CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 33, ISSUE
1, JANUARY/FEBRUARY 2022
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- Editorial: From the Editor’s Desk
Author: PJ Commerford
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Page: 3
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- Title: How do we measure the implementation of the World Health Assembly resolution on rheumatic fever and rheumatic heart disease in African countries? Rationale and design of an evidence-based scorecard
Authors: Hlengiwe Moloi, Mark Engel, Karen Daniels, Liesl Zühlke
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 4–9
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DOI Number: 10.5830/CVJA-2021-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2020-015
Background: This article aims to explain the rationale and design for developing an evidence-based scorecard to monitor country-level implementation of the 71st World Health Assembly resolution on rheumatic fever and rheumatic heart disease (RHD) in Africa.
Rationale: A scorecard provides a simple and reliable tool for tracking progress over time and establishing accountability mechanisms.
Methods: Development of the scorecard will incorporate engaging RHD stakeholders identified and categorised at a country level. We will conduct individual interviews to understand the barriers and facilitators to implementing the resolution. The Delphi technique will facilitate structured group discussions to develop appropriate indicators. Indicators will be linked to the resolution’s goals to create strategic lines of action, to inform the scorecard. The scorecard will be quantitatively validated in real-life settings.
Discussion: We deem that the rigor of the development process of this study will produce an evidence-based scorecard that is fit for purpose across Africa.
- Title: Association of changes in
NT-proBNP, hsTnT and uric acid levels with
haemodynamic changes after targeted medical
therapies in patients with idiopathic pulmonary
arterial hypertension
Authors: Wen-ting Li, Chang-wei Wu, Jin-ming Liu
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 10–14
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DOI Number: 10.5830/CVJA-2021-018
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-018
Background: During pulmonary arterial hypertension (PAH)-targeted therapies for patients with idiopathic pulmonary arterial hypertension (IPAH), regular follow up to evaluate treatment efficacy is essential. Serum biomarkers can reflect various pathobiological processes in IPAH and have the advantages of being non-invasive, simple to carry out and low cost. The aim of our study was to evaluate whether serum biomarkers could serve as non-invasive markers to reflect haemodynamic changes after PAH-targeted therapies in patients with IPAH.
Methods: A total of 31 eligible patients aged 38.1 ± 12.1 years (25 were female) were included in this study. Changes in haemodynamic parameters and several serum biomarkers (cardiac markers, serum uric acid, high-sensitivity C-reactive protein, hepatic and kidney function markers) were compared before and after at least six months of PAH-targeted therapies. The time interval between the blood assays and right heart catheterisation was within five days.
Results: After at least six months of PAH-targeted therapies, the N-terminal pro-brain natriuretic peptide (NT-proBNP) level decreased from 579 (191–905) to 135 pg/ml (60–395) (p < 0.01), high-sensitivity cardiac troponin T (hsTnT) level decreased from 0.009 (0.006–0.012) to 0.007 ng/ml (0.005– 0.01) (p < 0.01), and serum uric acid level decreased from 381.5 ± 131.4 to 327.2 ± 110.0 μmol/l (p = 0.011). The change in NT-proBNP level was positively correlated with changes in pulmonary vascular resistance (r = 0.538, p < 0.01) and mean pulmonary arterial pressure (r = 0.440, p = 0.013). The change in hsTnT level was positively correlated with the change in mean right atrium pressure (r = 0.504, p < 0.01). The change in serum uric acid level was negatively correlated with that of cardiac index (r = –0.471, p < 0.01).
Conclusion: NT-proBNP, hsTnT and serum uric acid levels can be used as non-invasive tools for evaluating the efficacy of PAH-targeted medications for IPAH patients. The role of these biomarkers in the follow up should be emphasised.
- Title: Comparison of endothelial function and cardiometabolic profiles of people living with HIV in two South African regions: the EndoAfrica study
Authors: Carla Swart, Carla Fourie, Patrick De Boever, Nandu Goswami, Leandi Lammertyn, Hans Strijdom, Festus Kamau, Shani Botha-Le Roux
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 15–20
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DOI Number: 10.5830/CVJA-2021-026
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-026
Background: People living with HIV (PLWH) are at risk for cardiovascular disease, but regional differences have not been studied in South Africa. We compared endothelial function and cardiometabolic markers in PLWH and HIV-free controls from two distinct South African regions.
Methods: We measured flow-mediated dilation (FMD), cardiometabolic, immunological and viral markers in age- and gender-matched PLWH on antiretroviral therapy (n = 100/ group) and HIV-free participants (n = 50/group) in samples from cohort studies in the North West and Western Cape provinces.
Results: Endothelial function and cardiometabolic profiles were not worse in PLWH than in HIV-free individuals, and %FMD was not associated with cardiometabolic, viral or immunological markers. PLWH from the North West region had lower %FMD but overall better metabolic profiles.
Conclusion: Ethnic, cultural and socio-economic differences need further investigation to understand the possible protective role of antiretroviral treatment on the vasculature and to direct region-specific HIV and AIDS guidelines in South Africa.
- Title: Ventricular septal defect closure using radial incision of the tricuspid valve for exposure: is it really necessary?
Authors: Mustafa Karacelik, Cagatay Bilen, Gokmen Akkaya, Ugur Karagoz, Burcin Abud, Ibrahim Erdinc, Osman Nejat Sariosmanoglu
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 21–25
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DOI Number: 10.5830/CVJA-2021-027
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-027
Aim: To evaluate the effects of radial incision of the tricuspid valve in patients who had undergone ventricular septal defect (VSD) closure.
Methods: Overall 173 patients were included in this study between 2012 and 2019. In 44 individuals, a tricuspid valve radial incision (TVRI) was included in the surgical process.
Results: There were no mortalities. The demographic data did not differ between the groups. The mean ages of the TVRI and non-TVRI groups were 2.92 ± 3.88 and 2.69 ± 2.80 years, respectively. There were no significant differences between the groups in terms of mean duration of cardiopulmonary bypass aortic cross-clamp, postoperative intubation time and intensive care unit stay. Mild tricuspid valve regurgitation was detected in only two patients in the TVRI and six patients in the non-TVRI groups. There was no tricuspid valve stenosis and all patients were in New York Heart Association functional class 1.
Conclusion: This technique, which can facilitate exposure and closure of VSDs, did not compromise the tricuspid valve function at mid-term, therefore proving to be safe.
- Title: Resistivity index in the diagnosis and assessment of loss of renal function in diabetic nephropathy
Authors: Yusuf Olanrewaju Jinadu, Yemi Raheem Raji, Samuel Oluwole Ajayi, Babatunde Lawal Salako, Ayodeji Arije, Solomon Kadiri
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 26–32
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DOI Number: 10.5830/CVJA-2021-032
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-032
Objective: The aim of this study was to determine the haemodynamics of the intrarenal arteries from the relationship between resistivity index (RI) and kidney function, and to identify the predictors of high RI among patients with diabetic nephropathy (DN) and those with diabetes mellitus (DM) without DN.
Methods: This was a cross-sectional survey of 133 participants, comprising 40 subjects with DM without DN, 53 with DM with DN and 40 healthy controls. Information obtained was demographics, lifestyle, medical and medication histories, while anthropometric and blood pressure measurements were taken. Albuminuria and estimated glomerular filtration rate were determined and RI was measured using a Doppler ultrasound scan.
Results: The mean intrarenal artery RIs were higher among the patients with DM without DN (0.60 ± 0.04) and the group with DM with DN (0.61 ± 0.04) than in the controls (0.56 ± 0.04) (p = 0.02). Glycated haemoglobin (HbA1c) predicted high RI in the DM without DN group (OR 2.81; CI: 1.73–9.03) while hypertension (OR 3.60; CI: 1.06–12.22) predicted high RI in the DM with DN group.
Conclusion: Elevated intrarenal artery RI was prevalent among patients with DM without DN and those with DM with DN, while elevated HbA1c level and hypertension predicted elevated RI in subjects with DM without DN and those with DM with DN.
- Title: Left brachiocephalic vein–right atrial bypass in superior vena cava syndrome
Authors: Hasan Reyhanoglu, Kaan Ozcan
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 33–35
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DOI Number: 10.5830/CVJA-2021-025
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-025
Abstract: Superior vena cava syndrome (SVCS) is a condition with total or partial stenosis in the superior vena cava (SVC) as a result of intrathoracic malignancies or microtrauma caused by central venous catheterisation. Various invasive and surgical interventions are performed to provide venous drainage in these patients whose head and neck venous blood flow is impaired. In this case report, we report on a bypass performed with a synthetic graft between the left brachiocephalic vein and the right atrium in a patient with SVCS.
- Title: Assessment of pacemaker lead-related infective endocarditis with three-dimensional echocardiography and cardiac computed tomography
Authors: Priya Parbhoo, Tamarin Nell, Ruchika Meel
From: Cardiovascular Journal of Africa, Vol 33, Issue 1 January/February 2022
Pages: 36–40
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DOI Number: 10.5830/CVJA-2021-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-029
Abstract: Pacemaker endocarditis is rare and symptoms may be misleading. If missed, it carries significant morbidity and mortality, particularly in the elderly. Advances in multi-modality imaging in recent years have emphasised its role in clinical decision making. This case highlights the ability of multi-modality imaging techniques to individualise diagnosis, management and prognosis in patients with suspected cardiovascular implantable electronic device (CIED) endocarditis.
