CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 224 AFRICA Pedersen C, et al. Predictors of right ventricular function as measured by tricuspid annular plane systolic excursion in heart failure. Cardiovasc Ultrasound 2009 Nov 4; 7(1): 51. 20. Alam M, Wardell J, Andersson E, Samad BA, Nordlander R. Right ventricular function in patients with first inferior myocardial infarction: Assessment by tricuspid annular motion and tricuspid annular. Am Heart J 2000; 139(4): 710–715. 21. Vachiéry J-LL, Tedford RJ, Rosenkranz S, Palazzini M, Lang I, Guazzi M, et al. Pulmonary hypertension due to left heart diseases. Eur Respir J 2019; 53(25): D100–108. 22. Guazzi M, Dixon D, Labate V, Beussink-Nelson L, Bandera F, Cuttica MJ, et al. RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: stratification of clinical phenotypes and outcomes. J Am Coll Cardiol Cardiovasc Imaging 2017; 10(10): 1211–1221. 23. Guazzi M. Pulmonary hypertension in heart failure preserved ejection fraction prevalence, pathophysiology, and clinical perspectives. Circ Hear Fail 2014; 7(2): 367–377. 24. Messerli FH, Rimoldi SF, Bangalore S. The transition from hypertension to heart failure: contemporary update. J Am Coll Cardiol Heart Fail 2017; 5(8): 543–551. 25. Oakley C. Diagnosis and natural history of congested (dilated) cardiomyopathies. Postgrad Med J 1978; 54(633): 440–447. 26. Adamopoulos C, Zannad F, Fay R, Mebazaa A, Cohen-Solal A, Guize L, et al. Ejection fraction and blood pressure are important and interactive predictors of 4-week mortality in severe acute heart failure. Eur J Heart Fail 2007; 9(9): 935–941. 27. Navaratnam M, Punn R, Ramamoorthy C, Tacy TA. LVOT-VTI is a useful indicator of low ventricular function in young patients. Pediatr Cardiol 2017; 38(6): 1148–1154. 28. Blanco P. Rationale for using the velocity–time integral and the minute distance for assessing the stroke volume and cardiac output in point-ofcare settings. Ultrasound J 2020; 12(1): 1–9. 29. Oketona OA, Balogun MO, Akintomide AO, Ajayi OE, Adebayo RA, Mene-Afejuku TO, et al. Right ventricular systolic function in hypertensive heart failure. Vasc Health Risk Manag 2017; 13: 353–360. 30. Bleeker GB, Steendijk P, Holman ER, Yu C-M, Breithardt OA, Kaandorp TAM, et al. Assessing right ventricular function: the role of echocardiography and complementary technologies. Heart 2006; 92(Suppl 1): i19–26. 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 exceptions. Wright said that for example, weightlifters consume unusually high amounts of protein, so high levels of serum creatinine in their urine do not necessarily signify kidney dysfunction. continued on page 229…
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