CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 32, ISSUE
4, JULY/AUGUST 2021
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- From the Editor’s Desk: Covid-19 and cardiovascular disease
Author: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Page: 177
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- Title: Value of peripheral blood neutrophil-to-lymphocyte ratio for clinical diagnosis and prognosis of elderly patients with chronic heart failure and atrial fibrillation
Authors: Chentao Yang, Hua Yang, Sufang Feng, Jie Qin
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 178–181
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DOI Number: 10.5830/CVJA-2021-004
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-004
Aim: We aimed to explore the value of peripheral blood neutrophil-to-lymphocyte ratio (NLR) for the clinical diagnosis and prognosis of elderly patients with chronic heart failure (CHF) and atrial fibrillation (AF).
Methods: A total of 248 eligible patients were followed up for five years, and divided into major adverse cardiovascular event (MACE) and non-MACE groups. The independent predictive factors for MACE were explored by multivariate logistic regression analysis. Based on quartile of NLR, they were divided into groups A to D. The duration of MACE was analysed using Kaplan–Meier survival curves. The diagnostic value of NLR for MACE was evaluated by receiver operating characteristic curves.
Results: Higher age, low-density lipoprotein cholesterol and NLR, lower left ventricular ejection fraction, diabetes and NYHA heart function class III and IV were independent predictive factors for MACE. The incidence of MACE rose with increasing NLR. Groups A to D had significantly different rates of acute myocardial infarction, severe arrhythmia and cardiac death (p < 0.05). The average duration of MACE in groups A to D were 49.31, 45.27, 43.63 and 40.34 months, respectively.
Conclusion: The sensitivity and specificity of NLR for diagnosis of MACE were 72.39 and 86.18%, respectively. NLR was an independent predictive factor for MACE in these elderly patients with CHF and AF.
- Title: Assessing volumetric changes in abdominal aortic aneurysms following endovascular repair
Authors: Yalçın Gunerhan, Mehmet Isik, Yüksel Dereli, Omer Tanyeli, Cengiz Kadıyoran, Mehmet Sinan Iyisoy, Niyazi Gormus
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 182–187
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DOI Number: 10.5830/CVJA-2021-005
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-005
Objective: Volumetric changes in the aneurysm sac were evaluated following endovascular aortic repair (EVAR) in intact abdominal aortic aneurysm (AAA) patients who underwent EVAR.
Methods: Fifty-two patients, who underwent EVAR from 2015 to 2019, were analysed retrospectively. A total of 158 computed tomography angiography scans was examined by performing reconsctructive volumetric calculations. Total aneurysm volume (TAV), patent lumen volume (PLV) and thrombuscoated aneurysm wall volume (TCAWV) were calculated. The results obtained at six, 12 and 24 months postoperatively were compared with those of the pre-operative period.
Results: Mean TAV had regressed 7% by the sixth month (p = 0.1), 27% by the 12th month (p = 0.0003) and 19% by the 24th month (p = 0.0008). Mean TCAWV had increased 2% by the sixth month (p = 0.3), and regressed 26% by the 12th month (p = 0.3) and 14% by the 24th month (p = 0.8). Mean PLV had regressed by 20% by the sixth month (p = 0.008), 29% by the 12th month (p = 0.0002) and 26% by the 24th month (p = 0.0006). For each individual proximal, middle and distal measurement, regression was observed at six and 12 months; however, an increase was observed at 24 months compared to the previous follow ups.
Conclusion: The expansion measurements of TAV in the 24th month support the doubts on the medium- to long-term results of EVAR. The largest regression in the aneurysm sac was observed in the distal portion, then in the proximal portion, and the least regression was observed in the middle section.
- Title: An epidemiological study to define the recent clinical characteristics and outcomes of infective endocarditis in southern Turkey
Authors: Aynur Acibuca, Mustafa Yilmaz, Sefa Okar, Ebru Kursun, Onur Acilar, Abdullah Tekin, Yusuf Ziya Demiroglu, Ibrahim Haldun Muderrisoglu
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 188–192
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DOI Number: 10.5830/CVJA-2021-009
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-009
Introduction: The aim of this study was to characterise the recent features of patients with infective endocarditis (IE) at one referral centre in southern Turkey, in order to be able to identify the high-risk subgroup and revise preventative measures and management strategies.
Methods: Medical records of patients 18 years and older, who had been diagnosed with IE according to the Duke criteria between January 2009 and October 2019, were retrospectively evaluated in a referral general hospital.
Results: The total of 139 IE cases comprised 59.7% males and 40.3% females, with a mean age of 55 ± 16 years. The most encountered symptom was fever (55.4%) and the mitral valve (54%) was the most frequently involved. The most common causative micro-organisms were coagulase-negative staphylococci (30.2%). The in-hospital mortality rate was 30.2%, with congestive heart failure, chronic renal disease and chronic dialysis found to be significantly associated with in-hospital mortality.
Conclusion: The study results demonstrate the recent epidemiological features of IE in southern Turkey that are important for clinicians to manage diagnostic and therapeutic processes successfully. Older age, the predominance of staphylococci and higher surgery rates are consistent with the changing trends of IE in some parts the world.
- Title: Experience of cardiac
implantable electronic device lead removal from
a South African tertiary referral centre
Authors: Philasande Mkoko, Nicholus Xolani Mdakane, Glenda Govender, Jacques Scherman, Ashley Chin
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 193–197
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DOI Number: 10.5830/CVJA-2021-010
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-010
Background: The rate of cardiac implantable electronic device (CIED) implantation in low- and middle-income countries is increasing. Patients recieving these devices are frequently older and with multiple co-morbidities, which may later lead to complications requiring CIED removal. CIED removals are associated with life-threatening complications. However, high sucesss rates are reported in high-income countries. The purpose of this study was to report on the experience of CIED removal in a resource-constrained setting.
Methods: In this retrospective study, we included consecutive adult patients admitted to Groote Schuur Hospital and the University of Cape Town Private Academic Hospital for CIED removal from 1 January 2008 to 31 December 2019.
Results: During the study period, 53 patients underwent CIED removal (26 extractions and 27 explants). The patients had a mean (standard deviation) age of 59.1 (16.0) years. A history of systemic hypertension was present in 50.9% of patients, diabetes mellitus in 30.2% and dilated cardiomyopathy in 47.2%. Complete heart block was the leading indication for CIED implantation (37.7%), and device infection was the leading indication for removal (69.2%). CIEDs were removed after a median (interquantile range) of 243 (53–831) days. There were 40 leads extracted and 35 explants. Lead extractions
were perfomed in the cardiac catheterisation laboratory under general anaesthesia via a percutaneous transvenous superior approach. There was one major and one minor complication related to lead extraction.
Conclusion: CIED infections were the primary indication for CIED removal in a tertiary referral centre in South Africa. Despite being a low-volume centre, we report a high percutaneous transvenous extraction success rate with low complication rate; results which are comparable to high-volume centres.
- Title: Knowledge, attitude and
practice towards therapeutic lifestyle changes
in the management of hypertension in Khartoum
State
Authors: Ahmed Ali Abdalla
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 198–203
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DOI Number: 10.5830/CVJA-2021-011
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-011
Background: Hypertension has long been recognised as a major risk factor for coronary artery disease, stroke and kidney disease. Despite a multitude of new pharmacological agents, in the Sudan, a significant proportion of hypertensive patients’ blood pressure remains uncontrolled. An important, often underutilised treatment approach is therapeutic lifestyle changes (TLC). This study aimed to assess the knowledge, attitude and practice of patients with regard to TLC in the management of hypertension in a Khartoum locality in 2016.
Methods: The study was cross sectional and descriptive. Data were collected via structured interviews using a questionnaire. Full coverage of patients attending Ahmed Gasim and Al-Shaab hospitals for follow up during August and September 2016 was carried out. Descriptive and inferential statistics were utilised for data analysis.
Results: We identified 112 patients for participation in this study. There was a slight preponderance of females (54.5%) and older age, with 58% in the 55- to 70-year age group. When assessed for knowledge on lifestyle and habits that affect blood pressure, respondents were most familiar with the fact that salt consumption affects blood pressure, 93.8% answering correctly. After knowledge scores were calculated, only 31.3% of participants had above-average knowledge on blood pressure and TLC. The lifestyle change the respondents were least adherent to was regular exercise, with 59.8% of participants struggling with this. Participants’ most-cited obstacle was lack of motivation, the same answer being most frequent for each lifestyle change.
Conclusion: This study demonstrated that although the hypertensive patients were generally aware of the importance of TLC in its management, they struggled to implement this. The researcher believes that novel approaches are needed to help motivate patients who are diagnosed with hypertension in a third-world country such as Sudan, and apply their knowledge regarding TLC.
- Title: The discrepancy of aromatase
expression in epicardial adipose tissue between
CHD and non-CHD patients
Authors: Yifan Li, Weiwei Cheng, Bin Zhao, Dongliang Ma, Xing Wei, Shunye Zhang
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 204–207
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DOI Number: 10.5830/CVJA-2021-012
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-012
Objectives: Epicardial adipose tissue (EAT) aromatase converts androstenedione and other adrenal androgens into oestrogens. The locally produced oestradiol (E2) may have cardiovascular protective effects. Little is known about the relationship between EAT aromatase level and coronary heart disease (CHD). Here, we compared EAT aromatase levels in CHD versus non-CHD patients and assessed the relationship between EAT aromatase levels and lesion degree in the coronary arteries.
Methods: EAT and blood specimens were obtained from patients undergoing thoracotomy prior to cardiopulmonary bypass. Serum E2 levels were obtained from our hospital laboratory. EAT aromatase expression was determined by RT-qPCR and ELISA assays. All patients underwent coronary angiography and the level of coronary lesions was evaluated with the SYNTAX score.
Results: Compared with non-CHD patients, CHD patients had lower EAT aromatase mRNA and protein levels. In the CHD patients, EAT aromatase and oestrogen levels negatively correlated with the severity of coronary artery disease.
Conclusion: Our data revealed that reduced EAT aromatase levels correlated with coronary atherosclerotic lesions. Reduced EAT aromatase protein levels may aggravate the severity of atherosclerosis. Future studies should investigate the mechanisms regulating aromatase expression in epicardial fat.
- Title: Long-term blood pressure
trajectories and associations with age and body
mass index among urban women in South Africa
Authors: Muchiri E Wandai, Samuel OM Manda, Jens Aagaard-Hansen, Shane A Norris
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 208–214
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DOI Number: 10.5830/CVJA-2021-014
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-014
Background: Blood pressure (BP) is known to increase inevitably with age. Understanding the different ages at which great gains could be achieved for intervention to prevent and control BP would be of public health importance.
Methods: Data collected between 2003 and 2014 from 1 969 women aged 22 to 89 years were used in this study. Growth curve models were fitted to describe intra- and inter-individual trajectories. For BP tracking, the intra-class correlation coefficient (ICC) was used to measure dependency of observations from the same individual.
Results: Four patterns were identified: a slow decrease in BP with age before 30 years; a period of gradual increase in midlife up to 60 years; a flattening and slightly declining trend; and another increase in BP in advanced age. These phases persisted but at slightly lower levels after adjustment for body mass index. Three groups of increasing trajectories were identified. The respective number (%) in the low, medium and highly elevated BP groups were 1 386 (70.4%), 482 (24.5%) and 101 (5.1%) for systolic BP; and 1 167 (59.3%), 709 (36.0%) and 93 (4.7%) for diastolic BP. The ICC was strong at 0.71 and 0.79 for systolic and diastolic BP, respectively.
Conclusion: These results show that BP preventative and control measures early in life would be beneficial for control later in life, and since increase in body mass index may worsen hypertension, it should be prevented early and independently.
- Title: Dietary intakes of green
leafy vegetables and incidence of cardiovascular
diseases
Authors: Akin Ojagbemi, Akinkunmi Paul Okekunle, Paul Olowoyo, Onoja Matthew Akpa, Rufus Akinyemi, Bruce Ovbiagele, Mayowa Owolabi
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 215–223
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DOI Number: 10.5830/CVJA-2021-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-017
Aim: Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. This study sought to determine the specific effect of GLV intake on the incidence of CVD.
Methods: Previously published cohort studies on GLV intake and incidence of CVD were retrieved through a systematic search of Google Scholar, EMBASE, MEDLINE, HINARI and Cochrane Library. A methodological evaluation of studies was carried out using the network of Ottawa scale, and a fixed-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI). Heterogeneity was determined using the I2 statistic. Sensitivity analysis was done using the leave-one-study-out technique. All statistical analysis was carried out at p < 0.05 using RevMan 5.4.
Results: The pooled RR (95% CI) of incident CVD events from 17 studies was 0.93 (0.92–0.95). Specifically, GLV intake was inversely related with incident cerebral infarction (RR: 0.92; 95% CI: 0.88–0.96), heart disease (RR: 0.93; 95% CI: 0.87–0.99) and other CVD events (RR: 0.95; 95% CI: 0.93–0.98).
Conclusion: GLV intake was associated with a lower incidence of CVD, and may be a promising primary-prevention strategy against CVD events. The findings are especially important in LMICs where the burden of CVD remains high.
- Title: Caseous calcification of the
mitral annulus mimicking benign cardiac tumour
of the mitral valve
Authors: Huanhuan Gao, Lei Yao, Yan Cheng, Chao Wu, Xiaoli Mei, Yun Mou, Lijun Jiang, Zhelan Zheng
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 224–227
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DOI Number: 10.5830/CVJA-2021-017
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-017
Abstract: Caseous calcification of the mitral annulus (CCMA) is a rare subtype of mitral annular calcification. It usually appears as a large, round, mass-like calcification with an echolucent core, which may be misdiagnosed as an intracardiac mass, cyst, thrombus or abscess of the mitral valve. We present a case report of CCMA that was misdiagnosed by echocardiography as a benign tumour due to its atypical imaging. The mitral valve mass was resected and it was pathologically confirmed to be a myxoid change with calcification. Echocardiography is the preferred initial diagnostic tool. Myocardial contrast echocardiography (MCE) is used to evaluate the vascularity of intracardiac masses or mass-like lesions, but neither echocardiography nor MCE is reliable for identifying atypical lesions. Cardiac computed tomography is helpful in establishing a diagnosis by showing dense calcifications, while cardiac magnetic resonance imaging is used primarily as a credible tool. We therefore recommend that a diagnosis should be made based on various imaging modalities, if necessary, and operators should be skilled to avoid misdiagnosis.
- Title: Prosthetic heart valve
thrombosis in pregnancy: a case series on acute
management
Authors: S Foolchand, H Ramnarain
From: Cardiovascular Journal of Africa, Vol 32, Issue 4 July/August 2021
Pages: 228–232
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DOI Number: 10.5830/CVJA-2021-013
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-013
Abstract: Rheumatic heart disease is one of the leading causes of valve dysfunction, resulting in prosthetic valve implantation. Changes in physiology and the haemodynamics of pregnancy increase the susceptibility of thrombosis to the prosthetic valve in the pregnant woman. Valve redo surgery carries a considerable risk of maternal and perinatal morbidity and mortality. Women of reproductive age should be well counselled regarding compliance with anticoagulation, contraception and pre-pregnancy planning.
