Cardiovascular Journal of Africa最新文献

Background: This study aimed to test a train-the-trainer model for scaling up echocardiographic screening for rheumatic heart disease (RHD).

Methods: This was a two-phased, prospective, pilot cohort study conducted in Lira, Uganda. In phase one, four nurse centres underwent a three-day training on echocardiographic screening for RHD. Thereafter, nurses integrated screening of patients aged 5-40 years into their routine clinic workflow. Echocardiograms were uploaded to a cloud-based server for review by an expert, who served as the gold standard for interpretation. In phase two, 12 nurses were trained by trainees included in phase one.

Results: A total of 16 nurses (four in phase one and 12 in phase two) were recruited. All nurses achieved the target of acquiring 100 echocardiograms, resulting in a total of 1620 screening echocardiograms (n = 406 in phase one and n = 1214 in phase two).Over 95% of the studies were of diagnostic quality. There were 44/1473 (3%) screen-positive participants, 40 with RHD. There was a decline in sensitivity from 70% to 50% (p = 0.33) and an increase in specificity from 86% to 94% (p < 0.0001) between phases one and two. All four cases of moderate/severe RHD were correctly identified. In phase one, 56 cases were incorrectly classified as left ventricular dysfunction using the auto ejection fraction function; this option was omitted for phase two.

Conclusion: This pilot study showed that utilising a train-the-trainer model to implement echocardiographic screening for RHD into primary health care in a low-resource setting is feasible.

Background: The Prognostic Nutritional Index (PNI) is a tool that combines serum albumin levels and lymphocyte count to assess a patient's nutritional and immune status. Malnutrition, often undetected in coronary bypass (CABG) patients may cause increased morbidity and mortality. PNI is a potential preoperative marker to identify high-risk patients who may benefit from nutritional support.

Aim: To investigate the association between the prognostic nutritional index (PNI) and 30-daymortality and morbidity in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).

Methods: Consecutive patients aged 60 years or older who underwent coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) at a single institute between 2021 and 2022 were included in the study. The Prognostic Nutritional Index (PNI) was calculated for each patient, and comparisons were made between those with and without mortality and morbidity. Multivariate analysis was conducted out to investigate the association between PNI and both mortality and morbidity.

Results: A total of 435 patients were included in the study. The mean age was 68.61 ± 5.16 years, and 114 patients (26.2%) were female. The mean EuroSCORE II was 1.71 ± 0.93, and the mean PNI was 50.65 ± 6.33. Patients who experienced mortality or morbidity had significantly lower PNI scores compared to those who did not.

Conclusions: Lower PNI values were associated with increased postoperative mortality and morbidity in patients over 60 years old undergoing CABG with CPB.

Background: Excellent mid-term outcomes are well-established for percutaneous pulmonary valve implantation (PPVI) in treating right ventricular outflow tract (RVOT) dysfunction. Despite this success, long-term data assessing PPVI performance are limited, especially within middle- to low-income country contexts.

Objective: To report on the patient characteristics and long-term outcomes after PPVI.

Methods: This retrospective study describes outcomes for 31 PPVI patients treated from 2012 to 2023 at the paediatric cardiology department, Universitas Academic Hospital, Bloemfontein, South Africa.

Results: The predominant underlying diagnosis was tetralogy of Fallot (n = 20, 64.5%). The primary indications for PPVI were pulmonary insufficiency (PI) (n = 15, 48.4%), followed by mixed PI and right ventricular outflow tract (RVOT) stenosis (n = 10, 32.3%), and isolated pulmonary/RVOT stenosis (n = 6, 19.4%). Most implants (n = 22, 71%) were placed within homograft conduits. One early death occurred during the study period, yielding a procedural mortality rate of 3.2%. At 10 years, Kaplan-Meier estimated valve survival was 77%, freedom from stent fracture was 85.3%, and freedom from infective endocarditis (IE) was 81%. The annualised incidence of IE was 1.9%.

Conclusions: These findings contribute long-term data on PPVI outcomes from a middle-income country setting. The results demonstrate favourable durability and performance, appearing comparable to surgical pulmonary valve replacement benchmarks. However, IE remains a significant long-term complication, underscoring the potential importance of implementing and adhering to stringent prophylactic protocols.

Objective: To explore the correlation between deep vein thrombosis and blood volume of inferior vena cava blood volume in the lower extremities through ultrasound.

Methods: A total of 149 patients with lower extremity deep vein thrombosis (DVT) developed after surgical treatment in West China Hospital from January 2023-March 2024 were enrolled, and they were classified into grade I,II, III, IV according to the classification of deep vein thrombosis, the blood volume of the inferior vena cava in four groups was examined and evaluated, and the correlation between the blood volume of the inferior vena cava and the grade of deep vein thrombosis of the lower extremity was analysed.

Results: There was a statistically significant difference in venous blood volume between the four groups (F = 14.568, p < 0.05). Pearson correlation analysis showed that venous blood volume was positively correlated with lower extremity deep vein thrombosis grade (r = 0.392, p < 0.05).

Conclusion: Venous blood volume was found to inversely influence the extent of venous stasis in the lower extremities, suggesting its potential utility as an indicator for the risk of developing deep vein thrombosis.

Infective endocarditis with splenic abscesses remains a complex and unusual clinical scenario. We present a rare case of splenic hematoma caused by percutaneous drainage of splenic abscess with infective endocarditis. After antibiotic therapy, mitral valve replacement combined with splenectomy was performed simultaneously. When infective endocarditis is complicated with splenic abscess, splenectomy rather than percutaneous drainage of the splenic abscess is preferred to lower the risk of splenic haemorrhage and eradicate the source of infection. The order of surgery is controversial and should be considered according to the patient's general condition.

Purpose: Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) surgery is a major complication. We investigated the association between platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), which are associated with inflammation, with the development of AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria.

Methods: We retrospectively evaluated 96 patients who underwent CABG surgery between October 11, 2022 and July 31, 2024. Patients were divided into two groups: postoperative acute kidney injury (AKI) (n = 32) and non-AKI (n = 64). The diagnosis of AKI was based on changes in serum creatinine level according to KDIGO 2012 criteria.

Results: In patients who had developed acute kidney injury, several inflammatory markers were significantly increased. Preoperative PLR and NLR values were significantly higher in the AKI group when presented as median (interquartile range) (PLR: 145.8 [98.5 - 183.1] vs 118.4 [89.7 - 147.1], p = 0.018; and NLR: 3.8 [2.5 - 5.1] vs 2.9 [2.0 - 3.8], p = 0.009). The CRP/albumin ratio was significantly higher in the AKI group (0.21 [0.14 - 0.32] vs 0.14 [0.09 - 0.22], p = 0.008). ROC analysis showed moderate discriminative ability for both markers, with AUC values of 0.728 (95% CI: 0.627 - 0.829) for PLR and 0.692 (95% CI: 0.588 - 0.796) for NLR. Multivariate analysis identified preoperative PLR > 132.5 as an independent predictor of AKI (OR: 2.41, 95% CI: 1.02 - 5.68, p = 0.044).

Conclusions: Our findings suggest that elevated PLR and NLR values are associated with increased risk of AKI after CABG surgery. The preoperative PLR ratio with a cut-off value of 132.5 and other inflammatory ratios can be used as independent predictors of post-CABG AKI. We suggest that these easily accessible markers may provide valuable information regarding the risk of AKI development following CABG.

Aim: Coronary artery disease (CAD) is an important health problem and accurate prognostic evaluations are critical. We aimed to investigate the association between the triglyceride glucose (TyG) index and coronary complexity in stable CAD patients.

Methods: We retrospectively enrolled 247 stable CAD patients. The patient group was classified into two groups; group 1: SYNTAX 0, group 2: SYNTAX ≥1. TyG index levels were analysed in these groups.

Results: A total of 247 patients were included in the study. Group 1 included 106 patients and, group 2 included 141 patients. Mean age was 68.9 ± 10.6 and 52.2% was male. TyG index was statistically significantly higher in group 2 (p < 0.001).Correlation analysis showed a strong correlation between the TyG index and SYNTAX score (r = 0.303, p < 0.001).

Conclusion: It was observed that high TyG index values increased the complexity of lesions in coronary arteries. The TyG index may be used to determine the prognosis of patients.

In this retrospective review of three patients presenting with anomalous aortic origin of the coronary arteries (AAOCA), we sought to highlight the varying presentations, discuss the optimal diagnostic imaging strategy and review current guidelines on the management of this condition. Over a one-year period three patients with AAOCA were identified. Pertinent data were extracted from case records and imaging, management and outcomes were reviewed in detail. All three patients had an anomalous right coronary artery originating from the left coronary sinus (AORCA) as well as a malignant course between the aorta and pulmonary artery. Although conventional angiography suggested the diagnosis, CT coronary angiography (CTA) was more useful in describing the anatomy and course of the anomalous artery and determining the necessity for and guidance to the type of surgical intervention required. All three patients underwent successful surgery. A brief literature review of the implications and management of this condition is provided.

We report a case of a 72-year-old man with advanced thyroid cancer who presented with massive neck bleeding from a ruptured infected pseudoaneurysm of the left common carotid artery, following radical neck dissection and radiotherapy. Due to active haemorrhage, tissue infection, and haemodynamic instability, endovascular treatment was contraindicated. Emergency surgical ligation of the left common and internal carotid arteries was performed. Postoperative infection control was achieved with broad-spectrum antibiotics and wound care. The patient recovered without neurological deficits. Prompt recognition and surgical intervention can be lifesaving in infected carotid pseudoaneurysm rupture.

Objective: The primary aim of this consensus is to identify strategies for diagnosing, treating, and managing heart failure in Africa.

Methods: The development of the manuscript involved a combination of literature review, expert consultations, and consensus-building workshops. A panel of experts was convened from various African countries to capture geographical diversity. Multiple discussions were held with focus on challenges in diagnosing heart failure with limited resources.

Results: Following a series of discussions, we prepared a manuscript that underwent peer review to validate its credibility and scientific rigor. This methodological approach demonstrates a commitment to evidence-based practice while also recognizing the need for solutions adapted to local contexts, with the goal of improving heart failure outcomes among Africa's diverse population.

Conclusion: In Africa, heart failure diagnosis often relies on echocardiography due to scarce BNP testing. Guideline-Directed Medical Therapy is often unaffordable, with medication access being a key challenge. Co-morbidities frequently complicate patient management.