Cardiovascular Journal of Africa最新文献

Background: Sutureless aortic prostheses are designed to make aortic valve replacement easier than stented or stentless prostheses in patients with significant aortic stenosis. Recently, a more minimally invasive approach combining sutureless aortic valve replacement with small incisions has emerged, but concerns remain about reduced surgical visibility and the risk of permanent pacemaker implantation.

Methods: Between 2015 and 2023, 216 patients underwent sutureless aortic valve replacement; of these, only 124 patients who underwent isolated primary aortic valve replacement surgery for severe calcific aortic valve stenosis were included in this study to compare in-hospital outcomes between the upper reversed-T mini-sternotomy and full sternotomy approaches.

Results: The mean age was 73.3 ± 7.1 years for full sternotomy [NK2] and 71.9 ± 5.7 years for mini sternotomy. The differences in preoperative risk factors, including associated cardiac pathologies, left ventricular functions, aortic valve pathologies, and aortic root status, were not significant. The mean aortic cross-clamp and associated total cardiopulmonary bypass times were higher in the mini-sternotomy group without any worsening of perioperative outcomes. Postoperative early complications were similar between the two groups, except for tube drainage and hospital stay, which were worse in the full sternotomy group.

Conclusions: In elderly patients with severe calcific aortic stenosis, sutureless aortic valve replacement via the upper reversed-T mini-sternotomy approach is at least as successful as the full sternotomy method and can be preferred in this patient group due to advantages such as less drainage and faster recovery.

Background: Postoperative cognitive dysfunction (POCD) following noncardiac surgery in the elderly is a growing concern. This study evaluates the relationship between carotid intima-media thickness (cIMT), a measure of subclinical atherosclerosis, and POCD.

Methods: In this prospective study, elderly patients (≥60 years) undergoing elective noncardiac surgery were divided into two groups based on cIMT. Cognitive assessments were conducted preoperatively and postoperatively using the mini-mental state examination, clock-drawing, digit span, trail-making, and Stroop tests.

Results: The study included 36 patients, with no significant differences in cognitive test outcomes between those with cIMT ≤0.9mmand >0.9mm. The overall incidence of POCD was 2.8%.

Conclusions: Increased cIMT was not associated with a higher risk of POCD. Larger studies are necessary to confirm these findings.

Purpose: To perform a systematic review of the diagnostic accuracy of low-dose cardiac CT scans in young children.

Methods: A search of MEDLINE via the PubMed, Web of Science Core Collection, Cochrane Library, and ScienceDirect databases for English-language literature was performed to identify studies on low-dose cardiac CT for the diagnosis of congenital heart disease. The image quality, diagnostic value and effective radiation dose of low-dose cardiac CT scans were compared.

Results: Fourteen studies utilized a total sample size of 474 neonates, infants, and young children. Twelve studies reported diagnostic accuracies ranging between 95.60% and 100.00%. Among the individual studies, the sensitivity ranged between 91.00% and 96.70%, whereas the specificity ranged between 92.30% and 99.91%. The effective radiation dose between individual studies ranged between 0.07mSv and 1.81mSv. The subjective image quality was either rated on a 5-point or a 4-point scale. Among the studies that used the 5-point scale, the image quality ranged between 3.77 and 4.90, whereas among the studies that used the 4-point scale, the image quality ranged between 1.20 and 3.06.

Conclusions: The findings of this study indicate that advanced CT scan protocols, such as high-pitched, dual-source, and ECG-triggered methods, can produce high-quality images and achieve very high diagnostic accuracy at extremely low radiation doses.

Background: Acute coronary syndrome (ACS) is a leading cause of mortality worldwide, especially among young males. While the incidence of ACS decreases in older populations, it remains significant in younger individuals. This study aimed to identify clinical and biochemical differences between young ACS patients with critical atherosclerotic stenoses and those without.

Methods: The study retrospectively analyzed 55 normotensive patients aged 18-35 years diagnosed with ACS between January 2023 and January 2024. Patients were categorized as "critical" (≥70% stenosis) or "noncritical". Demographic, etiological, and biochemical parameters were compared.

Results: Critical coronary lesions were found in 32 patients (58%). Active smoking was significantly more common in the critical group (p = 0.048), and mean MPV was lower (p = 0.024). Logistic regression identified male gender (p = 0.026), CRP (p = 0.010), GGT (p = 0.021), and interventricular septum thickness (p = 0.043) as risk factors.

Conclusion: This study underscores the importance of early detection and intervention in young ACS patients, particularly in addressing modifiable risk factors like smoking, inflammation, and oxidative stress. Further studies are needed to validate these findings.

Background: Transradial access (TRA) is a common technique used for diagnostic and interventional cardiac procedures. However, there are some challenges and risks of complications. This study aimed to evaluate the impact of periprocedural intermittent ischaemia of the contralateral arm on TRA and radial artery spasm.

Methods: We enrolled 80 patients with an indication for coronary angiography between December 2017 and June 2018. The patients were randomly grouped into two cohorts: intermittent contralateral arm ischaemia (n = 40) and control (n = 40) groups.

Results: The radial artery puncture success ratio was higher in the intermittent contralateral arm ischaemia group than in the control group (p = 0.025). In multivariable logistic regression analysis, intermittent contralateral arm ischaemia was significantly associated with radial artery puncture success (hazard ratio: 8.261, 95% confidence interval: 1.427-47.823, p = 0.018).

Conclusion: Periprocedural intermittent contralateral arm ischaemia increased the radial intervention success due to the remote ischaemic preconditioning, vasodilator factors and autonomic nervous system role.

Aim: Early identification of patients at risk for future cardiovascular events is essential. The aim of this study was to evaluate the relationship between cardiovascular risk factors and carotid intima-media thickness (CIMT) and radial intima-media thickness (RIMT).

Methods: A prospective, descriptive, analytical study design was used. Two hundred and fifty patients with one or more modifiable risk factors underwent an ultrasound measurement of left and right CIMT and RIMT, according to standard guidelines.

Results: Eighty-one percent of patients had two or more risk factors. Hypertension was the most common modifiable risk factor (89%), followed by obesity (66%). Male gender demonstrated a significant increase in mean CIMT (p < 0.05). Hypertension, diabetes mellitus, hypercholesterolaemia and smoking contributed to a thickened mean CIMT with odds ratios of 3.99, 2.82, 2.47 and 2.09, respectively (p < 0.05). Combinations associated with a thicker mean CIMT included hypertension and diabetes, and hypertension and smoking, with odds ratios of 6.92 and 3.67, respectively (p < 0.05). Only hypercholesterolaemia was significantly associated with a thicker mean RIMT (p < 0.05).

Conclusion: Male gender, increased age, hypertension, diabetes, hypercholesterolaemia and smoking significantly contributed to a thickened CIMT, whereas only hypercholesterolaemia was associated with a thickened RIMT. Hypertension had the most significant impact on the mean CIMT thickness. Combinations of risk factors appeared to add summative risks for thickened CIMT and RIMT.

Objective: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in adults worldwide, exerting a substantial impact on health, society and healthcare economics. Despite the current management strategies involving direct-current cardioversion (DCCV) and antiarrhythmic drug therapy, recurrence of AF remains a significant challenge. Brain natriuretic peptide (BNP), a crucial neurohormone, has been associated with AF recurrence; however, existing studies have yielded inconclusive results. Diastolic dysfunction, assessed using echocardiography, has also been implicated in AF recurrence. This study aimed to clarify the relationship between BNP levels, echocardiographic parameters and cardioversion success in patients with persistent AF.

Methods: This prospective, observational study enrolled 31 patients with persistent AF. Transthoracic (TTE) and transoesophageal echocardiography, alongside BNP measurements, were performed at various intervals: before cardioversion, 30 minutes post cardioversion and during a One-month follow up. Electrocardiography and TTE were conducted at the one-month mark, categorising patients based on diastolic dysfunction.

Results: Of the 31 patients, 28 successfully converted to sinus rhythm after DCCV. Baseline BNP levels correlated with heart rate and peak E/Em ratio. Patients with early AF recurrence had higher 30-minute BNP levels. Basal BNP levels were not found to be useful in predicting early AF recurrence, whereas BNPlevels at the 30th minute after cardioversion were significantly higher in the group with AF recurrence (318 ± 39.7 vs 153 ± 11.9 pg/ml; p = 0.05). Patients with or without mild diastolic dysfunction showed significantly lower BNP levels than those with moderate-to-severe dysfunction.

Conclusion: The study concluded that BNP levels, measured 30 minutes after DCCV, were more indicative of maintaining sinus rhythm than baseline levels. The correlation between baseline BNP and diastolic dysfunction parameters suggests a potential combined assessment for guiding rhythm-control strategies in patients with AF.

Introduction: Partial anomalous pulmonary venous return (PAPVR) can be treated with either the single- or double-patch technique. In this study, we evaluated the results of both techniques in adult patients with PAPVR.

Methods: We reviewed the records of 29 patients treated for PAPVR in two groups, according to which surgical technique was used.

Results: Double- and single-patch repair techniques were performed in 12 (group 1) and 17 patients (group 2),respectively. In group 2, three patients with a distance of more than 10 mm between the ostium of the anomalous pulmonary vein and the cava-atrial junction needed surgical re-intervention because of superior vena cava stenosis. There was no sinus node dysfunction and no mortality in either group.

Conclusion: In adult patients with PAPVR, the double-patch repair technique revealed better results than the single-patch technique, especially in patients with the ostium of the distal anomalous pulmonary vein more than 10 mm from the cava-atrial junction.

Background: The transradial approach (TRA) is preferred for coronary procedures due to improved outcomes and lower complication rates. However, complications such as radial artery stenosis (RAS) and occlusion (RAO) post TRA require investigation. This study aimed to explore the link between whole blood viscosity (WBV) and RAS/RAO after TRA coronary angiography.

Methods: A retrospective analysis of 215 TRA coronary angiography patients was conducted. Doppler ultrasonography assessed RAS/RAO one month post procedure. WBV, calculated from haematocrit and total plasma protein (TP), was evaluated at low (LSR) and high shear rates (HSR).

Results: RAS/RAO incidence was 15.3%, with 7.4% of patients experiencing RAO. Patients with RAS/RAO showed significantly elevated HSR, LSR and TP levels, with lower blood urea nitrogen levels. Multivariable analysis identified body mass index, HSR and LSR as independent RAS/RAO predictors.

Conclusions: This study established WBV association with RAS/RAO after TRA, suggesting WBV as a potential predictor and aiding pre-TRA risk assessment for alternative angiography routes.

Non-communicable diseases, including cardiovascular disease (CVD), are some of the leading causes of mortality worldwide. Despite the effectiveness of early diagnostic and treatment options, patient screening, disease detection and disease progression remain a challenge, resulting in suboptimal outcomes. Consequently, cardiovascular diseases remain underdiagnosed and undertreated, particularly in developing countries. Several barriers, including paucity of recommended cardiovascular health information and low literacy levels, lead to a poor understanding of the importance of intervention in terms of modifiable risk factors as well as treatment adherence. This narrative review focuses on cardiovascular patients' understanding of their disease, and the need for compliance with their medication and lifestyle modifications. Low levels of perception and insufficient knowledge of CVDs among patients continue to be indispensably important factors in health behaviour. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary cardiovascular team and ultimately improve the care provided to these patients.