CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 31, ISSUE
4, JULY/AUGUST 2020
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- Title: Editorial - Coronary reperfusion in STEMI patients in sub-Saharan Africa
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Page: 167-168
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- Title: Mitochondrial oxidative phosphorylation and mitophagy in myocardial ischaemia/reperfusion: effects of chloroquine
Authors: K Dhanabalan, B Huisamen, A Lochner
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 169-179
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DOI Number: 10.5830/CVJA-2019-067
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-067
Aim: The aim of this study was to evaluate the temporal relationship between mitochondrial oxidative phosphorylation and mitophagy in at hearts subjected to ischaemia/reperfusion. Measurements were made at specific points during the experimental protocol (snapshot pproach) and by assessments of mitophagic flux, using chloroquine pre-treatment.
Methods: Isolated working rat hearts were subjected to 25 or 30 minutes of global ischaemia/10 minutes of reperfusion. Half of each group received chloroquine (10 mg/kg, intraperitoneally) one hour before experimentation. Mitochondria were isolated after stabilisation, ischaemia and reperfusion, and oxidative phosphorylation was measured polarographically. Mitochondrial mitophagy markers were detected by Western blot analysis.
Results: Mitochondrial oxygen uptake (state 3) and oxidative phosphorylation rate were reduced by ischaemia and increased by reperfusion. Chloroquine pre-treatment increased both parameters. Using a snapshot approach, exposure to ischaemia ± reperfusion had little effect on mitochondrial PINK1, Parkin and p62/SQSTM1 expression. Ischaemia reduced Rab9 expression, and reperfusion upregulated the phospho DRP1, phospho/total DRP1 ratio and Rab9 levels. Chloroquine significantly reduced PINK1, p62/SQSTM1, Rab9 and particularly Parkin expression during reperfusion, without an effect on mitochondrial total and phospho DRP1 levels.
Conclusion: Ischaemia/reperfusion-induced changes in mitochondrial oxidative phosphorylation function occurred concomitantly with changes in mitophagic flux. Pre-treatment with chloroquine profoundly affected mitochondrial function as well as the pattern of mitophagy during ischaemia/reperfusion.
- Title: Family screening in black
patients with isolated left ventricular
non-compaction: the Chris Hani Baragwanath
experience
Authors: Anneen L Basson, Mohammed R Essop, Elena Libhaber, Ferande Peters
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 180-184
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DOI Number: 10.5830/CVJA-2020-003
DOI Citation Reference Link: ddx.doi.org/10.5830/CVJA-2020-003
Background: Isolated left ventricular non-compaction (ILVNC), dilated cardiomyopathy (DCMO) and hypertrophic cardiomyopathy (HCM) are diseases that may be present in family members of patients with ILVNC. The primary aim of this study was to identify the prevalence and spectrum of cardiomyopathy in first-degree relatives of patients with ILVNC. A secondary aim was to compare a strategy of clinical screening, utilising only a clinical assessment and electrocardiogram (ECG), compared to one that included echocardiography for screening of family members of patients with ILVNC.
Methods: Eighty-three close relatives of 38 unrelated patients from the ILVNC clinic at the Chris Hani Baragwanath Hospital underwent a detailed clinical history, physical examination, ECG and echocardiogram.
Results: Echocardiographic screening revealed unexplained left ventricular (LV) dysfunction in 10 (12.05%) relatives. Nine out of the 10 individuals satisfied the criteria for diagnosis of DCMO. No cases of HCM or LVNC were identified. A strategy of clinical assessment and ECG had a sensitivity of 76% and a specificity of 42% versus the gold standard of echocardiographic screening.
Conclusion: Echocardiographic screening detected DCMO in 10.8% of subjects. A strategy of clinical screening that included electrocardiography was sub-optimal as a screening strategy compared to echocardiographic screening.
- Title: Incidence and risk factors
for thromboembolism and major bleeding in
patients with mechanical heart valves: a
tertiary hospital-based study in Botswana
Authors: Elizabeth Botsile, Julius Chacha Mwita
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 185-189
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DOI Number: 10.5830/CVJA-2020-006
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-006
Introduction: Mechanical heart valve (MHV) prostheses increase the risk of thromboembolic complications. While warfarin anticoagulation reduces this risk, its use increases the risk of bleeding. We sought to estimate the rate of thromboembolic and bleeding complications among patients with MHVs at a tertiary hospital in Botswana. Factors associated with bleeding and thromboembolic complications are also described.
Methods: This retrospective cohort study involved a cohort of patients with MHV at Princess Marina Hospital who were operated on before September 2017. The study documented bleeding and thromboembolic events since the valve replacement, patients’ demographic information, co-existing medical conditions, drug history and details of valve replacement. Using the recent international normalised ratio (INR) results, each patient’s time in therapeutic range (TTR) was calculated to assess the level of anticoagulation control.
Results: The study enrolled 142 patients with a mean (SD) age of 42 (12) years and a median (IQR) duration since valve replacement of four years (1.8–10.0). The median (IQR) TTR was 29.8% (14.1–51.0) and only 14.8% of the patients had an optimal anticoagulation control. The rates of major bleeding and thromboembolic complications were 1.5 per 100 personyears and 2.80 per 100 person-years, respectively. A longer duration of warfarin use was associated with an increased risk of both bleeding (p = 0.008) and thromboembolic complications (p = 0.01).
Conclusion: Bleeding and thromboembolic complications were common in MHV prosthesis patients in this study. Long duration of anticoagulation, albeit sub-optimal control, was a risk factor for bleeding and thromboembolic complications in these patients. Therefore, long-term efforts are necessary to address these complications and possibly improve the quality of life of these patients.
- Title: Patterns of cardiovascular
risk and disease in HIV-positive adults on
anti-retroviral therapy in Mozambique
Authors: I Dobe, N Manafe, N Majid, I Zimba, B Manuel, A Mocumbi
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 190-195
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DOI Number: 10.5830/CVJA-2020-007
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-007
Introduction: With improved access to anti-retroviral therapy (ART) the focus of HIV treatment is changing to reducing chronic co-morbidities and their effects, but guidelines for HIV care in many African countries do not include screening for cardiac disease. Our study aimed to determine the pattern of cardiac abnormalities in HIV-positive patients on ART.
Methods: We implemented a prospective, observational study for 24 months on a random sample of adult patients seen at a dedicated HIV clinic in Mozambique. Demographic, clinical and full cardiovascular evaluations were performed on all participants.
Results: We enrolled 264 HIV-positive patients (mean age 39.3 years; 186 female, 70.5%). The mean time on ART was 46 (SD 36) months and most had low viral load (174, 65%). Obesity (45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and severe anaemia (21, 8.3%) were frequent. Diabetes was present in four patients (1.5%). The most important conditions in 252 patients submitted to echocardiography (88, 34.9% had cardiac abnormalities) were: severe rheumatic heart valve disease (six), severe dilated cardiomyopathy (five), aortic degenerative disease and congenital heart disease (in three patients each). At 24-month follow up, six of the 252 patients had died; of the 196 reviewed on echocardiography 29 had progressed and two had improved ventricular systolic function.
Conclusions: This young cohort of HIV-positive patients on ART showed lower occurrence of tuberculous pericarditis and dilated cardiomyopathy but high cardiovascular risk, as assessed by the presence of obesity, hypertension and anaemia. Cardiac abnormalities needing multidisciplinary care were also found. There is a need for tailored cardiovascular risk stratification and screening for cardiovascular disease in HIV-positive patients on ART in Africa.
- Title: Short-term efficacy and
safety of levosimendan in patients with chronic
systolic heart failure
Authors: Xiao-Ran Cui, Xiao-Hong Yang, Rui-Bin Li, Dong Wang, Min Jia, Long Bai, Ji-Dong Zhang
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 196-200
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DOI Number: 10.5830/CVJA-2020-008
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-008
Abstract: The objective was to investigate and evaluate the short-term efficacy and safety of levosimendan in patients with chronic systolic heart failure. Forty-nine patients with chronic systolic heart failure during acute decompensation were randomly divided into a levosimendan group (26 cases) and a control group (23 cases). The control group received only routine treatment, while the levosimendan group received a levosimendan bolus with a load of 12 μg/kg, in addition to the same routine treatment as the control group. After 48 hours of treatment, N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in the levosimendan group were significantly lower than those in the control group. In addition, the left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) cardiac function scores of the levosimendan group were significantly higher and more improved than those of the control group seven days after treatment, but there was no significant difference in the left ventricular end-diastolic diameter between the two groups. Furthermore, 48 hours after treatment, there were no significant differences in potassium, haemoglobin, haematocrit and creatinine levels between the levosimendan and control groups. During the whole hospitalisation, there was one case of sudden death in the control group and one case of palpitations in the levosimendan group, and no hypotension or severe hypokalaemia occurred in either group. Levosimendan significantly improved NT-proBNP and LVEF in patients with chronic systolic heart failure, and improved NYHA cardiac function classification without significant cardiovascular events. Levosimendan is therefore effective and safe in the short-term treatment of chronic systolic heart failure.
- Title: Primary PCI in the management
of STEMI in sub-Saharan Africa: insights from
Abidjan Heart Institute catheterisation
laboratory
Authors: Arnaud Ekou, Hermann Yao, Isabelle Kouamé, Rolande Yao Boni, Esther Ehouman, Roland N’Guetta
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 201-204
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DOI Number: 10.5830/CVJA-2020-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-012
Background: Implementation of primary percutaneous coronary intervention (PCI) in sub-Saharan Africa remains a challenging issue. The aim of this study was to report the results of primary PCI and outcomes in the catheterisation laboratory of the Abidjan Heart Institute.
Methods: Between April 2010 and March 2019, all patients aged 18 years presenting to the Abidjan Heart Institute for ST-segment elevation myocardial infarction (STEMI) over the study period and who underwent primary PCI were included. We considered primary PCI when it was performed within 48 hours of the onset of symptoms. Baseline data, PCI characteristics and outcomes were analysed.
Results: Among a total of 780 patients hospitalised for STEMI, 471 were admitted within 48 hours of the onset of symptoms. One-hundred and sixty six patients underwent primary PCI, with a ratio of primary PCI/STEMI of up to 21.3%. One hundred and six patients (63.9%) were admitted within 12 hours of the onset of symptoms. The femoral approach was the most commonly used (78.3%). Primary PCI was performed with stent implantation in 84.3% of patients. Drug-eluting stents (DES) were used in 42.1% of patients. In most cases, angiographic success was observed (157/166, 94.6%). Non-fatal complications were mainly haematomas (3.6%). Peri-procedural mortality rate was 1.2%.
Conclusion: Primary PCI can be performed safely in some small-volume centres in sub-Saharan Africa. Healthcare policies and regional networks must be encouraged in order to improve management of STEMI patients.
- Title: Cardiac surgery-associated
acute kidney injury: pathophysiology and
diagnostic modalities and management
Authors: Gontse Leballo, Palesa Motshabi Chakane
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 205-212
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DOI Number: 10.5830/CVJA-2019-069
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-069
Abstract: Acute kidney injury is a disease spectrum that can present with from mild renal dysfunction to complete renal failure that would require renal replacement therapy. Cardiac surgery-associated acute kidney injury is a complication that carries a grave disease burden. Risk factors are identified as being either modifiable or non-modifiable. This literature review aims to define the pathophysiology of cardiac surgeryassociated acute kidney injury, the current definition and classification of acute kidney injury and the available diagnostic modalities, especially the use of biomarkers.
- Title: Feasibility and effect of
community health worker support and home
monitoring for blood pressure control in
Nigeria: a randomised pilot trial
Authors: Dike B Ojji, Abigail S Baldridge, Anthony I Orji, Lamkur G Shedul, Olubunmi I Ojji, Nonye B Egenti, Ada M Nwankwo, Mark D Huffman
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 213-215
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DOI Number: 10.5830/CVJA-2019-066
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-066
Abstract: In a three-arm, randomised, controlled trial among 60 Nigerian adults with hypertension, community health worker support and home blood pressure monitoring led to greater reductions in systolic blood pressure at four weeks compared to the usual care.
- Title: In Memoriam - Prof Solomon
Elias Levin
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 216-217
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Abstract: It was with deep sadness that I learnt of the passing of Prof Solly Levin a mere 11 days after his wife Cynthia had also passed on. Prof, as he was fondly referred to, was a legend in his time, recognised internationally in the field of paediatric cardiology and paediatrics. He was a giant of a man, a gentleman and a gentle man who influenced countless students, registrars and fellows over a career which spanned close to 70 years.
- Title: Tricuspid valve vegetation
related to leaflet injury: a unique problem of
catheter malposition
Authors: Yan Chen, Hongxia Wang, Yun Mou, Shenjiang Hu
From: Cardiovascular Journal of Africa, Vol 31, Issue 4 July/August 2020
Pages: 217-220
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DOI Number: 10.5830/CVJA-2020-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-005
Abstract: The use of peripherally inserted central catheters (PICCs) has expanded substantially for drug delivery in clinical practice in recent years. However, PICC lines expose patients to potential complications associated with an increasing incidence of infective endocarditis. We herein report a case of a 57-yearold woman who was diagnosed with tricuspid valve endocarditis by echocardiography. The most probable cause was direct injury to the tricuspid valve by the tip of a PICC line with excessive length in the right heart. The vegetation disappeared with conservative treatment after removal of the PICC line. Clinicians must maintain vigilance against any suspected PICC-related infection in febrile patients with a PICC line. For echocardiographers, precise evaluation of the position of the PICC tip and the detection of endocarditis is important to devise the optimal clinical strategy.
