CARDIOVASCULAR JOURNAL OF AFRICA: VOLUME 34, ISSUE
4, SEPTEMBER/OCTOBER 2023
This journal is now available to be
viewed via our eJournal publication viewer.
- Editorial
Author: P Commerford
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Page:197
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
- Title: Association between carotid intima–media thickness and acute kidney injury following isolated coronary artery bypass surgery
Authors: Çağrı Düzyol, Hüseyin Şaşkin
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 198–205
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-035
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-035
Objective: The association between pre-operative carotid intima–media thickness (CIMT) and early postoperative acute kidney injury (AKI) following isolated coronary artery bypass grafting (CABG) was investigated.
Methods: Data were sought retrospectively of 237 patients (166 male, 71 female; mean age 61.4 ± 8.1 years; range: 32–74), operated on for isolated CABG with cardiopulmonary bypass (CPB) in a single centre between June 2014 and December 2020, with a serum creatinine level < 1.5 mg/dl and normal carotid arteries on Doppler ultrasonography. AKI diagnosis was made according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline. Patients were grouped as group 1 with AKI in the early postoperative period (n = 63) and group 2 without AKI (n = 174). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was done to determine independent predictors of AKI.
Results: AKI occurred in 63 (26.6%) patients. Pre-operative CIMT was significantly higher in the AKI group (p = 0.0001). Multivariate logistic regression analysis revealed that elevated pre-operative CIMT (p = 0.005), C-reactive protein (p = 0.001), erythrocyte sedimentation rate (p = 0.005), neutrophil– lymphocyte ratio (p = 0.0001) and platelet–lymphocyte ratio (p = 0.0001) increased on the postoperative seventh day. C-reactive protein (p = 0.04), postoperative first day platelet– lymphocyte ratio (p = 0.0001), postoperative seventh day erythrocyte sedimentation rate (p = 0.02) and intubation time (p = 0.02) were independent predictors of early postoperative AKI following isolated CABG.
Conclusion: Pre-operative CIMT was found to be an independent predictor of AKI in the early postoperative period of isolated CABG.
- Title: Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA)
Authors: Serkan Asil, Muhammet Geneş, Salim Yaşar, Serdar Fırtına, Suat Görmel, Erkan Yıldırım, Yalçın Gökoğlan, Hatice Tolunay, Barış Buğan, Ayşe Saatçi Yaşar, Murat Çelik, Uygar Çağdaş Yüksel, Cem Barçın, Hasan Kutsi Kabul
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 206–211
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-045
Background: The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients.
Methods: In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology–voltage–Pwave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak–Tend time and Tpeak–Tend/QT interval were used to determine ventricular arrhythmia risk.
Results: A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak–Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak–Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak–Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA.
Conclusion: In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients.
- Title: Radiation doses in endovascular revascularisation of lower-extremity arterial diseases
Authors: Ibrahim Çağrı Kaya, Fatma Altuntaş Kaya
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 212–216
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-046
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-046
Background: The use of percutaneous endovascular intervention in lower-extremity arterial diseases is increasing daily. With the growing technical experience of vascular surgeons, this is preferred to open surgery in more complex lesions.
Methods: The dose area product (DAP) and fluoro (FL) time values of 150 patients who underwent successful peripheral endovascular arterial intervention were analysed retrospectively. These values were evaluated by grouping according to the anatomical region and complexity of the lesion, type of procedure and arterial access.
Results: While the mean DAP was 18 ± 27 Gy cm2 in patients who underwent only angioplasty, it was 21 ± 17 Gy cm2 in patients who underwent stent implantation after angioplasty (p = 0.069). The DAP value was statistically significantly higher in patients who had intervention in the pelvic region, both in the angioplasty (23 ± 22 Gy cm2) group and in the stenting (29 ± 18 Gy cm2) group, than in patients who had intervention in the femoropopliteal region (18 ± 27 and 15 ± 12 Gy cm2, respectively) (p < 0.05). When the correlation between body mass index (BMI) of the patients and DAP was examined, a moderate positive correlation was found both in the pelvic region (r = 0.601, p = 0.00) and in the femoropopliteal region (r = 0.512, p = 0.00). Out of 78 patients in whom the ipsilateral popliteal retrograde approach was preferred, only two developed arteriovenous fistulae after the procedure, and only two of 77 patients in whom the femoral approach was preferred developed no major or minor complications, except femoral pseudo-aneurysm.
Conclusions: The most important factors affecting the radiation doses of the patients were the anatomical region and the patient’s BMI. Radiation doses were higher in pelvic interventions compared to the femoropopliteal region. This may encourage the choice of arterial approaches that can minimise visualisation of the pelvic region in particular. Therefore, attention should be paid to pre-operative planning, especially in patients undergoing multiple diagnostic and therapeutic imaging. The ipsilateral popliteal retrograde approach can be safely chosen in combined iliofemoral, common femoral and superficial femoral total occlusions in the hands of surgeons with good Doppler ultrasonography experience.
- Title: Determinants of right ventricular systolic dysfunction among patients with left heart failure in a Ghanaian hospital
Authors: Abdul-Subulr Yakubu, Eugene Amable, Alfred Doku, Francis Agyekum
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 218–224
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-051
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-051
Background: The presence of right ventricular dysfunction affects outcomes in patients with left heart failure. We assessed the determinants of right ventricular systolic dysfunction (RVSD) among patients with left heart failure presenting to the Korle Bu Teaching Hospital of Ghana.
Methods: Consecutive patients with left heart failure who were 18 years and above were prospectively enrolled and assessed for evidence of RVSD by measuring the tricuspid annular plane systolic excursion, the peak velocity of the tricuspid annulus in systole (RV S′), the two-dimensional right ventricular fractional area change (RV FAC) and the right ventricular myocardial performance index (RV MPI).
Results: Two hundred and seventy participants were enrolled, of whom 75.2% had at least one abnormal index of right ventricular systolic function. The prevalence of RVSD was significantly higher among those with non-hypertensive heart failure (85.3 vs 66.0%, p < 0.001). The left ventricular outflow tract velocity–time integral (LVOT VTI) was strongly correlated with the RV FAC and an LVOT VTI < 9.8 cm predicted the presence of an RV FAC < 35% with a sensitivity of 81.5% and specificity of 81.9% [area under the curve 0.882; 95% confidence interval (CI): 0.838–0.926, p < 0.001]. Independent predictors of the presence of RVSD included a transmitral E/A > 2 [odds ratio (OR) = 4.684, 95% CI: 1.521–14.428, p = 0.007), left ventricular ejection fraction < 40% (OR = 4.205, 95% CI: 1.643–10.760, p = 0.003), pulmonary artery systolic pressure (PASP) ≥ 35 mmHg (OR = 2.434, 95% CI: 1.012–5.852, p = 0.047) and systemic systolic blood pressure (SBP) < 140 mmHg (OR = 2.631, 95% CI: 1.152–6.011, p = 0.022).
Conclusion: RVSD was common in these Ghanaian patients with left heart failure. Left ventricular function, SBP and PASP were independent predictors of the presence of RVSD. Pending further validation, the LVOT VTI may serve as a useful surrogate or screening tool for RVSD in these patients.
- Title: Association between salt sensitivity and blood pressure variability in patients with essential hypertension and predictive value for cardiovascular events
Authors: Biao Zhang, Dexuan Zhao, Xiaohua Dai, Dengyue Pan
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 225–230
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-048
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-048
Abstract: We aimed to explore the association between salt sensitivity and blood pressure variability in patients with essential hypertension. A total of 730 patients with essential hypertension treated from 2016 to 2019 were subjected to salt-sensitivity risk stratification according to 24-hour ambulatory blood pressure monitoring. Their clinical data were compared among groups with different grades of salt-sensitivity risk, and the association between salt sensitivity and blood pressure variability was analysed. The influencing factors for cardiovascular events in patients with essential hypertension were analysed through multivariate regression analysis, and their predictive value was detected using receiver operating characteristic (ROC) curves. Salt sensitivity was positively correlated with night-time and 24-hour systolic standard deviation and 24-hour systolic blood pressure coefficient of variation. Age ≥ 55 years, family history of cardiovascular diseases, high risk of salt sensitivity, night-time systolic standard deviation ≥ 14 mmHg, 24-hour systolic standard deviation ≥ 20 mmHg and 24-hour systolic blood pressure coefficient of variation ≥ 13.5% were all independent risk factors for cardiovascular diseases in patients with essential hypertension (p < 0.05). The area under the ROC curve of the prediction model was 0.837. There was a positive correlation between salt sensitivity and blood pressure variability, which has predictive value for cardiovascular events in patients with essential hypertension.
- Title: Application of computed tomographic angiography and echocardiography in predicting left atrial appendage thrombosis in patients with non-valvular atrial fibrillation
Authors: Xiaodan Wu, Fan Sun, Shoucheng Ma, Zhichen Wang, Shenghai Xu
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 231–236
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-052
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-052
Aim: We aimed to explore the application of computed tomographic angiography (CTA) and echocardiography in predicting left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation.
Methods: The clinical data of 164 atrial fibrillation patients receiving cardiac CTA and real-time three-dimensional transoesophageal echocardiography (RT-3D-TEE) were retrospectively analysed. The patients were divided into group A (anticoagulant treatment group, n = 112) and group B (selective anticoagulant treatment group, n = 52) according to the CHA2DS2-VASc score, which scored for the presence or absence of congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischaemic attack, vascular disease, age 65–74 years and gender (female). The CHA2DS2-VASc score was used to predict risk of thromboembolism from atrial fibrillation. The correlations of CHA2DS2-VASc score with CTA-based LAA classification and RT-3D-TEE measurement parameters were explored using Spearman’s analysis. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of CTA and RT-3D-TEE for LAA thrombus.
Results: There were significant differences in age, disease course, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke/transient ischaemic attack/thromboembolism, vascular disease, B-type natriuretic peptide and serum uric acid levels, CHA2DS2-VASc score, LAA classification, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length (p < 0.05). CHA2DS2- VASc score was positively correlated with cauliflower LAA, LAD, maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length, and negatively correlated with LVEF (p < 0.001). ROC curve analysis indicated that CTA, RT-3D-TEE and CHA2DS2-VASc score had similar predictive values for risk of LAA thrombosis in atrial fibrillation patients, with the areas under the curve being 0.778, 0.814 and 0.792, respectively.
Conclusion: Both CTA and RT-3D-TEE had high predictive values for LAA thrombosis in atrial fibrillation patients.
- Title: Impact of diabetes mellitus on the frequency of postoperative complications after carotid endarterectomy
Authors: Gojko Lj Igrutinović, Dragoslav Dj Nenezić, Aleksandar R Jakovljević, Zlatan N Elek, Nikola M Miljković, Mladen N Kasalović, Danijela R Vićentijević
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 237–241
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-054
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-054
Background: There is significant controversy surrounding the link between diabetes mellitus and post-operative complications after carotid endarterectomy (CEA). The aim of this study was to identify the possible effects of diabetes on the frequency of post-operative complications after CEA.
Methods: This prospective study was conducted at the Dedinje Clinic for Vascular Surgery, Belgrade. The patients who underwent CEA were divided into two groups: group A (37.7%) included 98 (35.1%) insulin-dependent and 181 (64.9%) insulin-independent diabetic patients, and group B (62.3%) comprised non-diabetic subjects.
Results: The pre-operative characteristics were similar, except for a greater prevalence of dyslipidaemia in patients with diabetes. Post-operative cardiac events occurred more often in patients with diabetes (3.6%) than in non-diabetic patients (1.1%) (p = 0.039); post-operative neurological events among patients with diabetes were 3.6% and among non-diabetics, 0.9% (p = 0.009). Peri-operative mortality rate was 2.5% in the diabetic group and 0.9% in the non-diabetic group. The total percentage of post-operative complications was two or more times higher in the diabetic group than the non-diabetic group (8.5 vs 18.3%, p < 0.001).
Conclusions: Diabetes mellitus increased the surgical risk of CEA. Higher rates of mortality and post-operative complications were observed in patients being treated with oral antidiabetics than in those on insulin.
- Title:Comparison of flowmeter (transit time flow measurement) values for graft flow in three different surgical methods for isolated coronary artery bypass surgery
Authors: Ferhat Borulu, Ümit Arslan, Eyüpserhat Çalik, Bilgehan Erkut
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 242–247
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2023-029
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-029
Background: Graft patency is the most important factor in coronary artery bypass surgery. This study aimed to compare the relationship between three different surgical methods and transit time flow measurement (TTFM), which is used to detect technical problems in anastomoses performed during coronary artery bypass graft operations and to correct them if necessary.
Methods: A total of 110 patients undergoing isolated coronary artery bypass surgery were analysed. Of these patients, 48 were operated on by inducing cardiopulmonary arrest (group 1), 33 were operated on without inducing cardiac arrest (group 2) during cardiopulmonary bypass surgery, and 29 underwent surgery on the off-pump beating heart (group 3). TTFMs were performed on all the patients’ grafts. Additional surgical intervention requirements, the need for intra-operative and postoperative inotropic support, and all postoperative follow-up data were compared.
Results: In total, 110 patients were measured for 301 grafts. Due to insufficient measurements performed on these patients, additional surgical intervention was performed on five grafts in group 1, five grafts in group 2, and seven grafts in group 3. These interventions enabled a normal flow rate to be achieved. The number of grafts that required revision was highest in group 3. There was no difference between the groups in terms of demographic data, EuroSCORE II, preoperative ejection fraction, postoperative complications and mortality rate.
Conclusion: TTFM is important for detecting technical problems in grafts. We believe that all surgical methods can be applied more safely by controlling graft flow.
- Title: The importance of baseline fractional flow reserve to detect significant coronary artery stenosis in different patient populations
Authors: Ismet Zengin, Alper Karakus
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 248–254
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2023-045
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2023-045
Introduction: Fractional flow reserve (FFR) assessment compares the blood flow on either side of a blockage in the coronary artery and indicates how severe the stenosis is in the artery. Intravenous adenosine is widely used to achieve conditions of stable hyperaemia for the measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially. Therefore, FFR has some limitations, such as the side effects of adenosine and the long procedure time. In addition, there are not enough studies on the evaluation of the baseline ratio of distal coronary pressure to aortic pressure (Pd/Pa) according to standard cut-off values in coronary stenosis under special clinical conditions. This study aimed to assess the diagnostic power of the baseline FFR value for critical coronary stenosis and to determine its predictive value in special patient groups.
Methods: This retrospective study included 158 patients, who were stratified as Q1 (< 0.89), Q2 (0.89–0.92), Q3 (0.93–0.95) and Q4 (> 0.95) based on baseline FFR values. The baseline Pd/Pa value, the change in adenosine FFR and the raw FFR change were recorded. Its predictive value was also calculated for specific patient groups.
Results: The threshold value of baseline FFR level for predicting critical stenosis was ≤ 0.92 with a sensitivity of 92.8% and a specificity of 82% (upper limit of Q2 cartilage). Patients with a baseline FFR value ≤ 0.92 had a 58.4-fold greater likelihood of a critical outcome compared with patients with a baseline FFR value > 0.92 (OR: 58.4; 95% CI: 20.3–124.6). In patients with a baseline FFR ≤ 0.92, the Q1 group had a 10.23-fold higher odds of critical stenosis compared with the Q2 group (OR: 10.23; 95% CI: 2.14–48.84). The same values had similar diagnostic power for all specific patient groups.
Conclusion: The baseline FFR value could be used to predict critical coronary stenosis in our patients and had similar value for predicting lesion severity in all the subgroups.
- Title: Kounis syndrome caused by bee sting: a case report and literature review
Authors: Wen-Juan Lin, Yue-qing Zhang, Zhen Fei, Dan-dan Liu, Xing-Hang Zhou
From: Cardiovascular Journal of Africa, Vol 34, Issue 4 September/October 2023
Pages: 256–259
Full text: Click here to order »
Full text: Click here to read online »
Full text: Click here to read via Sabinet » (Login Required)
DOI Number: 10.5830/CVJA-2022-042
DOI Citation Reference Link: dx.doi.org/10.5830/CVJA-2022-042
Abstract: Kounis syndrome is defined as an acute coronary syndrome (ACS) secondary to allergic or hypersensitivity reactions. It can be further categorised into subtypes such as coronary vasospasms, acute myocardial infarction or stent thrombosis based on the pathogenesis. Kounis syndrome is most likely an underdiagnosed condition in China, given the many triggers reported in the literature. Herein, we report a case of Kounis syndrome, possibly triggered by a bee sting. The patient had late onset of angina symptoms with delayed diagnosis due to unfamiliarity with this condition. In patients with clinical signs of ACS that are superimposed on a hypersensitivity reaction, especially those with pre-existing cardiovascular risk factors, Kounis syndrome should be considered, so that appropriate assessment and treatment can be initiated. Prompt management of both the allergic reaction and the ACS is vital for Kounis syndrome.
