEDD, LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI values reduced significantly postoperatively (p < 0.001). EF was observed to increase by 2.1% (p = 0.008). Comparisons of the four valve groups revealed that LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI significantly decreased in all groups. EF significantly increased only in the sutureless valve group (p = 0.006). Analysis of PPM groups showed that LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI were significantly reduced in all groups. In the normal PPM group, there was an improvement in EF, which was significantly different to the other groups (p = 0.001), while in the severe PPM group, EF appeared to be reduced (p = 0.19).
- Title: The effects on clinical outcomes of administering medications together or separately in prolonged dual antiplatelet therapy after peripheral revascularisation
Authors: Ozgur Akkaya, Oguz Karahan
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 102–105
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DOI Number: 10.5830/CVJA-2023-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-013
Background: In the current guidelines, dual antiplatelet therapy [acetylsalicylic acid (ASA) + clopidogrel] is recommended for at least three months after peripheral iliac stenting. In this study, we investigated the effect on clinical outcomes of adding ASA in different doses and at different times after peripheral revascularisation.
Methods: Seventy-one patients were administered dual antiplatelet therapy after successful iliac stenting. Group 1, consisting of 40 patients, was given 75 mg of clopidogrel plus 75 mg of ASA in a single dose in the morning. In group 2, separate doses of 75 mg of clopidogrel (in the morning) and 81 mg of 1 × 1 ASA (in the evening) were started in 31 patients. The demographic data and bleeding rates of the patients after the procedure were recorded.
Results: The groups were found to be similar in terms of age, gender and accompanying co-morbid factors (p > 0.05). The patency rate was 100% in the first month in both groups, and it was above 90% at the sixth month. When one-year patency rates were compared, although the first group had higher rates (85.3%), no significant difference was found (p < 0.05). However, there were 10 (24.4%) bleeding events in group 1, and five (12.2%) of these were in the gastrointestinal system, resulting in reduced haemoglobin levels (p = 0.038).
Conclusion: ASA doses of 75 mg or 81 mg did not affect one-year patency rates. However, higher bleeding rates were observed in the group that received both clopidogrel and ASA treatment simultaneously (in the morning) despite the lower dose of ASA.
- Title: Empagliflozin significantly prevents QTc prolongation due to amitriptyline intoxication
Authors: Veysel Özgür Barış, Esra Gedikli, Adnan Berk Dinçsoy, Ayşen Erdem
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 106–110
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DOI Number: 10.5830/CVJA-2023-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-017
Aim: Empagliflozin (EMPA) is a sodium-glucose transporter-2 inhibitor used in the treatment of type 2 diabetes and has positive effects on cardiovascular outcomes. Amitriptyline (AMT) can be used in many clinical indications but leads to cardiotoxicity by causing QT prolongation. Our aim in this study was to determine how the effects of the concomitant use of empagliflozin and amitriptyline, which have been shown to have effects on sodium and calcium metabolism in cardiomyocytes, would cause an effect on QT and QTc intervals in clinical practice.
Methods: Twenty-four male Wistar albino rats were randomised into four groups. The control group received only physiological serum (1 ml) via orogastric gavage (OG). The EMPA group received empagliflozin (10 mg/kg) via OG. The AMT group received amitriptyline (100 mg/kg) via OG. The AMT+EMPA group (n = 6) received amitriptyline (100 mg/kg) and empagliflozin (10 mg/kg). Under anaesthesia, QT and QTc intervals were measured at baseline, and in the first and second hours.
Results: In the AMT group, QT intervals and QTc values were found to be statistically longer than in the control group (p ≤ 0.001). Empagliflozin significantly ameliorated amitriptyline-induced QT and QTc prolongation. In the AMT+EMPA group, QT and QTc intervals were significantly lower compared to that in the AMT group (p < 0.01)
Conclusion: In this study, we determined that empagliflozin significantly ameliorated amitriptyline-induced QT and QTc prolongation. This effect was probably due to the opposite effects of these two agents in the intracellular calcium balance. With more clinical trials, the routine use of empagliflozin may be suggested to prevent QT and QTc prolongation in diabetic patients receiving amitriptyline.
- Title: Changes in blood pressure after catheter-based renal denervation in South Africa
Authors: Iftikhar O Ebrahim, Mpiko Ntsekhe, Brian Rayner, Martin Fahy, Giuseppe Mancia, Michael Böhm
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 111–114
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DOI Number: 10.5830/CVJA-2023-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-021
Background: Renal denervation (RDN) is an interventional treatment for patients with uncontrolled hypertension. The Global SYMPLICITY Registry (GSR) is a prospective, all-comer, world-wide registry designed to assess the safety and efficacy of RDN. We evaluated the outcomes in South African patients in the GSR over 12 months.
Methods: Eligible patients with hypertension had a daytime mean blood pressure (BP) > 135/85 mmHg or night-time mean BP > 120/70 mmHg. Office and 24-hour ambulatory systolic BP reduction and adverse events over 12 months were evaluated.
Results: South African patients (n = 36) in the GSR had a mean age of 54.4 ± 9.9 years with a median of four prescribed antihypertensive medication classes. At 12 months, mean changes in office and 24-hour ambulatory systolic BP were –16.9 ± 24.2 and –15.3 ± 18.5 mmHg, respectively, with only one adverse event recorded.
Conclusion: RDN safety and efficacy in South African patients were consistent with world-wide GSR results.
- Title: Effects of intravenous sodium thiosulfate on vascular calcification in dialysis patients with end-stage renal disease: a systematic review and meta-analysis
Authors: Yu-Huan Song, AiBing Ning, Na Guo, Ying Yang, Fei Tang, Na Zhao, Jun Hu, Hong Wu, Ting Peng, Yue-fei Xiao, Guang-Yan Cai
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 115–123
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DOI Number: 10.5830/CVJA-2023-020
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-020
Background: In dialysis patients, vascular calcification is a common complication and is closely related to the morbidity and mortality of cardiovascular disease. We performed a systematic review to determine the efficacy and safety of sodium thiosulfate (STS) in the progression of vascular calcification in dialysis patients with end-stage renal disease.
Methods: The PubMed, Web of Science, Embase, Cochrane Library, Wanfang, CNKI, China Biology Medicine disc and Weipu databases were searched up to 9 March 2022 for clinical trials to synthesise findings on the efficacy and safety of STS in the progression of vascular calcification in dialysis patients. The primary outcome was coronary artery calcification scores (CACS) or abdominal aortic calcification scores (AACS) or Kauppila index. The secondary outcome was pulse-wave velocity (PWV). Laboratory data were shown in safety data. A random-effect model was used to provide the summary measures of effect [standardised mean difference (SMD) and 95% confidence interval (CI)].
Results: Seven randomised, controlled trials and one nonrandomised, controlled trial involving 370 patients were included. Six studies reported that the progression of CACS or AACS was slower in the intravenous STS group compared with the control group (SMD –3.24, 95% CI: –5.29, –1.18, p = 0.002). Two studies showed the increase in PWV was less in the STS group compared with the control group (SMD –0.52, 95% CI: –0.92, –0.13, p = 0.009). During the trial period, a lower high-sensitivity C-reactive protein level (SMD 1.61, 95% CI: 0.19, 3.04, p = 0.03), a decrease in serum bicarbonate level (SMD 0.67, 95% CI: 0.22, 1.11, p = 0.003) and an increase in serum phosphate level (SMD –0.32, 95% CI: –0.62, –0.03, p = 0.03) were noted in the intravenous STS group compared with the control group. However, serum calcium and parathyroid hormone levels showed no difference between the two groups after the trials. The most common adverse events were temporary nausea and vomiting, which occurred in 12.5 to 75% of patients.
Conclusions: Intravenous STS may slow down the progression of vascular calcification and ameliorate arterial stiffness in dialysis patients. Reliably defining the efficacy and safety of intravenous STS in attenuating the progression of vascular calcification requires a high-quality trial with a large sample size.
- Title: Identification and treatment of asymptomatic central venous catheter thrombosis after TAVI
Authors: Xin Huang
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 124–126
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DOI Number: 10.5830/CVJA-2023-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-015
Abstract: One of the most serious complications of central venous catheterisation is thrombus, particularly asymptomatic thrombus. If not recognised and promptly treated, it can result in pulmonary emboli. Here, we describe transcatheter aortic valve implantation performed in a 77-year-old female patient with the insertion of a central venous catheter into the right internal jugular vein as part of the procedure. The patient experienced no associated discomfort and received standard antiplatelet and antibiotic treatment. Given that the catheterisation procedure was unsuccessful on the first attempt, an ultrasonographic examination of the blood vessel was performed in order to prepare for extubation of the patient. A thrombus was identified, which was resolved with low-molecular-weight heparin anticoagulation therapy. The patient experienced no complications with removal of the central venous catheter.
- Title: Coronary artery bypass grafting in a patient with situs inversus totalis
Authors: Taha Okan, Caner Topaloglu, Orhan Kucuk, Selen Bayraktaroglu, Naim Ceylan
From: Cardiovascular Journal of Africa, Vol 35, Issue 2 May/August 2024
Pages: 127–130
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DOI Number: 10.5830/CVJA-2023-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-051
Abstract: Situs inversus totalis (SIT) describes a complete mirror image of the visceral organs in the thoracic and abdominal cavities. Dextrocardia, in combination with SIT, is a rare congenital anomaly with a frequency of 1:10 000, and coronary heart disease may occur with a similar frequency and manifestation as in the general population. Coronary computed tomography (CT) angiography is useful for accurately assessing the coronary artery origin and position for preprocedural planning of difficult coronary artery catheterisation in SIT. In this case, invasive coronary angiography (ICA) was performed from the same angle but on the opposite side compared to standard angiography. With the use of volume-rendered three-dimensional and curved reformatted images reconstructed from coronary CT angiography, the advancement of guidewires and catheters during ICA as well as the planning of surgical procedures can be performed more safely.
