Cardiovascular Journal of Africa最新文献

Background: Rheumatic heart disease (RHD) continues to be one of the leading causes of cardiovascular morbidity and mortality. The mitral valve frequently develops mitral stenosis (MS), and it is the most prevalent valve lesion in patients with chronic RHD. Left atrial (LA) functional impairment is associated with rheumatic MS.

Aim: The aim of this study was to evaluate the association between LA function and mitral valve area (MVA) in rheumatic MS patients, and to assess the echocardiographic parameters in sinus rhythm and atrial fibrillation (AF) patients.

Methods: This was a cross-sectional, descriptive study that involved patients with rheumatic MS. Patients underwent a standard 12-lead electrocardiogram and echocardiographic examination. MVA was assessed and correlated with LA function. Comparison was made between sinus rhythm and AF patients.

Results: Eighty-one patients with rheumatic MS were included in this study, with 71.6% of them having associated MR. MVA showed a statistically highly significant positive correlation with LA and right ventricular (RV) function, and a statistically significant/highly significant negative correlation with their dimensions. A higher percentage of patients with severe MS was in AF (58.1%).

Conclusions: There was a positive correlation between LA function and MVA in rheumatic MS patients. AF was related to the severity of MS.

Malposition of a catheter is found in approximately 7% of cases after central venous catheterisation. This may result in haemorrhage, venous thrombosis and functional impairment, depending on the injury to the vessel wall. Uncomplicated catheterisation, easy aspiration of blood and monitoring of catheterisation do not guarantee correct placement of the catheter. In our rare case series, we share our experience of four cases of malposition into the left internal mammary vein (LIMV) that we experienced in a three-year period. The thinness and fragility of the vessel wall, particularly, increases the probability of complications in malposition into the LIMV. Administration of a catheter through the right jugular vein is associated with the lowest incidence of malposition. Performing the procedure under the guidance of ultrasonography (USG) and confirmation of the catheter position after puncture using one of the USG techniques will minimise the probability of malposition. In addition, a lung X-ray should immediately be taken, and venography and fluoroscopy should be considered in the presence of suspicion.

Spontaneous isolated superior mesenteric arterial dissection with coeliac axis stenosis is rare but serious. We report a case of a 54-year-old male with coeliac axis stenosis who presented with acute superior mesenteric arterial dissection, which caused thrombosis of the branches. This is the first report of the full course of treatment using endovascular repair and laparoscopic surgery to deal with spontaneous isolated superior mesenteric arterial dissection combined with coeliac axis stenosis. This approach has been shown to be safe and effective for yielding short-term results.

Sub-Saharan Africa (SSA) faces the highest rate of hypertension worldwide. Blood pressure (BP) control rests on the association of lifestyle modification and antihypertensive medicines. We aimed to systematically review antihypertensive strategies implemented in SSA to achieve BP control. A systematic search beginning in 2003 was performed in MEDLINE, COCHRANE and EMBASE. We included only original and observational studies in SSA countries. Thirty studies were included from 11 countries. No study was multinational. The number of patients varied from 111 to 897 (median: 294; IQR: 192-478). Overall, 21% of patients received monotherapy, 42.6% two-drug and 26.6% three-drug combinations. Out of all the strategies, renin-angiotensin system (RAS) blockers were mostly prescribed, followed by diuretics and calcium channel blockers. In monotherapy, RAS blockers were the first to be prescribed. Only 10 articles described antihypertensive strategies beyond triple combinations. BP control was highly variable (range: 16.4 to 61.2%). Multicentre studies performed in several SSA countries are needed to ensure international guidelines actually do improve outcomes in SSA.

Objective: Monocyte-to-high-density lipoprotein cholesterol ratio has emerged as an indicator of inflammation and oxidative stress in recent years. The aim of this study was to evaluate the association of monocyte-to-high-density lipoprotein ratio with postoperative acute kidney injury in isolated coronary artery bypass grafting.

Methods: A total of 954 patients (672 males, mean age 60.8 ± 8.2 years), operated on between June 2014 and June 2022, at the same centre by the same team, for isolated coronary artery bypass grafting with cardiopulmonary bypass, whose preoperative serum creatinine level was < 1.5 mg/dl, were enrolled in the study. Patients were placed in group 1 if they had acute kidney injury in the early postoperative period (n = 161) and group 2 comprised those without (n = 793). Univariate and subsequent multivariate logistic regression analysis were done to determine significant clinical factors, and independent predictors of acute kidney injury.

Results: Pre-operative monocyte count (p = 0.0001), monocyte count-high-density lipoprotein cholesterol ratio (p = 0.0001), C-reactive protein (p = 0.0001), erythrocyte sedimentation rate (p = 0.0001), mean platelet volume (p = 0.0001) and postoperative first- and third-day C-reactive protein levels (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis revealed that pre-operative elevated monocyte count (p = 0.0001), monocyte-high-density lipoprotein ratio (p = 0.0001), erythrocyte sedimentation rate (p = 0.0001), postoperative first-day C-reactive protein level (p = 0.0001), postoperative first-third day erythrocyte sedimentation rate (p = 0.002, p = 0.004, respectively) and mean platelet volume (p = 0.02, p = 0.0001, respectively) were independent predictors of early postoperative acute kidney injury in patients who had undergone isolated coronary artery bypass grafting.

Conclusions: Pre-operative monocyte-high-density lipoprotein cholesterol ratio was found to be an independent predictor of acute kidney injury in the early postoperative period of isolated coronary artery bypass grafting.

Background: South Africa is home to a multi-ethnic society with a large range of cultures and lifestyles. Cardiovascular disease is a major cause of morbidity and mortality. South Africa is known to have one of the highest incidence rates of hypercholesterolaemia in the world, especially among the Caucasian population.

Aim: The aim of this retrospective chart review was to establish whether a multisource simvastatin (Simvotin^®, Ranbaxy, a Sun Pharma company) maintained the cholesterol-lowering effect after switching from the innovator brand Zocor^® (MSD South Africa) in the public-sector hospitals. Since prescribers often doubt the registration requirements of multisource products based on bioequivalence alone, this research was done to confirm similar clinical outcomes in a real-world setting.

Methods: More than 200 charts were identified from patients treated for hyperlipidaemia. Patients were treated for at least six months prior to and again six months after the switching of brands in order to meet criteria to be eligible for inclusion. The lipid values at initiation of therapy as well as before switching (visit 1 and 2) had to be available and again six months after treatment on the multisource product (visit 3).

Results: No significant change was observed in the lipid control after switching, confirming similarity.

Conclusion: This real-world evidence should allay any fears of generic inferiority of this important medicine in the treatment and prevention of high cardiovascular risk in patients requiring lipid-lowering therapy.

We aimed to explore the predictive values of stress hyperglycaemia (SHG) and glycosylated haemoglobin (HbA_1c) levels on admission for long-term recovery of cardiac function in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PPCI). A total of 210 AMI patients were randomly selected. The levels of SHG and HbA_1c were measured on admission, and all patients were treated with PPCI and followed up for one year. According to the recovery status of cardiac function during follow up, the patients were divided into a good recovery group and a poor recovery group. At one year after treatment, there were statistically significant differences in the levels of SHG (6.75 ± 0.69 vs 7.81 ± 0.92 mmol/l) and HbA_1c (5.13 ± 0.25 vs 5.91 ± 0.39%) between the good and poor recovery groups (p < 0.05). The levels of SHG and HbA_1c were associated with long-term recovery of cardiac function (p < 0.05). The receiver operating characteristic curves were plotted, and the area under the curves of SHG and HbA_1c for predicting the long-term recovery of cardiac function were > 0.70. The levels of SHG and HbA_1c were closely associated with longterm recovery of cardiac function after PPCI in AMI patients, displaying high predictive values.

Objective: The choroidal vascularity index (CVI) is a method that measures the density of blood vessels in the choroidal layer and can be used to evaluate the effects of hypertension. In this study we aimed to investigate the relationship between epicardial fat thickness (EFT) and CVI in patients with hypertension.

Methods: This prospective study included 112 patients diagnosed with hypertension and 120 healthy individuals. Patients' demographic data such as age, gender, weight, height, body mass index (BMI), smoking status, and presence of coronary artery disease and diabetes mellitus were recorded. BMI was calculated by dividing a patient's weight in kilograms by their height in metres squared. EFT was measured by echocardiography and CVI was calculated using the optical coherence tomography method.

Results: The mean CVI was found to be 66.57 ± 2.21 in the patient group and 69.22 ± 2.39 in the control group and the difference was significant (p < 0.001). The mean EFT was found to be 5.23 ± 3.25 mm in the patients and 2.57 ± 1.97 mm in the control group and the difference was statistically significant (p = 0.003). According to Spearman's correlation analysis, there was a significant positive correlation between BMI and EFT (r = 0.379, p < 0.001) and a significant negative correlation between CVI and EFT (r = -0.412, p < 0.001).

Conclusion: The CVI value was significantly lower and the EFT value was significantly higher in patients with hypertension compared to non-hypertensive patients. There was a significant positive correlation between EFT and BMI and a significant negative correlation between EFT and CVI.

Aim: As the impact of angiotensin receptor/neprilysin inhibitor (ARNI) on cardiac function in acute myocardial infarction (AMI) patients is unclear in clinical therapy, we conducted this research to investigate the actual effects of improving cardiac function with ARNI in AMI patients.

Methods: Publications were checked up to June 2022. Standardised mean differences (SMD) and 95% confidence intervals (CI) were utilised for assessing the size of the effect of continuous variables. To assess the magnitude of the effect of dichotomous variables, a relative risk (RR) with 95% CI was used.

Results: ARNI could improve left ventricular ejection fraction (SMD = 0.40; 95% CI: 0.23 - 0.58), while lowering left ventricular end-diastolic volume (SMD = -0.43, 95% CI: -0.78 to -0.08), left ventricular end-systolic volume (SMD = -0.39, 95% CI: -0.66 to -0.11) and left ventricular enddiastolic diameter (SMD = -0.49; 95% CI: -0.65 to -0.33). Besides, it could decrease the rates of major adverse cardiac events (RR = 0.55; 95% CI: 0.43 - 0.69) and heart failure (RR = 0.42; 95% CI: 0.31 - 0.58).

Conclusion: ARNI could greatly improve cardiac function in AMI patients.