CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 35, ISSUE
3, SEPTEMBER/OCTOBER 2024
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- Editorial
Author: Paul Brink
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Page: 133
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- Title: The association between CHA2DS2-VASc score and aortic valve sclerosis
Authors: Funda Başyiğit, Havva Tuğba Gürsoy, Özlem Özcan Çelebi, Kevser Gülcihan Balcı, Özgül Uçar Elalmış, Kerem Özbek, Özge Çakmak Karaaslan, Mehmet İleri, Telat Keleş, Sinan Aydoğdu
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 134–139
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DOI Number: 10.5830/CVJA-2023-022
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-022
Background: Antithrombotic therapy in atrial fibrillation is generally managed with the CHA2DS2-VASc score. Aortic valve sclerosis (AVS) is a focal thickening of the aortic valve without a restriction of motion. AVS is related to several cardiovascular risk factors. Our study was performed to evaluate whether the presence of AVS was associated with the CHA2DS2-VASc score.
Methods: This cross-sectional, observational study comprised 411 patients with AVS grades 1–3 [AVS (+)] and 102 patients with AVS grade 0 [AVS (–)]. We compared CHA2DS2-VASc scores between the AVS (+) and AVS (–) groups.
Results: We determined that the AVS (+) group had a higher CHA2DS2-VASc score than the AVS (–) group [3 (0–8) vs 1 (0–4), p < 0.001)].
Conclusion: In our study, the CHA2DS2-VASc score was found to be higher in patients with AVS than in those without AVS. AVS may predict cardiovascular risk in the general population.
- Title: Long-term experience of the modified David V re-implantation technique for valve-sparing aortic root replacement
Authors: Sabit Sarikaya, Kaan Kirali
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 140–146
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DOI Number: 10.5830/CVJA-2023-018
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-018
Objective: The modified David V technique is one of the valve-sparing aortic root replacement (V-SARR) techniques, which is an alternative to traditional composite valve graft root replacement techniques. We aimed to analyse our longterm experience with the modified David V re-implantation technique for the treatment of aortic root aneurysm and significant aortic valve insufficiency.
Methods: From March 2009 to November 2021 the modified David V re-implantation technique, one of the V-SARR techniques, was performed on 48 patients in our centre. The results were analysed retrospectively. Two different-sized grafts were used in all patients. The grafts used in the proxi- mal position were larger than the distal grafts. We performed both intra-operative and post-procedural transoesophageal echocardiography on each patient. All patients were followed by means of transthoracic echocardiography. The mean follow-up period was 5.7 ± 3.1 years.
Results: The mean age of this cohort was 56.3 ± 14.3 years (24–79) and the majority were men (75%). The mean aortic root diameter was 5.1 ± 0.6 cm. The mean diameter for the assending aorta was 5.4 ± 2.1 cm. The in-hospital mortality rate was 4.2% (n = 2). One patient needed aortic valve replacement in the early postoperative period. Two (4.2%) patients died in the early postoperative period and four (8.3%) died in the late postoperative period. Overall survival was 91 ± 4 and 86 ± 5% at one and five years, respectively. Aortic valve insufficiancy was at moderate levels postoperatively. Freedom from moderate to severe residual aortic insufficiency was 89.6% at 10 years. None of the patients needed late re-operation of the aortic valve postoperatively. Freedom from valve re-operation was 100% at the end of the follow up.
Conclusions: Our study shows that the David V technique is associated with excellent long-term durability, a remarkably low rate of valve-related complications, and it protects the re-implanted native aortic valve from a second operation. Additionally this technique could be safely implemented in patients with a bicuspid aortic valve and acute type A aortic dissection without leaflet deformity.
- Title: Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study
Authors: Bernard Kianu Phanzu, Aliocha Nkodila Natuhoyila, Eleuthère Kintoki Vita, Benjamin Longo-Mbenza, Jean-René M’Buyamba Kabangu
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 147–154
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DOI Number: 10.5830/CVJA-2023-024
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-024
Background: In clinical practice, left ventricular hypertrophy (LVH) is defined by physical findings and electrocardiographic criteria, which are useful but imperfect tools, echocardiographic criteria and cardiac magnetic resonance imaging. In echocardiography, LVH is defined not by left ventricular wall thicknesses but by left ventricular mass. The latter is calculated according to Devereux’s formula, and is increased by insulin resistance/hyperinsulinaemia. It is however unclear whether insulin resistance, hyperinsulinaemia, or both, is actually causative and what their collective or individual influence is on the components of Devereux’s formula and parameters of left ventricular diastolic function. This study evaluated the associations of the homeostatic model assessment for insulin resistance (HOMAIR) and fasting plasma insulin levels with components of Devereux’s formula and parameters of left ventricular diastolic function.
Methods: Relevant clinical data were collected from 220 hypertensive patients recruited between January and December 2019. The associations of components of Devereux’s formula and parameters of diastolic function with insulin resistance were tested using binary ordinal, conditional and classical logistic regression models.
Results: Thirty-two (14.5%) patients (43.9 ± 9.1 years), 99 (45%) patients (52.4 ± 8.7 years) and 89 (40.5%) patients (53.1 ± 9.8 years) had normal left ventricular geometry, concentric left ventricular remodelling and concentric left ventricular hypertrophy, respectively. In multivariable adjusted analysis, 46.8% of variation in interventricular septum diameter (R² = 0.468; overall p = 0.001) and 30.9% of E-wave decelera- tion time (R² = 0.309; overall p = 0.003) were explained by insulin level and HOMAIR, 30.1% of variation in left ventricular end-diastolic diameter (R² = 0.301; p = 0.013) by HOMAIRalone, and 46.3% of posterior wall thickness (R² = 0.463; p = 0.002) and 29.4% of relative wall thickness (R² = 0.294; p = 0.007) by insulin level alone.
Conclusions: Insulin resistance and hyperinsulinaemia did not have the same influence on the components of Devereux’s formula. Insulin resistance appeared to act on left ventricular end-diastolic diameter, while hyperinsulinaemia affected the posterior wall thickness. Both abnormalities acted on the interventricular septum and contributed to diastolic dysfunction via the E-wave deceleration time.
- Title: Impact of the COVID-19 pandemic on cardiology fellowship training in a sub-Saharan African training centre: an African perspective
Authors: E Amendezo, M Ngunga, AH Ahmed, MH Varwani, B Karau, R Kimeu, M Jeilan
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 155–159
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DOI Number: 10.5830/CVJA-2023-023
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-023
Aim: The impact of the COVID-19 pandemic on cardiology fellowship training in sub-Saharan Africa (SSA) is not known. This study aimed to determine the impact of the COVID-19 pandemic on fellowship training, and reviewed the adaptiveness of the existing training systems.
Methods: We conducted a three-month data survey related to the cardiology fellows’ clinical exposure at the Aga Khan University Hospital, Kenya, before the COVID-19 pandemic and compared it with a three-month period during the pandemic. Hospital data volumes for patients’ contacts, ambulatory and catheterisation laboratory procedures record- ed during the periods of March to May 2019 (three months pre-COVID-19) and March to May 2020 (three months during the COVID-19 pandemic) were analysed. A comparative fellows’ logbook evaluation of recorded cases was also conducted for the two study time periods. In addition, fellows answered a survey questionnaire related to their roles and responsibilities in the hospital, their views on cardiology training during the COVID-19 pandemic and the pandemic’s impact on their training.
Results: There was a significant reduction in the volume of patients and cardiac procedures during the COVID-19 period compared to the pre-COVID-19 period. In the same line, the number of fellows’ training episodes reduced significantly during the COVID-19 pandemic compared to their performances before the pandemic. Fellows felt that the COVID-19 crisis has had a moderate to severe impact on their fellowship training. They however noted an increase in the provision of virtual local and international meetings and conferences, which supported the training positively.
Conclusions: This study showed that the COVID-19 crisis resulted in a significant reduction in the total volume of patients and cardiac procedures and, in turn, the number of training episodes. This may have limited the fellows from achieving a great amount of skills base in highly technical skills by the end of their training. Opportunities for post-fellowship training in the form of continued mentorship and proctorship would be a valuable option for the trainees if there is a similar pandemic in the future.
- Title: Is the transradial approach associated with decreased acute kidney injury following percutaneous coronary intervention in patients not complicated by major bleeding and haemodynamic disturbance?
Authors: Tolga Dasli, Burak Turan
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 160–165
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DOI Number: 10.5830/CVJA-2023-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-025
Background: The impact of the transradial approach (TRA) on the development of acute kidney injury (AKI) after percutaneous coronary interventions (PCI) has been controversial.
Methods: We retrospectively analysed 463 patients undergoing PCI for either acute or chronic coronary syndrome. Excluded patients were those with missing laboratory or procedural data, acute/decompensated heart failure, major bleeding, haemodynamic instability, long-term dialysis and mortality. The primary endpoint of the study was the incidence of AKI after PCI, which was defined as an increase in serum creatinine (SCr) level of 0.5 mg/dl or 25% from the baseline. Secondary endpoints were change in SCr level, increase in SCr of ≥ 0.3 and ≥ 0.5 mg/dl, and increase in SCr of ≥ 25 and ≥ 50%. We compared the incidence of AKI between the TRA and the transfemoral approach (TFA) in the overall and a propensity score (PS)-matched study population.
Results: The study population included 339 patients. After PS matching, we obtained a well-balanced population of 182 patients. The differences between the incidence of AKI in the TRA and TFA were not significant in both the overall (9.0 vs 11.2%, p = 0.503) and PS-matched (9.9 vs 7.7%, p = 0.601) study population. TRA resulted in a significantly lower incidence of SCr increase of ≥ 50% in unmatched patients. However, after PS matching, there was no difference between the TRA and TFA in any variable of secondary post-PCI renal outcomes. Age, female gender, baseline SCr level, baseline estimated glomerular filtration rate and contrast volume were independent predictors of AKI.
Conclusion: Compared to the conventional TFA, TRA was not associated with a reduced incidence of AKI after PCI in patients not complicated by major bleeding, acute heart failure and haemodynamic disturbances.
- Title: Evaluation of clinical results of esmarch bandage application in giant saphenous vein closure during endovenous glue ablation
Authors: Oğuz Karahan, Ozgur Akkaya, Eyup Aydogan
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 166–171
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DOI Number: 10.5830/CVJA-2023-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-026
Background: In recent years, the endovenous technique has been presented as a good alternative to surgery in the treatment of patients with lower extremity varicose veins. However, its effectiveness in very advanced saphenous vein diameters is controversial. In this study, we investigated the results of an endovenous glue ablation closure system applied with an esmarch bandage in saphenous veins with very large diameters.
Methods: Eighty-nine patients who were operated on for varicose veins were divided into three groups according to their saphenous vein diameters: less than 10 mm (group 1), between 10 and 15 mm (group 2), and larger than 15 mm (group 3). Endovenous closure was performed with n-butyl cyanoacrylate in all patients. An esmarch bandage was applied during the procedure to all patients, except for the group with a diameter of less than 10 mm. This group underwent the standard procedure. All patients were followed up for six months after the procedure and postoperative symptoms, complications and closure rates were recorded.
Results: There was complete closure of all veins in the first month postoperatively. While no thrombophlebitis was observed in group 3, thrombophlebitis was detected in two patients in groups 1 and 2. In the third month, minimal saphenofemoral reflux was observed in two (4.2%) patients in group 1 and in one (4.3%) in group 2. In the sixth month, minimal saphenofemoral reflux was detected in three (6.3%) patients in group 1 and in one (4.3%) in group 2. No residual leakage was observed in group 3 (p = 0.001). In all groups, the severity score regressed significantly in the postoperative sixth month. However, the most significant symptomatic regression was observed in group 3, which had the largest saphenous diameters and we used an esmarch bandage during closure (p = 0.000).
Conclusion: Our findings support the idea that the application of an esmarch bandage during endovenous closure improves clinical outcomes, especially in saphenous veins with larger diameters.
- Title: Effect of lactate levels on extubation time in coronary artery bypass grafting surgery
Authors: Selen Öztürk
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 172–176
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DOI Number: 10.5830/CVJA-2023-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-027
Aim: In current practice, fast-track protocols are gaining importance in patients undergoing cardiac surgery. For this purpose, besides different application techniques, biomarkers are frequently examined in the peri-operative period. We aimed to examine whether serum lactate levels at different peri-operative intervals had an effect on the extubation time.
Methods: The patients were analysed in two groups according to the extubation time (early < 6 hours, and late extubation > 6 hours). Individual characteristics, co-existing diseases, blood transfusion, inotropic support, intra-aortic balloon pump, cardiopulmonary bypass time, aortic cross-clamp time, and the serial measurements of serum lactate levels were recorded. Correlations of serial measurements of lactate levels and the peri-operative variables with extubation times were analysed.
Results: No significant differences were observed between the groups in terms of co-existing diseases and individual characteristics. However, cardiopulmonary bypass, aortic cross-clamp times and all lactate levels after aortic crossclamping were found to be significantly different (p = 0.001). A statistically significant correlation was found between the cut-off value of 1.7 for serum lactate levels after aortic-cross clamping (L2); 1.9 for levels after aortic cross-clamp removal (L3); 2.2 for levels after cardiopumonary bypass (L4); 2.1 for levels after intensive care admission (L5); 1.7 for levels after first postoperative hour in the intensive care unit (L6), and 1.8 for the difference between pre-operative levels (L0) and the peak level of lactate in the peri-operative period (ΔL) in predicting extubation time (p < 0.01).
Conclusion: We concluded that cardiopulmonary bypass and aortic cross-clamp times, and intra-operative serum lactate levels were important in predicting early extubation after isolated coronary artery bypass graft surgery.
- Title: Disparities in patients’ understanding of cardiovascular disease management
Authors: Rumaanah Ayob, Muhammed Vally, Razeeya Khan, Ané Orchard
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 178–184
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DOI Number: 10.5830/CVJA-2024-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2024-007
Abstract: Non-communicable diseases, including cardiovascular disease (CVD), are some of the leading causes of mortality worldwide. Despite the effectiveness of early diagnostic and treatment options, patient screening, disease detection and disease progression remain a challenge, resulting in suboptimal outcomes. Consequently, cardiovascular diseases remain underdiagnosed and undertreated, particularly in developing countries. Several barriers, including paucity of recommended cardiovascular health information and low literacy levels, lead to a poor understanding of the importance of intervention in terms of modifiable risk factors as well as treatment adherence. This narrative review focuses on cardiovascular patients’ understanding of their disease, and the need for compliance with their medication and lifestyle modifications. Low levels of perception and insufficient knowledge of CVDs among patients continue to be indispensably important factors in health behaviour. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary cardiovascular team and ultimately improve the care provided to these patients.
- Title: Delayed diagnosis of cardiac amyloidosis in a West African octogenarian
Authors: Dzifa Ahadzi, Abdul-Subulr Yakubu, Alfred Doku, Francis Agyekum, Cyril Ofori, Harold Ayetey
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 185–188
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DOI Number: 10.5830/CVJA-2024-001
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2024-001
Abstract: Left ventricular hypertrophy (LVH) is a common finding on cardiac imaging. Although there are multiple aetiologies for LVH, hypertension is frequently a presumed cause due to its high prevalence in the African region. Establishing a specific cause of LVH however requires thorough clinical evaluation with multimodality cardiac imaging playing a key role in the diagnostic pathway. We report on a case of a West African octogenarian who was treated presumptively for heart failure with preserved ejection fraction from hypertensive heart disease, based on his initial clinical presentation and echocardiographic findings three years earlier. By adopting a stepwise approach to his evaluation, including revisiting the history, and the application of multimodality cardiac imaging, the patient was diagnosed with cardiac amyloidosis.
- Title: Successful surgical treatment of left ventricular free wall rupture
Authors: Hakan Kara
From: Cardiovascular Journal of Africa, Vol 35, Issue 3 September/October 2024
Pages: 185–192
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DOI Number: 10.5830/CVJA-2024-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2024-002
Abstract: Left ventricular free wall rupture (LVFWR) is a rare mechanical complication of acute myocardial infarction. The clinical course of LVFWR is very poor. Direct or patch closure of the rupture area and sutureless procedures constitute the treatment for LVFWR. We present the surgical treatment of a patient who developed LVFWR after high lateral myocardial infarction, and its successful outcome. Successful salvage of LVFWR remains relatively rare. Transthoracic echocardiography, myocardial contrast echocardiography and thoracic computed tomography are important diagnostic tools for LVFWR. These patients usually present with acute cardiac tamponade symptoms requiring immediate treatment.
