Cardiovascular Journal of Africa - Volume 27, Issue 1, 2016
Volumes & issues
Volume 27, Issue 1, 2016
Localised pericardial effusion mimicking anterior myocardial infarction following coronary angiography : case reportSource: Cardiovascular Journal of Africa 27, pp 1 –3 (2016) http://dx.doi.org/10.5830/CVJA-2015-086More Less
The diagnosis of pericarditis is important, especially in patients assumed to have acute coronary syndrome. Distinguishing these two conditions is vital but not always easy. Accurate diagnosis is essential to provide appropriate treatment as soon as possible and to avoid inappropriate invasive procedures. By highlighting this distinction, we report a case of pericarditis that occurred after percutaneous coronary intervention and mimicked acute coronary syndrome.
Author Patrick CommerfordSource: Cardiovascular Journal of Africa 27 (2016)More Less
It is interesting to one trained in the era that preceded the availability of new and sophisticated imaging modalities to see just how well the 'old' and often currently poorly regarded imaging techniques still serve. Ganie and colleagues (page 31) record how in seven of eight patients with vascular rings, the chest radiograph was abnormal, and they propose a diagnostic imaging algorithm for such patients, which includes chest radiographs.
Source: Cardiovascular Journal of Africa 27, pp 4 –11 (2016) http://dx.doi.org/10.5830/CVJA-2015-049More Less
Aim:KCNE2 encodes for the potassium voltage-gated channel, KCNE2. Mutations in KCNE2 have been associated with long-QT syndrome (LQTS). While KCNE2 has been extensively studied, the functions of its C-terminal domain remain inadequately described. Here, we aimed to elucidate the functions of this domain by identifying its protein interactors using yeast two-hybrid analysis.
Methods: The C-terminal domain of KCNE2 was used as bait to screen a human cardiac cDNA library for putative interacting proteins. Co-localisation and co-immunoprecipitation analyses were used for verification.
Results: Filamin C (FLNC) was identified as a putative interactor with KCNE2. FLNC and KCNE2 co-localised within the cell, however, a physical interaction was only observed under hypoxic conditions.
Conclusion: The identification of FLNC as a novel KCNE2 ligand not only enhances current understanding of ion channel function and regulation, but also provides valuable information about possible pathways likely to be involved inLQTS pathogenesis.
The effect of anatomical factors on mortality rates after endovascular aneurysm repair : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 12 –15 (2016) http://dx.doi.org/10.5830/CVJA-2015-057More Less
Objective: The objective of this study was to investigate the effect of anatomical characteristics on mortality rates after endovascular aneurysm repair (EVAR).
Methods: We investigated 56 EVAR procedures for infrarenal aortic aneurysms performed between January 2010 and December 2013, and the data were supplemented with a prospective review. The patients were divided into two groups according to the diameter of the aneurysm. Group I (n = 30): patients with aneurysm diameters less than 6 cm, group II (n = 26): patients with aneurysm diameters larger than 6 cm. The pre-operative anatomical data of the aneurysms were noted and the groups were compared with regard to postoperative results.
Results: There were no correlations between diameter of aneurysm (p > 0.05), aneurysm neck angle (p > 0.05) and mortality rate. The long-term mortality rate was found to be high in patients in whom an endoleak occurred.
Conclusion: We found that aneurysm diameter did not have an effect on postoperative mortality rates. An increased EuroSCORE value and the development of endoleaks had an effect on long-term mortality rates.
Electrocardiographic abnormalities and dyslipidaemic syndrome in children with sickle cell anaemia : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 16 –20 (2016) http://dx.doi.org/10.5830/CVJA-2015-059More Less
Background: Lipid and electrocardiographic (ECG) abnormalities have been reported in adults with sickle cell anaemia (SCA) and may reflect underlying structural and/ or functional damage. However, the relationship between ECG and lipid abnormalities among children with sickle cell disease is not fully understood.
Objectives: To compare the steady-state lipid and ECG abnormalities in children with SCA to the controls and examine the hypothesis that lipid abnormalities are closely related to electrocardiographic abnormalities, and therefore are a reflection of cardiac damage among these children.
Methods: Clinical, laboratory and ECG profiles of 62 children with SCA and 40 age- and gender-matched haemoglobin AA controls were compared. The influence of clinical characteristics, lipids profiles, markers of haemolysis, and renal and hepatic dysfunction on ECG pattern in children with SCA was then determined.
Results: The patients had lower average diastolic and mean arterial blood pressure, total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels than the controls, (p = 0.001, 0.002, 0.000 and 0.000, respectively). The mean triglyceride level was significantly higher (p < 0.001), while high-density lipoprotein cholesterol (HDL-C) levels were comparable (p = 0.858). The cases were about six times more likely to have left ventricular hypertrophy than the controls (OR = 6.4, 95% CI = 2.7-15.6, p = 0.000). Haematocrit level had a negative correlation with QTC (r = -0.3, p = 0.016) and QT intervals (r = - 0.3, p = 0.044). Triglyceride levels had a positive correlation with the PR interval (r = 0.3, p = 0.012), while serum alanine transferase (ALT) concentrations had an inverse correlation with PR interval (r = -0.3, p = 0.015). There was no statistical difference in the sociodemographic and clinical characteristics of the SCA children with or without ECG abnormalities. However, the mean triglyceride and serum ALT levels in those with ECG abnormalities were significantly higher than those without (p = 0.007 and 0.045, respectively).
Conclusion: Lipid and ECG abnormalities are common in children with SCA. Elevated triglyceride and serum ALT levels are possible biochemical markers of ECG abnormalities in these patients.
Combined effects of FTO rs9939609 and MC4R rs17782313 on elevated nocturnal blood pressure in the Chinese Han population : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 21 –24 (2016) http://dx.doi.org/10.5830/CVJA-2015-064More Less
Aim: In this study we investigated the association of FTO rs9939609 and MC4R rs17782313 with elevated blood pressure in the Chinese Han population, and analysed the relationship between the rs9939609 and rs17782313 variants.
Methods: We tested the rs9939609 and rs17782313 variants with the sequence-retrieval method.
Results: The increase in odds ratios of the A allele of rs9939609 and the C allele of rs17782313 for nocturnal blood pressure were 1.37 and 1.69. The nocturnal blood pressure of participants simultaneously carrying the A and C alleles was significantly higher than the blood pressure of those carrying neither FTO nor MC4R risk alleles (p < 0.05), and that of the controls carrying only the A or C alleles (p < 0.05). No association between the FTO or MC4R genes with daytime hypertension was found in this Chinese population (p > 0.05).
Conclusion: Our data suggest that the rs9939609 and rs17782313 variants may be significantly associated with nocturnal but not daytime blood pressure levels and their combined effects were significant in this Chinese Han population.
Left ventricular systolic function in Nigerian children infected with HIV/AIDS : a cross-sectional study : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 25 –29 (2016) http://dx.doi.org/10.5830/CVJA-2015-066More Less
Background: Cardiac complications contribute significantly to morbidity and mortality in children with HIV/AIDS. These rates have been under-reported in sub-Saharan African children.
Methods: This was an observational, cross-sectional Doppler echocardiographic study of ventricular systolic function, performed at a tertiary clinic on children with HIV/AIDS.
Results: Left ventricular systolic dysfunction was present in 27.0% of the children with HIV infection and 81.2% of those with AIDS. The mean fractional shortening in the AIDS group (31.6 ± 9.5%) was significantly lower than in the HIV-infected group (35.3 ± 10.5%, p = 0.001). A significant correlation was found with CD4+ cell count and age, and these were the best predictors of left ventricular systolic dysfunction in the stepwise multiple regression analysis (r = 0.396, p = 0.038; r = -0.212, p = 0.025, respectively).
Conclusion: Left ventricular systolic dysfunction is common in Nigerian children with HIV/AIDS.
Source: Cardiovascular Journal of Africa 27, pp 30 –36 (2016) http://dx.doi.org/10.5830/CVJA-2015-076More Less
Background: The imaging modalities used to diagnose vascular rings have evolved over time, from basic radiographic studies to advanced cross-sectional imaging. The goal of preoperative imaging is to provide the surgeon with an accurate representation of the ring configuration so that the surgical approach may be planned.
Methods: We conducted a review of all patients with vascular rings who underwent surgery at Inkosi Albert Luthuli Central Hospital, Durban, South Africa from 1 July 2008 to 1 July 2013.
Results: Eight patients were diagnosed with vascular rings. Seven patients had an abnormal plain chest radiograph (right aortic arch, tracheal narrowing, or abnormal mediastinal silhouette), while in six patients the contrast oesophagogram demonstrated a fixed extrinsic oesophageal indentation. Computed tomography angiography confirmed the pathology in all cases, with six double aortic arches and two right aortic arches with aberrant left subclavian artery and left ligamentum arteriosum.
Conclusions: We advocate a diagnostic imaging algorithm consisting of plain chest radiography, contrast esophagogram and computed tomography angiography prior to surgery. Magnetic resonance imaging may provide an alternative axial imaging modality depending on institutional preference.
The change in right ventricular systolic function according to the revascularisation method used, following acute ST-segment elevation myocardial infarction : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 37 –44 (2016) http://dx.doi.org/10.5830/CVJA-2015-077More Less
Objective: The level of right ventricular (RV) systolic function has prognostic importance in right ventricular ST-segment elevation myocardial infarction (RV-STEMI). This study aimed to evaluate the changes in RV systolic function in patients with RV-STEMI according to the revascularisation method used for their management.
Methods: The first group consisted of 132 patients who received primary percutaneous coronary intervention (PPCI). The 78 patients who had received thrombolytic therapy (TT) in external centres before referral to our centre for PCI within three to 12 hours of RV-STEMI were included in the second group. All patients were evaluated by conventional and two-dimensional speckle-tracking echocardiography.
Results: There were 172 male patients and their mean age was 63.7 ± 11.8 years. There were no significant differences between the two groups with regard to right ventricular systolic parameters at admission and at the one-month follow-up visit. The echocardiographic changes between admission and the one-month follow up were investigated for the patients included in the study groups. Mean values of each parameter observed at the one-month follow up were significantly increased compared to those at admission within each group.
Conclusion: Our study demonstrated that PCI within three to 12 hours following TT provided similar benefits on right ventricular systolic function compared to PPCI in patients with RV-STEMI.
Source: Cardiovascular Journal of Africa 27, pp 45 –48 (2016) http://dx.doi.org/10.5830/CVJA-2015-063More Less
Heterotaxy syndrome with left ventricular non-compaction is a rare co-existence of abnormalities with unknown cause. It can be isolated with no other associations, or associated with congenital heart diseases, or it can occur with multiple other congenital abnormalities. We describe the third reported case of heterotaxy syndrome with left ventricular non-compaction presenting in an adult.
Intimomedial mucoid degeneration causing aortic and renal artery aneurysms in a young adult : case reportSource: Cardiovascular Journal of Africa 27, pp 49 –52 (2016) http://dx.doi.org/10.5830/CVJA-2015-079More Less
Intimomedial mucoid degeneration (IMMD) is characterised by aneurysm formation following mucin deposition in the intima and media, with elastic tissue degeneration of the arterial wall. We present a case of a young adult who developed a diffusely aneurysmal aorta and its major branches, which was histopathologically confirmed as intimomedial mucoid degeneration, and a review of the literature. This case report attempts to raise the awareness of the reader to this rare cause of aortic aneurysm and to the bleeding diathesis associated with IMMD that may complicate surgery.
First reported cases : renal denervation with secondgeneration multi-electrode catheter via brachial and radial access : case reportSource: Cardiovascular Journal of Africa 27, pp 53 –55 (2016) http://dx.doi.org/10.5830/CVJA-2015-089More Less
Renal denervation is a minimally invasive procedure that aims to reduce brain-kidney sympathetic cross-talk. Despite the negative results of the recent SYMPLICITY HTN-3 trial, the procedure is considered safe and has been associated with many beneficial effects, including the reversal of hypertensive heart disease substrate and the prevention of cardiac arrhythmia. The first-generation radiofrequency catheter system featured a monopolar catheter that required sequential single-point energy application, followed by rotation, partial withdrawal of the catheter and re-application of energy. The latest generation device features four electrodes configured in a helical arrangement that can simultaneously ablate in four quadrants of the vessel circumference. Renal denervation via brachial or radial arterial access with the second-generation system has not been described before.
Source: Cardiovascular Journal of Africa 27 (2016)More Less
In March 2015, Groote Schuur Hospital (GSH) in Cape Town made history by becoming the first hospital in Africa, the Middle East, Central Asia and Turkey to implant the world's smallest pacemaker: the Medtronic Micra™ transcatheter pacing system (TPS). Three patients in Cape Town had this device successfully implanted by the GSH team, led by Dr Ashley Chin, as part of Medtronic's global pivotal clinical trial. After nearly one year of follow up, all three patients' pacemakers are functioning well with no pacemaker-related complications.