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• Disparities in patients’ understanding of cardiovascular disease management
  Rumaanah Ayob, Muhammed Vally, Razeeya Khan, Ané Orchard
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  DOI: 10.5830/CVJA-2024-007
  Online Publication Date: 23 May 2024
  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.
   
• High intracardiac clot burden in a young mother with peripartum cardiomyopathy in Uganda
  Juliet Nabbaale, Emmy Okello, Karen Sliwa, Annette Nakimuli
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  DOI: 10.5830/CVJA-2024-008
  Online Publication Date: 25 April 2024
  Abstract: Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with a reduction in left ventricular systolic function towards the end of pregnancy or in the months after delivery. It is a life-threatening condition with a substantial mortality rate ranging from six to 25%, commonly due to heart failure or sudden cardiac death. Pregnancy is a prothrombotic state. Due to poor systolic function, women with PPCM are prone to intracardiac thrombi and a high risk of thromboembolic events. Early diagnosis with echocardiography and treatment plays a critical role. We describe a case of a woman with PPCM and biventricular thrombi, with the aim of creating awareness for early echocardiographic screening for thrombi and appropriate implementation of care.
   
• The temporal relationship between body composition and cardiometabolic profiles in an HIV-infected (on antiretroviral therapy) versus HIV-free Western Cape study population
  Yushra Dinnie, Frans Everson, Festus M Kamau, Ingrid Webster, Boipelo Kgokane, Patrick De Boever, Nandu Goswami, Hans Strijdom
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  DOI: 10.5830/CVJA-2024-005
  Online Publication Date: 05 April 2024
  Abstract: Cardiovascular risk is a health concern in people living with HIV/AIDS (PLWH). This longitudinal study (baseline vs 36 months) aimed to investigate the relationship between body composition and markers of cardiovascular risk in a South African study population [HIV free, n = 22 vs HIV positive on antiretroviral therapy (HIV+ART), n = 73)]. Health questionnaires, anthropometric measurements, biochemical analyses and flow-mediated dilation were performed. Linear mixedmodel statistical analyses were applied. The HIV+ART vs the HIV-free groups were independently associated with body mass index (BMI) [–4.92 (–7.99 to –1.84), p = 0.002] and waist circumference [–10.5 (–17.2 to –3.77), p = 0.003]. ART duration was associated with BMI [2.60 (0.57–4.62), p = 0.013], waist circumference [3.83 (0.03–7.63), p = 0.048] and highdensity lipoprotein cholesterol [20.18 (2.37–41.09), p = 0.025]. The data showed that intricate relationships existed in this study population between HIV, ART, body composition and cardiometabolic variables. There is a need for more research investigating cardiovascular risk in PLWH, particularly in the context of changes in body composition measures.
   
• The role of C-reactive protein:albumin ratio and neutrophil:lymphocyte ratio in predicting coronary artery disease
  Murat Özmen
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  DOI: 10.5830/CVJA-2024-004
  Online Publication Date: 26 March 2024
  Introduction: Acute coronary syndrome (ACS), one of the most common causes of death worldwide, is a condition characterised by ischaemia and/or infarction due to reduced coronary blood flow. The most prevalent cause of ACS is coronary artery disease. In this study, we aimed to investigate the relationship between blood parameters that we commonly use in the laboratory [C-reactive protein (CRP), albumin, neutrophils and lymphocytes] and coronary artery disease (CAD).
  Methods: This retrospective, single-centre study included 100 patients who underwent coronary angiography, with the diagnosis of acute coronary syndrome between January and June 2023, and 106 patients with high clinical suspicion and normal coronary arteries as a control group. The NLR was obtained from the ratio of neutrophils to lymphocytes and the CAR was obtained from the ratio of CRP to albumin. We analysed the relationship between CAD and NLR and CAR according to laboratory findings and demographic characteristics of the patients.
  Results: The average age of the study group was 59 ± 10 years. NLR and CAR values were higher in the patient group than the control group (5.2 ± 3.3 vs 2.27 ± 1.2, p = 0.004 and 0.5 ± 0.1 vs 0.097 ± 0.095, respectively, p < 0.001). Albumin ratios were found to be statistically significantly lower in the patient group than the patient group (42.4 ± 4 vs 44 ± 3.3, respectively, p = 0.01). In addition, CAR and NLR showed a significant diagnostic value for CAD in receiver operating characteristic curve analysis (area under the curve: 0.68 ± 0.07, p = 0.003; 0.66 ± 0.09 p ≤ 0.001).
  Conclusion: NLR and CAR values, which are important indicators of inflammation, were found to be higher in the patient group. We believe it may be important to monitor these patients more frequently and follow them closely in terms of CAD, especially if the rate is higher in individuals without CAD who come for out-patient clinic check-ups.
   
• Evaluation of cardiac function in paediatric Wilson’s disease patients with advanced echocardiographic modalities (strain and strain rate echocardiography)
  Kerem Ertaş, Özlem Gül, Fatma Demirbaş
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  DOI: 10.5830/CVJA-2024-006
  Online Publication Date: 26 March 2024
  Objective: In Wilson’s disease (WD), copper accumulation in the organs and/or damage caused by oxygen free radicals occurs due to disturbances in copper excretion. In our study, we aimed to evaluate cardiac involvement with advanced echocardiographic modalities (tissue Doppler echocardiography, strain and strain-rate echocardiography).
  Methods: Twenty WD patients and 20 healthy children from the Pediatric Gastroenterology Department of Diyarbakır Children’s Hospital were included in the study between 2022 and 2023.
  Results: The mean age of the WD patients was 12.89 ± 3.79 years. Left ventricular wall thicknesses and diameters (diastolic interventricular septum thickness, diastolic left ventricular posterior wall thickness, left ventricular end-diastolic diameter), left ventricular diastolic function parameters (E, A, E/A, deceleration time) and left ventricular ejection fraction and tricuspid annular plane systolic excursion were similar and not statistically significantly different in the WD and control groups. Mitral lateral e′, mitral septal e′ and tricuspid lateral e′ velocities were lower in the WD patients and statistically significantly different from the controls (p = 0.02, 0.04 and 0.005, respectively), as assessed by tissue Doppler echocardiography. Global longitudinal systolic strain was similar in the WD and control groups and no statistically significant difference was detected. Longitudinal early diastolic strain rate was lower in the WD patients and statistically significantly different (p = 0.002).
  Conclusion: Subclinical early diastolic dysfunction and segmental systolic dysfunction were detected in WD patients with advanced echocardiographic modalities, in addition to normal cardiac function as assessed by conventional echocardiography. Advanced echocardiographic modalities can be used in the follow up of WD patients.
   
• Comprehensive ABC (HbA1c, blood pressure, LDL-C) control and cardiovascular disease risk in patients with type 2 diabetes mellitus and major depressive disorder in a South African managed healthcare organisation
  Lovina A Naidoo, Neil Butkow, Paula Barnard-Ashton, Elena Libhaber
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  DOI: 10.5830/CVJA-2024-003
  Online Publication Date: 25 March 2024
  Aim: Patients with type 2 diabetes mellitus (T2DM) who have suboptimal control of the triad of glucose (A), blood pressure (B) and lipid profile (C) have an increased risk of cardiovascular disease (CVD). Additionally, the presence of major depressive disorder (MDD) can lead to poor outcomes. Therefore, the aim of this study was to assess the role of MDD with ABC control in patients with T2DM in a South African private healthcare setting.
  Methods: Healthcare medical claims and electronic health records of 1 211 adult patients with T2DM and/or MDD were analysed for 2019.
  Results: Only 24% of the T2DM +/– MDD patients reached a low-density lipoprotein cholesterol (LDL-C) target < 1.8 mmol/l, and only 13% of the T2DM + MDD and 7.1% of T2DM – MDD patients achieved simultaneous ABC targets. The proportion of patients admitted due to macrovascular complications was higher in the T2DM + MDD group (22.8%) compared to the T2DM – MDD (13.1%) and MDD group (9.9%) (p = 0.012). Multivariate logistic regression analysis showed that older patients with T2DM + MDD achieved better glycated haemoglobin and LDL-C control. Significantly more patients with T2DM + MDD (12%) had repeat macrovascular admissions in 2019 compared to the T2DM – MDD patients (2.9%) (p = 0.005).
  Conclusion: Despite a managed-care environment, the comprehensive ABC control among patients with T2DM was suboptimal, particularly in those with MDD, placing them at greater risk for CVD events.
   
• The predictive value of triglyceride–glucose index for assessing the severity and MACE of premature coronary artery disease
  Ling Yang, Yu Peng, Zheng Zhang
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  DOI: 10.5830/CVJA-2023-060
  Online Publication Date: 21 February 2024
  Objective: The aim of this study was to investigate the predictive value of the triglyceride–glucose (TyG) index to assess the severity and major adverse cardiovascular events (MACE) of patients in hospital with premature coronary artery disease (PCAD).
  Methods: A total of 300 patients with PCAD, diagnosed by coronary angiography (CAG), were enrolled in this study. According to the tertiles of TyG index, the 300 patients were divided into a T1 (n = 100), T2 (n = 100) and T3 group (n = 100). According to the presence or absence of MACE, the 300 patients were divided into a MACE (n = 80) and a non-MACE group (n = 220). The patients’ clinical data were compared between the groups, the relationship between TyG index and the severity of PCAD and MACE were analysed through multivariable logistic regression analysis, and their predictive value was detected using receiver operating characteristic (ROC) curves.
  Results: Multivariable logistic regression analysis showed that the TyG index was an independent risk factor for the severity of PCAD and MACE. The area under the ROC curve was 0.833 and 0.807, respectively (all p < 0.05).
  Conclusion: The TyG index was independently associated with the severity of PCAD and MACE, and had a good predictive value.
   
• Obesity is associated with long-term outcome of catheter ablation of atrial fibrillation in patients with dilated cardiomyopathy
  Jiaqi Yang, Tienan Sun, Xunxun Feng, Yuchao Zhang, Biyang Zhang, Yang Liu, Qianyun Guo
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  DOI: 10.5830/CVJA-2023-063
  Online Publication Date: 20 February 2024
  Background: Patients with atrial fibrillation (AF) and dilated cardiomyopathy (DCM) often exhibit cardiac dysfunction and a poor prognosis. However, the specific reasons are unclear. This study aimed to describe the impact of obesity in patients with AF and DCM.
  Methods: Seventy-four consecutive patients with AF and DCM were enrolled and classified by body mass index. We measured primary endpoints, including cardiac death, recurrent AF, recurrent atrial tachyarrhythmia and stroke, as well as secondary endpoints.
  Results: In multivariate analysis, compared to the normalweight group, the overweight and obese groups had greater incidences of recurrent AF (0.0 vs 30.3 vs 40.0%, respectively, log-rank p = 0.048) and rehospitalisation (9.1 vs 36.4 vs 45.0%, respectively, log-rank p = 0.035). Compared to the normalweight group, five-year outcomes for primary endpoints were inferior in the overweight and obese groups (18.2 vs 30.3 vs 50.0%, respectively, log-rank p = 0.042). Overweight patients exhibited more benefit in recovery of left ventricular ejection fraction after ablation (from 39.1 to 50.0%, p = 0.005) than the normal-weight group (from 43.1 to 52.3%, p = 0.199) and obese group (from 44.9 to 51.2%, p = 0.216).
  Conclusion: Patients with AF and DCM with overweight or obesity exhibited worse long-term outcomes in recurrent AF than normal-weight patients. However, overweight patients showed the most benefit in cardiac function after ablation.
   
• Successful surgical treatment of left ventricular free wall rupture
  Hakan Kara
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  DOI: 10.5830/CVJA-2024-002
  Online Publication Date: 19 February 2024
  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.
   
• Correlation of osteopontin hormone with TIMI score and cardiac markers in patients with acute coronary syndrome presenting with chest pain
  Ayşe Şule Akan, Ibrahim Özlü
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  DOI: 10.5830/CVJA-2023-066
  Online Publication Date: 16 February 2024
  Aim: Rapid evaluation of patients with acute coronary syndrome (ACS) attending the emergency service under emergency room conditions and using appropriate risk scoring would improve treatment success. Calcium levels accumulate in the tissue in people with coronary artery disease and this has been found to correlate with osteopontin levels in some studies. It is predicted that osteopontin level could be used as a biomarker to detect coronary artery calcification. In this study, we aimed to evaluate the use of osteopontin levels in the differential diagnosis of ACS in conjunction with cardiac troponin I (cTnI) levels, and HEART (history, ECG, age, risk factors, troponin) and thrombolysis in myocardial infarction (TIMI) scores in patients with chest pain who attended the emergency service.
  Methods: This study was conducted as a prospective observational clinical study in the Department of Emergency Medicine, Faculty of Medicine, Ataturk University. There was a total of 90 participants, including 60 patients and 30 healthy individuals in the control group. All participants’ demographic information, electrocardiography (ECG) findings, cTnI level, TIMI and HEART score, and osteopontin level were evaluated.
  Results: The patients’ mean age was 51.61 ± 17.56 years and 63.3% (n = 57) were male. The body mass index (BMI) of the patients was 25.63 ± 4.67 kg/m2. Patients with chest pain [CP(+)] and high cardiac troponin I levels [cTnl(+)] were found to be older and to have higher HEART and TIMI scores than individuals with CP(+) and normal cardiac troponin I levels [cTnl(–)] and the healthy control group (p < 0.001). While the HEART score was zero in 22 (24.4%) of the patients, the TIMI score was zero in 42 (46.7%). In terms of gender distribution, vital signs and serum osteopontin levels, there was no significant difference between the patient groups (p > 0.05). It was found that patients with CP(+) and cTnl(+) had a higher rate of ECG abnormalities than the CP(+) and cTnl (–) group and the healthy control group (p = 0.13 and p < 0.001, respectively). In 65 (72.2%) of the patients, the ECG results were normal. ST-segment elevation was detected in 13 (14.4%) patients. In our study, cTnl levels were found to be positively correlated with age (r = 0.624), BMI (r = 0.291), HEART score (r = 0.794) and TIMI score (r = 0.805) (p = 0.001, p = 0.005, p = 0.001 and p = 0.001, respectively). In our study, we discovered that osteopontin levels could not reach the differential diagnostic level for ST-elevation myocardial infarction or non-ST-elevation myocardial infarction. No statistically significant difference was found in osteopontin levels between the groups (p > 0.05).
  Conclusion: While very positive results were obtained in this approach to the ACS diagnosis using HEART and TIMI scores in patients with chest pain who attended the emergency service and were diagnosed with ACS, no significant results could be obtained regarding the use of osteopontin levels as a biomarker. More comprehensive, multicentre studies involving a large number of appropriately selected patients are considered to be necessary.
   
• Delayed diagnosis of cardiac amyloidosis in a West African octogenarian
  Dzifa Ahadzi, Abdul-Subulr Yakubu, Alfred Doku, Francis Agyekum, Cyril Ofori, Harold Ayetey
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  DOI: 10.5830/CVJA-2024-001
  Online Publication Date: 12 February 2024
  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.
   
• Impact of COVID-19 on cardiac surgery outcomes
  Danica Mandić, Aleksandra Milovančev, Aleksandar Redžek, Milovan Petrović, Aleksandra Ilić, Milenko Čanković, Melisa Mironicki Pekarić, Vanja Dudaš, Bojana Šarošković
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  DOI: 10.5830/CVJA-2023-065
  Online Publication Date: 12 February 2024
  Aim: This study aimed to assess the impact of COVID-19 infection on cardiac surgery outcomes in patients who contracted COVID-19 peri-operatively or had recently recovered from COVID-19.
  Methods: The study prospectively enrolled 95 patients scheduled for cardiac surgery who had recently recovered from COVID-19. This formed the post-COVID-19 group. The other group consisted of 25 patients who contracted COVID-19 peri-operatively. Patients were followed for all-cause mortality as the primary endpoint and postoperative course complications as the secondary endpoint. Data were compared to a historical cohort of 280 non-COVID-19 patients.
  Results: The peri-operative COVID-19 group exhibited a significantly higher prevalence of primary outcome all-cause mortality (28%), compared with 4.3% in the controls (p < 0.01), as well as the secondary composite endpoint (stroke, peri-operative myocardial infarction and pneumonia) (52 vs 13.9%, p < 0.01). The post-COVID-19 group had a higher incidence of acute pulmonary embolism (3.2 vs 0%, p < 0.01) and atrial fibrillation (23.4 vs 11.4%, p < 0.01).
  Conclusion: Patients who contracted COVID-19 peri-operatively had an increased rate of mortality and postoperative complications, while cardiac surgery in the recently recovered COVID-19 group was associated with a higher incidence of pulmonary embolism and atrial fibrillation.
   
• Association of ratios of monocyte/high-density lipoprotein cholesterol and neutrophil/high-density lipoprotein cholesterol with atherosclerotic plaque type on coronary computed tomography
  Taha Okan, Caner Topaloglu
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  DOI: 10.5830/CVJA-2023-064
  Online Publication Date: 26 January 2024
  Objectives: The monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR) and neutrophil/HDL-C ratio (NHR) are markers for inflammation and dyslipidaemia, which are important factors in atherosclerosis. Studies have linked MHR and NHR to the prediction, severity and prognosis of coronary artery disease. However, no study has explored their connection to plaque stability, specifically its calcific or soft/mixed content.
  Methods: Monocyte, neutrophil and HDL-C levels were examined in 99 patients who had coronary computed tomographic angiography (CTA) between January and August 2023. They were divided into three groups: a group of 42 healthy individuals (group 0) with no coronary artery plaque and an Agatson score of 0, an unstable plaque group (group 1) with 31 patients displaying mixed and/or soft plaque on CTA, and a stable plaque group (group 2) with 26 patients showing only calcific plaque.
  Results: White blood cell (WBC), monocyte and neutrophil counts were significantly higher in group 1 patients compared to group 0 patients (group 0: WBC = 6.31 ± 0.97 × 103 cells/μl, monocytes = 0.40 ± 0.09 × 10³ cells/μl, neutrophils = 3.32 ± 0.81 × 10³ cells/μl; and group 1: WBC = 7.61 ± 1.95 × 10³ cells/μl, monocytes = 0.50 ± 0.11 × 10³ cells/μl, neutrophils = 4.19 ± 1.36 10³ cells/μl; p < 0.05). MHR and NHR were significantly higher in group 1 patients compared to group 0 patients (group 0: MHR = 0.0079 ± 0.0029, NHR = 0.063 ± 0.023 and group 1: MHR = 0.0102 ± 0.003, NHR = 0.085 ± 0.036, p < 0.05).
  Conclusion: The significant differences in MHR and NHR between the three groups were due to the differences between groups 0 and 1. MHR and NHR were significantly higher in group 1 patients, although there was no statistically significant difference between groups 1 and 2.
   
• Assessment of Tp–Te interval in patients with cardiac AL amyloidosis
  Yavuz B Tor, Ismat Habibov, Mustafa Altinkaynak, Mehmet Aydogan, Derya Baykiz, Mehmet Tayfur, Mehmet G Gonenli, Imran Onur, Sevgi Kalayoglu-Besisik, Bulent Saka, Sebile N Erten, Timur S Akpinar
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  DOI: 10.5830/CVJA-2023-059
  Online Publication Date: 15 January 2024
  Background: Prolonged Tp–Te interval is strongly associated with fatal ventricular arrhythmias and mortality. This association has been demonstrated in various diseases. However, the current literature does not give any information on Tp–Te interval in cardiac amyloid light-chain (AL) amyloidosis.
  Methods: We retrospectively screened 116 cardiac AL amyloidosis patients and 35 patients were included in the study. Demographic, laboratory, 12-lead electrocardiographic (QTc, Tp–Te V1–V6) and transthoracic echocardiographic data of the patients were analysed and compared with 35 healthy controls.
  Results: QTc and Tp–Te V2–V5 were significantly prolonged in the cardiac AL amyloidosis group (p < 0.05). Also, there was a positive and statistically significant correlation between the parameters of QTc and Tp–Te V3–V6, and also between the parameters of interventricular septum thickness at enddiastole and Tp–Te V2–V5.
  Conclusion: We present the first strong evidence of prolonged Tp–Te intervals in patients with cardiac AL amyloidosis. There may also be a relationship between prolonged Tp–Te interval and the development of arrhythmia in this patient group, as in some other groups. There is a need for prospective studies examining the relationship of prolonged Tp–Te interval with arrhythmias and its prognostic significance in cardiac AL amyloidosis.
   
• Association between Pfizer-BioNTech mRNA vaccine and myocardial infarction: clinical and angiographic insights
  Fatih Aydin, Bektaş Murat, Selda Murat, Ayse Huseyinoglu Aydin
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  DOI: 10.5830/CVJA-2023-062
  Online Publication Date: 13 December 2023
  Objective: With the widespread administration of the BioNTech mRNA-based COVID-19 vaccine, there is a need to evaluate its potential effects on cardiovascular health, particularly its association with myocardial infarction (MI). This study aimed to investigate the relationship between BioNTech vaccination and MI, as well as its impact on clinical and angiographic parameters.
  Methods: A retrospective analysis was conducted at the Eskisehir Osmangazi University, Eskisehir City Hospital, between April 2020 and May 2023 on a cohort of 1 151 patients hospitalised with MI. The patients were stratified into a BioNTech+ (vaccinated) and a BioNTech– (unvaccinated) groups. Medical records were reviewed for demographic information, clinical data and angiographic findings. Statistical analyses were performed, including logistic regression models adjusting for potential confounders.
  Results: The BioNTech– group had a higher mean number of percutaneous transluminal coronary angioplasty procedures and stents compared to the BioNTech+ group. Haematological parameters and lipid profiles showed some discrepancies between the two groups. The BioNTech– group had higher white blood cell and platelet counts, while also exhibiting a higher mean low-density lipoprotein cholesterol level. The prevalence of co-morbidities and cardiovascular risk factors differed between the groups.
  Conclusion: This study found associations between the BioNTech vaccination and clinical and angiographic parameters in patients with MI.
   
• Investigation of the effects of ellagic, vanillic and rosmarinic acid on reperfusion-induced renal injury
  Alper Gurmen, Orkut Guclu, Serhat Huseyin, Nuray Can, Eray Ozgun, Mursel Buyukadali, Adem Reyhancan, Suat Canbaz
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  DOI: 10.5830/CVJA-2023-061
  Online Publication Date: 29 November 2023
  Introduction: The aim of this study was to investigate the effects of ellagic, vanillic and rosmarinic acid on reperfusionrelated kidney damage, developed in an experimental lowerextremity ischaemia/reperfusion (I/R) model.
  Methods: Forty-eight female Sprague-Dawley rats were divided into six groups. A median laparotomy and dissection were performed. In the I/R group, 60 minutes of ischaemia followed by 120 minutes of reperfusion was achieved. In addition one group was given 100 mg/kg ellagic acid, one group was given 12 mg/kg vanillic acid, one group was given 50 mg/kg rosmarinic acid and one group was given all three drugs 15 minutes before clamp removal. Bilateral kidney and blood samples were taken in all groups.
  Results: Tubular epithelial degeneration, necrosis of the tubule epithelium and vessel wall thickening were significantly higher in the I/R group. Some parameters in the groups that were given drugs were found to be lower than in the I/R group and close to that of the control group. Total oxidant status (TOS) and oxidative stress index (OSI) were significantly higher and total antioxidant status (TAS) was significantly lower in the I/R group. Although not statistically significant in the groups given drugs, TAS was higher, and TOS and OSI were lower than in the I/R group.
  Conclusion: The antioxidant effect of ellagic, vanillic and rosmarinic acid administration may have beneficial effects on renal damage after reperfusion in acute lower-extremity ischaemia. This study is expected to provide information for future clinical trials.
   
• A novel method that can be used in both the diagnosis and treatment of peripheral arterial disease in diabetics: vibration-mediated dilation
  Mehmet Aydogan, Omer Kumet, Alp Ozcan, Ilke Ozcan, Ahmet Tas, Sabahattin Umman
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  DOI: 10.5830/CVJA-2023-058
  Online Publication Date: 29 November 2023
  Objective: The growing incidence of diabetes and the increasing life expectancy of the diabetic population worldwide has increased the number of diabetic vascular complications occurring in cardiology practice. As current treatment and prevention methods are less effective in this patient group, there is a need for new treatment methods in this area. Exercise, which reduces metabolic and vascular problems associated with diabetes, often becomes impossible, especially in advanced-stage patients who need exercise the most. Since exercise and flow-mediated dilation (FMD) are effective by stimulating mechanotransduction mechanisms on the endothelium, it can be expected that the same mechanisms could also be stimulated by direct vibration.
  Methods: In order to test this hypothesis, in this study, a group of 20 type 2 diabetes patients (11 males, age 56.80 ± 11.05 years and diagnosed for 15.35 ± 8.61 years) were examined via the application of FMD and vibration-mediated dilation (VMD). We performed vibration for five minutes with 20-Hz frequency and 3-mm vertical amplitude, to the same side forearm, with a 30-minute interval. Using a 10-MHz linear echo probe, brachial artery diameter and flow velocities were recorded for 10 minutes before and at two-minute intervals after the FMD and VMD applications. Then brachial artery flow and resistance were calculated at each stage.
  Results: In the first minute after FMD and VMD applications, brachial artery diameter and flow velocities increased significantly, and vascular resistance decreased significantly. None of the corresponding FMD or VMD parameters in the first minute was different. The artery diameters in the first minute after FMD and VMD were increased by 6.04 ± 5.29 and 5.49 ± 5.21%, respectively. At the tenth minute, these values decreased to 1.73 ± 3.21 and 2.05 ± 3.31%. In the FMD series, all parameters except brachial artery diameter returned to their baseline values after the fourth minute. After VMD, all parameters also decreased after the first minute, but the recovery was much slower. At each stage after the first minute, the VMD averages were higher than the baseline value and their corresponding FMD values.
  Conclusion: The results of this study indicated that vibration may be a powerful, long-lasting and feasible treatment option in patients with peripheral perfusion failure, developed due to diabetic macro- and microvascular complications.
   
• Predictive values of stress hyperglycaemia and glycosylated haemoglobin on admission for long-term recovery of cardiac function in patients with acute myocardial infarction after primary percutaneous coronary intervention
  Jinfeng Xiao, Chuanchao Luo, Lixin Yang
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  DOI: 10.5830/CVJA-2023-056
  Online Publication Date: 22 November 2023
  Abstract: We aimed to explore the predictive values of stress hyperglycaemia (SHG) and glycosylated haemoglobin (HbA1c) levels on admission for long-term recovery of cardiac function in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PPCI). A total of 210 AMI patients were randomly selected. The levels of SHG and HbA1c were measured on admission, and all patients were treated with PPCI and followed up for one year. According to the recovery status of cardiac function during follow up, the patients were divided into a good recovery group and a poor recovery group. At one year after treatment, there were statistically significant differences in the levels of SHG (6.75 ± 0.69 vs 7.81 ± 0.92 mmol/l) and HbA1c (5.13 ± 0.25 vs 5.91 ± 0.39%) between the good and poor recovery groups (p < 0.05). The levels of SHG and HbA1c were associated with long-term recovery of cardiac function (p < 0.05). The receiver operating characteristic curves were plotted, and the area under the curves of SHG and HbA1c for predicting the long-term recovery of cardiac function were > 0.70. The levels of SHG and HbA1c were closely associated with longterm recovery of cardiac function after PPCI in AMI patients, displaying high predictive values.
   
• The relationship between epicardial adipose tissue and choroidal vascularity index in patients with hypertension
  Güvenç Toprak, Muhammet Fatih Bayraktar
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  DOI: 10.5830/CVJA-2023-057
  Online Publication Date: 20 November 2023
  Objective: The choroidal vascularity index (CVI) is a method that measures the density of blood vessels in the choroidal layer and can be used to evaluate the effects of hypertension. In this study we aimed to investigate the relationship between epicardial fat thickness (EFT) and CVI in patients with hypertension.
  Methods: This prospective study included 112 patients diagnosed with hypertension and 120 healthy individuals. Patients’ demographic data such as age, gender, weight, height, body mass index (BMI), smoking status, and presence of coronary artery disease and diabetes mellitus were recorded. BMI was calculated by dividing a patient’s weight in kilograms by their height in metres squared. EFT was measured by echocardiography and CVI was calculated using the optical coherence tomography method.
  Results: The mean CVI was found to be 66.57 ± 2.21 in the patient group and 69.22 ± 2.39 in the control group and the difference was significant (p < 0.001). The mean EFT was found to be 5.23 ± 3.25 mm in the patients and 2.57 ± 1.97 mm in the control group and the difference was statistically significant (p = 0.003). According to Spearman’s correlation analysis, there was a significant positive correlation between BMI and EFT (r = 0.379, p < 0.001) and a significant negative correlation between CVI and EFT (r = –0.412, p < 0.001).
  Conclusion: The CVI value was significantly lower and the EFT value was significantly higher in patients with hypertensioncompared to non-hypertensive patients. There was a significant positive correlation between EFT and BMI and a significant negative correlation between EFT and CVI.
   
• Improving cardiac function of angiotensin receptor/neprilysin inhibitor in patients with acute myocardial infarction: a systematic review and meta-analysis
  Qiuli Niu, Changyuan Wang, Xiurong Xing
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-028
  Online Publication Date: 17 November 2023
  Aim: As the impact of angiotensin receptor/neprilysin inhibitor (ARNI) on cardiac function in acute myocardial infarction (AMI) patients is unclear in clinical therapy, we conducted this research to investigate the actual effects of improving cardiac function with ARNI in AMI patients.
  Methods: Publications were checked up to June 2022. Standardised mean differences (SMD) and 95% confidence intervals (CI) were utilised for assessing the size of the effect of continuous variables. To assess the magnitude of the effect of dichotomous variables, a relative risk (RR) with 95% CI was used.
  Results: ARNI could improve left ventricular ejection fraction (SMD = 0.40; 95% CI: 0.23–0.58), while lowering left ventricular end-diastolic volume (SMD = –0.43, 95% CI: –0.78 to –0.08), left ventricular end-systolic volume (SMD = –0.39, 95% CI: –0.66 to –0.11) and left ventricular enddiastolic diameter (SMD = –0.49; 95% CI: –0.65 to –0.33). Besides, it could decrease the rates of major adverse cardiac events (RR = 0.55; 95% CI: 0.43–0.69) and heart failure (RR = 0.42; 95% CI: 0.31–0.58).
  Conclusion: ARNI could greatly improve cardiac function in AMI patients.
   
• Ultrasonographic assessment and clinical outcomes after deployment of a suture-mediated femoral vascular closure device
  Dimitrios Papoutsis, Konstantinos Mourouzis, Nikoleta Bozini, Konstantinos Aznaouridis, Evangelos Oikonomou, Katerina Chatzimichael, Elias Brountzos, Manolis Vavuranakis, Costas Tsioufis, John Lekakis, Gerasimos Siasos, Dimitris Tousoulis
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-054
  Online Publication Date: 16 November 2023
  Introduction: Data regarding changes in the arterial vascular wall after the deployment of suture-mediated vascular closure devices (VCD) at the femoral site in patients undergoing percutaneous coronary angiography (CAG) or percutaneous coronary intervention (PCI) are sparse. This study investigated the occurrence of structural vascular changes or adverse vascular complications at the access site in the short term after the deployment of a suture-mediated intravascular VCD.
  Methods: Ninety-three patients (72% males) with a mean age of 62 ± 11 years were enrolled. Duplex sonography was conducted at the access site at baseline, 24 hours and 30 days after femoral puncture in patients with successful VCD deployment. Vessel diameter, flow velocities, the severity of atherosclerosis, and the intravascular or perivascular tissue alterations in both the right common femoral artery (RCFA) and right external iliac artery (REILA) were assessed. Vascular complications were documented.
  Results: There were no significant changes regarding the diameter of the RCFA in the transverse and longitudinal view, peak systolic velocity (PSV) of the RCFA, PSV ratio of the RCFA to REILA, the resistive index of the RFCA and the severity of arterial wall abnormalities before femoral puncture, the day following VCD deployment and 30 days after (p = NS for all) in the general population and in patients with diabetes mellitus, on oral anticoagulants or with mild peripheral artery disease (p = NS for all markers). Device failure was observed in four cases. Few (4.4%) patients had vascular complications, which included exclusively major or minor haematomas, most of which did not persist at the 30-day follow up.
  Conclusion: The use of a suture-mediated VCD was safe and was not associated with adverse vascular wall changes at the femoral access site 30 days after deployment in patients undergoing CAG and/or PCI.
   
• Correlation between carotid intima–media thickness and patient outcomes in coronary artery disease in central South Africa
  V Mokoena, L Botes, SC Brown, FE Smit
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-055
  Online Publication Date: 16 November 2023
  Objectives: Carotid intima–medial thickness (CIMT) is a non-invasive tool used to detect atherosclerosis and diagnose cardiovascular disease. This study aimed to determine whether pre-operative CIMT measurements correlated with intraand postoperative outcomes in patients with acute coronary syndrome (ACS) undergoing coronary artery bypass graft (CABG) surgery.
  Methods: This retrospective, analytical cohort included 89 patients diagnosed with ACS who received CABG surgery. Patients were divided into two cohorts: group 1: normal CIMT < 0.07 cm and group 2: abnormal CIMT ≥ 0.07 cm. B-mode ultrasound was used to measure the CIMT in all patients. Pre-, intra- and postoperative data and complications were recorded for each patient.
  Results: The study included 77 (86.5%) males and 12 (13.5%) females. Pre-operative mean body mass index was significantly higher (p = 0.03) in group 2 than in group 1. Group 2 had a significantly increased incidence of diabetes (p = 0.008) and hypertension (p = 0.009), and increased NT-proBNP levels (p = 0.02). Intra- and postoperative outcomes between the groups were comparable, with no significant differences.
  Conclusion: The study showed no correlation between abnormal CIMT and increased adverse intra- and postoperative patient outcomes. Therefore, the results of this study show CIMT should not be considered a tool to predict adverse events in patients undergoing CABG surgery.
   
• Contemporary risk factors associated with ischaemic heart disease in central South Africa: a single-centre study
  Michelle Butler, Lezelle Botes, Stephen Brown, Francis Smit
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-053
  Online Publication Date: 06 November 2023
  Background: Deaths from non-communicable diseases have increased in sub-Saharan Africa over the years, with limited data on coronary artery disease (CAD) and the risk factors thereof. The objective of this study was to investigate modifiable and non-modifiable risk factors in central South Africa in patients with CAD.
  Methods: Patients with angiographically confirmed CAD who were evaluated in the catheterisation laboratory for the first time over a two-year period (2016–2017) were included. Data were extracted from the patients’ medical records.
  Results: Four hundred and eighty-two patients met the inclusion criteria, presenting at a mean age of 58.4 ± 10.8 years, and were predominantly male (66%). Females were significantly older than the males (60.3 ± 9.6 vs 57.4 ± 11.1 years; p < 0.05). The mean age at presentation was comparable between ethnic groups, except Asian patients who presented at a significantly younger age compared to Caucasians (49.8 ± 10.5 vs 59.1 ± 10.8 years; p < 0.05). Hypertension (91%) was the most common risk factor, followed by smoking (67%) and obesity (41%). Black Africans demonstrated a higher incidence of hypertension when compared to Caucasians (96 vs 87%; p < 0.05). Smoking was more prevalent in Caucasians than black Africans (68 vs 55%; p < 0.05) and occurred more commonly in males than females (73 vs 55%; p < 0.05). Most patients presented with acute coronary syndrome (ACS) (72%), mainly with ST-elevation myocardial infarction (STEMI) (36%). The majority of patients presenting with ACS were in the age group 51–60 years. The ACS risk-factor profile was similar to that of the total study group.
  Conclusion: CAD was present in all ethnic groups, and modifiable and non-modifiable risk factors were similar to the classical risk factors described worldwide. Minor interracial differences were observed and hypertension was the most prevalent risk factor recorded in central South Africa. Most patients with CAD presented with ACS, particularly STEMI. Recognition of the risk factors associated with CAD would contribute to improved planning of healthcare systems and increased awareness of CAD.
   
• Comparison of early postoperative results in patients with and without diabetes with low ejection fraction and normal serum creatinine values who underwent coronary artery bypass operation
  Cihan Yücel, İlhan Özgöl
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  DOI: 10.5830/CVJA-2023-052
  Online Publication Date: 27 October 2023
  Background: Low left ventricular ejection fraction and renal insufficiency are factors that increase the risk of coronary artery bypass graft surgery in patients with diabetes mellitus. The aim of this study was to group patients with low left ventricular ejection fraction undergoing coronary artery bypass graft surgery according to the presence or absence of diabetes mellitus and to evaluate postoperative changes in serum creatinine levels and postoperative outcomes.
  Methods: A total of 93 patients undergoing isolated coronary artery bypass grafting were included in this single-centre, retrospective, cohort study. Patients with a pre-operative low left ventricular ejection fraction of less than 35% were included in the study. Patients were divided into diabetic and non-diabetic groups and intra- and intergroup values were compared. Pre-operative, and postoperative days 2 and 5 serum creatinine levels of the patients were measured and compared.
  Results: Of the 93 patients included in the study, 60 were in the diabetic group (group 1) and 33 were in the non-diabetic group (group 2). Postoperative 2- and 5-day creatinine levels were significantly higher in group 1 than in group 2 (p = 0.033 and p = 0.005, respectively). Postoperative 2- and 5-day creatinine levels were significantly higher than pre-operative creatinine levels in group 1 (p = 0.008 and p = 0.001, respectively). The intensive care unit stay was significantly longer in the diabetes mellitus group than in the group without diabetes mellitus (p = 0.031).
  Conclusion: Following coronary artery bypass graft surgery in patients with low left ventricular ejection fraction, which is already a risk factor, creatinine levels were found to have increased in the diabetes mellitus group.
   
• Correlation between maternally expressed gene 3 expression and heart rate variability in heart failure patients with ventricular arrhythmia
  Ling Lin, Mei Hou, Ailing Yang, Yunfei Li, Rong Su, Li Li, Siyun Wu, Mingguo Zhang
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  DOI: 10.5830/CVJA-2023-044
  Online Publication Date: 06 October 2023
  Aim: The aim of the study was to analyse the correlation between maternally expressed gene 3 (MEG3) expression and heart rate variability (HRV) in heart failure patients with ventricular arrhythmia (VA).
  Methods: A total of 130 heart failure patients, treated from July 2018 to March 2021, were prospectively selected and divided into a non-VA group (n = 85) and a VA group (n = 45) according to the presence or absence of VA. The correlations of serum MEG3 expression and HRV with cardiac function indicators were investigated by Pearson correlation analysis. Receiver operating characteristic (ROC) curves were plotted to assess the predictive value of MEG3, HRV and their combination for the occurrence of heart failure complicated with VA.
  Results: The VA group had a higher left atrial diameter (LAD) and left ventricular end-diastolic diameter (LVEDD) but lower left ventricular ejection fraction (LVEF) and ratio of mitral early diastolic peak velocity (E) to late peak atrial filling velocity (A) (E/A) than the non-VA group (p < 0.05). The serum MEG3 expression was negatively correlated with: standard deviation of the average RR intervals calculated over five-minute segments in the 24-hour record (SDANN), SDANN index, standard deviation of normal-to-normal RR interval (SDNN) index, percentage of differences between adjacent normal RR intervals exceeding 50 ms (PNN50), root mean square of successive difference (RMSSD), low frequency (LF), high frequency (HF), very low frequency (VLF), LVEF and E/A (r < 0, p < 0.05). The serum MEG3 expression was positively correlated with LAD and LVEDD (r > 0, p < 0.05). The areas under the ROC curves of MEG3, SDANN, SDANN index, SDNN index, PNN50, RMSSD, LF, HF, VLF and their combination for the prediction of the occurrence of heart failure complicated with VA were 0.812, 0.731, 0.737, 0.689, 0.860, 0.783, 0.791, 0.856, 0.769 and 0.966, respectively.
  Conclusion: MEG3 combined with HRV can effectively predict the occurrence of heart failure complicated with VA.
   
• A novel U-shaped relationship between serum klotho and abdominal aortic calcification in the general population
  Na Wei, Zuolei Shi, Yan Gong
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  DOI: 10.5830/CVJA-2023-048
  Online Publication Date: 05 October 2023
  Background: Abdominal aortic calcification (AAC) is considered an independent predictor of cardiovascular morbidity and mortality. Klotho, an anti-aging gene, has cardiovascular protective effects. At present, the association between klotho and AAC in the general population is uncertain. We investigated the relationship between serum soluble α-klotho (SSKL) and AAC in 2 327 participants from the National Health and Nutrition Examination Survey.
  Methods: To estimate the association between log-transformed SSKL (lnSSKL) and AAC, multivariate logistic regression analyses were conducted. Stratified analyses were performed to evaluated the potential modifiers. Smoothed curve fitting and generalised additive models were also performed.
  Results: We found lnSSKL correlated negatively with AAC after adjusting for other confounders. The relationship of lnSSKL with AAC was a U-shaped curve (inflection point: 7.01 pg/ml). On subgroup analyses, stratified by age and smoking habit, the negative correlation of lnSSKL with AAC remained in men and in the population who smoked.
  Conclusion: Our study revealed a negative relationship between lnSSKL and AAC in the general population. This relationship showed a U-shaped curve and was influenced by age and smoking habit.
   
• Echocardiographic multiparameter assessment for patients with heart failure with preserved ejection fraction and atrial fibrillation
  Lingling Qin, Junhua Yang, Fenglan Xu
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  DOI: 10.5830/CVJA-2023-047
  Online Publication Date: 04 October 2023
  Abstract: We aimed to assess the echocardiographic parameters of cardiac structure and function in patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF). Thirty-seven HFpEF patients with AF were selected, while 38 patients with simple HFpEF in the same period were selected as controls. Three-dimensional speckletracking echocardiography was performed on both groups and the parameters were compared. The early diastolic longitudinal peak strain rates [early diastolic longitudinal strain rate (LSRE), early diastolic circumferential strain rate (CSRE), early diastolic radial strain rate (RSRE) and early diastolic rotational strain rate (RotRE)], late diastolic longitudinal peak strain rates (LSRA, CSRA, RSRA and RotRA) and untwisting parameters [untwisting rate during isovolumic relaxation time (UTRIVR) and early peak untwisting rate (UTRE)] were all negatively correlated with the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/E′) (p < 0.01). The cardiac event-free survival rate of the simple HFpEF group (92.11%) was significantly higher than that of the HFpEF + AF group (81.08%) (p < 0.0001). UTRIVR had a more significant correlation with E/E′ ratio than the other indicators and could serve as a sensitive indicator for evaluating the diastolic function of patients with HFpEF + AF.
   
• Relationship between adiponectin and copeptin levels with long-term cardiovascular mortality in ST-segment elevation myocardial infarction after percutaneous coronary intervention
  Ayça Türer Cabbar, Ersin Yıldırım, Özge Güzelburç Çalbayram, Mustafa A Şimşek, Servet Altay, Kazım S Özcan, M Muzaffer Değertekin
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-046
  Online Publication Date: 04 October 2023
  Objective: The aim of this study was to determine adiponectin and copeptin levels that might be prognostic for cardiovascular mortality (CvsM) in ST-segment elevation myocardial infarction (STEMI) patients who had percutaneous coronary intervention (PCI).
  Methods: Patients who underwent PCI between November 2010 and April 2011 were enrolled and followed for more than eight years. The baseline, demographic and angiographic findings, in-hospital follow up, laboratory results including adiponectin and copeptin levels, and echocardiographic data of the patients were evaluated.
  Results: There were 78 males and 20 females. The CvsM rate was 26.66% at 112 months of follow up. Some factors were significantly related to CvsM and adiponectin level was an independent predictor of mortality. A cut-off value of ≥ 8 950 ng/ml for adiponectin and ≥ 7.41 ng/ml for copeptin was related to a 3.01- and 2.83-times higher CvsM risk, respectively.
  Conclusion: Adiponectin level was a predictor for CvsM. Higher levels of adiponectin and copeptin could predict a higher risk of CvsM in STEMI patients.
   
• Six months of resistance training improves heart rate variability in the elderly
  Matteus Dinis Oliveira, Perciliany Martins de Souza, Aparecida Patricia Guimarães, Lenice Kappes Becker, Daniel Barbosa Coelho, Emerson Cruz de Oliveira
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  DOI: 10.5830/CVJA-2023-050
  Online Publication Date: 27 September 2023
  Abstract: Heart rate variability is a non-invasive method of assessing global health through the analysis of the autonomous central nervous system, including both the sympathetic and parasympathetic systems. The aim of this study was to evaluate the effect of resistance training on heart rate variability at rest in elderly individuals undergoing six months of resistance training with progressive loads. Training reduced the body fat percentage of the volunteers (pre: 39.39 ± 7.21 vs post: 34.97 ± 6.40%; p = 0.0069). There was also a significant reduction in the low-frequency index (pre: 69621.50 ± 9817.28 vs post: 54210.50 ± 14903.94; p = 0.0322) and a significant increase in the high-frequency index (pre: 30308.00 ± 9857.86 vs post: 45627.10 ± 14838.80; p = 0.0326). We concluded that six months of resistance training with progressive loads were beneficial for heart rate variability and reduced the body fat percentage in the elderly.
   
• Association between serum α-klotho level and the prevalence of heart failure in the general population
  Weimin Luo, Na Wei, Zhaoling Sun, Yan Gong
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  DOI: 10.5830/CVJA-2023-042
  Online Publication Date: 27 September 2023
  Background: Heart failure is a major cause of global morbidity and mortality. Studies in laboratory animals have shown the direct protective effects of α-klotho on the cardiovascular system although it has limited expression in the heart. The association between α-klotho and cardiovascular disease is still controversial in different clinical studies. We designed a cross-sectional study in order to investigate the association between serum α-klotho level and the prevalence of heart failure in the American general population.
  Methods: The data were obtained from the National Health and Nutrition Examination Survey (NHANES), which included 11 271 participants aged 40–80 years. Serum α-klotho level was examined by enzyme-linked immunosorbent assay and divided into four quartiles for further analysis. Heart failure status was obtained from self-reported questionnaires. To estimate the association between α-klotho level and prevalence of heart failure, multivariate logistic regression analyses were conducted. Interaction and stratified analyses were performed to evaluate the potential modifiers.
  Results: After adjusting for multiple covariates, a per-standard deviation increase in serum α-klotho level was associated with a decrease in prevalence of heart failure [odds ratio (OR): 0.76, 95% confidence interval (CI): 0.68–0.85). The ORs for participants in quartiles 2 to 4 were 0.77 (95% CI: 0.58–1.01), 0.70 (95% CI: 0.52–0.93) and 0.71 (95% CI: 0.53–0.95), respectively, compared with those in quartile 1. Stratified analysis revealed significant gender and racial differences.
  Conclusion: We revealed an independent association between serum α-klotho level and the prevalence of heart failure in the American general population. The association was not always consistent and varied according to gender and race.
   
• The assessment of thoracal approaches in the treatment of aortic coarctation
  Onur Işık, Gökmen Akkaya, Fatih Durak, Defne Engür, Meltem Çakmak, Ali Rahmi Bakiler, Muhammet Akyüz
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  DOI: 10.5830/CVJA-2023-041
  Online Publication Date: 15 September 2023
  Objectives: The optimal choice of surgery in coarctation of the aorta (CoA) remains controversial but it needs to be individualised. However, in most conditions, a surgical approach through thoracotomy maintains adequate exposure to create aortic patency. This study aimed to assess the efficiency and reliability of thoracal approaches in the treatment of CoA by examining the mid- and late-term outcomes, and determining the predictive factors for re-intervention.
  Methods: Patients who underwent CoA repair through thoracotomy between September 2015 and February 2023 were included in the study, except for those with complex cardiac diseases. Medical records were retrospectively analysed and peri-operative course, follow-up findings on echocardiogram and physical examinations were obtained. The complication rate, postoperative arch gradient, need for antihypertensive medication use, and freedom from re-intervention were evaluated and then compared in terms of age at surgery.
  Results: Overall, 98 patients including 50 neonates were reviewed. The most common surgical method was extended end-to-end anastomosis, performed in 53 patients. The median follow-up time was 4.6 years. There was one death in hospital and one late mortality in the cohort. Eight complications were observed in the cohort but all recovered well. Overall, 13 re-interventions, six redo surgeries and seven balloon angioplasties were carried out in 12 patients. Ten of the re-interventions were carried out within the first year of the initial surgery. One- and three-year freedom from re-intervention rates were 89.5 and 86.4%, respectively. However, there was no significant predictive factor for re-intervention. Comparisons according to the age at surgery did not differ, except for intensive care unit stay. The need for hypertensive medication was initially in 14 (14.2%) patients and then reduced to eight (8%) patients. The mean peak residual gradient on postoperative examination was 9 mmHg.
  Conclusion: Thoracotomy provided feasible surgical access that led to satisfactory results with a low complication rate, negligible residual gradient, low incidence of hypertension and excellent rate for freedom from re-intervention in the treatment of CoA.
   
• Point-of-care testing compared to gold-standard laboratory methods in the measurement of serum lipids
  Brett S Mansfield, Belinda Stevens, Frederick J Raal, Farzahna Mohamed
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  DOI: 10.5830/CVJA-2023-039
  Online Publication Date: 31 August 2023
  Background: Cardiovascular disease is the leading cause of mortality worldwide, with dyslipidaemia being one of the major risk factors. Point-of-care testing (POCT) allows for the rapid measurement of serum lipids. The aim of this study was to assess the accuracy of serum lipid measurement by the Fujifilm™ NX700 POCT compared to a gold-standard clinical laboratory method (Medpace, Leuven, Belgium).
  Methods: This was a prospective, observational study conducted at the Lipid Clinic at Charlotte Maxeke Johannesburg Academic Hospital from July to September 2022. Participants were known to have a lipid disorder, most commonly, familial hypercholesterolaemia. Samples sent for lipid measurement by standard laboratory methods were simultaneously measured by the Fujifilm™ NX700 POCT.
  Results: Lipograms evaluating total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and calculated low-density lipoprotein cholesterol (LDL-C) were obtained from 115 participants. No statistically significant difference was noted between the parameters tested on the different platforms. The Fujifilm™ NX700 POCT correctly identified > 91% of serum lipid results as normal or abnormal, as defined by NCEP-ATP III criteria, and exhibited good sensitivity and specificity for each parameter. Lin’s concordance correlation coefficient demonstrated a strong correlation for all parameters; TC (ρc = 0.9861), HDL-C (ρc = 0.95919), LDL-C (ρc = 0.98134) and TG (ρc = 0.92775). Bland–Altman plots identified low bias and a good level of agreement between the two test methods.
  Conclusion: The Fujifilm™ NX700 POCT compared favourably with gold-standard laboratory methods in the determination of serum lipid measurements, allowing for rapid screening at the primary healthcare level.
   
• Outcomes of single-ventricle physiology in central South Africa
  MJ van Jaarsveld, L Botes, FE Smit, SC Brown
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  DOI: 10.5830/CVJA-2023-043
  Online Publication Date: 25 August 2023
  Introduction: Single-ventricle physiology is a critical cardiac condition requiring early diagnosis and intervention. The objectives of this study were to report on the management and outcomes of patients diagnosed with single-ventricle physiology in central South Africa.
  Methods: This study was a retrospective, observational analysis of patients presenting with single-ventricle physiology at the Universitas Academic Hospital in central South Africa between November 1997 and June 2021.
  Results: Patients were referred from the Free State (54%) and Northern Cape (29%) provinces and Lesotho. One hundred and fifty-four patients presented with single-ventricle physiology: 114 received interventions and 40 were not eligible for intervention. Patients presented for the first time at a median age of 34.5 days, with patients from nearby districts presenting within a few days of birth. However, patients from outlying areas presented much later. Eighty-seven patients received systemic-to-pulmonary artery shunting or pulmonary artery banding. Sixty-three patients proceeded to bidirectional Glenn procedures, and 30 patients (26%) had full palliation to Fontan. Twenty-one patients died after stage 1, six after the Glenn procedure and two after the Fontan procedure. Overall, 34 (29.8%) patients were lost to follow up.
  Conclusion: Patients in our study presented late and follow up of these patients was a challenge. The highest mortality rate occurs during the first stage of palliation. Outcomes from this study are comparable to other sub-Saharan studies.
   
• Comparison of serum lipoprotein(a) levels in young and middle-aged patients presenting for the first time with ST-elevation myocardial infarction: a single-centre stud
  Songül Usalp, Emine Altuntaş, Bayram Bağırtan, Kanber Ö Karabay
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  DOI: 10.5830/CVJA-2023-038
  Online Publication Date: 25 August 2023
  Background: Lipoprotein(a) [Lp(a)] is associated with coronary artery disease due to its atherogenic and thrombogenic nature. In this study, we aimed to compare the level of Lp(a) in young and middle-aged patients with ST-elevation myocardial infarction (STEMI).
  Methods: This retrospective study included 287 patients aged 20–65 years who presented to the emergency department for the first time due to STEMI. The patients were divided into two groups: 20–45 years (young group, n = 111) and 46–65 years (middle-aged group, n = 176). The groups were compared in terms of demographic characteristics, co-morbidities and laboratory findings.
  Results: In the young group, smoking (99, 89.2% vs 130, 73.9%; p = 0.001), family history of coronary artery disease (75, 67.6% vs 80, 45.5; p < 0.001), serum Lp(a) level [38.1 ± 27.9 (93 ± 68) vs 23.5 ± 23.2 mg/dl (57 ± 56 nmol/l); p < 0.001], triglyceride level [219.1 ± 231.9 (2.48 ± 2.62) vs 170.2 ± 105.6 mg/dl (1.92 ± 1.19 mmol/l); p = 0.018), ejection fraction (52.4 ± 6.1 vs 47.2 ± 7.7%; p = 0.004) and single-vessel disease (83, 74.8% vs 110, 62.5%; p = 0.031) were higher than in the middle-aged group. In multivariable logistic regression analyses, family history (OR: 2.073, 95% CI: 1.210–3.549; p = 0.008), low high-density lipoprotin cholesterol level (OR: 1.032, 95% CI: 1.003–1.062; p = 0.029) and Lp(a) elevation (OR: 1.981, 95% CI: 1.871–3.991; p < 0.001) were possible independent risk factors for STEMI in young patients.
  Conclusion: Lp(a) level was found to be a higher and a possible independent risk factor in young patients who presented with STEMI for the first time, compared to the middle-aged patient group. Lp(a) is a highly atherogenic molecule and it has been associated with stroke, heart failure, aortic stenosis, as well as coronary artery disease. Measurement of Lp(a) levels may be recommended in young patients with high cardiovascular risk.
   
• The value of measured partial oxygen pressure during pulmonary vein closure and the relationship with the diameter of the closed vein in patients with cryoablation
  Enes Çon, Namık Kemal Eryol, Mehmet Tuğrul İnanç, Deniz Elçik
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-040
  Online Publication Date: 17 August 2023
  Aim: The aim of this study was to investigate the value of partial oxygen pressure (PO2) changes measured in the left atrium (LA) during transient pulmonary vein (PV) closure in patients undergoing cryoablation and its relationship with the diameter of the closed PV.
  Methods: The study was carried out on a total of 25 cases. The grouping of PVs was made separately as the left superior, left inferior, left common, right superior, right inferior, right common and total PVs. PV measurement was made from angiographic images obtained after the cryoablation balloon was inflated and opaque. From the LA, the difference between the PO2 values in the blood gases obtained before and during the temporary closure of each PV was evaluated as the PO2 change. The difference of the lowest temperature reached during the closing of each PV from –36°C was termed the heat difference. The relationship of PO2 change with PV diameter and the heat difference were investigated.
  Results: There was no significant relationship between any of the PV diameters and PO2 changes (p > 0.05). There was a significant relationship between heat differences and PO2 changes in the left superior (p = 0.011), right superior (p = 0.049), right ‘common’ (p = 0.037) and total PVs (p = 0.001), but there was no significant relationship between heat differences and PO2 changes in the left inferior, left ‘common’ and right inferior PVs (p > 0.05).
  Conclusion: In the light of these data, PO2 change could demonstrate the success of cryoablation, and was related with the cooling degree, but not with the PV diameter.
   
• Paying more attention to arterial hypertension, dyslipidaemia, women and the rural environment in our ongoing fight against cardiovascular diseases and their risk factors
  Pêngd-Wendé Habib Boussé Traore, Jean Augustin Diégane Tine, Oumar Bassoum, Abdoul Kane, Adama Faye
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-033
  Online Publication Date: 17 August 2023
  Background: The diagnostic and therapeutic efforts instituted by the state of Senegal since the results of the STEPwise survey in 2015 could and should be reinforced with an effective and targeted preventative approach against cardiovascular accidents. This study aimed to (1) identify the pathological population that contains the most incidents of stroke in Senegal, (2) identify the prevalence, and geographical and gender distribution of biological co-morbidities with hypertension, stroke and advice for a change in behaviour, and (3) research the factors associated with the occurrence of cardiovascular accidents specific to the Senegalese context.
  Methods: This was a secondary analysis of the STEPwise WHO Senegal 2015 survey: a descriptive quantitative epidemiological study with an analytical aim.
  Results: Biological co-morbidities with arterial hypertension as well as cardiovascular accidents affected more women than men. Biological co-morbidities with arterial hypertension predominated in urban areas, while cardiovascular accidents were more common in rural areas. The population with arterial hypertension and total hypercholesterolaemia simultaneously was at the top of a list of 25 pathological populations in terms of the proportion of cardiovascular accidents within them. In addition, total hypercholesterolaemia was found in the first three populations with the most cardiovascular accidents. Regarding advice for behavioural change, advice for smoking cessation was the most widespread. All advice was given mostly to the gender most affected by the health problem, but some advice was mostly addressed to the environment least affected by the problem. Therefore, despite being the most affected, the rural environment received the least advice for a change in behaviour with regard to the practice of any of the forms of the physical activities described, the consumption of oil of palm, the consumption of cubed sugar or sugary drinks, smoked and non-smoked tobacco and attempted smoking cessation. In multivariate analysis, it was found that arterial hypertension produced a 2.74 times greater risk of having a cardiovascular accident (adjusted odds ratio = 2.74; 95% confidence interval = 1.88–3.99; p < 0.001).
  Conclusion: In Senegal, we need to pay more attention to arterial hypertension, dyslipidaemia, women and the rural environment in our ongoing fight against cardiovascular diseases and their risk factors.
   
• The relationship between serum osteoprotegerin levels and right atrial and ventricular speckle-tracking measurements in essential hypertension patients with normal left ventricular systolic function
  Ender Emre, Ezgi Kalaycıoğlu, Ahmet Özderya, Murat Gökhan Yerlikaya, Turhan Turan, Kaan Hancı, Tayyar Gökdeniz, Mustafa Çetin
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-036
  Online Publication Date: 27 July 2023
  Objective: We planned to reveal the relationship between OPG (osteoprotegerin) level and right heart function in hypertensive patients with normal ejection fraction, using strain analysis, which is a sensitive method in demonstrating subclinical dysfunction.
  Methods: Between February and June 2018, 625 consecutive patients with a diagnosis of hypertension who applied to the cardiology out-patient clinic of our hospital were evaluated for our study and 175 eligible patients were included. The patients were divided into two groups according to their OPG level. Strain analysis was performed in the echocardiographic evaluation.
  Results: The mean OPG value was 6.33 ± 1.87 pg/l. There were 93 patients (age 51.1 ± 8.5 years) in the low OPG group and 82 patients (age 54.6 ± 10.4 years) in the high OPG group. A significant difference was found between the two groups with regard to age (p = 0.016), statin use (p = 0.026), C-reactive protein level (p = 0.048), office systolic blood pressure (SBP) (p = 0.001) and office diastolic blood pressure (DBP) (p = 0.001). A significant difference was found between values of strain during reservoir phase (RASr) (p = 0.01), strain during conduit phase (RAScd) (p < 0.001) and peak strain rate during reservoir phase (pRASRcd) (p = 0.044). In multivariate regression analysis, age (OR: 1.162, 95% CI: 1.064–1.269, p = 0.001), office DBP (OR: 1.089, 95% CI: 1.020–1.161, p = 0.011) and RAScd (OR: 0.890, 95% CI: 0.815–0.972, p < 0.010) were found to be independent predictors of high OPG.
  Conclusion: In our study, we found high OPG level was inversely correlated with right atrial strain values and linearly associated with high blood pressure. In order to take advantage of the negative indicators of high OPG, positive results can be obtained in strain values of the right heart by indirectly reducing the afterload of the right heart. This can be done by reducing high systemic blood pressure and providing tight blood pressure control.
   
• The association between CHA2DS2-VASc score and aortic valve sclerosis
  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
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-022
  Online Publication Date: 26 July 2023
  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.
   
• Oxidative metabolism of neutrophils in acute coronary syndrome
  Elena Proskurnina, Tatiana Danilova, Madina Sozarukova, Artem Snitsar, Anatoly Baranov
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  DOI: 10.5830/CVJA-2023-032
  Online Publication Date: 25 July 2023
  Background: Inflammation in acute coronary syndrome (ACS) involves neutrophil activation and oxidative stress. Here, we studied the production of reactive oxygen species (ROS) by neutrophils in ACS.
  Methods: The study included 42 patients, men and women aged 46–91 years with ischaemic heart disease (IHD), non-ST-segment elevation ACS and ST-segment elevation ACS. Neutrophil-derived ROS were quantified with double-step stimulated luminol-enhanced chemiluminometry.
  Results: The specific indices of spontaneous and double-step stimulated chemiluminescence did not differ in the subgroups of IHD, non-ST-segment elevation ACS and ST-segment elevation ACS. The total double-step stimulated ROS production by neutrophils was significantly higher in ST-segment elevation ACS than in non-ST-segment elevation ACS and IHD.
  Conclusions: In ACS, special activation mechanisms of peripherical neutrophils were not triggered in our study. The significant increase in free radical production by neutrophils in acute myocardial infarction was presumably a consequence of an increase in their number.
   
• Yield of family screening in dilated cardiomyopathy within low-income setting: Tanzanian experience
  LS Fundikira, J Julius, P Chillo, H Mayala, E Kifai, LW van Laake, A Kamuhabwa, G Kwesigabo, FW Asselbergs
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-037
  Online Publication Date: 25 July 2023
  Background: Dilated cardiomyopathy (DCM) is often familial and screening of relatives is recommended. However, studies on the yield of screening are scarce in developing countries.
  Aim: The aim of the study was to identify and characterise first-degree relatives of patients with DCM in Tanzania. Methods: We recruited first-degree relatives of 57 DCM patients. DCM in the relatives was diagnosed using the 2016 revised definition by the European Society of Cardiology working group on myocardial and pericardial diseases.
  Results: We screened 120 first-degree relatives. All were asymptomatic (100%) with a median age of 39.0 years (29.5– 49.0), slightly over a half (53.3%) were females and 17 (14.1%) were found to have previously unknown DCM. The mean (± SD) indexed left ventricular end-diastolic volume was significantly higher in relatives with DCM (71 ± 11.5 ml) compared to relatives without DCM (50 ± 11.5) (p = 0.001).
  Conclusion: First-degree relatives of patients with DCM are at risk of developing asymptomatic DCM at a young age.
   
• Study of the mechanism of Shexiang Baoxin pill-mediated angiogenesis in acute myocardial infarction
  Jingxun Wei, Binchang Dong, Xin Du, Huipu Xu
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  DOI: 10.5830/CVJA-2023-030
  Online Publication Date: 04 July 2023
  Aim: The Shexiang Baoxin pill (SBP) is a commonly used drug for the treatment of coronary artery disease in China. More recently, some studies have found that it improved coronary microvascular function. This study aimed to explore the possible mechanism by which the SBP promotes angiogenesis after acute myocardial infarction (AMI).
  Methods: A rabbit model of acute myocardial infarction was established by ligating the left anterior descending coronary artery with silk thread, and the limb lead electrocardiogram was recorded to determine the success of the model. The rabbits were divided into a control group (SBP + normal rabbit group), a sham operation group, a saline + AMI group and an SBP + AMI group. There were 10 rabbits in each group. The animals were sacrificed and myocardial tissue was collected seven days after the operation. Haematoxylin–eosin staining was used to observe the histological changes in the rabbit myocardium in each group. The degree of acute myocardial infarction was observed with picric acid staining, which was used to detect the expression of vascular endothelial growth factor (VEGF), silent information regulator 1 (SIRT1), Beclin1 and mTOR protein in the myocardial tissue of each group. Immunofluorescence CD31-labelled microvascular density (MVD) was used to observe the vascular regeneration of the rabbits in each group.
  Results: Compared with the normal saline + AMI group, the myocardial infarction area of the SBP + AMI group decreased and CD31 immunofluorescence-labelled MVD increased. Compared with the control and sham operation groups, the expression of VEGF, Beclin1 and mTOR in the normal saline + AMI group and the SBP + AMI group increased, while the expression of SIRT1 decreased. Compared with the normal saline + AMI group and the SBP + AMI group, the positive expression of VEGF, Beclin1, mTOR and SIRT1 in the SBP + AMI group was significantly increased.
  Conclusion: Autophagy was enhanced after acute myocardial infarction. SBP may affect angiogenesis through the SIRT1/mTOR signalling pathway after acute myocardial infarction to inhibit ventricular remodelling and a decline in cardiac function.
   
• Right ventricular function in treatment-naïve human immunodeficiency virus-infected patients
  Bassey Effiong, Victor Ansa, Joseph Andy, Idongesit Odudu-Umoh, Taiwo Shogade, Aquaowo Udosen, Udeme Ekripko
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-031
  Online Publication Date: 03 July 2023
  Background: Right ventricular dysfunction carries a poorer prognosis in human immunodeficiency virus (HIV)-positive patients. The objectives of this study were to ascertain the prevalence of right ventricular systolic and diastolic dysfunction, as well as its predictors, in antiretroviral therapy-naïve HIV-positive patients.
  Methods: Participants in this cross-sectional, descriptive study comprised 60 HIV-positive patients and 60 HIV-negative controls. All participants had transthoracic echocardiography done to assess right ventricular systolic and diastolic function. The HIV-positive patients had their CD4 counts measured.
  Results: The mean age of the study population was 34.63 ± 8.7 years versus that of the controls (34.45 ± 9.40 years) (p = 1.000). Right ventricular systolic dysfunction was found in 11.6% of the HIV-positive patients versus the controls (3.33%, p = 0.166) while right ventricular diastolic dysfunction was found in 15.0% of HIV-positive patients versus the controls (1.7%, p = 0.021). The CD4 count did not contribute to the frequency and degree of right ventricular systolic or diastolic dysfunction.
  Conclusion: Right ventricular systolic and diastolic dysfunction was common in treatment-naïve HIV-infected individuals but the frequency and degree were not associated with the CD4 count or other measured parameters.
   
• Effect of insulin resistance on left ventricular remodelling in essential hypertensives: a cross-sectional study
  Bernard Kianu Phanzu, Aliocha Nkodila Natuhoyila, Eleuthère Kintoki Vita, Benjamin Longo-Mbenza, Jean-René M’Buyamba Kabangu
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-024
  Online Publication Date: 21 June 2023
  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 deceleration 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 HOMAIR alone, 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.
   
• Impact of the COVID-19 pandemic on cardiology fellowship training in a sub-Saharan African training centre: an African perspective
  E Amendezo, M Ngunga, AH Ahmed, MH Varwani, B Karau, R Kimeu, M Jeilan
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-023
  Online Publication Date: 19 June 2023
  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 recorded 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 postfellowship 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.
   
• The effects on clinical outcomes of administering medications together or separately in prolonged dual antiplatelet therapy after peripheral revascularisation
  Ozgur Akkaya, Oguz Karahan
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-013
  Online Publication Date: 19 June 2023
  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.
   
• Is the transradial approach associated with decreased acute kidney injury following percutaneous coronary intervention in patients not complicated by major bleeding and haemodynamic disturbance?
  Tolga Dasli, Burak Turan
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-025
  Online Publication Date: 05 June 2023
  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.
   
• Effect of lactate levels on extubation time in coronary artery bypass grafting surgery
  Selen Öztürk
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-027
  Online Publication Date: 05 June 2023
  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 arterybypass graft surgery.
   
• Surgical experience in adults with Ebstein’s anomaly: long-term results
  Ozge Altas, Sabit Sarikaya
  Full text: Click here to download PDF »
  DOI: 10.5830/CVJA-2023-008
  Online Publication Date: 24 March 2023
  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.