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TABLE OF CONTENT: Cardiovascular Journal of
Africa, Vol 19, Issue 6, Nov / Dec 2008
- Title: From the Editor's Desk
Authors: Brink, A.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 291
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Abstract: The Cardiovascular Journal of South Africa (CVJSA)
has made unprecedented strides in the past 18 months, based
on steady progress since its inception in 1989.
In October 2007 the Journal became the Cardiovascular
Journal of Africa (CVJA), incorporating the CVJSA, in issue
5 of volume 18. It is now widely visible, not only in
Africa, but also in North America, Europe and the Middle
East.
Currently, both CVJSA and CVJA are recorded in databases by
their printed and on-line ISSN numbers for indexing and
listing purposes. These data can be retrieved and viewed,
providing an integrated statistical history, some of which
will be reflected for the month of September 2008 on page
308 in this issue.
- Title: A randomised, controlled, double-blind,
cross-over pilot study assessing the effects of
spironolactone, losartan and their combination on heart rate
variability and QT dispersion in patients with chronic heart
failure : cardiovascular topic
Authors: Shehab, A.; Elnour, A.A.; Struthers, A.D.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 292-296
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Abstract: Background and objective : The blocking of
aldosterone or angiotensin II receptors improves mortality
in patients with chronic heart failure. We explored whether
combining losartan and spironolactone would have any added
benefit on the known surrogate of mortality by using heart
rate variability (HRV) and QT dispersion as our endpoints.
Methods : We designed a three-phase, consecutive, randomised,
controlled, double-blind, cross-over pilot study to assess
the effects of losartan alone (50 mg / day), spironolactone
(25 mg / day) with angiotensin converting enzyme (ACE)
inhibitor and, finally, losartan with spironolactone, on HRV
and QT dispersion. We enrolled eight patients (aged 47 to 72
years, mean = 63.7 years), with New York Heart Association (NYHA)
class II-III heart failure and ejection fraction (EF) < 35%,
in the study at a university-affiliated hospital in Dundee,
Scotland. Digital 24-hour Holter recordings were analysed
for time-domain HRV and the 12-lead ECG was optically
scanned and digitised for analysis of QT dispersion.
Evaluations were done at baseline, and at six, 12 and 18
weeks from baseline.
Results : Losartan and spironolactone showed statistically
significant, favourable effects on HRV, QT dispersion and
mean heart rate (p < 0.05).
Conclusion : The data showed that in these patients with
heart failure, the addition of spironolactone to an ACE
inhibitor, or the use of losartan on its own, or the
combination of losartan plus spironolactone induced a
favourable sympathovagal balance. The drugs significantly
improved HRV indices and QT dispersion further, and the
combination appeared to be safe. However, no significant
differences were seen between the effects of each of these
regimes on HRV and QT dispersion.
- Title: In-hospital and mid-term adverse clinical
outcomes of a direct stenting strategy versus stenting after
predilatation for the treatment of coronary artery lesions :
cardiovascular topic
Authors: Alidoosti, M.; Salarifar, M.; Kassaian, S.E.;
Zeinali, A.M.H.; Fathollahi, M.S.; Dehkordi, M.R.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 297-302
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Abstract: Background : Direct stenting without balloon
dilatation may reduce procedural costs and duration, and
hypothetically, the restenosis rate. This study was designed
to compare the in-hospital and long-term outcomes of direct
stenting (DS) versus stenting after pre-dilatation (PS) in
our routine clinical practice.
Methods : The 1 603 patients treated with stenting for
single coronary lesions were enrolled into a prospective
registry. Patients with acute myocardial infarction (MI)
within the preceding 48 hours, and those with highly
calcified lesions, total occlusions, or a lesion in a
saphenous graft were excluded. The baseline, angiographic
and procedural data, in-hospital outcomes and follow-up data
were recorded in our database and analysed with appropriate
statistical methods.
Results : Eight hundred and fifty-seven patients (53.5%)
were treated with DS and 746 (46.5%) underwent PS. In the DS
group, lesions were shorter in length, larger in diameter
and had lower pre-procedural diameter stenosis. Type C and
diffuse lesions and drug-eluting stents were found less
often (p < 0.001). With univariate analysis, dissection and
non-Q-wave MI occurred less frequently in this group (0.2
and 0.6% vs 3.9 and 2.1%, p < 0.001 and p = 0.01,
respectively). However, the cumulative major adverse cardiac
events (MACE) did not differ significantly (4.9 vs 4.6%, p =
0.79). With multivariate analysis, direct stenting reduced
the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33, but
neither the cumulative endpoint of MACE (OR = 1.1, 95% CI =
0.58-2.11, p = 0.7) nor its constructing components were
different between the groups.
Conclusions : Direct stenting in the real world has at least
similar long-term outcomes in patients treated with stenting
after pre-dilatation, and is associated with lower
dissection rates.
- Title: William Nelson ECG quiz
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 302, 310
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Abstract: This is the ECG of a 73-year-old man.
Rhythm? How many MIs?
- Title: Validation of a model to predict
all-cause in-hospital mortality in vascular surgical
patients : cardiovascular topic
Authors: Biccard, B.M.; Pooran, R.R.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 303-308
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Abstract: Objective : To develop and validate a pre- and
postoperative model of all-cause in-hospital mortality in
South African vascular surgical patients.
Methods : We carried out a retrospective cohort study. A
multivariate analysis using binary logistic regression was
conducted on a derivation cohort using clinical,
physiological and surgical data. Interaction and colinearity
between covariates were investigated. The models were
validated using the Homer-Lemeshow goodness-of-fit test.
Results : Independent predictors of in-hospital mortality in
the pre-operative model were : (1) age (per one-year
increase) [odds ratio (OR) 1.03, 95% confidence interval
(CI) 1.0-1.06), (2) creatinine > 180 µmol.l-1 (OR 6.43, 95%
CI: 3.482-11.86), (3) chronic beta-blocker therapy (OR 2.48,
95% CI: 1.38-4.48), and (4) absence of chronic statin
therapy (OR 2.81, 95% CI: 1.15-6.83). Independent predictors
of mortality in the postoperative model were: (1) age (per
one-year increase) (OR 1.05, 95% CI: 1.02-1.09), (2)
creatinine > 180 µmol.l-1 (OR 5.08, 95% CI: 2.50-10.31), (3)
surgery out of hours without statin therapy (OR 8.27, 95%
CI: 3.36-20.38), (4) mean daily postoperative heart rate
(HR) (OR 1.02, 95% CI: 1.0-1.04), (5) mean daily
postoperative HR in the presence of a mean daily systolic
blood pressure of less than 100 beats per minute or above
179 mmHg (OR 1.02, 95% CI: 1.01-1.03) and (6) mean daily
postoperative HR associated with withdrawal of chronic
beta-blockade (OR 1.02, 95% CI: 1.01-1.03). Both models were
validated.
Conclusion : The pre-operative model may predict the risk of
in-hospital mortality associated with vascular surgery. The
postoperative model may identify patients whose risk
increases as a result of surgical or physiological factors.
- Title: Readership survey on CVJA
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 308
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Abstract: The Cardiovascular Journal of Africa (CVJA),
incorporating the Cardiovascular Journal of South Africa, is
widely read locally and internationally.
- Title: FDG-PET and MIBI-Tc SPECT as follow-up
tools in a patient with cardiac sarcoidosis requiring a
pacemaker : case report
Authors: Smedema, J.P.; White, L.; Klopper, A.J.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 309-310
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Abstract: A 63-year-old man presented with recent-onset
symptoms secondary to third-degree atrio-ventricular block,
for which a dual-chamber pacemaker was inserted. Additional
investigations resulted in the diagnosis of cardiac
sarcoidosis. FDG-PET and MIBI-technetium SPECT were used as
follow-up tools for monitoring active granulomatous
myocardial infiltration.
- Title: Ischaemic postconditioning : from bench
to bedside ... : review article
Authors: Van Vuuren, D.; Lochner, A.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 311-320
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Abstract: The increase in the incidence of ischaemic heart
disease and acute myocardial infarction (AMI) in both high-
and low-income countries necessitates the development of
myocardial salvaging / protection interventions, to be
applied alongside standard reperfusion therapies. Although
the phenomenon of ischaemic preconditioning (IPC) is
associated with the desired protective capacity, the
necessity of its application before sustained ischaemia
limits its clinical potential.
The recently described phenomenon of postconditioning (postC),
or short cycles of reperfusion / ischaemia applied at the
onset of reperfusion, falls within the clinically relevant
time period of reperfusion, but can it elicit reliable and
potent cardioprotection? The answer to this problem is
intimately related to the question whether postC can be
translated from a laboratory technique to a clinical
therapy.
In this brief overview of postconditioning, the experimental
set-ups and postC algorithms utilised, and their associated
outcomes in all animal models studied (dog, rabbit, mouse,
rat and pig) are discussed. The therapeutic potential of
postC is also addressed by discussing reported preliminary
studies on the efficacy and feasibility of postC (both
ischaemic and pharmacological) in humans.
- Title: Hatter Institute Cardiac Horizons series
: in my opinion
Authors: Hitzeroth, J.; Hendricks, N.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 321-323
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Abstract: We recently had the privilege of attending the
Hatter Institute Cardiac Horizons lectures. Among the
prestigious panel of speakers were Profs Yellon, Opie and
Commerford, who shed some light on two of the most common
conditions cardiologists treat on a daily basis : acute
myocardial infarction (AMI) and congestive cardiac failure (HF).
Prof Schwartz provided some insights on sudden cardiac death
and the long QT (LQT) syndrome.
- Title: Letters to the Editor
Response to Dr A Bonny, et al.
Authors: Bonny, A.; Yitemben, I.D.M.; Hamdaoui, B.; Larrazet,
F.; Aalbers, J.L.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 323-324
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Abstract: Referring to the BEAUTIfUL study, we would like to
point out why adding ivabradine in the management of stable
coronary artery disease with left ventricular dysfunction is
worthless.
Ivabradine failed to reduce the primary composite endpoint :
cardiovascular death, admission to hospital for acute
myocardial infarction and admission to hospital for
new-onset or worsening heart failure.
- Title: Heparin-induced thrombocytopaenia :
cardiovascular prescriber
Authors: Gounden, R.; Blockman, M.
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 325-327
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Abstract: Heparin-induced thrombocytopaenia (HIT) is an
acquired, transient prothrombotic disorder caused by
heparin. The predominant problem is the creation of a
prothrombotic milieu, accompanied by a fall in the platelet
count. This explains the apparent paradox of thrombosis in
the face of thrombocytopaenia and why non-heparin
antithrombotic agents are integral to its management.
- Title: Jump on the bus of opportunity : cardio
news
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 327
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Abstract: PACE, the support organisation for patients with
arrhythmias, hit the fast lane at the recent South African
Heart Congress, with a presentation on its 2009 plans to
interested pharmaceutical industry stakeholders. PACE CEO,
Lusan Luscombe and Franciska du Toit from Medical Society
Management described the achievements of the past few years,
which include the development of five regional contract
offices in Cape Town, Johannesburg, Bloemfontein, Port
Elizabeth and Durban, and the development of their website
(www.paceafrica.org.za) lobbying Parliament and medical aid
funders for improved facilities and care for patients.
- Title: Impact of recent trial results on
cardiovascular risk management (Hatter Institute Cardiac
Horizons series) : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 328, 330-331
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Abstract: 'Results of recent clinical trials from this
year's major international cardiology meetings are
challenging the way we treat our patients at risk of
experiencing adverse cardiovascular events.' This view was
expressed by Dr Colin Schamroth and Dr Naomi Rapeport and
substantiated during two thought-provoking presentations at
the annual Hatter Institute cardiology registrars'
symposium, held in association with Servier Laboratories.
- Title: 2009 PASCAR Conference, Nigeria
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 331
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Abstract: We are planning the 2009 Pan-African Society of
Cardiology (PASCAR) conference, which will be held in Abuja,
Nigeria, from 26-30 September 2009.
- Title: Low-risk older patients (50 years and
older) with raised high-sensitivity CRP (hs-CRP) benefit
from rosuvastatin therapy : the JUPITER study
A South African expert comments on the JUPITER study
: drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 332-335
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Abstract: The JUPITER (Justification for the Use of statins
in Prevention: an Intervention Trial Evaluating Rosuvastatin)
study, which tested the role of underlying low-grade
inflammation using the determination of high-sensitivity
C-reactive protein levels (hs-CRP) as the differential of
additional risk in an otherwise healthy population, has
shown that statin therapy using rosuvastatin significantly
reduced the incidence of major cardiovascular events.
- Title: Heart failure patients with preserved
left ventricular ejection fraction did not benefit from
additional ARB therapy : drug trends in cardiology
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 337-339
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Abstract: The addition of an angiotensin receptor blocker (ARB),
irbesartan, to the normal treatment therapy of heart failure
patients who had a left ventricular ejection fraction (LVEF)
of at least 45% did not improve outcomes in this
difficult-to-treat patient group (Fig. 1).
Currently, there is no specific evidence-based therapy for
this group of patients who typically, according to both
registry and community-based studies, tend to be older,
overweight females who have a history of hypertension,
rather than ischaemia and heart failure symptoms. These
patients are frequently also diabetic and have atrial
fibrillation (Table 1).
- Title: SA Heart 2008 : cardio news
From: Cardiovascular Journal of Africa, Vol 19, Issue 6, Nov
/ Dec
Published: 2008
Pages: 340
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Abstract: The recent South African Heart Congress, held at
the Wild Coast Sun from 2-5 November, proved to be a
tremendous success, with 16 international guests and 1 200
delegates.
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