Cardiovascular Journal of Africa最新文献

Background: Structural remodelling of the heart and blood vessels is an important basis for the development of cardiovascular disease. Krüppel-like factor 5 (KLF5), an important regulator of cardiovascular remodelling, promotes vascular smooth muscle cell (VSMC) proliferation and inflammatory responses. Neuregulin 1 (NRG1) is a positive regulator of angiogenesis, and its receptors are human epidermal growth factor receptors ErbB2, ErbB3, and ErbB4, which constitute the NRG1/ErbB signalling system. However, the relationship between the mechanism by which KLF5 promotes smooth muscle cell proliferation and the role of NRG1 has not been elucidated.

Materials and methods: Human coronary artery smooth muscle cells (HCASMCs) were cultured, and DNA fragments specifically enriched for binding to KLF5 proteins in HCASMCs. These were sequenced and analysed by chromatin immunoprecipitation sequencing (ChIP-seq), and downstream proteins NRG1 that could be regulated by KLF5 were identified. Dual luciferase assay was performed to verify whether KLF5 regulated the expression of NRG1, and HCASMC was transfected using KLF5 lentivirus, which was further verified by reverse transcription-polymerase chain reaction (RT-PCR) and western blot. To examine the function of the KLF5/NRG1/ErbB pathway in VSMC proliferation, we performed VSMC proliferation assays utilising ErbB2/3/4 receptor blockers.

Results: NRG1 is a direct transcriptional target gene of KLF5. KLF5 was able to promote the mRNA and protein expression of NRG1 in HCASMC, blocking ErbB2/3/4 receptors, and the role of KLF5 in promoting smooth muscle cell proliferation was attenuated.

Conclusion: KLF5 may be one of the mechanisms by which VSMC proliferation may be promoted by upregulating the NRG1/ErbB pathway.

Introduction: Surgical closure of ventricular septal defects remains the predominant paediatric cardiac surgical intervention. This study aims to identify risk factors influencing the duration of intensive care stay and complications following surgical correction for ventricular septal defects.

Methods: Preoperative, perioperative, and postoperative data were comprehensively assessed from echocardiography reports, perfusion reports, and clinical, inpatient, and operative notes for all patients. Outcome variables included in-hospital mortality, mechanical ventilation duration (hours), paediatric intensive care unit stay (days), and overall hospital stay (days). The study presents findings from a single paediatric cardiac centre experience spanning from October 2015 to October 2018.

Results: Among the 108 patients who underwent surgical ventricular septal defect closure, younger age (p < 0.001 for PICU stay, p = 0.001 for hospital stay, and p = 0.036 for mechanical ventilation time) and lower weight (p < 0.001, p = 0.009, and p = 0.006, respectively) were identified as risk factors for prolonged paediatric intensive care unit (PICU) stay, extended hospital stay, and increased mechanical ventilation time. Additionally, patients with genetic syndromes showed significantly longer mechanical ventilation times (p < 0.001), PICU stays (p < 0.001), and hospital stays (p = 0.002).

Conclusion: While genetic syndromes did not impact complication rates, they significantly influenced the durations of hospital and paediatric intensive care unit stays, as well as mechanical ventilation. Younger age and lower body weight emerged as risk factors for prolonged hospitalisation, extended paediatric intensive care unit stays, and prolonged mechanical ventilation. Consequently, these factors warrant consideration in the postoperative follow-up of patients with ventricular septal defects.

Myxoma is the most common cardiac tumor, typically found in the left atrium. Here, we present a case of a large right atrial myxoma.

Objective: This study compares posterior pericardiectomy (PP) and posterior pericardial Hemovac drainage (PPHD) in terms of their effects on post-operative atrial fibrillation (POAF) incidence in patients undergoing coronary artery bypass grafting (CABG).

Methods: A total of 149 patients (mean age 59.6 ± 7.5 years, 75.8% male) were included in this study. Patients were divided into two groups based on the drainage technique. Demographic characteristics, perioperative parameters, and post-operative POAF incidence were analysed.

Results: POAF incidence was 8.9% in the PP group and 5.1% in the PPHD group, but the difference was not statistically significant (p = 0.385). The first 24-hour drainage volume was significantly higher in the PPHD group (p = 0.034), whereas left thoracic drainage was more pronounced in the PP group (p < 0.001). Residual pleural effusion was more frequent in the PP group compared to the PPHD group (15.6% vs. 3.4%, p = 0.019).

Conclusion: Although the difference in POAF incidence between the two groups was not statistically significant, PPHD demonstrated more effective early drainage and resulted in less residual pleural effusion.

Kounis syndrome (KS) has been defined as an acute coronary syndrome (ACS) triggered by allergic/hypersensitivity reactions induced by various conditions, drugs, environmental factors, foods, and coronary stents. Three types of Kounis syndrome have been described to date: vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis. Despite the clinical manifestations of Kounis syndrome expanding and its aetiology continuously increasing, it is still an underdiagnosed entity. Herein, I present a case of Type II Kounis syndrome after intake of amoxicillin/clavulanic acid, which appeared to be Type I.

Background: No-reflow is a phenomenon of unclear pathophysiology that occurs in approximately 5-10% of patients after primary percutaneous coronary intervention. Recently, the relationship between the systemic immune-inflammatory index (SII), which reflects inflammatory status, and the triglyceride-glucose index (TyG), which reflects insulin resistance, as well as heart disease and its complications, has been under investigation. In this study, we aimed to evaluate the ability of a combination of the SII and TyG, routinely obtained at admission, to identify ST-segment elevation myocardial infarction (STEMI) patients at risk of no-reflow.

Method: Between 2018 and 2024, 2382 patients with STEMI, who underwent percutaneous coronary intervention (PCI), were included. The patients were divided into two groups according to whether no-reflow developed or not, and the relationships between the SII and TyG, as well as their combined use in the prediction of no-reflow, were evaluated. Receiver operating curve (ROC) analyses were performed to predict the development of no-reflow.

Results: In the ROC analyses, the cut-off values of SII and TyG for best predicting no-reflow were 421 and 7.82, respectively. Using the combination of these two markers was the most powerful predictor of no-reflow risk when included in a single variable, such as high SII or high TyG. Furthermore, the co-presence of a high SII and a high TyG showed the highest specificity (84%) and sensitivity (85%) for no-reflow.

Conclusion: The combination of the SII and TyG, simple and cost-effective risk assessments, may be a more reliable prognostic indicator of the development of no-reflow in STEMI patients undergoing PCI than the use of the SII and TyG alone.

Background: The aim of the present study was to obtain EKG parameters in an urban community in the Democratic Republic of Congo (DRC), to determine the prevalence of asymptomatic atrial fibrillation (AF) and other abnormalities, including the long QT syndrome, and to determine factors associated with such abnormalities.

Methods: This is a cross-sectional study conducted from June 2022 to April 2023 in Bukavu, in the eastern region of the DRC, involving 413 (>16-year old) participants, grouped according to gender (44.8% females) and according to age (subjects aged ≥30 years; mean ± SEM: 56.4 ± 0.8 years, n = 190, versus subjects aged < 30 years; mean ± SEM: 24.1 ± 0.17 years, n = 223). Demographic, clinical and electrocardiographic data were collected. Various EKG parameters were measured or calculated.

Results: Average standard EKG parameters (RR, PR and QT interval durations, QRS duration and mean axis, T wave amplitude) had values within known reference values. The Sokolow-Lyon index was high (>38 mm in 15.0% of participants). ST segment elevation presents in anterior precordial leads, mainly in males and young participants, rarely exceeded 2 mm. Prolonged QT_c (>440-ms) was present in 11.4% of participants and was associated with female gender, hypertension and diabetes. There was only 1 case of atrial fibrillation.

Conclusion: Mean EKG parameters in the population of Bukavu are similar to those found in other regions of Sub-Saharan Africa (SSA) and in the world. Except for large Sokolow-Lyon indices EKG variants such as large ST segment elevation and T wave inversion found among asymptomatic Blacks in certain other regions of SSA are not found in Bukavu. The scarcity of AF suggests that other aetiologies do account for the increasing incidence of ischaemic strokes in the studied population. Prolonged QT_c was related to female gender, hypertension and diabetes.

Background: Ischaemic stroke is frequently associated with electrocardiographic (ECG) abnormalities, including repolarisation disturbances. These disturbances, often seen as prolonged QT intervals or altered T-wave morphology, reflect impaired ventricular repolarisation and have been linked to an increased risk of cardiovascular events. One specific marker, the frontal QRS-T angle (FQRS-T angle), which measures the relationship between the QRS complex and T wave, has gained attention as a potential prognostic indicator in cardiovascular diseases. However, its role in ischaemic stroke has been scarcely investigated. This study aimed to assess the prognostic value of the frontal QRS-T angle in predicting survival and cardiovascular events in patients with cryptogenic ischaemic stroke.

Methods: In this retrospective analysis, patients with confirmed cryptogenic ischaemic stroke were stratified into two groups based on a frontal QRS-T angle threshold of 90°. Clinical outcomes, including survival, cardiovascular events, recurrent stroke, and atrial fibrillation, were compared between the two groups.

Results: Patients with a frontal QRS-T angle >90° exhibited significantly higher mortality rates (26.3% vs. 6.3%, p < 0.05) and shorter survival durations (19.58 ± 1.72 months vs. 25.54 ± 0.63 months, p = 0.003). The >90° group also had a higher incidence of cardiovascular events (42.9% vs. 18.8%, p = 0.039). No significant association was found with recurrent stroke or atrial fibrillation.

Conclusion: The frontal QRS-T angle is a valuable prognostic marker for mortality and adverse events in cryptogenic ischaemic stroke patients. This simple parameter could be integrated into clinical practice to identify patients at higher risk for adverse outcomes, allowing for more targeted monitoring and management.

Background: This study was conducted to compare the procedure-related knowledge and anxiety levels among patients who underwent elective and emergency percutaneous transluminal coronary angioplasty (PTCA) in the coronary intensive care unit (CICU).

Methods: The study was descriptive and conducted in the Cardiology Clinic CICU of a training and research hospital in Ankara, Turkey, between January 2022 and June 2024. The study sample was completed with 95 volunteer participants who underwent PTCA. These were either elective (n = 47) or emergency admissions (n = 48) to the CICU.

Results: 37 (38.9%) of the patients were female, 58 (61.1%) were male, and the mean age was 61.1 ± 12.1 years. 23 (24.1%) were smokers, and 55 (57.89%) had chronic diseases. A statistically significant difference (p < 0.001)was found between the two groups in terms of their knowledge levels regarding the PTCA procedure. A significant difference (p < 0.05) was also found between the two groups in terms of the mean scores on Spielberger's State-Trait Anxiety Inventory (STAI).

Conclusion: The knowledge level of patients admitted to elective CICU was found to be higher than that of patients admitted to the emergency department. Patients admitted to emergency CICU were found to have more anxiety and fear of death than elective patients.

Background: The practice of pacing patients with Mobitz type 1 atrioventricular (AV) block that present with symptomatic bradycardia or who are older than 65 years of age is well established. There is limited evidence that guides the management of younger asymptomatic patients presenting with Mobitz 1 AV block.

Objectives: To describe the natural history of Mobitz 1 AV block in patients aged 45-64 years, and to assess the need for pacing.

Methods: This was a retrospective descriptive analysis conducted at Tygerberg Hospital, Cape Town, South Africa. Patients with electrocardiograms (ECG) showing Mobitz type 1 AV block in 2016 were followed up after 6.5 years to observe the natural history of unpaced patients.

Results: A total of 15 141 ECGs and 1506 cardiology admissions were screened. Fifteen patients with Mobitz type 1 AV block were identified and reviewed. There was a near even male to female distribution, 8:7, with a mean age of 59.4 ± 17.8 years. Six patients were aged 45-64 years, and their unpaced (n = 5) 5-year survival rate was 80%. One patient died, but the cause of death was end-stage heart failure and not progression of heart block.

Conclusion: Both this study and other notable publications in this field feature small sample sizes. Caution is therefore warranted in drawing definitive conclusions. Nevertheless, our findings suggest a potentially more benign natural history for Mobitz 1 AV block in this age group compared to existing literature.