Cardiovascular Journal of Africa最新文献

In this report, we describe an unexpected finding of Brugada Syndrome (BrS) in a young Kenyan athlete presenting with multiple episodes of syncope. This diagnosis could be the index case of BrS in the country, a diagnosis that is well described in Asia and the West, but rarely in Sub-Saharan Africa. A healthy 25-year-old male patient was referred by his teammate for episodes of syncope while playing field hockey. He noted that he has been healthy all his life with no significant medical history. His first episode of syncope was in late 2024, around October. He noted a prodromal episode of dizziness, fatigue and visual changes before passing out. He came to after about 30 seconds to 1 minute with no significant changes in his sensorium. He noted no fevers, no history of anaemia, no chest pain, no palpitations, no seizures or known cardiac history in the family. He subsequently had had two more episodes since then. His last episode was in the last week of March 2025. He had borderline bradycardic pulse in the mid 50s, with no murmurs, rubs or gallops, with a single, intact and non-displaced point of maximal impulse; normal JVP and no peripheral oedema. Radial, brachial and posterior tibial pulses were normal. Lungs had normal air movement without wheezing, rales or rhonchi. Abdominal exam had no organomegaly. His EKG revealed a normal sinus rhythm with a heart rate of 55 bpm, but with a prolonged PR interval of about 250 milliseconds; the right precordial leads V1 to V3 revealed elevated and coved ST segments diagnostic of type I Brugada Syndrome. A 12-hour Holter monitor revealed sinus bradycardia with persistent ventricular dysrhythmia, were consistent with the EKG, consistent with type I Brugada Syndrome. His echocardiogram revealed a normal left ventricle with mild concentric hypertrophy and normal function and an EF of 65 to 70%. Brugada syndrome (BrS) is a known leading cause of sudden cardiac death in young patients with structurally normal hearts. It is an autosomal dominant sodium channelopathy that causes a coved elevation in the ST segment in the right precordial leads that can degenerate in to a ventricular arrhythmia (polymorphic ventricular tachycardia or ventricular fibrillation) resulting in convulsive syncope and death.

Introduction: Substance abuse poses a significant global health challenge, particularly due to its adverse effects on the cardiovascular system. This study investigates the association between substance abuse and electrocardiogram (ECG) parameters, specifically the QT interval, corrected QT (QTc) interval, and the novel Tp-e interval, to assess potential arrhythmogenic risks.

Methods: In this cross-sectional study, we included 126 male substance abusers and 126 age-matched substance-free male controls. Standard 12-lead ECGs were used to measure QT, QTc (corrected by Bazett and Friedrich methods), and Tp-e intervals. Statistical analyses compared these ECG parameters between the two groups and identified risk factors for QT prolongation.

Results: Substance abusers predominantly used methamphetamine, heroin, and synthetic cannabinoids. Compared to controls, substance abusers exhibited significantly longer QT, QTcB (Bazett), and QTcF (Friedrich) intervals. Methamphetamine users had the longest QTcB, followed by heroin and synthetic cannabinoid users. Multivariate logistic regression identified age, methamphetamine use, multiple substance use, duration of synthetic cannabinoid use, and frequency of heroin use as significant predictors of QTcB > 450 ms.While Tp-e intervals did not differ significantly between groups, the corrected Tp-ec interval was longer in substance abusers.

Conclusion: Substance abuse is linked to prolonged QT and QTc intervals, highlighting an elevated risk of arrhythmias. The corrected Tp-e interval may provide a more sensitive measure of repolarisation heterogeneity in substance abusers, necessitating further research and clinical monitoring.

Background: Epicardial adipose tissue (EAT) is proposed to be a marker of cardiovascular risk. We aimed to evaluate the association of EAT with the presence of coronary artery disease (CAD) in patients with valvular heart disease.

Methods: A total of 72 patients scheduled for heart valve surgery were included in this prospective study. EAT was measured by transthoracic echocardiography (TTE) preoperatively. EAT thickness with positive coronary angiography (CAG) results were compared with the negative ones. The Mann-Whitney U test and Spearman Correlation was used to analyse in terms of non-normally distributed variables. The diagnostic decision-making characteristics of the presence of coronary lesions in the prediction of EAT were examined by ROC analysis.

Results: Patients with concomitant hypertension (HT) disease had higher EAT thickness than without HT disease (4.11 mm vs 3.57 mm, p = 0.02). Median values were 4.10 (IQR 1.50) and 3.60 (IQR 0.80) respectively. Patient with CAD had significantly higher EAT thickness than without CAD (4.87 mm vs 3.50 mm; p < 0.001). Median values were 4.80 (IQR 0.80) and 3.50 (IQR 0.85), respectively. Smoking habit (Rho = 0.414, p = 0.013), ascending aortic diameter (Rho = 0.24, p = 0.043) and body/mass index (Rho = 0.360, p = 0.002) had positive correlation with EAT thickness. To define diagnostic value of EAT in predicting coronary lesion, UAC was calculated 0.929 in ROC analysis (p < 0.001). When the cut-off point was selected as 4.3 mm, EAT strongly predicts presence of any coronary lesion (sensitivity 78%, specificity 92%).

Conclusion: EAT thickness > 4.3 mm is a strong predictor of suspected CAD and may help determine the need for CAG in patients undergoing heart valve surgery.

Aim: To assess the diagnostic ability and cut-points of traditional and novel adiposity measures for cardiometabolic disease (CMD) risk, and to determine the associations between these adiposity measures and metabolic syndrome (MetS) among corporate employees.

Methods: In this cross-sectional study, health risk assessments were completed on 625 employees (469 men and 156 women, mean age 50 ± 8 years). Adiposity measures included waist circumference (WC), waist-height ratio (WHtR), body roundness index (BRI), a body shape index (ABSI) and lipid accumulation product (LAP). Sex-stratified receiver operator characteristic (ROC) curve analyses assessed the diagnostic performance of adiposity measures for CMD risk. Logistic regression analyses determined the association between adiposity measures and MetS, which was defined according to the International Diabetes Federation (IDF).

Results: MetS was prevalent in 30% of the group, and higher in men than women (33.9% vs. 18%). The area under the curve (AUC) for the different CMD risk factors, for WC, WHtR, BRI and LAP, were similar to each other but higher than ABSI, for men and women. WC cut-points for both sexes (men: 96.5-99.5cm; women: 86.5-92.5cm) were higher than the internationally accepted IDF guidelines for CMD risk, namely 94cm and 80cm for men and women. WHtR (0.6), BRI (4.5) and ABSI (men: 0.08, women: 0.07) cut-points were similar for the group and LAP, higher in men (45.5-53.5) compared to women (22.8-41.5). In men, BRI (OR: 2.5; 95% CI: 1.9-3.3) and in women, LAP (OR: 3.4; 95% CI: 1.4-8.4) were most strongly associated with MetS after accounting for confounders.

Conclusions: BRI and LAP may be considered as alternative and complementary adiposity measures for CMD screening in corporate executives with high MetS and obesity prevalence.

Objective: To compare ECG, laboratory, comorbid disease and angiography data of patients diagnosed with acute coronary syndrome according to young, middle and old age groups.

Method: Demographic data such as age, gender and time of admission were analysed. Patients included in the study were over 18 years of age and were categorised into young (18-44), middle (45-64) and elderly (≥ 65) age groups. Data were accessed from the hospital electronic data system. Patients' comorbidity status, COVID-19 status and laboratory data were analysed, and comparisons were made according to age groups.

Results: 780 patients were analysed in the study. 74% of the patients were male. The mean age was 63.60 ± 12.26 years. Most patients were in the middle age group (51.6%). According to ECG findings at admission, most cases were without ST elevation. LAD (67.9%) and RCA (58.5%) were the most frequently occluded vessels. The age at onset of acute coronary syndrome was lower in patients with COVID-19.

Conclusion: Acute coronary syndrome is most common in males gender and at older ages, but most commonly in patients without ST elevation. The incidence of acute coronary syndrome in patients with COVID-19 is higher, especially in the young-middle-aged age group.

Objective: Coronary artery bypass graft (CABG) surgeries, which are used in the treatment of coronary artery disease are still generally performed under cardiopulmonary bypass (CPB). In addition to the mechanical effects of the surgery, pulmonary complications due toCPB are common. This study aimed to compare the effects of incentive spirometry (IS) and oscillating positive expiratory pressure (OPEP) devices used after CABG surgery on pulmonary system rehabilitation.

Methods: Two hundred and fifty-three coronary artery disease patients who underwent CABG were analysed retrospectively. The patients were divided into two groups: those using IS (n = 52) devices and those using OPEP (n = 52) devices. Arterial blood gases were evaluated on the 1st, 2nd, and 3rd postoperative days, and the 6-minute walking test (6MWT) was performed on the 2nd and 3rd postoperative days.

Results: The PO2, PCO2, and SaO2 values measured on the 2nd and 3rd postoperative days showed significant improvement in Group OPEP compared to Group IS (p = 0.016, 0.006, 0.031,0.039, 0.022, and 0.003, respectively). As a result of 6MWT performed on the 2nd and 3rd postoperative days, walking distance increased more in Group OPEP compared to Group IS (p < 0.001 and 0 < 0.001, respectively). In Group OPEP, both the length of stay in the intensive care unit and the length of hospital stay were found to be lower (p = 0.005 and p < 0.001, respectively).

Conclusion: As a result of this study, we think that the use of OPEP devices in pulmonary rehabilitation will be beneficial in preventing pulmonary complications after CABG.

Abbreviations: ABG: Arterıal blood gas, CABG: Coronary artery bypass graft, CAD: Coronary Artery Disease, COPD: Chronic Obstructive Pulmonary Disease, CPB: Cardiopulmonary Bypass, DM: Diabetes mellutus, ECHO: Echocardiography, EF: Ejection Fraction, EPAP: Expiratory positive airway pressure, EZPAP: Positive Airway Pressure Therapy System, FEV1: Volume Of Air Exhaled İn The 1st Second Of Forced Expiration, HL: Hyperlipidaemia, HT: Hypertension, IS: Incentive Spirometry, MİN: MİNİMUM, MAX: MAXİMUM, IMA: İnternal Mammary Artery, OPEP: Oscillating Positive Expiratory Pressure, PAD: Peripheral artery disease, PEFR: Peak Expiratory Flow Rate, PEP: Positive Expiratory Pressure, RD: Renal dysfunction, STD: Standard Deviation, 6MWT: 6 Minutes Walking Test.

Background: Cardiovascular disease (CVD) remains one of the preventable causes of death. Increasing patient knowledge of CVD may lead to success in the prevention and control of CVD, and an improved quality of life.

Aims: The study aimed to assess the knowledge, attitudes and perception of patients with CVD, and the need for regular monitoring and medication compliance at a state tertiary hospital in Johannesburg, South Africa.

Methods: A cross-sectional study was conducted among 191 adults with high cardiovascular (CV) risk in the vascular and diabetic outpatient clinics. A researcher-administered questionnaire was used to gather responses and a point-of-care-test (POCT) assessing glycated haemoglobin (HbA1c) and lipogram was done.

Results: The mean age of the cohort was 54 years, with a female predominance (64.4%), of which 56.5% were familiar with the term 'CVD' and 97.4% acknowledging the importance of attending follow-up visits. Despite having heard of CVD conditions, many participants did not have a sufficient understanding. There was an association of knowledge with medication adherence, socio-economic status, monthly income, and level of education. Patients' perceptions of disease control did not align with values measured in POCTs. Approximately 30% of participants achieved target blood pressure levels and 25% achieved target HbA1c levels. Healthcare professionals were well recognised in the role of CVD prevention and monitoring.

Conclusion: Although more than half of the study participants had knowledge of CVD, target blood pressure and HbA1c were only achieved in approximately one-third and a quarter of the patients, respectively. A significant gap exists between self-perception and knowledge among participants.

Optimal low-density lipoprotein cholesterol (LDL-C) control in patients with established atherosclerotic cardiovascular disease (ASCVD) is defined as LDL-C levels less than 1.4 mmol/L and a reduction of ≥ 50% in baseline LDL-C levels. This study aims to assess LDL-C control in patients with ASCVD on statin treatment in a tertiary academic hospital. We conducted a cross-sectional study on patients with ASCVD on statin therapy and compared LDL-C levels at the time of presentation with coronary syndromes with the most recent LDL-C obtained during follow-up visits. There were 458 patients with coronary syndromes. After a median duration of 17 months (interquartile range [IQR]: 7-31), 93 (20.3%) patients had optimal LDL-C control. A history of previous coronary artery disease or stroke (odds ratio [OR]: 1.73; 95% confidence interval [CI]: 1.05-2.85; p = 0.031) increased the risk of poor LDL-C control. Only 20.3% of patients with ASCVD on statins achieved the guideline-recommended LDL-C target.

Introduction: Despite the advances in CPB, various complications may occur. Prediction and anticipation of these undesirable outcomes is of great importance. For this reason, various markers have been tried to be determined.

Objective: The aim of this retrospective study was to evaluate whether the delta perfusion ratio, i.e. (v-a)CO₂/(av) O₂ ratio, and other perfusion markers are good indices for predicting adverse postoperative outcomes in patients undergoing cardiac surgery with CPB.

Methods: This study retrospectively included data from 169 adult patients aged 20 to 85 years who underwent consecutive CPB-guided isolated CABG surgery after applying exclusion criteria. Perfusion indices were compared between patients with and without adverse outcomes after CPB.

Results: There was a statistically significant correlation between the (v-a)CO₂/(a-v)O₂ ratio at CPB output and ICU admission (p < 0.001; p = 0.004, respectively); ScvO2 and CO₂ deficit after ACC and at CPB output and adverse outcomes after CPB (p = 0.010; p = 0.007; p = 0.000; p = 0.008, respectively). In ROC curve analysis, the cut-off value for CPB output (v-a)CO₂/(a-v)O₂ value was 2.27 (67.9% sensitivity, 65.9% specificity). The cut-off value for ICU entry (v-a)CO₂/(a-v)O₂ value was 2.6 (62.6% sensitivity, 73.3% specificity).

Conclusions: There was a statistically significant correlation between the (v-a)CO₂/(a-v)O₂ ratio after CPB and at ICU admission, ScvO2 and CO₂ deficit after ACC and after CPB and adverse outcomes after CPB. Therefore, we think that these are reliable perfusion indices in CPB-guided cardiac surgery.

Background: Few studies have assessed the prevalence and independent prognostic relevance of right ventricular dysfunction (RVD) and pulmonary hypertension (PH) in Africans with heart failure (HF) despite the different trajectories of HF in Africans compared to other ethnicities. We investigated the frequency and independent associations of RVD and PH with incident death in Nigerian-Africans with hypertensive HF.

Methods: Present analyses include 118 participants (mean age 57.6 years, 55% men) with ambulatory hypertensive HF. RVD was assessed with pulsed wave Doppler of tricuspid inflow velocities, tissue Doppler imaging of the tricuspid annulus and tricuspid annular plane systolic excursion (TAPSE) while PH was assessed with systolic pulmonary artery pressure during transthoracic echocardiography. Independent predictors of each of RVD and PH were determined using multivariable logistic regression models. Associations between each of RVD, PH and incident death were determined using Kaplan Meier plots and Cox proportional hazards regression models.

Results: The frequency of right ventricular systolic dysfunction (RVSD) was 56.8%, right ventricular diastolic dysfunction (RVDD) was 65.3% while PH was 56.8%. Over a mean follow-up of 2.4 years, each of RVSD, RVDD and PH was associated with higher risk of incident death (adjusted Hazards Ratio (aHR) 2.32 [95% CI: 1.39-3.90]; aHR 2.32 [95% CI:1.31-4.12]; aHR 1.69 [95% CI: 1.02-2.81] respectively). Associations of RVDD and PH with incident death were fully explained by left ventricular function indices, arrhythmia and systolic blood pressure while RVSD remained significantly associated with incident death after accounting for potential mediators. Only RVSD was independently associated with incident death when RVSD, RVDD and PH were mutually adjusted for each other (aHR 1.92 [95% CI: 1.10-3.32]; aHR 1.67 [95% CI: 0.82-3.41]; aHR 1.13 [95% CI: 0.62-2.07] respectively).

Conclusion: RVSD, RVDD and PH are common in hypertensive HF but only RVSD significantly increases the risk of incident death independent of RVDD, PH or left ventricular function.

Abbreviations: aHR: adjusted Hazards Ratio, EDV: end diastolic volume, ESV: end systolic volume, FS: fractional shortening, HF: heart failure, HFpEF: heart failure with preserved ejection fraction, HFrEF: heart failure with reduced ejection fraction, LV: left ventricle, LVEF: left ventricular ejection fraction, LVIDd: LV internal diameter in diastole, LVIDs: LV internal diameter in systole, RV: right ventricle, RVDD: right ventricular diastolic dysfunction, RVSD: right ventricular systolic dysfunction, SBP: systolic blood pressure, SPAP: systolic pulmonary artery pressure, PH: pulmonary hypertension.