Cardiovascular Journal of Africa最新文献

Background: Heart failure is a major cause of global morbidity and mortality. Studies in laboratory animals have shown the direct protective effects of α-klotho on the cardiovascular system although it has limited expression in the heart. The association between α-klotho and cardiovascular disease is still controversial in different clinical studies. We designed a cross-sectional study in order to investigate the association between serum α-klotho level and the prevalence of heart failure in the American general population.

Methods: The data were obtained from the National Health and Nutrition Examination Survey (NHANES), which included 11 271 participants aged 40-80 years. Serum α-klotho level was examined by enzyme-linked immunosorbent assay and divided into four quartiles for further analysis. Heart failure status was obtained from self-reported questionnaires. To estimate the association between α-klotho level and prevalence of heart failure, multivariate logistic regression analyses were conducted. Interaction and stratified analyses were performed to evaluate the potential modifiers.

Results: After adjusting for multiple covariates, a per-standard deviation increase in serum α-klotho level was associated with a decrease in prevalence of heart failure [odds ratio (OR): 0.76, 95% confidence interval (CI): 0.68-0.85). The ORs for participants in quartiles 2 to 4 were 0.77 (95% CI: 0.58-1.01), 0.70 (95% CI: 0.52-0.93) and 0.71 (95% CI: 0.53-0.95), respectively, compared with those in quartile 1. Stratified analysis revealed significant gender and racial differences.

Conclusion: We revealed an independent association between serum α-klotho level and the prevalence of heart failure in the American general population. The association was not always consistent and varied according to gender and race.

Heart rate variability is a non-invasive method of assessing global health through the analysis of the autonomous centralnervous system, including both the sympathetic and parasympathetic systems. The aim of this study was to evaluate the effect of resistance training on heart rate variability at rest in elderly individuals undergoing six months of resistance training with progressive loads. Training reduced the body fat percentage of the volunteers (pre: 39.39 ± 7.21 vs post: 34.97 ± 6.40%; p = 0.0069). There was also a significant reduction in the low-frequency index (pre: 69621.50 ± 9817.28 vs post: 54210.50 ± 14903.94; p = 0.0322) and a significant increase in the high-frequency index (pre: 30308.00 ± 9857.86 vs post: 45627.10 ± 14838.80; p = 0.0326). We concluded that sixmonths of resistance training with progressive loads were beneficial for heart rate variability and reduced the body fat percentage in the elderly.

Aim: We aimed to explore the application of computed tomographic angiography (CTA) and echocardiography in predicting left atrial appendage (LAA) thrombosis in patients with non-valvular atrial fibrillation.

Methods: The clinical data of 164 atrial fibrillation patients receiving cardiac CTA and real-time three-dimensional transoesophageal echocardiography (RT-3D-TEE) were retrospectively analysed. The patients were divided into group A (anticoagulant treatment group, n = 112) and group B (selective anticoagulant treatment group, n = 52) according to the CHA₂DS₂-VASc score, which scored for the presence or absence of congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischaemic attack, vascular disease, age 65-74 years and gender (female). The CHA₂DS₂-VASc score was used to predict risk of thromboembolism from atrial fibrillation. The correlations of CHA₂DS₂-VASc score with CTA-based LAA classification and RT-3D-TEE measurement parameters were explored using Spearman's analysis. Receiver operating characteristic (ROC) curves were plotted to explore the predictive value of CTA and RT-3D-TEE for LAA thrombus.

Results: There were significant differences in age, disease course, hypertension, diabetes mellitus, coronary heart disease, heart failure, stroke/transient ischaemic attack/thromboembolism, vascular disease, B-type natriuretic peptide and serum uric acid levels, CHA₂DS₂-VASc score, LAA classification, left ventricular ejection fraction (LVEF), left atrial diameter (LAD), maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length (p < 0.05). CHA₂DS₂- VASc score was positively correlated with cauliflower LAA, LAD, maximum diameter of LAA orifice, minimum diameter of LAA orifice and LAA length, and negatively correlated with LVEF (p < 0.001). ROC curve analysis indicated that CTA, RT-3D-TEE and CHA₂DS₂-VASc score had similar predictive values for risk of LAA thrombosis in atrial fibrillation patients, with the areas under the curve being 0.778, 0.814 and 0.792, respectively.

Conclusions: Both CTA and RT-3D-TEE had high predictive values for LAA thrombosis in atrial fibrillation patients.

Background: Graft patency is the most important factor in coronary artery bypass surgery. This study aimed to compare the relationship between three different surgical methods and transit time flow measurement (TTFM), which is used to detect technical problems in anastomoses performed during coronary artery bypass graft operations and to correct them if necessary.

Methods: A total of 110 patients undergoing isolated coronary artery bypass surgery were analysed. Of these patients, 48 were operated on by inducing cardiopulmonary arrest (group 1), 33 were operated on without inducing cardiac arrest (group 2) during cardiopulmonary bypass surgery, and 29 underwent surgery on the off-pump beating heart (group 3). TTFMs were performed on all the patients' grafts. Additional surgical intervention requirements, the need for intra-operative and postoperative inotropic support, and all postoperative follow-up data were compared.

Results: In total, 110 patients were measured for 301 grafts. Due to insufficient measurements performed on these patients, additional surgical intervention was performed on five grafts in group 1, five grafts in group 2, and seven grafts in group 3. These interventions enabled a normal flow rate to be achieved. The number of grafts that required revision was highest in group 3. There was no difference between the groups in terms of demographic data, EuroSCORE II, preoperative ejection fraction, postoperative complications and mortality rate.

Conclusion: TTFM is important for detecting technical problems in grafts. We believe that all surgical methods can be applied more safely by controlling graft flow.

Background: The use of percutaneous endovascular intervention in lower-extremity arterial diseases is increasing daily. With the growing technical experience of vascular surgeons, this is preferred to open surgery in more complex lesions.

Methods: The dose area product (DAP) and fluoro (FL) time values of 150 patients who underwent successful peripheral endovascular arterial intervention were analysed retrospectively. These values were evaluated by grouping according to the anatomical region and complexity of the lesion, type of procedure and arterial access.

Results: While the mean DAP was 18 ± 27 Gy cm² in patients who underwent only angioplasty, it was 21 ± 17 Gy cm² in patients who underwent stent implantation after angioplasty ( p = 0.069). The DAP value was statistically significantly higher in patients who had intervention in the pelvic region, both in the angioplasty (23 ± 22 Gy cm²) group and in the stenting (29 ± 18 Gy cm²) group, than in patients who had intervention in the femoropopliteal region (18 ± 27 and 15 ± 12 Gy cm², respectively) (p < 0.05). When the correlation between body mass index (BMI) of the patients and DAP was examined, a moderate positive correlation was found both in the pelvic region (r = 0.601, p = 0.00) and in the femoropopliteal region (r = 0.512, p = 0.00). Out of 78 patients in whom the ipsilateral popliteal retrograde approach was preferred, only two developed arteriovenous fistulae after the procedure, and only two of 77 patients in whom the femoral approach was preferred developed no major or minor complications, except femoral pseudo-aneurysm.

Conclusions: The most important factors affecting the radiation doses of the patients were the anatomical region and the patient's BMI. Radiation doses were higher in pelvic interventions compared to the femoropopliteal region. This may encourage the choice of arterial approaches that can minimise visualisation of the pelvic region in particular. Therefore, attention should be paid to pre-operative planning, especially in patients undergoing multiple diagnostic and therapeutic imaging. The ipsilateral popliteal retrograde approach can be safely chosen in combined iliofemoral, common femoral and superficial femoral total occlusions in the hands of surgeons with good Doppler ultrasonography experience.

Background: There is significant controversy surrounding the link between diabetes mellitus and post-operative complications after carotid endarterectomy (CEA). The aim of this study was to identify the possible effects of diabetes on the frequency of post-operative complications after CEA.

Methods: This prospective study was conducted at the Dedinje Clinic for Vascular Surgery, Belgrade. The patients who underwent CEA were divided into two groups: group A (37.7%) included 98 (35.1%) insulin-dependent and 181 (64.9%) insulin-independent diabetic patients, and group B (62.3%) comprised non-diabetic subjects.

Results: The pre-operative characteristics were similar, except for a greater prevalence of dyslipidaemia in patients with diabetes. Post-operative cardiac events occurred more often in patients with diabetes (3.6%) than in non-diabetic patients (1.1%) (p = 0.039); post-operative neurological events among patients with diabetes were 3.6% and among non-diabetics, 0.9% (p = 0.009). Peri-operative mortality rate was 2.5% in the diabetic group and 0.9% in the non-diabetic group. The total percentage of post-operative complications was two or more times higher in the diabetic group than the non-diabetic group (8.5 vs 18.3%, p < 0.001).

Conclusions: Diabetes mellitus increased the surgical risk of CEA. Higher rates of mortality and post-operative complications were observed in patients being treated with oral antidiabetics than in those on insulin.

Introduction: Fractional flow reserve (FFR) assessment compares the blood flow on either side of a blockage in the coronary artery and indicates how severe the stenosis is in the artery. Intravenous adenosine is widely used to achieve conditions of stable hyperaemia for the measurement of FR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially. Therefore, FFR has some limitations, such as the side effects of adenosine and the long procedure time. In addition, there are not enough studies on the evaluation of the baseline ratio of distal coronary pressure to aortic pressure (Pd/Pa) according to standard cut-off values in coronary stenosis under special clinical conditions. This study aimed to assess the diagnostic power of the baseline FFR value for critical coronary stenosis and to determine its predictive value in special patient groups.

Methods: This retrospective study included 158 patients, who were stratified as Q1 (< 0.89), Q2 (0.89-0.92), Q3 (0.93-0.95) and Q4 (> 0.95) based on baseline FFR values. The baseline Pd/Pa value, the change in adenosine FFR and the raw FFR change were recorded. Its predictive value was also calculated for specific patient groups.

Results: The threshold value of baseline FFR level for predicting critical stenosis was ≤ 0.92 with a sensitivity of 92.8% and a specificity of 82% (upper limit of Q2 cartilage). Patients with a baseline FFR value ≤ 0.92 had a 58.4-fold greater likelihood of a critical outcome compared with patients with a baseline FFR value > 0.92 (OR: 58.4; 95% CI: 20.3-124.6). In patients with a baseline FFR ≤ 0.92, the Q1 group had a 10.23-fold higher odds of critical stenosis compared with the Q2 group (OR: 10.23; 95% CI: 2.14-48.84). The same values had similar diagnostic power for all specific patient groups.

Conclusion: The baseline FFR value could be used to predict critical coronary stenosis in our patients and had similar value for predicting lesion severity in all the subgroups.

We aimed to explore the association between salt sensitivity and blood pressure variability in patients with essential hypertension. A total of 730 patients with essential hypertension treated from 2016 to 2019 were subjected to salt-sensitivity risk stratification according to 24-hour ambulatory blood pressure monitoring. Their clinical data were compared among groups with different grades of salt-sensitivity risk, and the association between salt sensitivity and blood pressure variability was analysed. The influencing factors for cardiovascular events in patients with essential hypertension were analysed through multivariate regression analysis, and their predictive value was detected using receiver operating characteristic (ROC) curves. Salt sensitivity was positively correlated with night-time and 24-hour systolic standard deviation and 24-hour systolic blood pressure coefficient of variation. Age ≥ 55 years, family history of cardiovascular diseases, high risk of salt sensitivity, night-time systolic standard deviation ≥ 14 mmHg, 24-hour systolic standard deviation ≥ 20 mmHg and 24-hour systolic blood pressure coefficient of variation ≥ 13.5% were all independent risk factors for cardiovascular diseases in patients with essential hypertension (p < 0.05). The area under the ROC curve of the prediction model was 0.837. There was a positive correlation between salt sensitivity and blood pressure variability, which has predictive value for cardiovascular events in patients with essential hypertension.

Background: The presence of right ventricular dysfunction affects outcomes in patients with left heart failure. We assessed the determinants of right ventricular systolic dysfunction (RVSD) among patients with left heart failure presenting to the Korle Bu Teaching Hospital of Ghana.

Methods: Consecutive patients with left heart failure who were 18 years and above were prospectively enrolled and assessed for evidence of RVSD by measuring the tricuspid annular plane systolic excursion, the peak velocity of the tricuspid annulus in systole (RV S'), the two-dimensional right ventricular fractional area change (RV FAC) and the right ventricular myocardial performance index (RV MPI).

Results: Two hundred and seventy participants were enrolled, of whom 75.2% had at least one abnormal index of right ventricular systolic function. The prevalence of RVSD was significantly higher among those with non-hypertensive heart failure (85.3 vs 66.0%, p < 0.001). The left ventricular outflow tract velocity-time integral (LVOT VTI) was strongly correlated with the RV FAC and an LVOT VTI < 9.8 cm predicted the presence of an RV FAC < 35% with a sensitivity of 81.5% and specificity of 81.9% [area under the curve 0.882; 95% confidence interval (CI): 0.838-0.926, p < 0.001]. Independent predictors of the presence of RVSD included a transmitral E/A > 2 [odds ratio (OR) = 4.684, 95% CI: 1.521-14.428, p = 0.007), left ventricular ejection fraction < 40% (OR = 4.205, 95% CI: 1.643-10.760, p = 0.003), pulmonary artery systolic pressure (PASP) ≥ 35 mmHg (OR = 2.434, 95% CI: 1.012-5.852, p = 0.047) and systemic systolic blood pressure (SBP) < 140 mmHg (OR = 2.631, 95% CI: 1.152-6.011, p = 0.022).

Conclusions: RVSD was common in these Ghanaian patients with left heart failure. Left ventricular function, SBP and PASP were independent predictors of the presence of RVSD. Pending further validation, the LVOT VTI may serve as a useful surrogate or screening tool for RVSD in these patients.

Kounis syndrome is defined as an acute coronary syndrome (ACS) secondary to allergic or hypersensitivity reactions. It can be further categorised into subtypes such as coronary vasospasms, acute myocardial infarction or stent thrombosis based on the pathogenesis. Kounis syndrome is most likely an underdiagnosed condition in China, given the many triggers reported in the literature. Herein, we report a case of Kounis syndrome, possibly triggered by a bee sting. The patient had late onset of angina symptoms with delayed diagnosis due to unfamiliarity with this condition. In patients with clinical signs of ACS that are superimposed on a hypersensitivity reaction, especially those with pre-existing cardiovascular risk factors, Kounis syndrome should be considered, so that appropriate assessment and treatment can be initiated. Prompt management of both the allergic reaction and the ACS is vital for Kounis syndrome.