Cardiovascular Journal of Africa最新文献

Aim: Empagliflozin (EMPA) is a sodium-glucose transporter-2 inhibitor used in the treatment of type 2 diabetes and has positive effects on cardiovascular outcomes. Amitriptyline (AMT) can be used in many clinical indications but leads to cardiotoxicity by causing QT prolongation. Our aim in this study was to determine how the effects of the concomitant use of empagliflozin and amitriptyline, which have been shown to have effects on sodium and calcium metabolism in cardiomyocytes, would cause an effect on QT and QTc intervals in clinical practice.

Methods: Twenty-four male Wistar albino rats were randomised into four groups. The control group received only physiological serum (1 ml) via orogastric gavage (OG). The EMPA group received empagliflozin (10 mg/kg) via OG. The AMT group received amitriptyline (100 mg/kg) via OG. The AMT + EMPA group (n = 6) received amitriptyline (100 mg/kg) and empagliflozin (10 mg/kg). Under anaesthesia, QT and QTc intervals were measured at baseline, and in the first and second hours.

Results: In the AMT group, QT intervals and QTc values were found to be statistically longer than in the control group (p ≤ 0.001). Empagliflozin significantly ameliorated amitriptyline-induced QT and QTc prolongation. In the AMT + EMPA group, QT and QTc intervals were significantly lower compared to that in the AMT group (p < 0.01).

Conclusion: In this study, we determined that empagliflozin significantly ameliorated amitriptyline-induced QT and QTc prolongation. This effect was probably due to the opposite effects of these two agents in the intracellular calcium balance. With more clinical trials, the routine use of empagliflozin may be suggested to prevent QT and QTc prolongation in diabetic patients receiving amitriptyline.

Background: The impact of the transradial approach (TRA) on the development of acute kidney injury (AKI) after percutaneous coronary interventions (PCI) has been controversial.

Methods: We retrospectively analysed 463 patients undergoing PCI for either acute or chronic coronary syndrome. Excluded patients were those with missing laboratory or procedural data, acute/decompensated heart failure, major bleeding, haemodynamic instability, long-term dialysis and mortality. The primary endpoint of the study was the incidence of AKI after PCI, which was defined as an increase in serum creatinine (SCr) level of 0.5 mg/dl or 25% from the baseline. Secondary endpoints were change in SCr level, increase in SCr of ≥ 0.3 and ≥ 0.5 mg/dl, and increase in SCr of ≥ 25 and ≥ 50%. We compared the incidence of AKI between the TRA and the transfemoral approach (TFA) in the overall and a propensity score (PS)-matched study population.

Results: The study population included 339 patients. After PS matching, we obtained a well-balanced population of 182 patients. The differences between the incidence of AKI in the TRA and TFA were not significant in both the overall (9.0 vs 11.2%, p = 0.503) and PS-matched (9.9 vs 7.7%, p = 0.601) study population. TRA resulted in a significantly lower incidence of SCr increase of ≥ 50% in unmatched patients. However, after PS matching, there was no difference between the TRA and TFA in any variable of secondary post-PCI renal outcomes. Age, female gender, baseline SCr level, baseline estimated glomerular filtration rate and contrast volume were independent predictors of AKI.

Conclusion: Compared to the conventional TFA, TRA was not associated with a reduced incidence of AKI after PCI in patients not complicated by major bleeding, acute heart failure and haemodynamic disturbances.

Aim: In current practice, fast-track protocols are gaining importance in patients undergoing cardiac surgery. For this purpose, besides different application techniques, biomarkers are frequently examined in the peri-operative period. We aimed to examine whether serum lactate levels at different peri-operative intervals had an effect on the extubation time.

Methods: The patients were analysed in two groups according to the extubation time (early < 6 hours, and late extubation > 6 hours). Individual characteristics, co-existing diseases, blood transfusion, inotropic support, intra-aortic balloon pump, cardiopulmonary bypass time, aortic cross-clamp time, and the serial measurements of serum lactate levels were recorded. Correlations of serial measurements of lactate levels and the peri-operative variables with extubation times were analysed.

Results: No significant differences were observed between the groups in terms of co-existing diseases and individual characteristics. However, cardiopulmonary bypass, aortic cross-clamp times and all lactate levels after aortic cross-clamping were found to be significantly different (p = 0.001). A statistically significant correlation was found between the cut-off value of 1.7 for serum lactate levels after aortic-cross clamping (L2); 1.9 for levels after aortic cross-clamp removal (L3); 2.2 for levels after cardiopumonary bypass (L4); 2.1 for levels after intensive care admission (L5); 1.7 for levels after first postoperative hour in the intensive care unit (L6), and 1.8 for the difference between pre-operative levels (L0) and the peak level of lactate in the peri-operative period (ΔL) in predicting extubation time (p < 0.01).

Conclusion: We concluded that cardiopulmonary bypass and aortic cross-clamp times, and intra-operative serum lactate levels were important in predicting early extubation after isolated coronary artery bypass graft surgery.

Background: In recent years, the endovenous technique has been presented as a good alternative to surgery in the treatment of patients with lower extremity varicose veins. However, its effectiveness in very advanced saphenous vein diameters is controversial. In this study, we investigated the results of an endovenous glue ablation closure system applied with an esmarch bandage in saphenous veins with very large diameters.

Methods: Eighty-nine patients who were operated on for varicose veins were divided into three groups according to their saphenous vein diameters: less than 10 mm (group 1), between 10 and 15 mm (group 2), and larger than 15 mm (group 3). Endovenous closure was performed with n-butyl cyanoacrylate in all patients. An esmarch bandage was applied during the procedure to all patients, except for the group with a diameter of less than 10 mm. This group underwent the standard procedure. All patients were followed up for six months after the procedure and postoperative symptoms, complications and closure rates were recorded.

Results: There was complete closure of all veins in the first month postoperatively. While no thrombophlebitis was observed in group 3, thrombophlebitis was detected in two patients in groups 1 and 2. In the third month, minimal saphenofemoral reflux was observed in two (4.2%) patients in group 1 and in one (4.3%) in group 2. In the sixth month, minimal saphenofemoral reflux was detected in three (6.3%) patients in group 1 and in one (4.3%) in group 2. No residual leakage was observed in group 3 (p = 0.001). In all groups, the severity score regressed significantly in the postoperative sixth month. However, the most significant symptomatic regression was observed in group 3, which had the largest saphenous diameters and we used an esmarch bandage during closure (p = 0.000).

Conclusion: Our findings support the idea that the application of an esmarch bandage during endovenous closure improves clinical outcomes, especially in saphenous veins with larger diameters.

Objective: The modified David V technique is one of the valve-sparing aortic root replacement (V-SARR) techniques, which is an alternative to traditional composite valve graft root replacement techniques. We aimed to analyse our long-term experience with the modified David V re-implantation technique for the treatment of aortic root aneurysm and significant aortic valve insufficiency.

Methods: From March 2009 to November 2021 the modified David V re-implantation technique, one of the V-SARR techniques, was performed on 48 patients in our centre. The results were analysed retrospectively. Two different-sized grafts were used in all patients. The grafts used in the proximal position were larger than the distal grafts. We performed both intra-operative and post-procedural transoesophageal echocardiography on each patient. All patients were followed by means of transthoracic echocardiography. The mean follow-up period was 5.7 ± 3.1 years.

Results: The mean age of this cohort was 56.3 ± 14.3 years (24-79) and the majority were men (75%). The mean aortic root diameter was 5.1 ± 0.6 cm. The mean diameter for the assending aorta was 5.4 ± 2.1 cm. The in-hospital mortality rate was 4.2% (n = 2). One patient needed aortic valve replacement in the early postoperative period. Two (4.2%) patients died in the early postoperative period and four (8.3%) died in the late postoperative period. Overall survival was 91 ± 4 and 86 ± 5% at one and five years, respectively. Aortic valve insufficiency was at moderate levels postoperatively. Freedom from moderate to severe residual aortic insufficiency was 89.6% at 10 years. None of the patients needed late re-operation of the aortic valve postoperatively. Freedom from valve re-operation was 100% at the end of the follow up.

Conclusion: Our study shows that the David V technique is associated with excellent long-term durability, a remarkably low rate of valve-related complications, and it protects the re-implanted native aortic valve from a second operation. Additionally this technique could be safely implemented in patients with a bicuspid aortic valve and acute type A aortic dissection without leaflet deformity.

Introduction: Despite considerable advances in treatment, heart failure (HF) remains a serious public health problem linked to a high rate of mortality. The aim of this work was to describe the epidemiological, clinical and evolutionary features of HF in a Tunisian university hospital.

Methods: This was a retrospective study including 350 hospitalised patients diagnosed with HF with reduced ejection fraction (≤ 40%) during the period between 2013 and 2017.

Results: The average age was 59 ± 12 years. A male predominance was noted. The main cardiovascular risk factor was the use of tobacco (47%). The electrocardiogram showed atrial fibrillation in 41% of patients and left bundle branch block in 36% of patients. Laboratory results revealed an electrolyte disorder in 30 cases, renal insufficiency in 25% of patients and anaemia in 20%. Echocardiography revealed reduced ejection fraction, with an average of 34 ± 6% (range: 20-40%). The main causes of HF were ischaemic heart disease in 157 patients. The most commonly used medications were diuretics (90% of patients), angiotensin converting enzyme inhibitors (88%), beta-blockers (91%) and mineralocorticoid receptor antagonists (35%). Cardiac resynchronisation therapy was performed on 30 patients and cardioverter defibrillator implantation on 15 patients. The hospital mortality rate was 10% and the average hospital stay was 12 ± 5 days. During six months of follow up, 56 patients died and 126 were re-admitted. Multivariate model predictors of six-month mortality were: age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 21, p = 0.004).

Conclusion: This study illustrates the main characteristics of HF in our population. These include relatively young age, a predominance of males, ischaemic heart disease as the main aetiology, insufficient care strategies and a poor prognosis.

Background: Intensive physical activity in athletes leads to considerable changes in the morphology and physiology of the left atrium through physiological, exercise-induced remodelling.

Aim: This study aimed to assess the mechanical and electrophysiological changes in professional football players using electrocardiographic and echocardiographic assessment tools.

Methods: This prospective, case-control study was performed between February and June 2022. The population consisted of elite male football players (n = 49, group F) as the study group, and healthy male non-athlete individuals of matching age (n = 50, group C) as the control group. All participants underwent electrocardiographic and echocardiographic (two-dimensional and tissue Doppler) examinations. Volumetric and functional assessment of the left atrium was identified as the study's primary outcome.

Results: There was no significant difference between the groups in terms of demographic and morphometric characteristics (p > 0.05). Maximum and minimum P waves and PR-interval duration were significantly higher in group F than in group C (p = 0.011, p = 0.005 and p < 0.001). Diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes were significantly increased in group F (p < 0.0). Ejection fraction of the left atrium was significantly lower in group F than in group C (p = 0.001). Pulmonary acceleration time and tricuspid annular plane systolic excursion was significantly higher in the football players (p = 0.023 and p < 0.001).

Conclusions: Increased diameter, maximum and minimum volumes of the left atrium, and their corresponding indexes could be demonstrated in the elite football players. The morphological and functional changes in the left atrium might be a physiological consequence of left atrial cardiac remodelling to intensive and chronic training.

The re-emergence of diphtheria in South Africa in recent years warns of incomplete vaccination coverage. Recent outbreaks have been associated with a high mortality rate, due to late presentation, limited access to antitoxin and the occurrence of serious systemic complications. Death due to diphtheria is most commonly associated with diphtheritic myocarditis, which presents with heart failure, cardiogenic shock and conduction abnormalities. This case highlights the key clinical features and systemic complications, and examines the reasons for the return of diphtheria in our community.

The Nigerian Cardiovascular Symposium is an annual conference held in partnership with cardiologists in Nigeria and the diaspora to provide updates in cardiovascular medicine and cardiothoracic surgery with the aim of optimising cardiovascular care for the Nigerian population. This virtual conference (due to the COVID-19 pandemic) has created an opportunity for effective capacity building of the Nigerian cardiology workforce. The objective of the conference was for experts to provide updates on current trends, clinical trials and innovations in heart failure, selected cardiomyopathies such as hypertrophic cardiomyopathy and cardiac amyloidosis, pulmonary hypertension, cardiogenic shock, left ventricular assist devices and heart transplantation. Furthermore, the conference aimed to equip the Nigerian cardiovascular workforce with skills and knowledge to optimise the delivery of effective cardiovascular care, with the hope of curbing 'medical tourism' and the current 'brain drain' in Nigeria. Challenges to optimal cardiovascular care in Nigeria include workforce shortage, limited capacity of intensive care units, and availability of medications. This partnership represents a key first step in addressing these challenges. Future action items include enhanced collaboration between cardiologists in Nigeria and the diaspora, advancing participation and enrollment of African patients in global heart failure clinical trials, and the urgent need to develop heart failure clinical practice guidelines for Nigerian patients.

Background: Diagnosis of acute rheumatic fever (ARF) is mainly clinical. Delayed or missed diagnosis and failure to administer appropriate and timely treatment of ARF leads to rheumatic heart disease (RHD), which could necessitate expensive treatments such as open-heart surgery. Implementation of preventative guidelines depends on availability of trained healthcare workers. As part of the routine support supervision, the Uganda Heart Institute sent out a team to rural eastern Uganda to evaluate health workers' knowledge level regarding management of ARF.

Methods: Health workers from selected health facilities in Tororo district, eastern Uganda, were assessed for their knowledge on the clinical features and role of benzathine penicillin G (BPG) in the treatment and prevention of ARF recurrence. Using the RHD Action Needs assessment tool, we generated and administered a pre-test, then conducted training and re-administered a post-test. Eight months later, health workers were again assessed for knowledge retention and change in practices. Statistical analysis was done using Stata version 15.

Results: During the initial phase, 34 of the 109 (31%) health workers passed the pre-test, indicating familiarity with clinical features of ARF. The level of knowledge of BPG use in ARF was very poor in all the health units [25/109 (22.6%)] but improved after training to 80%, as shown by the chi-squared test ( χ² = 0.000). However, retention of this knowledge waned after eight months and was not significantly different compared to pre-training (χ² ≥ 0.2).

Conclusions: A critical knowledge gap is evident among health workers, both in awareness and treatment of ARF, and calls for repetitive training as a priority strategy in prevention.