Cardiovascular Journal of Africa - latest Issue
Volumes & issues
Volume 27, Issue 6, 2016
Source: Cardiovascular Journal of Africa 27, pp 1 –3 (2016) http://dx.doi.org/10.5830/CVJA-2016-044More Less
A coronary fistula (CF) is a rare congenital cardiac anomaly in which there is a connection between the coronary artery and a cardiac chamber or a great vessel. In the paediatric population, a CF is usually asymptomatic. While the circumflex coronary artery (Cx) is the least common source of a CF, the right heart chambers are the most common location of drainage. Herein, we present a symptomatic 10-month-old boy with an atrial septal defect (ASD) in whom we incidentally detected a CF, which stemmed from the Cx and drained to the right atrium. Because the patient was symptomatic and his small size was not appropriate for percutaneous closure of the ASD, surgical closure of the ASD and CF was performed.
SASCI/SCTSSA joint consensus statement and guidelines on transcatheter aortic valve implantation (TAVI ) in South Africa : consensus guidelinesSource: Cardiovascular Journal of Africa 27, pp 298 –300 (2016) http://dx.doi.org/10.5830/CVJA-2016-092More Less
The South African Heart Association (SA Heart) together with two of its special-interest groups, the South African Society of Cardiovascular Intervention (SASCI) and the Society of Cardiothoracic Surgeons in South Africa (SCTSSA), represent the scientific, educational and professional interests of South African cardiac specialists, with a combined membership of over 200 members. These two interest groups exclusively represent practicing cardiologists and cardiothoracic surgeons in South Africa. SASCI and SCTSSA are dedicated to maintaining the highest standards of specialist practice and the highest quality of patient care. As a result, SASCI and SCTSSA seek to serve as a knowledge resource for patients and funders in matters related to new technology used in the cardiac interventional and surgical disciplines.
Author Paul BrinkSource: Cardiovascular Journal of Africa 27 (2016)More Less
The impact factor, or, more correctly, the journal impact factor [JIF; Thompsons Reuters (ISI)] has featured in previous reports of the Cardiovascular Journal of Africa (CVJA). As expected, it has been steadily rising and is now at 1.022 (2015). This is not to be scoffed at. Of the 14 listed medical journals in Africa, it is third to the South African Medical Journal (SAMJ; JIF = 1.5). Similarly, in another major database, Scopus, it ranks at number 184 out of 333 journals of cardiovascular medicine globally. Within Africa it is the only cardiovascular journal indexed by Thompson Reuters and also by Scopus. These statistics are based on citations to articles that appear in journals, and formulae that relate the number of citations to published articles in a journal over a given time period, and are part of the more extensive ways of evaluating scientific output under the umbrella term bibliometrics.
The importance of perseverance, pilot studies and the search for effective adjuvant therapies in the management of tuberculous pericarditis : editorialSource: Cardiovascular Journal of Africa 27, pp 336 –337 (2016)More Less
Tuberculous pericarditis remains one of the most feared manifestations of extra-pulmonary tuberculosis (TB). The relatively high morbidity and mortality rates associated with the condition arise via two distinct mechanisms. The first is related to the combined impact of the virulence of Mycobacterium tuberculosis (MTb) itself and TB-induced dysregulated immune responses in both HIV-positive and -negative individuals, resulting in disseminated infection, multi-organ involvement, and prolonged acute infection. The second mechanism is related to compressive pericardial disease (cardiac tamponade, effusive constrictive pericarditis and constrictive pericarditis), which can cause significant compromise of cardiovascular function.
Should patients undergo ascending aortic replacement with concomitant cardiac surgery? : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 338 –344 (2016) http://dx.doi.org/10.5830/CVJA-2016-026More Less
Aim: To determine whether concomitant surgery is a predictor of mortality in patients undergoing surgery for ascending aortic aneursym.
Methods: Ninety-nine patients who underwent ascending aortic aneursym surgery between January 2010 and January 2015 were included in this study. Nineteen patients underwent ascending aortic replacement (RAA) only, 36 underwent aortic valve replacement (AVR) and RAA, 25 underwent coronary artery bypass grafting (CABG) and RAA, 11 underwent the Bentall procedure, and eight underwent AVR, CABG and RAA.
Results: Depending on the concomitant surgery performed with RAA, the mortality risk increased 2.25-fold for AVR, 4.5-fold for CABG, 10.8-fold for AVR + CABG and four-fold for the Bentall procedure, compared with RAA alone.
Conclusion: Concomitant cardiac surgery increased the mortality risk in patients undergoing RAA, but the difference was not statistically significant. Based on these study results, patients undergoing cardiac surgery, with a pre-operative ascending aortic diameter of over 45 mm, should undergo concomitant RAA.
Procedural and one-year clinical outcomes of bioresorbable vascular scaffolds for the treatment of chronic total occlusions : a single-centre experience : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 345 –349 (2016) http://dx.doi.org/10.5830/CVJA-2016-033More Less
Introduction: The bioresorbable vascular scaffold system (BVS) is the latest fully absorbable vascular therapy system that is used to treat coronary artery disease. The BVS has been used in different coronary lesion subsets, such as acute thrombotic lesions, bifurcation lesions, ostial lesions and lesions originating from bypass grafts. However, data about the use of BVS in chronic total occlusions (CTO) are limited. We report our BVS experience for the treatment of CTOs in terms of procedural features and one-year clinical follow-up results.
Methods: An analysis was made of 41 consecutive patients with CTO lesions who were referred to our clinic between January 2013 and December 2014. A total of 52 BVS were implanted. An analysis was made of patient characteristics, procedural features [target vessel, BVS diameter, BVS length, post-dilatation rate, type of post-dilatation balloon, procedure time, fluoroscopy time, contrast volume, post-procedure reference vessel diameter (RVD), post-procedure minimal lesion diameter (MLD), type of CTO technique and rate of microcatheter use] and one-year clinical follow-up results [death, myocardial infarction, angina, coronary artery bypass graft (CABG), target-lesion revascularisation (TLR) and target-vessel revascularisation (TVR)]. Descriptive and frequency statistics were used for statistical analysis.
Results: The mean age of the patient group was 61.9 ± 9.7 years, 85.4% were male, and 51.2 % had diabetes. Prior myocardial infarction incidence was 65.9%, 56.1% of the patients had percutaneous coronary intervention and 17.1% had a previous history of CABG. The procedure was performed via the radial route in 24.3% of the patients. The target vessel was the right coronary artery in 48.7% of the patients. Post-dilatation was performed on the implanted BVS in 97.5% of the patients, mainly by non-compliant balloon; 87.8% of the BVS were implanted by the antegrade CTO technique. Mean procedure time was 92 ± 35.6 minutes. Mean contrast volume was 146.6 ± 26.7 ml. At one year, there were no deaths. One patient had lesion-related myocardial infarction and needed revascularisation because of early cessation of dual anti-platelet therapy. Eleven patients had angina and five of them needed target-vessel revascularisation.
Conclusions: BVS implantation appeared to be effective and safe in CTO lesions but randomised studies with a larger number of patients and with longer follow-up times are needed.
A prospective investigation into the effect of colchicine on tuberculous pericarditis : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 350 –355 (2016) http://dx.doi.org/10.5830/CVJA-2016-035More Less
Introduction: Tuberculous (TB) pericarditis carries significant mortality and morbidity rates, not only during the primary infection, but also as part of the granulomatous scar-forming fibrocalcific constrictive pericarditis so commonly associated with this disease. Numerous therapies have previously been investigated as adjuvant strategies in the prevention of pericardial constriction. Colchicine is well described in the treatment of various aetiologies of pericarditis. The aim of this research was to investigate the merit for the use of colchicine in the management of tuberculous pericarditis, specifically to prevent constrictive pericarditis.
Methods: This pilot study was designed as a prospective, double-blinded, randomised, control cohort study and was conducted at a secondary level hospital in the Northern Cape of South Africa between August 2013 and December 2015. Patients with a probable or definite diagnosis of TB pericarditis were included (n = 33). Study participants with pericardial effusions amenable to pericardiocentesis underwent aspiration until dryness. All patients were treated with standard TB treatment and corticosteroids in accordance with the South African Tuberculosis Treatment Guidelines. Patients were randomised to an intervention and control group using a web-based computer system that ensured assignment concealment. The intervention group received colchicine 1.0 mg per day for six weeks and the control group received a placebo for the same period. Patients were followed up with serial echocardiography for 16 weeks. The primary outcome assessed was the development of pericardial constriction. Upon completion of the research period, the blinding was unveiled and data were presented for statistical analysis.
Results: TB pericarditis was found exclusively in HIV-positive individuals. The incidence of pericardial constriction in our cohort was 23.8%. No demonstrable benefit with the use of colchicine was found in terms of prevention of pericardial constriction (p = 0.88, relative risk 1.07, 95% CI: 0.46-2.46). Interestingly, pericardiocentesis appeared to decrease the incidence of pericardial constriction.
Conclusion: Based on this research, the use of colchicine in TB pericarditis cannot be advised. Adjuvant therapy in the prevention of pericardial constriction is still being investigated and routine pericardiocentesis may prove to be beneficial in this regard.
Epidemiology and patterns of hypertension in semi-urban communities, south-western Nigeria : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 356 –360 (2016) http://dx.doi.org/10.5830/CVJA-2016-037More Less
Objective: To determine the prevalence and subtypes of hypertension among semi-urban residents in south-western Nigeria.
Methods: All adults aged 18 years or older in 10 semi-urban communities were recruited for the study. The blood pressure (BP) reading taken with a validated electronic BP monitor after at least 10 minutes of rest was used in the analysis. Hypertension was defined as BP ≥ 140/90 mmHg.
Results: Seven hundred and fifty subjects with a mean age of 61.7 ± 18.2 years participated in the study. The prevalence of hypertension was 55.5%. Stage 2 hypertension was the most common, present among 225 (54.1%) of the participants with hypertension, and 191 (45.9%) had stage 1 hypertension. Of those with hypertension, systolic-diastolic hypertension (SDH) was present among 198/416 (47.6%), while isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) were present among 181/416 (43.6%) and 37/416 (8.9%), respectively. The prevalence of hypertension increased significantly with age.
Conclusion: The prevalence of hypertension was high in these semi-urban communities. Hence, increased awareness and integrating hypertension care into primary healthcare and other community health services in these areas may prove beneficial in ameliorating its adverse effects.
Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 361 –366 (2016) http://dx.doi.org/10.5830/CVJA-2016-036More Less
Background: Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare.
Objective: The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo.
Methods: A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥140/90 or ≥130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension.
Results: Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p= 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension.
Conclusion: Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.
Determinants of change in body weight and body fat distribution over 5.5 years in a sample of free-living black South African women : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 367 –374 (2016) http://dx.doi.org/10.5830/CVJA-2016-038More Less
Objective: To identify socio-demographic and lifestyle determinants of weight gain in a sample of premenopasual black South African (SA) women.
Methods: Changes in body composition (dual-energy X-ray absorptiometry, computerised tomography), socio-economic status (SES) and behavioural/lifestyle factors were measured in 64 black SA women at baseline (27 ± 8 years) and after 5.5 years.
Results: A lower body mass index (BMI) and nulliparity, together with access to sanitation, were significant determinants of weight gain and change in body fat distribution over 5.5 years. In addition, younger women increased their body weight more than their older counterparts, but this association was not independent of other determinants.
Conclusion: Further research is required to examine the effect of changing SES, as well as the full impact of childbearing on weight gain over time in younger women with lower BMIs. This information will suggest areas for possible intervention to prevent long-term weight gain in these women.
The differential effects of FTY720 on functional recovery and infarct size following myocardial ischaemia/reperfusion : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 375 –386 (2016) http://dx.doi.org/10.5830/CVJA-2016-039More Less
Aim: The aim of this study was to evaluate the effects of the sphingosine analogue, FTY720 (Fingolimod), on the outcomes of myocardial ischaemia/reperfusion (I/R) injury.
Methods: Two concentrations of FTY720 (1 or 2.5 μM) were administered either prior to (PreFTY), or following (PostFTY) 20 minutes' global (GI) or 35 minutes' regional ischaemia (RI) in the isolated, perfused, working rat heart. Functional recovery during reperfusion was assessed following both models of ischaemia, while infarct size (IFS) was determined following RI.
Results: FTY720 at 1 μM exerted no effect on functional recovery, while 2.5 μM significantly impaired aortic output (AO) recovery when administered prior to GI (% recovery: control: 33.88 ± 6.12% vs PreFTY: 0%, n = 6-10; p < 0.001), as well as before and after RI (% recovery: control: 27.86 ± 13.22% vs PreFTY: 0.62%; p < 0.05; and PostFTY: 2.08%; p = 0.0585, n = 6). FTY720 at 1 μM administered during reperfusion reduced IFS [% of area at risk (AAR): control: 39.89 ± 3.93% vs PostFTY: 26.56 ± 4.32%, n = 6-8; p < 0.05), while 2.5 μM FTY720 reduced IFS irrespective of the time of administration (% of AAR: control: 39.89 ± 3.93% vs PreFTY: 29.97 ± 1.03%; and PostFTY: 30.45 ± 2.16%, n = 6; p < 0.05).
Conclusion: FTY720 exerted divergent outcomes on function and tissue survival depending on the concentration administered, as well as the timing of administration.
Cortisol:brain-derived neurotrophic factor ratio associated with silent ischaemia in a black male cohort : the SA BPA study : cardiovascular topicsSource: Cardiovascular Journal of Africa 27, pp 387 –391 (2016) http://dx.doi.org/10.5830/CVJA-2016-065More Less
Aim: Emotional distress has been associated with cardiovascular disease (CVD) in Africans. Cortisol and brain-derived neurotrophic factor (BDNF), as markers of emotional distress, increase cardiometabolic risk. We therefore aimed to investigate associations between cardiometabolic risk markers and the cortisol-to-BDNF ratio (cortisol:BDNF).
Methods: A cross-sectional study included a bi-ethnic gender cohort (n = 406) aged 44.7 ± 9.52 years. Ambulatory blood pressure (ABPM), ECG, fasting serum cortisol and BDNF levels and cardiometabolic risk markers were obtained.
Results: Africans had increased incidence of hyperglycaemia and 24-hour silent ischaemic events, and elevated 24-hour blood pressure (BP) and cortisol:BDNF ratios compared to Caucasians. Forward stepwise linear regression analysis underscored a similar trend with associations between hyperglycaemia, 24-hour BP [Adj R2 0.21-0.29; β 0.23 (0.1-0.4); p = 0.01], silent ischaemia [Adj R2 0.22; β 0.40 (0.2-0.6); p < 0.01] and cortisol:BDNF levels in Africans, mostly in the men.
Conclusion: Attenuated cortisol levels in this group may be indicative of emotional distress and if chronic, drive the cortisol:BDNF ratio to desensitise BDNF. Desensitised cortisol:BDNF may sustain cardiometabolic risk and induce neurodegeneration in African men via silent ischaemia. Compensatory increases in blood pressure to increase perfusion and maintain homeostasis may increase coronary artery disease risk.
Author Anthony J. DalbySource: Cardiovascular Journal of Africa 27, pp 392 –398 (2016)More Less
The annual European Society of Cardiology (ESC) meeting was held at the Nuova Fiera di Roma with over 32 000 delegates from 126 countries in attendance.
The meeting commenced with an outstanding address on the heart and art by a British cardiac surgeon, who demonstrated the amazing discoveries in cardiac anatomy and function made by Leonardo da Vinci over 500 years ago, and the awarding of the ESC gold medal to Dr Bernard Gersh of the Mayo Clinic, whose foundational training in cardiology took place at Groote Schuur Hospital.
Four new ESC guidelines addressing atrial fibrillation (AF), heart failure, cardiovascular (CV) disease prevention and dyslipidaemia, as well as a position paper on cardio-oncology, were released during the meeting. The full texts of these documents are available to all at https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines.
The meeting planners placed particular emphasis on the 'heart team' approach and included a large number of 'heart hub' presentations. The latter were delivered 'in the round' and provided a more informal, more easily accessible presentation format, which improved interaction between presenters and the audience.
The following are my impressions of the presentations I attended over the five days of the meeting.