Cardiovascular Journal of Africa: Vol 34 No 3 (JULY/AUGUST 2023)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 3, July/August 2023 188 AFRICA 64. Ito T, Suwa M, Otake Y, et al. Assessment of left atrial appendage function after cardioversion of atrial fibrillation: relation to left atrial mechanical function. Am Heart J 1998; 135: 1020–1026. 65. Fatkin D, Kuchar DL, Thorburn CW, et al. Transesophageal echocardiography before and during direct current cardioversion of atrial fibrillation: evidence for ‘atrial stunning’ as a mechanism of thromboembolic complications. J Am Coll Cardiol 1994; 23: 307–316. 66. Berger M, Schweitzer P. Timing of thromboembolic events after electrical cardioversion of atrial fibrillation or flutter: a retrospective analysis. Am J Cardiol 1998; 82(12): 1545–1547. 67. Dentali F, Botto GL, Gianni M, et al. Efficacy and safety of direct oral anticoagulants in patients undergoing cardioversion for atrial fibrillation: a systematic review and meta-analysis of the literature. Int J Cardiol 2015; 185: 72–77. 68. Gorczyca I, Uziębło-Życzkowska B, Krzesiński P, et al. Is transesophageal echocardiography necessary before electrical cardioversion in patients treated with non-vitamin K antagonist oral anticoagulants? Current evidence and practical approach. Cardiol J 2021, Oct 21. Online ahead of print. 69. Leung DY, Davidson PM, Cranney GB, Walsh WF. Thromboembolic risks of left atrial thrombus detected by transesophageal echocardiogram. Am J Cardiol 1997; 79: 626–629. 70. Stoddard MF, Dawkins PR, Prince CR, Ammash NM. Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study. J Am Coll Cardiol 1995; 25: 452–459. 71. Scherr D, Dalal D, Chilukuri K, et al. Incidence and predictors of left atrial thrombus prior to catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2009; 20: 379–384. 72. McCready JW, Nunn L, Lambiase PD, et al. Incidence of left atrial thrombus prior to atrial fibrillation ablation: is pre-procedural transoesophageal echocardiography mandatory? Europace 2010; 12: 927–932. 73. Calvo N, Mont L, Vidal B, et al. Usefulness of transoesophageal echocardiography before circumferential pulmonary vein ablation in patients with atrial fibrillation: is it really mandatory? Europace 2011; 13: 486–491. 74. Lip GY, Hammerstingl C, Marin F, et al. Left atrial thrombus resolution in atrial fibrillation or flutter: results of a prospective study with rivaroxaban (X-TRA) and a retrospective observational registry providing baseline data (CLOT-AF). Am Heart J 2016; 178: 126–134. 75. Ferner M, Wachtlin D, Konrad T, et al. Rationale and design of the RE-LATED AF—AFNET 7 trial: resolution of left atrial-appendage thrombus-effects of dabigatran in patients with atrial fibrillation. Clin Res Cardiol 2016; 105: 29–36. 76. Marsico F, Cecere M, Parente A, et al. Effects of novel oral anticoagulants on left atrial and left atrial appendage thrombi: an appraisal. J Thromb Thrombolysis 2017; 43: 139–148. 77. Mitamura H, Nagai T, Watanabe A, et al. Left atrial thrombus formation and resolution during dabigatran therapy: a Japanese Heart Rhythm Society report. J Arrhythm 2015; 31: 226–231. 78. Piotrowski R, Zaborska B, Pilichowska-Paszkiet E, et al. RIVAroxaban TWICE daily for lysis of thrombus in the left atrial appendage in patients with non-valvular atrial fibrillation: the RIVA-TWICE study. Arch Med Sci 2019; 16: 289–296. 79. Kołakowski K, Farkowski MM, Pytkowski M, et al. The comparative effectiveness and safety of different anticoagulation strategies for treatment of left atrial appendage thrombus in the setting of chronic anticoagulation for atrial fibrillation or flutter. Cardiovasc Drugs Ther 2021 Oct 20. Online ahead of print. Simple urine test might predict heart failure risk: Dutch study People with consistently high levels of urinary albumin excretion (UAE) and serum creatinine in their urine are at higher risk of developing heart failure, according to recent research, with the study team saying this supports the known connection between renal failure and heart failure. The scientists, from the University of Groningen in The Netherlands, had analysed urine-sample data from nearly 7 000 Dutch participants who were 28 to 75 years old at the start of the study, which followed them for 11 years. Medical News Today reports that the results found people with stable and high levels of both UAE and serum creatinine in their samples had a higher risk of experiencing heart failure for the first time, while those with elevated levels of UAE had an increased risk of dying from all causes. Similarly, high levels of serum creatinine were not found to be linked to all-cause mortality. The study, published in the European Journal of Heart Failure, was an attempt to explore the potential health risks for people whose UAE and serum creatinine levels remain high over the long term instead of fluctuating, as they do in most people. The findings may provide physicians with a new biomarker of susceptibility for heart failure, said the authors. ‘Circulating in the bloodstream are lots of substances, some very tiny, for example, sodium or glucose molecules, and some large, such as proteins and antibodies,’ said Dr Richard Wright, a cardiologist specialising in heart failure and transplantation cardiology at Providence Saint John’s Health Centre, who was not involved in the study. An important function of the kidneys is to filter extra fluid and waste, including acids produced by cells. When they are functioning properly, the kidneys help maintain a healthy balance of chemicals in the blood. Wright said albumin is the most common protein circulating in the bloodstream. ‘As a large molecule, the filter of the kidney normally does not allow albumin to appear in the urine because it’s too large to make it through the filter. Smaller molecules, such as sugar, pass through to the urine easily.’ As the health of kidneys and their filtration degrade, albumin passes into the urine. This makes its presence there a valuable marker of kidney dysfunction. ‘Serum creatinine is a waste product of muscle use, and found in the blood. It is filtered out of the blood by the kidneys,’ said Dr Jayne Morgan, cardiologist and clinical director of the Covid Task Force at Piedmont Healthcare Corporation, who was also not involved in the study. Higher levels of serum creatinine in the urine are often a sign of declining kidney function, though there are some continued on page 193…

RkJQdWJsaXNoZXIy NDIzNzc=