CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 34, ISSUE
5, NOVEMBER/DECEMBER 2023
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- Editorial
Author: P Commerford
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Page: 263
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- Title: A retrospective study: efficacy of an originator versus a generic formulation of simvastatin in patients who suffer from hyperlipidaemia
Authors: JR Snyman, KR Snyman on behalf of Simvotin® study group
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 264–267
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DOI Number: 10.5830/CVJA-2022-053
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-053
Background: South Africa is home to a multi-ethnic society with a large range of cultures and lifestyles. Cardiovascular disease is a major cause of morbidity and mortality. South Africa is known to have one of the highest incidence rates of hypercholesterolaemia in the world, especially among the Caucasian population.
Aim: The aim of this retrospective chart review was to establish whether a multisource simvastatin (Simvotin®, Ranbaxy, a Sun Pharma company) maintained the cholesterol-lowering effect after switching from the innovator brand Zocor® (MSD South Africa) in the public-sector hospitals. Since prescribers often doubt the registration requirements of multisource products based on bioequivalence alone, this research was done to confirm similar clinical outcomes in a real-world setting.
Methods: More than 200 charts were identified from patients treated for hyperlipidaemia. Patients were treated for at least six months prior to and again six months after the switching of brands in order to meet criteria to be eligible for inclusion. The lipid values at initiation of therapy as well as before switching (visit 1 and 2) had to be available and again six months after treatment on the multisource product (visit 3).
Results: No significant change was observed in the lipid control after switching, confirming similarity.
Conclusion: This real-world evidence should allay any fears of generic inferiority of this important medicine in the treatment and prevention of high cardiovascular risk in patients requiring lipid-lowering therapy.
- Title: Feasibility of focused cardiac ultrasound training for non-cardiologists in a resource-limited setting using a handheld ultrasound machine
Authors: Benjamin Acheampong, Joseph R Starnes, Yaw A Awuku, David Parra, Muktar H Aliyu, Jonathan H Soslow
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 268–272
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DOI Number: 10.5830/CVJA-2022-057
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-057
Background: Heart disease remains a leading cause of morbidity and mortality, particularly in low- and middle-income countries. Access to diagnostic modalities is limited in these settings. Limited echocardiographic studies performed by non-cardiologists can increase access, improve diagnosis and allow for earlier medical therapy.
Methods: Two internal medicine residents at a tertiary-level hospital in Ghana were trained to perform limited echocardiographic studies. Each trainee performed 50 echocardiograms and interpreted 20 studies across three predetermined timepoints. Interpretation was compared to expert interpretation.
Results: Agreement improved over time. At the final evaluation, there was high agreement across all aspects: left ventricular structure (70%, kappa 0.52, p = 0.01), left ventricular function (80%, kappa 0.65, p = 0.004), right ventricular structure (90%, kappa 0.71, p = 0.002), right ventricular function (100%, kappa 1.00, p < 0.001), and presence of effusion (100%, kappa 1.00, p < 0.001).
Conclusion: Non-cardiologists can be trained in focused echocardiography using handheld machines. Such training can increase access to diagnostic capabilities in resource-limited settings.
- Title: Association between the serum lipoprotein-associated phospholipase A2 level and acute coronary syndrome
Authors: Le Dong, Jiayi Tong, Shimin Fan
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 273–277
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DOI Number: 10.5830/CVJA-2022-056
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-056
Aim: The aim of this study was to explore the association between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and acute coronary syndrome (ACS), and to analyse the correlations of Lp-PLA2 concentration with highsensitivity C-reactive protein (hs-CRP) level, body mass index (BMI), triglyceride (TG), troponin I (TNI), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels, and severity of coronary artery disease.
Methods: A total of 75 patients were divided into an unstable angina (UA) group (n = 54) and an acute myocardial infarction (AMI) group (n = 21). Another 72 subjects with normal coronary angiography results were selected as a control group. The levels of hs-CRP, TG, LDL-C, HDL-C and TNI were determined. Serum Lp-PLA2 concentration was measured by enhanced immunoturbidimetry. The Gensini score was obtained based on coronary angiography results.
Results: The serum Lp-PLA2 concentration significantly increased in the AMI and UA groups compared with that of the control group (p < 0.05). Compared with the UA group, the AMI group had significantly increased levels of hs-CRP and TNI and higher Gensini score (p < 0.05). The UA group had increased levels of hs-CRP and higher Gensini score compared with those of the control group (p < 0.05), while the two groups had similar TNI levels (p > 0.05). Using serum Lp-PLA2 concentration as the dependent variable, and hs-CRP, TG, LDL-C, HDL-C, TNI and Gensini score as independent variables, the analysis results showed that Lp-PLA2 concentration was positively correlated with BMI and hs-CRP, LDL-C and TNI levels.
Conclusions: There was a positive correlation between Lp-PLA2 concentration and LDL-C level, therefore plasma LDL-C level should be controlled to prevent ACS.
- Title: Is pre-operative monocyte count-high-density lipoprotein ratio associated with postoperative acute kidney injury in isolated coronary artery bypass grafting?
Authors: Hüseyin Şaşkın
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 278–284
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DOI Number: 10.5830/CVJA-2022-055
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-055
Objective: Monocyte-to-high-density lipoprotein cholesterol ratio has emerged as an indicator of inflammation and oxidative stress in recent years. The aim of this study was to evaluate the association of monocyte-to-high-density lipoprotein ratio with postoperative acute kidney injury in isolated coronary artery bypass grafting.
Methods: A total of 954 patients (672 males, mean age 60.8 ± 8.2 years), operated on between June 2014 and June 2022, at the same centre by the same team, for isolated coronary artery bypass grafting with cardiopulmonary bypass, whose preoperative serum creatinine level was < 1.5 mg/dl, were enrolled in the study. Patients were placed in group 1 if they had acute kidney injury in the early postoperative period (n = 161) and group 2 comprised those without (n = 793). Univariate and subsequent multivariate logistic regression analysis were done to determine significant clinical factors, and independent predictors of acute kidney injury.
Results: Pre-operative monocyte count (p = 0.0001), monocyte count-high-density lipoprotein cholesterol ratio (p = 0.0001), C-reactive protein (p = 0.0001), erythrocyte sedimentation rate (p = 0.0001), mean platelet volume (p = 0.0001) and postoperative first- and third-day C-reactive protein levels (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis revealed that pre-operative elevated monocyte count (p = 0.0001), monocyte-high-density lipoprotein ratio (p = 0.0001), erythrocyte sedimentation rate (p = 0.0001), postoperative first-day C-reactive protein level (p = 0.0001), postoperative first-third day erythrocyte sedimentation rate (p = 0.002, p = 0.004, respectively) and mean platelet volume (p = 0.02, p = 0.0001, respectively) were independent predictors of early postoperative acute kidney injury in patients who had undergone isolated coronary artery bypass grafting.
Conclusion: Pre-operative monocyte-high-density lipoprotein cholesterol ratio was found to be an independent predictor of acute kidney injury in the early postoperative period of isolated coronary artery bypass grafting.
- Title: A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa
Authors: S Budhram, P Krishundutt
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 285–290
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DOI Number: 10.5830/CVJA-2022-061
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-061
Objective: The aim of this study was to describe the profile and outcomes of pregnancies in women with pulmonary hypertension in South Africa.
Methods: A retrospective study was undertaken at a statesubsidised hospital. Data were analysed using SPSS. Descriptive statistics were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. A p-value less than 0.05 was considered statistically significant.
Results: Of a cohort of 185 women, 86.3% had pulmonary hypertension secondary to left heart disease. The median age of the cohort was 28 years (interquartile range 23–33) with 37.8% being HIV infected and 59% having mild pulmonary hypertension. Frequencies of deaths, intensive care unit admissions and cardiac failure events increased with increasing severity of pulmonary hypertension (p < 0.001). Women with more severe pulmonary hypertension had higher rates of preterm births (p < 0.001).
Conclusion: Adverse pregnancy outcomes were concentrated in women with moderate-to-severe pulmonary hypertension.
- Title: Outcomes of pregnancy with pulmonary hypertension: low risk or a false dawn?
Authors: Onyedika J Ilonze
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 291
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DOI Number: 10.5830/CVJA-2023-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-014
Abstract: I read with keen interest the article titled ‘A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa’ by Budhram et al.1 In this large, retrospective cohort study of 185 women, they reported on outcomes of women with pulmonary hypertension (PH) [World Health Organisation (WHO) group 1, n = 24, WHO group II, n = 151] with Doppler echocardiogram-derived pulmonary artery (PA) pressures. The results were similar to those of the ROPAC study,2 and the authors found that of that cohort, four women underwent elective termination of pregnancy and three had spontaneous miscarriages. The reported case-fatality rate at 42 days postpartum was 2.7%. Cesarean section was the mode of delivery for almost 80% of patients. Gestational age and birth weight were inversely proportional to the severity of the PH. The proportion of low-birthweight (< 2 500 g) babies was also highest in patients with severe PH.
- Title: Correlation between mitral valve area and left atrial function in rheumatic mitral valve stenosis patients
Authors: Ahmed Fareed, Mohamed Hamed, Fathy Makaldy, Omar Saleh
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 292–298
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DOI Number: 10.5830/CVJA-2022-059
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-059
Background: Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS. Aim: The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients.
Methods: This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients.
Results: Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%).
Conclusion: There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS.
- Title: A new biomarker to predict atrial fibrillation and its adverse events after coronary artery bypass surgery: red blood cell distribution volume
Authors: Hüseyin Şaşkın, Durmuş Alper Görür
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 299–306
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DOI Number: 10.5830/CVJA-2022-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-063
Objective: Recent studies suggest that increased red blood cell distribution width may be associated with increased risk of atrial fibrillation. This study aimed to evaluate the relationship between pre-operative and postoperative erythrocyte distribution volume, postoperative atrial fibrillation and related adverse events in patients undergoing isolated coronary artery bypass surgery.
Methods: A total of 790 patients (611 males, mean age 58.3 ± 6.2 years) in pre-operative sinus rhythm, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass at the same centre and by the same surgical team between January 2015 and December 2021, were enrolled retrospectively. Two groups were created, group 1 (n = 183) and group 2 (n = 607), with regard to the occurrence of atrial fibrillation in the early postoperative period or not, respectively. Clinical and demographic data, biochemical and complete blood count parameters, and intra-operative and postoperative data of the patients were recorded. Univariate and subsequent multivariate logistic regression analysis was done to determine significant clinical factors and independent predictors of postoperative atrial fibrillation.
Results: Among the patients, 182 (23.2%) developed atrial fibrillation during the 72 hours postoperatively. Pre-operative and postoperative first-, third- and seventh-day red blood cell distribution volume (p = 0.0001), C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis showed elevated pre-operative and postoperative first-, thirdand seventh-day red blood cell distribution volume, erythrocyte sedimentation rate and C-reactive protein as independent predictors of early postoperative atrial fibrillation.
Conclusion: Pre-operative and postoperative red blood cell distribution volume was found to be an independent predictor of atrial fibrillation and associated adverse events in the early postoperative period of isolated coronary artery bypass grafting.
- Title: Hypertension treatment in sub-Saharan Africa: a systematic review
Authors: Pauline Cavagna, Céline Leplay, Roland N’Guetta, Kouadio Euloge Kramoh, Ibrahima Bara Diop, Dadhi M Balde, Jean Bruno Mipinda, Michel Azizi, Xavier Jouven, Marie Antignac
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 307–317
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DOI Number: 10.5830/CVJA-2022-065
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-065
Abstract: Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. Blood pressure (BP) control rests on the association of lifestyle modification and antihypertensive medicines. We aimed to systematically review antihypertensive strategies implemented in SSA to achieve BP control. A systematic search beginning in 2003 was performed in MEDLINE, COCHRANE and EMBASE. We included only original and observational studies in SSA countries. Thirty studies were included from 11 countries. No study was multinational. The number of patients varied from 111 to 897 (median: 294; IQR: 192–478). Overall, 21% of patients received monotherapy, 42.6% two-drug and 26.6% three-drug combinations. Out of all the strategies, renin–angiotensin system (RAS) blockers were mostly prescribed, followed by diuretics and calcium channel blockers. In monotherapy, RAS blockers were the first to be prescribed. Only 10 articles described antihypertensive strategies beyond triple combinations. BP control was highly variable (range: 16.4 to 61.2%). Multicentre studies performed in several SSA countries are needed to ensure international guidelines actually do improve outcomes in SSA.
- Title: A case of spontaneous isolated superior mesenteric arterial dissection with coeliac axis stenosis
Authors: Kun Ye, Yong Wang, Shengyun Wan
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 318–320
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DOI Number: 10.5830/CVJA-2022-066
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-066
Abstract: Spontaneous isolated superior mesenteric arterial dissection with coeliac axis stenosis is rare but serious. We report a case of a 54-year-old male with coeliac axis stenosis who presented with acute superior mesenteric arterial dissection, which caused thrombosis of the branches. This is the first report of the full course of treatment using endovascular repair and laparoscopic surgery to deal with spontaneous isolated superior mesenteric arterial dissection combined with coeliac axis stenosis. This approach has been shown to be safe and effective for yielding short-term results.
- Title: Very rare malposition of central venous catheter in cardiac surgery patients
Authors: Nursen Tanrikulu, Ali Haspolat, Ali Sefik Koprulu
From: Cardiovascular Journal of Africa, Vol 34, Issue 5 November/December 2023
Pages: 321–324
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DOI Number: 10.5830/CVJA-2022-062
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-062
Abstract: Malposition of a catheter is found in approximately 7% of cases after central venous catheterisation. This may result in haemorrhage, venous thrombosis and functional impairment, depending on the injury to the vessel wall. Uncomplicated catheterisation, easy aspiration of blood and monitoring of catheterisation do not guarantee correct placement of the catheter. In our rare case series, we share our experience of four cases of malposition into the left internal mammary vein (LIMV) that we experienced in a three-year period. The thinness and fragility of the vessel wall, particularly, increases the probability of complications in malposition into the LIMV. Administration of a catheter through the right jugular vein is associated with the lowest incidence of malposition. Performing the procedure under the guidance of ultrasonography (USG) and confirmation of the catheter position after puncture using one of the USG techniques will minimise the probability of malposition. In addition, a lung X-ray should immediately be taken, and venography and fluoroscopy should be considered in the presence of suspicion.
