CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 33, ISSUE
4, JULY/AUGUST 2022
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- Editorial: A report card for healthy aging in South Africa
Author: Dirk J Blom
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Page: 167-168
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DOI Number: 10.5830/CVJA-2022-047
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-047
- Title: Associations of conscientiousness with cardiac troponin T and stress coping responses in a teacher cohort: the SABPA prospective cohort study
Authors: Catharina Elizabeth Myburgh, Leoné Malan, Roland von Känel, Hendrik Stefanus Steyn, Nicolaas Theodor Malan
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Pages: 169–178
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DOI Number: 10.5830/CVJA-2021-058
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-058
Background: In a South African bi-ethnic cohort, defensive (DefS)/social support/avoidance coping strategies have been shown to influence cardiac troponin T (cTnT) levels through different stress signalling pathways. Personality traits (extraversion, neuroticism, conscientiousness, openness to experience, agreeableness) partially control stress coping responses and may affect prospective cardiac responses. Hence in this cohort, we aimed to examine relationships between personality traits and coping strategies, and to assess associations between cTnT changes over time, personality traits and coping strategies.
Methods: A cohort of African and Caucasian male and female teachers (n = 359) participating in both phases of the Sympathetic activity and Ambulatory Blood Pressure in Africans (SABPA) study, was prospectively followed for three years. Personality traits (Basic Traits Inventory) and coping (Coping Strategy Indicator) scores were determined. Fasting serum samples for cTnT determination were collected. Established hypertension-related cTnT cut-off points of 4.2 pg/ml (Africans) and 5.6 pg/ml (Caucasians) were applied.
Results: Higher neuroticism and lower conscientiousness scores were found in the Africans than in the Caucasians (p < 0.05). Both traits correlated with all three coping strategies in Caucasians, but only with DefS and avoidance coping in Africans. Over a period of three years, cTnT levels decreased in both races. Compared to Africans, Caucasians showed a greater recovery from the ethnic-specific cTnT cut-off point over time. In the Africans with high DefS scores, cTnT level changes were inversely associated with conscientiousness (adjusted R2 = 0.14; β = –0.26). In Caucasians scoring high in avoidance coping, conscientiousness (odds ratio 0.84) and neuroticism (odds ratio 0.90) showed a lower likelihood of predicting the cTnT cut-off point.
Conclusion: In both races, conscientiousness may contribute to healthier stress coping responses and protect against cardiac ischaemia and risk of hypertension.
- Title: Awareness of heart failure and perception of the problem in the general population
Authors: Marta Kałużna-Oleksy, Michał Wawrzyniak, Monika Klimkowska, Magdalena Dudek, Jacek Migaj, Ewa Straburzyńska-Migaj
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Pages: 180–185
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DOI Number: 10.5830/CVJA-2021-059
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-059
Objective: The aim of this study was to analyse the understanding of heart failure (HF) by the general public and find the best way to raise people’s awareness of this issue.
Methods: This prospective, survey-based registry involved 501 people over 18 years old. The survey included information on the participants’ gender, education, place of residence, medical history, involvement in any area of healthcare, and having relatives suffering from HF. The participants were divided into three age groups, young (< 40 years), middle aged (40–65 years) and elderly (> 65 years), and two groups, depending on whether the participant’s relative was a HF sufferer or not.
Conclusion: Despite an increasing prevalence of heart failure, the general public still has insufficient knowledge on symptoms, causes and treatment methods of this disease. New methods of disseminating information should be considered in order to stop an escalating problem of low awareness of heart failure.
- Title: Bleeding complications in patients on new oral anticoagulants for venous thromboembolism in Kenya
Authors: Antonina Obayo, Mzee Ngunga, Jasmit Shah, Ahmed Sokwala, Anders Barasa
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Pages: 186–192
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DOI Number: 10.5830/CVJA-2021-060
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-060
Background: The incidence of bleeding complications in patients with venous thromboembolism (VTE) on new oral anticoagulants (NOACs) has not been widely studied in contemporary clinical practice in Africa. The purpose of this study was to determine the rates of major bleeding, clinically relevant non-major bleeding (CRNM) and minor bleeding associated with NOAC use
Methods: A retrospective review was carried out of patients diagnosed with venous thromboembolism and treated with NOACs at the Aga Khan University Hospital, Nairobi, from January 2014 to December 2019. Clinical and outcome data were collected from medical records and the hospital mortality database. All patients with VTE aged > 18 years and initiated on NOACS were recruited. Patients with missing information were excluded. They were followed up from the time of commencement of oral anticoagulation to completion of therapy, or to the time of the first major bleed, CRNM or minor bleeding. Data on bleeding were obtained from the hospital database and through telephone interviews. Unadjusted rates of the first major bleeding event or CRNM were calculated as the number of bleeding events per 100 person-years.
Results: Two hundred and forty-three patients with VTE were recruited and 222 (91.4%) were initiated on rivaroxaban, 12 (4.9%) on dabigatran and nine (3.7%) on apixaban, with a median follow up of 213 [interquartile range (IQR): 119–477] days. The median age of the patients was 57 (IQR: 45–71) years. A total of 64 bleeding events were identified in 50 (20.6%) patients. Overall, the incidence rate for bleeding events was 17.24 per 100 patient-years. The incidence rate of major bleeding was 3.79 per 100 person-years. Gastrointestinal bleeding was the most common major bleeding site. There were more females with bleeding events (70.7%) compared to males. Anaemia and the use of aspirin and other antiplatelets were associated with a higher incidence of major and CRNM bleeding [relative risk (RR) = 3.77, confidence interval (CI) = 1.37–10.39, p = 0.005 and RR = 8.89, CI = 2.06–38.33, p = 0.0003, respectively].
Conclusions: Most of these bleeds were minor, with the gastrointestinal tract being the most common source of major bleeding and menorrhagia being the commonest cause of bleeding. Anaemia and the use of aspirin were associated with a higher incidence of major bleeding.
- Title: A 10-year retrospective analysis of the clinical profile and outcomes of infective endocarditis at a tertiary hospital in KwaZulu-Natal, South Africa
Authors: Nerissa Sanrisha Naidoo, Somalingum Ponnusamy, Datshana Prakesh Naidoo
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Pages: 194–199
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DOI Number: 10.5830/CVJA-2021-063
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-063
Objective: To examine the clinical profile and treatment outcomes of infective endocarditis (IE) at a tertiary hospital in KwaZulu-Natal.
Methods: A 10-year retrospective analysis was conducted on cases of definite IE (modified Duke criteria).
Results: Ninety-seven subjects (HIV infected, n = 12) satisfied the study criteria (mean age 29.7 ± 15.6 years, M:F 1.4:1). Underlying rheumatic heart disease was present in 84.5% and severe dyspnoea in 67.0% of cases. Staphylococcus aureus was the commonest pathogen isolated (18.6%). Heart failure was present in 61.9% and vegetations were identified in 85 (87.6%) subjects, resulting in 41 (42.3%) embolic events. The clinical profile and outcomes were similar in the HIV-positive and -negative patients. Surgery was performed in 73 subjects (surgical mortality rate 9.5%, total mortality rate 26.4%). Multivariate analysis identified acute-onset IE [odds ratio (OR) 251.46, 95% confidence interval (CI) 1.18–5343.63, p = 0.043], vegetation size > 15 mm (OR 222.60, 95% CI 1.04–4730.34, p = 0.043) and medical management only (OR 20.89, 95% CI 2.12–200.06, p = 0.037) as predictors for increased in-hospital mortality.
Conclusion: IE affects young people with underlying rheumatic heart disease and is associated with high morbi-mortality attributable to advanced disease at presentation and to haemodynamic failure resulting from valve destruction due to acute onset of aggressive infection.
- Title: The Healthy Aging Adult South Africa report card: a systematic review of the evidence between 2013 and 2020 for middle-aged South African men and women
Authors: Lisa K Micklesfield, Andrea Kolkenbeck-Ruh, Gudani Mukoma, Alessandra Prioreschi, Rihlat Said-Mohamed, Lisa J Ware, Molebogeng Motlhatlhedi, Stephanie V Wrottesley, Shane A Norris
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Pages: 200–219
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DOI Number: 10.5830/CVJA-2022-015
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-015
Abstract: Due to the increasing non-communicable disease burden in Africa, several strategies that target the major lifestyle and physiological risk factors have been implemented to combat such diseases. The Healthy Aging Adult South Africa report card systematically reviews national and regional prevalence data of middle-aged South African adults (45–65 years) published between 2013 and 2020 on diet, physical activity, tobacco use and alcohol consumption, obesity, hypertension, dyslipidaemia and diabetes mellitus. Each indicator was assigned two grades, (1) based on the availability of prevalence data, and (2) based on whether policies have been proposed and implemented for the respective indicators. Alcohol consumption, obesity, hypertension and diabetes received an A grade for the availability of prevalence data. Tobacco use and diet received an A grade for policy and implementation. Gaps have been identified that need to be filled by future research focusing on continued surveillance of all indicators in order to inform and implement effective policies.
- Title: Surgical treatment of left atrial dissection caused by percutaneous coronary intervention
Authors: Shiqiang Wang, Jiakan Weng, Fan He, Ximing Qian, Yu Liu, Huaidong Chen
From: Cardiovascular Journal of Africa, Vol 33, Issue 4 July/August 2022
Pages: 220–224
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DOI Number: 10.5830/CVJA-2021-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2021-045
Abstract: Left atrial dissection (LatD), also known as left atrial intramural haematoma, is a rare condition that requires rapid diagnosis and frequently calls for timely surgical intervention. Diagnosis can be challenging because of a lack of definitive clinical criteria, and a patient’s situation can be complicated by co-morbidities, including unstable haemodynamics. We surgically repaired a case of LatD related to percutaneous coronary intervention (PCI). The operation went smoothly, and the patient was discharged one week after the operation. For LatD patients with co-morbidities, especially haemodynamic disorders, active surgical intervention is recommended.
