CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 31, ISSUE
5, SEPTEMBER/OCTOBER 2020
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- Title: Editorial - The prevalence of congenital heart disease: we need to work towards getting more data
Author: J Lawrenson
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Page: 225-226
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- Title: A new inflammatory marker: elevated eosinophil-tolymphocyte ratio associated with presence and severity of isolated coronary artery ectasia
Authors: Mücahid Yilmaz, Hidayet Kayançiçek, Hasan Korkmaz, Nevzat Gözel, Mehmet Nail Bilen, Özlem Seçen, Pinar Öner, Ökkeş Uku, Suat Demirkiran, Yusuf Çekici, Orkun Eroğlu, Kurtoğlu Ertuğrul
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 227-235
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DOI Number: 10.5830/CVJA-2019-049
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2019-049
Objectives: The pathophysiology of isolated coronary artery ectasia (CAE) involves atherosclerosis and inflammation. Eosinophils and lymphocytes have been found to play a significant role in inflammation, atherosclerosis and endothelial dysfunction. Many studies have explored the relationship between isolated CAE and systemic inflammation. However, there are no data regarding the relationship between eosinophil-to-lymphocyte ratio (ELR) and isolated CAE. Therefore, this study analysed the relationship between ELR and isolated CAE.
Methods: All patients who underwent coronary angiography between January 2009 and June 2018 were investigated retrospectively. Of 16 240 patients, 232 patients with isolated CAE (141 males) and 247 age- and gender-matched control subjects (130 males) with normal coronary angiography (NCA) were enrolled in this study. Baseline demographic and laboratory data were obtained from the hospital database. The severity of isolated CAE was determined according to the Markis classification, vessel count and diffuseness of ectasia.
Results: Patients with angiographic isolated CAE had significantly elevated white blood cell (WBC) and eosinophil counts and ELR values compared to patients with NCA [8.11 ± 1.75 vs 7.49 ± 1.80 × 109 cells/l, p < 0.0001; 0.22 (0.13–0.32) vs 0.19 (0.12–0.28) × 109 cells/l, p = 0.02; 0.11 (0.06–0.17) vs 0.08 (0.05–0.12), p < 0.0001. The ELR value for Markis I was significantly higher than for Markis IV (p = 0.04), and three-vessel isolated CAE was significantly higher than onevessel isolated CAE (p = 0.04). Additionally, the ELR value for diffuse ectasia (Markis class I, II and III) was significantly higher compared to focal (Markis class IV) ectasia (p = 0.02). In receiver operating characteristics (ROC) analyses, it was determined that an ELR value > 0.099, measured in isolated CAE patients at application, had a predictive specificity of 60.3% and a sensitivity of 56.5% (area under the curve: 0.604, 95% confidence interval: 0.553–0.655, p < 0.0001).
Conclusion: Patients with isolated CAE had higher blood eosinophil counts and ELR. Furthermore, the ELR was significantly correlated with severity of isolated CAE. These findings demonstrate that ELR may have a significant role in the aetiopathogenesis of isolated CAE.
- Title: Echocardiographic abnormalities in children and adolescents living with human immunodeficiency virus on highly active antiretroviral treatment
Authors: Tewolde Wubayehu, Workeabeba Abebe, Endale Tefera
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 236-240
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DOI Number: 10.5830/CVJA-2019-072
DOI Citation Reference Link: ddx.doi.org/10.5830/CVJA-2019-072
Background: The availability and use of highly active antiretroviral treatment (HAART) has turned human immunodeficiency virus (HIV) into a chronic disease, allowing patients to live much longer. Objectives: To report asymptomatic cardiac abnormalities in children and adolescents based on both conventional and tissue Doppler imaging (TDI) echocardiography.
Methods: One hundred and fifty-one patients on HAART were recruited. Demographic and clinical variables were collected through patient interviews and medical record reviews. Conventional echocardiography and TDI were performed on each patient.
Results: Mean age was 13.0 ± 3.2 (4.0–19.0) years. Eightythree patients (55%) were female. Age at diagnosis of HIV infection was 5.7 ± 3.3 years. Age at initiation of HAART was 7.34 ± 3.54 years, while duration of HAART was 59 ± 39.1 months. On conventional echocardiography, three cases of left ventricular (LV) systolic dysfunction, two of pulmonary hypertension and one of minimal pericardial effusion were identified. Calculation of myocardial mass index (MMI) revealed that 16 patients had abnormal values. Twenty-seven (17.9%) patients had evidence of LV diastolic dysfunction and 18 (11.9%) had right ventricular (RV) diastolic dysfunction. Nineteen (12.6%) patients had tricuspid annular systolic velocity of < 9.5 cm/s, indicating asymptomatic RV systolic dysfunction.
Conclusion: While few patients had abnormalities such as reduced LV ejection fraction, pulmonary hypertension and minimal pericardial effusion detectable on conventional echocardiography, a larger proportion of patients had subtle abnormalities such as increased MMI, LV diastolic dysfunction on TDI, RV dysfunction and abnormal myocardial performance index. Such patients may need routine screening and cardiac follow up.
- Title: Effect of heroin on right ventricular cardiac performance
Authors: Murat Selcuk, Ersin Yildirim, Faysal Saylik, Ozgur Deniz, Ferit Onur Mutluer
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 241-244
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DOI Number: 10.5830/CVJA-2020-002
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-002
Objective: The aim of this study was to investigate the effects of heroin addiction, which is an important social and health problem, on right cardiac function.
Methods: A total of 85 individuals were included in the study. The study group comprised 45 patients smoking heroin and the control group was 40 healthy individuals with no drug addiction. Patients injecting heroin were excluded. Echocardiographic evaluation of patients using heroin was performed and compared with those in the control group.
Results: The right ventricle and pulmonary artery diameters in the heroin group were found to be higher compared to the control group. The myocardial performance index (MPI) was higher and more abnormal in the heroin group (0.48 ± 0.22 vs 0.39 ± 0.11, p < 0.05) whereas isovolumic acceleration (IVA) of the right ventricle was significantly lower in the heroin group (2.92 ± 0.69 vs 3.4 ± 0.68 m/s2, p < 0.01). No significant difference was observed between the groups with regard to the right ventricular ejection fraction (RVEF) (59.6 ± 2.5 vs 60.6 ± 2.3%, p = 0.08), tricuspid annular plain systolic excursion (TAPSE) (24.1 ± 4.2 vs 24.5 ± 2.4 mm, p = 0.7), tissue Doppler imaging S wave (TDI-S) (13.7 ± 2.1 vs 13.8 ± 2.1 cm/s, p = 0.86) and right ventricular fractional area change (RVFAC) (42.7 ± 8.3 vs 43.9 ± 3.5%, p = 0.4). Multivariate and univariate regression analyses revealed independent correlation between the pulmonary artery diameter and RVIVA, and heroin addiction.
Conclusion: Heroin addiction negatively affected right ventricular function and more attention should be paid to the cardiac function of these patients.
- Title: The therapeutic management of South African dyslipidaemic patients at very high cardiovascular risk (CARDIO TRACK): a cross-sectional study
Authors: Dirk Jacobus Blom, Naresh Ranjith, Pankaj Joshi, Poobalan Naidoo, Alet van Tonder, Moji Ganiyat Musa, Shaifali Joshi, Rory Leisegang, Julien Shane Trokis, Hemant Makan, Frederick Johan Raal
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 245-251
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DOI Number: 10.5830/CVJA-2020-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-010
Background: Dyslipidaemia is a major modifiable risk factor for atherosclerotic cardiovascular disease. At the time the study was conducted, guidelines recommended a low-density lipoprotein cholesterol (LDL-C) target of less than 1.8 mmol/l and a reduction of at least 50% if the baseline LDL-C was between 1.8 and 3.5 mmol/l in patients with either very high cardiovascular risk or established atherosclerosis. In South Africa, there is a paucity of data on attainment of LDL-C goal in patients with very high cardiovascular risk who are on maximum tolerated statin with or without ezetimibe. Objective: The aim was to assess the percentage of very high cardiovascular risk South African patients with dyslipidaemia not reaching an LDL-C goal of less than 1.8 mmol/l, despite maximum tolerated statin with or without ezetimibe.
Methods: This was a multi-centre, observational, crosssectional study conducted at 15 private healthcare sector sites and one public sector site. Adults (> 18 years) with very high cardiovascular risk of familial hypercholesterolaemia receiving stable, maximum-tolerated statin therapy for at least four weeks prior to their latest lipid profile were enrolled into the study, and electronic case report forms were completed after written informed consent was provided. LDL-C goal attainment was modelled, first assuming an increase in the statin dose to the registered maximum, followed by the addition of ezetimibe or a PCSK9-inhibitor.
Results: In total, 507 patients were screened, of whom 492 were eligible for study participation. One patient was excluded from the analysis because of a missing LDL-C value. Most participants were male (male 329, 67%; female 162, 33%). Most patients were either obese (223, 46.0%) or overweight (176, 36.3%). Hypertension and diabetes mellitus were frequent co-morbidities and were found in 381 (77.6%) and 316 (64.4%) patients, respectively. Eighty (16.3%) patients reported current smoking. Only 68 (13.8%) patients were taking ezetimibe in addition to a statin. Reasons for not using ezetimibe included no requirement for ezetimibe in the opinion of the treating physician (229, 48.7%), cost (149, 31.7%), physician’s choice (39, 8.3%), or other (53, 11.3%). Only 161 (32.8%) of the patients attained their goal LDL-C level. In our modelling analysis, increasing the statin dose to the registered maximum and adding ezetimibe brought an additional 34.5% of patients to goal, while adding a PCSK9-inhibitor, irrespective of any other changes to lipid-lowering therapy brought over 90% of not-at-goal patients to goal.
Conclusion: Most study participants were not at LDL-C goal despite maximum-tolerated statin, highlighting the need for treatment intensification in this high-risk population. Although intensifying treatment by adding a PCSK9- inhibitor brought more patients to goal, the initial addition of ezetimibe would be more reasonable, given the cost of PCSK9-inhibitors.
- Title: Effect of invasive strategy on long-term mortality in elderly patients presenting with acute coronary syndrome
Authors: Samet Yilmaz, Mehmet Koray Adali, Oguz Kilic, Aysen Til, Yalin Tolga Yaylali
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 252-256
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DOI Number: 10.5830/CVJA-2020-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-011
Objective: The elderly have the highest incidence of cardiovascular disease and frequently present with acute coronary syndrome (ACS). In this study, our aim was to evaluate the effect of an invasive strategy on long-term mortality in patients of 80 years and older presenting with ACS.
Methods: Patients who were admitted to hospital with ACS were recruited using appropriate ICD codes in the computerised hospital data system. After exclusion of patients below 80 years old, the remaining 156 patients were involved in the final analyses. Ninety-four of 156 patients (60.3%) underwent coronary angiography and they constituted the invasivestrategy group, whereas the remaining 62 (39.7%) patients were treated medically and they constituted the conservativestrategy group.
Results: Median follow-up duration of patients was 8.5 (0–61) months. Total mortality at the end of the follow-up period was 24 (25.5%) patients in the invasive-strategy group and 30 (48.4%) in the conservative-strategy group (p = 0.006). According to Cox regression analysis, the invasive strategy (OR: 0.26, 95% CI: 0.12–0.56, p = 0.001), presentation with ST-segment elevation myocardial infarction (OR: 7.76, 95% CI: 1.74–34.57, p = 0.002), low ejection fraction below 40% (OR: 3.11, 95% CI: 1.43–6.76, p = 0.004), heart rate (OR: 0.98, 95% CI: 0.96–0.99, p = 0.013) and GRACE risk score between 150 and 170 (OR: 7.76, 95% CI: 1.74–34.57, p = 0.002) were related to long-term mortality.
Conclusions: Our results show the benefit of the invasive strategy on mortality rate in elderly patients over 80 years old and presenting with ACS.
- Title: Clinical spectrum and prevalence of congenital heart disease in children in Botswana
Authors: Tiny Mazhani, Andrew P Steenhoff, Endale Tefera, Thuso David, Zaakir Patel, Warona Sethomo, Marek Smieja, Loeto Mazhani
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 257-261
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DOI Number: 10.5830/CVJA-2020-021
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-021
Background: Reliable data on congenital heart disease (CHD) from diverse settings is important both for planning health systems in each country and to elucidate possible aetiologies of CHD in different settings. There is a lack of data on the clinical spectrum and prevalence of CHD in Botswana. The aim of this study was to describe the clinical spectrum and prevalence of CHD in Botswana.
Methods: This was a retrospective, descriptive, cross-sectional study of all children from birth to 15 years who had had an echocardiogram performed as an in- or out-patient at Princess Marina Hospital (PMH) between 1 January 2010 and 31 December 2012.
Results: Of 377 enrollees, 140 (40%) had normal echocardiographs, 170 (45%) had CHD, and 57 (15%) had an acquired lesion. In the CHD patients, median age was 0.9 years (Q1: 0.2, Q3: 4.1) and 85 (50%) were male. Ventricular septal defect (VSD) (29%), patent ductus arteriosus (18%), atrioventricular septal defect (AVSD) (10%) and tetralogy of Fallot (TOF) (6%) were the predominant pathologies. VSD was the most common acyanotic lesion and TOF the most common cyanotic lesion. The estimated prevalence of CHD was between 2.8 and 4.95 per 1 000 live births.
Conclusions: The clinical spectrum of CHD in Botswana is similar to that observed in other African countries and in the Western world, with VSD the most common acyanotic lesion and TOF the most common cyanotic lesion. The prevalence of CHD was 2.8–4.95 per 1 000 live births, in keeping with other settings. This is the first study to describe CHD in Botswana, and it aimed to stimulate subsequent studies in this field.
- Title: Subclinical anthracycline therapy-related cardiac dysfunction: an ignored stage B heart failure in an African population
Authors: Wan Zhu Zhang, Feriel Azibani, Karen Sliwa
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 262-266
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DOI Number: 10.5830/CVJA-2020-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-013
Abstract: Anthracyclines are potent antineoplastic agents with a proven efficacy in the treatment of many paediatric and adult haematological and solid-organ cancers. Anthracycline therapy- related cardiac dysfunction (ATRCD) is the commonest and most well-studied chemotherapy-induced cardiovascular toxicity. Therefore patients who received anthracycline therapy are considered in stage A heart failure. Recent study findings suggest that anthracycline cardiotoxicity represents a continuum that begins with subclinical myocardial cell injury, followed by an early asymptomatic decline in left ventricular ejection fraction that can progress to symptomatic heart failure if left untreated. In Western countries, ATRCD has been reported in 57% of anthracyclines-treated patients. However, data on incidence and spectrum of ATRCD in Africa are not available. This literature review aimed to highlight the concept of subclinical ATRCD as a stage B heart failure in the spectrum of ATRCD, and the importance of early detection. We emphasise the potential burden and risk of subclinical ATRCD in the African population, with the ultimate aim of drawing the attention of health workers in Africa to improve care of the relevant population.
- Title: PASCAR and WHF Cardiovascular Diseases Scorecard project
Authors: Habib Gamra, Jihene Maatoug, Jean M Fourie, Wihan Scholtz, Oana Scarlatescu, George Nel, Hassen Ghannem
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 267-273
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DOI Number: 10.5830/CVJA-2020-043
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-043
Abstract: Data collected by the Pan-African Society of Cardiology for the World Heart Federation’s scorecard project regarding the current state of cardiovascular disease prevention, control and management along with related non-communicable diseases in Tunisia are presented. Furthermore, the strengths, threats, weaknesses and priorities identified from these data are highlighted in concurrence with related sections in the incorporated infographic. Information was collected using open-source data sets available online and relevant government publications.
- Title: Idiopathic hypereosinophilic syndrome associated with rapid progression of cardiac, pulmonary and skin infiltration
Authors: Yu-Quan He, Jin-Ming Zhu, Ya-Liang Tong, Hong Zeng, Ping Yang
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 274-280
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DOI Number: 10.5830/CVJA-2020-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-009
Abstract: Idiopathic hypereosinophilic syndrome (IHES) is a rare myeloproliferative disease characterised by multisystem dysfunction and persistent, extreme eosinophilia of unknown cause. Here we present a 42-year-old patient complaining of moderate to severe chest pain and shortness of breath, and typical ischaemic electrocardiography changes were recorded. He was initially suspected of having acute coronary syndrome, however the coronary angiogram excluded coronary abnormalities. Bone marrow biopsy, left ventriculography, transthoracic echocardiography and cardiac magnetic resonance examinations confirmed the diagnosis of IHES and IHES-mediated cardiac involvement. The patient’s illness was alleviated during the first hospitalisation, whereas it had rapidly worsened one month after discharge. In addition, simultaneous pulmonary and skin-infiltrating lesions occurred during the second hospitalisation. The patient’s condition improved markedly with combined glucocorticoid, hydroxyurea and warfarin therapy, as well as treatment for heart failure. In this report the diagnostic modalities and treatment strategies for IHES are discussed and reviewed.
- Title: Internal thoracic artery pseudoaneurysm after redo aortic root replacement
Authors: Yoshinori Kuroda, Tetsuro Uchida, Azumi Hamasaki, Mitsuaki Sadahiro
From: Cardiovascular Journal of Africa, Vol 31, Issue 5 September/October 2020
Pages: 281-282
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DOI Number: 10.5830/CVJA-2020-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-014
Abstract: Pseudoaneurysm of the internal thoracic artery (ITA) or bleeding from the ITA is an extremely rare complication after cardiovascular surgery via a median sternotomy. Early treatment is needed in the case of massive haemorrhage or a rapidly enlarging pseudoaneurysm. Herein, we present a rare case of a delayed large pseudoaneurysm of the right ITA in a 49-year-old woman with Marfan syndrome who underwent redo aortic root replacement via re-median sternotomy and pacemaker implantation. Diagnostic selective angiography revealed the origin of the pseudoaneurysm, and simultaneous transcatheter embolisation of the ITA was successfully performed. Follow-up computed tomography imaging showed no evidence of contrast media extravasation from the ITA and recurrent extra-pleural haemorrhage. Our findings suggest that postoperative management of patients who have undergone median sternotomy, including cardiovascular surgeries, should also focus on the prevention or early detection of pseudoaneurysm of the ITA to avoid life-threatening conditions.
