Cardiovascular Journal of Africa最新文献

Objective: There is sparse information on the outcomes of percutaneous coronary intervention (PCI) in Nigeria. This study examines the outcomes of PCI in a private hospital in Lagos, Nigeria.

Methods: This retrospective study included all patients who underwent coronary angiography and PCI between March 2017 and March 2022. Analysis of variance was used to examine the difference between means across the coronary angiography group. An independent sample t-test was used to analyse the difference across the means in the acute coronary syndrome (ACS) subcategories. Group comparisons were made using the chi-squared test for the non-sparse categorical data.

Results: The number of coronary angiography procedures performed over five years was 317. Most coronary angiography patients were male (73.9%) and Nigerian (78.6%). Ninety patients were diagnosed with ACS, 69 patients had PCI, and 18 patients were referred for coronary artery bypass grafting (CABG). Drug-eluting stents were used exclusively and radial access was utilised on 49.3% of the PCI patients. The average length of hospital stay for the PCI patients was 1.5 days. All patients were placed on dual antiplatelet therapy (DAPT) on discharge and most patients (73.8%) were placed on DAPT, statin, and a beta-blocker. The in-hospital mortality was 7.25% in high-risk patients with complex medical comorbidities and patients with no alternate revascularisation options.

Conclusions: This five-year single-site experience shows the potential of interventional cardiology care in Nigeria. There needs to be continued process improvement to ensure access to the standard of care for coronary artery disease in Nigeria.

Objective: Apical thrombus (AT) is a severe complication in myocardial infarction (MI), increasing the risk of thromboembolic events. Platelet-to-haemoglobin ratio (PHR) is a novel, inexpensive predictor of cardiovascular outcomes. This study explores the association between PHR and AT in MI patients.

Materials & methods: This retrospective study included 690 anterior MI patients (314 patients with AT and 376 patients without AT as a control group). Blood samples were analysed to calculate PHR, and echocardiographic evaluations identified AT. Logistic regression and ROC analysis determined independent predictors and the optimal PHR cut-off value for AT.

Results: PHRwas significantly higher in the AT group (2.03 ± 0.64 vs. 1.85 ± 0.50; p <0.001).Multivariate analysis identified PHR, proximal LAD lesions, and lower LVEF as independent predictors. The PHR cut-off of 1.88 showed 69.3% sensitivity and 68.4% specificity.

Conclusion: PHR is a simple, accessible marker for predicting AT in MI patients. Its use may improve early risk stratification and clinical outcomes.

Aim: This study aimed to assess the prevalence of key cardiometabolic risk factors, including hypertension, obesity, dyslipidaemia and diabetes, among public school teachers in Vhembe district, Limpopo Province, South Africa.

Methods: A cross-sectional study design was employed, involving 201 public school teachers. Stratified random sampling was used to select teachers on the teachers' list obtained from the Department of Education. Anthropometric measurement variables, which included including body mass index (BMI), waist circumference (WC), and blood pressure (BP), were measured. Biochemical analyses included fasting blood profiles, measuring total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGL) and glucose levels. Statistical analyses were conducted using STATA 17, with a significance level set at p < 0.05.

Results: Obesity was observed in 43.7% of participants, with females demonstrating a significantly (P = 0.000) higher prevalence (62.5%) than males (20.2%). Additionally, 43.2% of participants presented with high-risk WC, with males (50.5%) being more affected than females (37.5%). Stage 1 systolic blood pressure hypertension was identified in 18.4% of participants, and 23.8% had diabetes. Dyslipidaemia was marked by elevated LDL, low HDL and increased triglyceride levels, with a higher prevalence in females.

Conclusions: The findings indicate a substantial burden of cardiometabolic risk factors among teachers in the Vhembe district. Urgent implementation of targeted interventions, including health promotion, lifestyle modification, and routine health screenings, is imperative. Further research is needed to validate these findings across different regions in South Africa.

Objective: Post-thrombotic syndrome (PTS) and recurrent thrombosis are the common morbidities associated with deep venous thrombosis (DVT). There are several treatment modalities have been defined in the literature. Here, we aimed to compare the effects of edoxaban, rivaroxaban and warfarin on recanalised flow, inflammation and postthrombotic syndrome in patients with DVT.

Methods: A total of 320 patients treated with Edoxaban 60 mg(n = 107), Rivaroxaban 20 mg(n = 107) and Warfarin 5 mg(n = 106) due to DVT were included to the study. Venous Doppler ultrasonography and VILLALTA score were used for the assessment of recanalised flow and PTS.

Results: There were no statistically significant differences between the groups in terms of demographic characteristics. 1-month NLR levels were significantly lower in rivaroxaban group and PLR levels were significantly lower in both rivaroxaban and edoxaban groups. 3-month villalta score was statistically higher inWarfarin group and no differences in 6^th month measurements between the groups.

Conclusions: Treatment of DVT is a dynamic process which requires the exact evaluation of the patients according to the several parameters. Recanalised flow, inflammation and situations related to inflammation such as PTS can be used for the assessment. Drugs can be shifted according to the response.

Abbreviations and acronyms: DVT: Deep Venous Thrombosis, PTS: Post-thrombotic Syndrome, NOACs: New Oral Anticoagulants, NLR: Neutrophil/lymphocyte ratio, PLR: Platelet/lymphocyte ratio, TTR: Time in therapeutic range, QoL: Quality of Life.

Despite advances in prevention and treatment, coronary artery disease (CAD) remains a major cause of death globally. Glycated haemoglobin (HbA1c) and body mass index (BMI) are known risk factors for CAD. This study aimed to investigate the relationship between the metabolic coronary risk index (MCRI) and the severity of CAD, measured by the SYNTAX score (SS), in patients with acute coronary syndrome (ACS) who underwent coronary angiography (CAG). A total of 214 patients were included, with a mean age of 59.29 ± 11.93 years, and 25.7% were female. Regression analysis showed that MCRI independently predicted CAD severity. MCRI differentiated moderate and high SS from low SS with 70% sensitivity and 50% specificity at a cutoff value of 158.9. The study concluded that MCRI is a significant predictor of CAD severity in ACS patients.

Introduction: Neurological complications occur after CEA, independent of CCO. These neurological complications appear to occur more frequently in CEA patients with CCO. In our study, we aimed to share the perioperative and postoperative 1-year neurological results of CEA patients.

Methods: Patients who underwent CEA between January 2017 and January 2023 were retrospectively examined. Patients who underwent CEA with total occlusion of the contralateral internal carotid artery (ICA) were included in the study (42 patients). The patients were routinely checked on the 15th day, 6th month and 12th month after discharge, and the presence of symptoms (stroke, TIA) and carotid-related mortality were assessed.

Results: The average age of the patients was 69.18 ± 7.9 years. One patient experienced postoperative nerve damage, responded to anti-inflammatory treatment during follow-up and was discharged without sequelae. Weakness in the ipsilateral left arm developed in 1 patient. One patient who underwent postoperative revision as mentioned previously suffered stroke, and 1 patient had a history of TIA at the 6-month follow-up. During the 1-year follow-up, stroke developed in 1 patient, and diffuse infarction was observed in the ipsilateral median cerebral artery area. It is known that this patient is noncompliant with medical treatment. One patient died in the 10th postoperative month, but the direct relationship with mortality is unknown.

Conclusions: With respect to neurological risks in patients with CCO, CEA should always be performed by experienced surgeons. We believe that preoperative collateral evaluation during CEA in patients with CCO and the routine use of shunts during the procedure minimise the risk of cerebrovascular events.

Abbreviations: CEA: Carotid endarterectomy, CAD: Carotid artery disease, CCO: Contralateral carotid occlusion, CAS: Carotid artery stenting, ICA: internal carotid artery, TIA: Transient ischemic attack, NIRS: near-infrared spectroscopy.

Introduction: Poor healthcare outcomes from cardiovascular disease (CVD) have prompted a shift towards measuring patient-reported outcomes (PROs) to improve quality of care. We conducted a scoping review of the current use of PRO measures (PROMs) in the care of people with CVD in African countries.

Methods: This study included studies that reported the use of at least one PROM in participants with CVD. The study took place in at least one African country.

Results: The 25 included studies originating from13 countries were primarily observational (n = 23), and most commonly studied adults with congestive heart failure (n = 17). Themost common PROM was quality of life (QOL) (n = 17). Overall QOL was poor; lower QOL was associated with various clinical and patient factors.

Conclusion: Further work is needed to expand the availability of adapted PROMs and to explore effective implementation strategies to better integrate their use into clinical practice.

Objective: Substantial advancements have been made in the identification of genetic risk variants associated with myocardial infarction (MI), predominantly within developed nations. The limited representation of the Pakistani population in genetic studies motivated us to design this study. The objective of this study is to identify the genetic variants within the PCSK9 gene and its possible association with myocardial infarction (MI) in Pakistani Pashtun population.

Methods: Whole Exome Sequencing (WES) was performed to pinpoint and propose pathogenic Single Nucleotide Polymorphisms (SNPs) associated with MI. Subsequent, MassARRAY genotyping and rigorous statistical analyses were used to confirmthe association of WES reported variants with MI.

Results: Exome sequencing identified n=5 SNPs in PCSK9. Of the five reported variants, SNPs rs2483205 (OR = 1.429, 95% CI = 0.925-2.207, p = 0.061) and rs562556 (OR = 2.50, 95% CI = 1.274-4.906, p = 0.001) showed strong positive association with myocardial infarction (MI).Whereas SNPs rs540796, rs509504, and rs505151 (p > 0.05) showed no association with MI in the study population. Genotypic distribution of SNPs rs562556 and rs2483205 were reported significant different between MI cases and controls (p < 0.05). Moreover recessive model (TT + CT versus CC) for rs2483205 and the dominant model (GG + AG versus AA) for rs562556 demonstrated strong associations with MI.

Conclusions: The present study identified potential genetic markers increasing susceptibility/risk of MI in the study population. Our study provides a platform for future large scale genetic studies and identifying individuals who at risk of developing MI. The present study emphasise the development of treatments strategies based on genetic makeup of individual.

Introduction: This study aimed to determine the association between angiotensin converting enzyme (ACE) gene I/D polymorphism and peripartum cardiomyopathy (PPCM) in Kano, Nigeria.

Methods: 50 PPCM patients were consecutively recruited and compared with 50 apparently healthy puerperal wo men as controls, in Aminu Kano Teaching Hospital, Kano, Nigeria. ACE genotyping was done by polymerase chain reaction method, after obtaining written informed consent.

Results: There was no significant difference in the prevalence of ACE ID and DD genotypes in the PPCM patients versus controls (44.0% vs 36.0%, p = 0.414; and 36.0% versus 40.0%, p = 0.680, respectively). Importantly, the association between ACE gene polymorphism and PPCM was not statistically significant (odds ratio: 1.46, 95% confidence interval: 0.52-4.17; p = 0.477).

Conclusions: The prevalence of ACE gene I/D polymorphism was not significantly different between PPCM patients and controls. ACE gene I/D polymorphism was not associated with PPCM in Kano, Nigeria.

Objective: Coronary artery disease is the leading cause of death worldwide. Prompt revascularisation is crucial once a diagnosis of ST-segment elevation myocardial infarction (STEMI) is established. It is well-known that improved coronary flow and perfusion result in better long-term outcomes. In our study, we aimed to compare the effects of balloon angioplasty with prolonged and brief balloon inflation on coronary flow in primary percutaneous coronary intervention (PCI) in STEMI patients.

Methods: We included 62 patients who presented to our clinic diagnosed with STEMI and underwent primary PCI in our study. Pre-dilation was performed briefly, under 30 seconds (s), in 31 patients, while prolonged balloon dilation exceeding 30 s was conducted in the remaining 31 patients. ST-segment resolutions, laboratory parameters, troponin monitoring, and troponin peak times were collected for both groups before and after the procedure. After revascularisation of the responsible vessel, coronary flow parameters like thrombolysis in myocardial infarction (TIMI) score, TIMI frame count (TIMIfc), and myocardial blush grade (MBG) were evaluated.

Results: Participants in both groups were similar in characteristics aside from the investigated parameters (p >0.05). The troponin peak occurred earlier in those with prolonged balloon inflation times. Electrocardiography (ECG) improvement percentages at 1, 3, and 6 hours were higher in the prolonged balloon group (78.71±21, 92.26±1, 96.77±1) compared to the brief balloon group (60.97±2, 81.94±1, 92.90±1) (p <0.05). Logistic regression showed that increasing age negatively affected TIMI flow grade and myocardial blush grade, while prolonged balloon times had a positive impact (p <0.05).

Conclusion: The current study demonstrated that prolonged balloon pre-dilation yielded superior outcomes compared to brief balloon pre-dilation in primary PCI performed on STEMI patients. These outcomes included enhanced TIMI, TIMIfc, and MBG parameters, along with faster and improved ST-segment resolution, allowing for a more rapid attainment of the troponin peak value. If similar findings are demonstrated in larger studies, standardising the balloon duration could be beneficial in primary PCI of STEMI patients. Thus, improved coronary flow would be associated with better long-term outcomes.