Pieter-Paul S Robbertse, Jan Steyn, Megan R Rajah, Anton F Doubell, Jean B Nachega, Philip G Herbst
Cardiovascular abnormalities are increasingly recognised among people newly diagnosed with HIV, but subclinical pathology may be challenging to diagnose. We present a case study of subtle cardiovascular changes in identical twins, one without HIV-infection and the other recently diagnosed with HIV (serodiscordant). We hypothesise that cardiovascular parameters would be similar between the twins, unless non-genetic (environmental) factors are at play. These differences likely represent occult pathology secondary to the effects of early HIV-infection. A 25-year-old female incidentally diagnosed with HIV, and her HIV-uninfected identical twin, living with her since birth, underwent comprehensive cardiovascular assessments. The HIV-positive twin exhibited a globular left ventricle (LV), larger LV volumes, decreased LV strain, peak atrial longitudinal strain (PALS) and higher native T1 and T2 mapping values compared to her sister. Cardiac biomarkers high sensitivity cardiac troponin T and N-terminal proBNP, as well as the novel markers of fibrosis and remodelling, galectin-3 and soluble-ST2, were higher in the HIV-infected twin. Given the twins' shared environment and genetic makeup, these differences likely stem from HIV-infection. Our study supports previous findings and suggests potential screening markers for HIV-associated cardiovascular disease, including PALS. Further research is warranted to explore PALS' utility in this context.
{"title":"Subclinical cardiovascular remodelling in HIV-infection: A multimodal case study of 2 serodiscordant, monozygotic twins.","authors":"Pieter-Paul S Robbertse, Jan Steyn, Megan R Rajah, Anton F Doubell, Jean B Nachega, Philip G Herbst","doi":"10.24170/21-1-6322","DOIUrl":"10.24170/21-1-6322","url":null,"abstract":"<p><p>Cardiovascular abnormalities are increasingly recognised among people newly diagnosed with HIV, but subclinical pathology may be challenging to diagnose. We present a case study of subtle cardiovascular changes in identical twins, one without HIV-infection and the other recently diagnosed with HIV (serodiscordant). We hypothesise that cardiovascular parameters would be similar between the twins, unless non-genetic (environmental) factors are at play. These differences likely represent occult pathology secondary to the effects of early HIV-infection. A 25-year-old female incidentally diagnosed with HIV, and her HIV-uninfected identical twin, living with her since birth, underwent comprehensive cardiovascular assessments. The HIV-positive twin exhibited a globular left ventricle (LV), larger LV volumes, decreased LV strain, peak atrial longitudinal strain (PALS) and higher native T1 and T2 mapping values compared to her sister. Cardiac biomarkers high sensitivity cardiac troponin T and N-terminal proBNP, as well as the novel markers of fibrosis and remodelling, galectin-3 and soluble-ST2, were higher in the HIV-infected twin. Given the twins' shared environment and genetic makeup, these differences likely stem from HIV-infection. Our study supports previous findings and suggests potential screening markers for HIV-associated cardiovascular disease, including PALS. Further research is warranted to explore PALS' utility in this context.</p>","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"21 1","pages":"48-57"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11087033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More women with complex congenital heart disease (CHD) reach adulthood resulting in a cohort of patients who are at high risk for adverse events during pregnancy. The haemodynamic changes usual to pregnancy may be poorly tolerated in patients with poor systemic ventricular function, cyanosis, left-sided obstructive lesions and pulmonary hypertension. Complex CHD patients are best managed by a multi-disciplinary team at a high-risk centre. Pre-conception counselling aims at risk stratifying by means of a clinical evaluation, electrocardiogram and echocardiography. Echocardiography plays a vital role in delineating the initial lesions and residual lesions with its haemodynamic complications. The modified WHO (mWHO) classification provides a helpful tool to stratify anatomical and physiological lesions by maternal and foetal event rates and is recommended by the European Society of Cardiology (ESC). Patients with cyanosis, severe aortopathy and severe pulmonary hypertension fall into Class IV and termination of pregnancy is advised. Patients may however choose to continue their pregnancy. We present 3 such cases of complex CHD (Fontan circulation, severe aortopathy and severe pulmonary hypertension) and illustrate some pertinent management principles in the peripartum period.
{"title":"Management of congenital heart disease in the peripartum period: An illustrative case series","authors":"B. Cupido","doi":"10.24170/19-3-5690","DOIUrl":"https://doi.org/10.24170/19-3-5690","url":null,"abstract":"More women with complex congenital heart disease (CHD) reach adulthood resulting in a cohort of patients who are at high risk for adverse events during pregnancy. The haemodynamic changes usual to pregnancy may be poorly tolerated in patients with poor systemic ventricular function, cyanosis, left-sided obstructive lesions and pulmonary hypertension. Complex CHD patients are best managed by a multi-disciplinary team at a high-risk centre. Pre-conception counselling aims at risk stratifying by means of a clinical evaluation, electrocardiogram and echocardiography. Echocardiography plays a vital role in delineating the initial lesions and residual lesions with its haemodynamic complications. The modified WHO (mWHO) classification provides a helpful tool to stratify anatomical and physiological lesions by maternal and foetal event rates and is recommended by the European Society of Cardiology (ESC). Patients with cyanosis, severe aortopathy and severe pulmonary hypertension fall into Class IV and termination of pregnancy is advised. Patients may however choose to continue their pregnancy. We present 3 such cases of complex CHD (Fontan circulation, severe aortopathy and severe pulmonary hypertension) and illustrate some pertinent management principles in the peripartum period.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82758493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Aremu, S. Jermy, P. Samuels, Morné F. Kahts, Daniel W. Muthithu, T. Bana, N. Ntusi
Pregnant women with known or suspected cardiovascular disease (CVD) often require cardiovascular imaging during pregnancy. Decisions about imaging in pregnancy are premised on understanding the physiology of pregnancy, understanding basic concepts of different imaging modalities, the clinical manifestations of existent CVD in pregnancy and features of new CVD. Cardiovascular magnetic resonance (CMR) imaging is safe in pregnancy and is not associated with any adverse foetal effects, provided there are no general contra-indications to magnetic resonance (MR) imaging. CMR also does not involve any ionising radiation. In pregnancy, CMR is useful to confirm diagnosis of CVD, assess disease severity, to stratify risk and prognosticate, to plan appropriate management, and to assess response to therapy. Use of any imaging test in pregnancy needs to have safety considerations balanced against the importance of accurate diagnosis and thorough assessment of the pathological condition. This review summarises the evolving role of CMR in evaluation of known or suspected new CVD in pregnancy.
{"title":"Utility of cardiovascular magnetic resonance in pregnancy","authors":"O. Aremu, S. Jermy, P. Samuels, Morné F. Kahts, Daniel W. Muthithu, T. Bana, N. Ntusi","doi":"10.24170/19-3-5691","DOIUrl":"https://doi.org/10.24170/19-3-5691","url":null,"abstract":"Pregnant women with known or suspected cardiovascular disease (CVD) often require cardiovascular imaging during pregnancy. Decisions about imaging in pregnancy are premised on understanding the physiology of pregnancy, understanding basic concepts of different imaging modalities, the clinical manifestations of existent CVD in pregnancy and features of new CVD. Cardiovascular magnetic resonance (CMR) imaging is safe in pregnancy and is not associated with any adverse foetal effects, provided there are no general contra-indications to magnetic resonance (MR) imaging. CMR also does not involve any ionising radiation. In pregnancy, CMR is useful to confirm diagnosis of CVD, assess disease severity, to stratify risk and prognosticate, to plan appropriate management, and to assess response to therapy. Use of any imaging test in pregnancy needs to have safety considerations balanced against the importance of accurate diagnosis and thorough assessment of the pathological condition. This review summarises the evolving role of CMR in evaluation of known or suspected new CVD in pregnancy.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80760018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why publish in the South African Heart Journal?","authors":"J. Hitzeroth","doi":"10.24170/19-1-5367","DOIUrl":"https://doi.org/10.24170/19-1-5367","url":null,"abstract":"","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74864119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mechanical valve thrombosis is a feared complication in pregnant women with mechanical heart valves (MHV). It is associated with a high maternal and foetal morbidity and mortality. Optimal anticoagulation strategies for pregnant women with MHV remain controversial. Vitamin K antagonists (VKA) are the most effective treatment regimen to prevent valve thrombosis and are therefore considered the safest treatment for the mother. However, VKAs increase the risk of embryopathy, foetopathy, foetal haemorrhage and foetal loss. A particular challenge is to balance the need for adequate anticoagulation for MHV during pregnancy against the risk of bleeding, teratogenicity and fetotoxicity. In this case series, we describe complexity of the management of anticoagulation in pregnant patients with MHV, and describe 2 treatment approaches in patients with MHV thrombosis. Our case series high-lights that anticoagulation strategy should be individualised, and that best management is provided by a multidisciplinary cardio-obstetric team.
{"title":"Challenges of managing patients with mechanical heart valve thrombosis in pregnancy: A case series","authors":"J. Hoevelmann, K. Sliwa, A. Chin, C. Viljoen","doi":"10.24170/19-3-5689","DOIUrl":"https://doi.org/10.24170/19-3-5689","url":null,"abstract":"Mechanical valve thrombosis is a feared complication in pregnant women with mechanical heart valves (MHV). It is associated with a high maternal and foetal morbidity and mortality. Optimal anticoagulation strategies for pregnant women with MHV remain controversial. Vitamin K antagonists (VKA) are the most effective treatment regimen to prevent valve thrombosis and are therefore considered the safest treatment for the mother. However, VKAs increase the risk of embryopathy, foetopathy, foetal haemorrhage and foetal loss. A particular challenge is to balance the need for adequate anticoagulation for MHV during pregnancy against the risk of bleeding, teratogenicity and fetotoxicity. In this case series, we describe complexity of the management of anticoagulation in pregnant patients with MHV, and describe 2 treatment approaches in patients with MHV thrombosis. Our case series high-lights that anticoagulation strategy should be individualised, and that best management is provided by a multidisciplinary cardio-obstetric team.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74635750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Lumngwena, I. Parker, Dipolelo Mokaila, S. Skatulla, Jonathan Blackburn
Rheumatic heart disease (RHD) is the major cause of cardiovascular morbidity and mortality in children and young adults in low- and middle-income countries. Acute rheumatic fever (ARF) is characterised by multiorgan inflammatory symptoms initiated through cross reaction of immune responses (IRs) to group A streptococcus (GAS) proteins to host proteins. Recurrence of these IRs targeting the heart valves may lead to permanent damage, a sequela which is termed RHD. Preliminary studies suggested genetic associations in RF reactions, but that other host factors are also involved, leaving the determinants of RHD progression incompletely understood. Previous clinical and recent epidemiological studies support differential clinical phenotypes, with varying history from different settings. This review summarises the protein-centric biomolecular changes in RHD and highlights outstanding molecular gaps where urgent focus is required to improve our understanding RHD pathophysiology. Numerous studies have confirmed alterations in the expression of structural and immune response proteins, but the modifications giving rise to neo-epitopes and their involvement in RHD have not been established. As RHD is associated with poor living conditions, identification of other factors driving inflammation to enhance RHD progression is necessary to advance our knowledge and improve patient management. Furthermore, biomarkers for early identification, disease stratification, and alternative therapeutic strategies are necessary to improve treatment and prevention strategies in order to reduce the burden of RHD. Relevance: Despite the explosion of scientific innovation over the last few decades, fundamental scientific studies to understand the pathophysiological mechanisms of RHD remain in their infancy and the determinants of RHD progression thus remain uncertain. Moreover, inconsistency in natural history and phenotypic presentations are seen between Africans and other cohorts in which preliminary studies were conducted, implying that differences in genetic complexity and environmental factors may be responsible for the differential disease progression rates.
{"title":"The pathophysiology of RHD and outstanding gaps","authors":"E. Lumngwena, I. Parker, Dipolelo Mokaila, S. Skatulla, Jonathan Blackburn","doi":"10.24170/19-1-5362","DOIUrl":"https://doi.org/10.24170/19-1-5362","url":null,"abstract":"Rheumatic heart disease (RHD) is the major cause of cardiovascular morbidity and mortality in children and young adults in low- and middle-income countries. Acute rheumatic fever (ARF) is characterised by multiorgan inflammatory symptoms initiated through cross reaction of immune responses (IRs) to group A streptococcus (GAS) proteins to host proteins. Recurrence of these IRs targeting the heart valves may lead to permanent damage, a sequela which is termed RHD. Preliminary studies suggested genetic associations in RF reactions, but that other host factors are also involved, leaving the determinants of RHD progression incompletely understood. Previous clinical and recent epidemiological studies support differential clinical phenotypes, with varying history from different settings. This review summarises the protein-centric biomolecular changes in RHD and highlights outstanding molecular gaps where urgent focus is required to improve our understanding RHD pathophysiology. Numerous studies have confirmed alterations in the expression of structural and immune response proteins, but the modifications giving rise to neo-epitopes and their involvement in RHD have not been established. As RHD is associated with poor living conditions, identification of other factors driving inflammation to enhance RHD progression is necessary to advance our knowledge and improve patient management. Furthermore, biomarkers for early identification, disease stratification, and alternative therapeutic strategies are necessary to improve treatment and prevention strategies in order to reduce the burden of RHD. Relevance: Despite the explosion of scientific innovation over the last few decades, fundamental scientific studies to understand the pathophysiological mechanisms of RHD remain in their infancy and the determinants of RHD progression thus remain uncertain. Moreover, inconsistency in natural history and phenotypic presentations are seen between Africans and other cohorts in which preliminary studies were conducted, implying that differences in genetic complexity and environmental factors may be responsible for the differential disease progression rates.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73566945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Women's health is prioritised in national health policies and strategies in Mozambique. However, only 34.1% of women start antenatal consultations before the 16th gestational week and attend at least 4 visits – the reported lack of easy access to health facilities contributing to late initiation of antenatal care. Data from the Mozambique National Audit Committee of maternal, perinatal, and neonatal deaths demonstrate institutional maternal mortality ratio increased from 81 deaths per 100 000 live births in 2016 to 84 in 2019, highlighting the need for greater surveillance and a vigorous response to this increase. In Mozambique, there are opportunities for improving access to and quality of peripartum care to reduce maternal morbidity and mortality. Research is needed to uncover the major causes of maternal mortality and morbidity, particularly the role of cardiovascular disease.
{"title":"Peripartum access to care in Mozambique: Opportunities for reducing maternal mortality","authors":"Ana O. Mocumbi, E. Jacinto, S. Mocumbi","doi":"10.24170/19-3-5686","DOIUrl":"https://doi.org/10.24170/19-3-5686","url":null,"abstract":"Women's health is prioritised in national health policies and strategies in Mozambique. However, only 34.1% of women start antenatal consultations before the 16th gestational week and attend at least 4 visits – the reported lack of easy access to health facilities contributing to late initiation of antenatal care. Data from the Mozambique National Audit Committee of maternal, perinatal, and neonatal deaths demonstrate institutional maternal mortality ratio increased from 81 deaths per 100 000 live births in 2016 to 84 in 2019, highlighting the need for greater surveillance and a vigorous response to this increase. In Mozambique, there are opportunities for improving access to and quality of peripartum care to reduce maternal morbidity and mortality. Research is needed to uncover the major causes of maternal mortality and morbidity, particularly the role of cardiovascular disease.","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75787308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiovascular medicine in South Africa","authors":"N. Ntusi","doi":"10.24170/19-1-5355","DOIUrl":"https://doi.org/10.24170/19-1-5355","url":null,"abstract":"","PeriodicalId":55781,"journal":{"name":"SA Heart Journal","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75233589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号