Cardiovascular Journal of Africa最新文献

Background: Thoracic aortic aneurysms (TAA) are associated with significant morbidity and mortality worldwide. Determining the clinical outcomes after the surgical repair of TAA and correlation with the histological findings may improve our approach to the disease.

Methods: Patients undergoing surgery for TAA over a seven-year period at a large regional referral centre in South Africa were included. Patient's demographics, surgical intervention, histopathological findings and outcomes were recorded and analysed.

Results: 39 patients were included in the study. The mean age was 48.2 ± 13.7 years. The commonest risk factors were hypertension (41%, n-16), Human Immunodeficiency Virus (HIV) (41%, n-16) and smoking (20.5%, n-8). The 30-day mortality was 12.8% (n = 5) and causes of death were stroke (20%, n = 1), sepsis (20%, n = 1) and low cardiac output state (LCOS) (60%, n = 3). Histology showed cystic medial degeneration (66.7%, n = 26), atherosclerotic plaque (23.1%, n = 9) and active aortitis (10.3%, n = 4). At follow up 24 patients showed clinical improvement with no evidence of TAA recurrence. 10 patients were lost to follow up.

Conclusion: The outcomes of surgery for TAA are not directly correlated with the histological features of the excised aneurysm wall, and are more likely related to patient clinical characteristics and surgical technique.

Aim: Left atrial volume index (LAVI) is correlated with the risk of atrial fibrillation, cerebrovascular events, congestive heart failure, and death. In this study, we aim to reveal the relationship between the SYNTAX score I and LAVI.

Methods: A total of 176 (128 male, 48 female) patients who underwent elective coronary angiography with the diagnosis of stable angina pectoris (SAP) were included in the study. The biplane disc method was used to calculate the LAVI in transthoracic echocardiography.

Results: Based on the LAVI mean level, the patients were split into two groups: Group 1 (LAVI <27.8 mL/m2) and Group 2 (LAVI>27.8mL/m²).We found that body mass index (OR: 1.13495% CI 1.014-1.268; p = 0.028), left ventricular ejection fraction (OR: 0.938 95% CI 0.889-0.991; p = 0.022), age (OR: 3.849, 95% CI 1.430-10.15 p = 0.008), SYNTAX Score I (OR: 1.072 95% CI 1.009-1.140; p = 0.024) and left ventricular mass index (OR: 1.048 95% CI 1.015-1.082; p = 0.004) independently predicted LAVI increase.

Conclusion: Regardless of the anatomy and function of the left ventricle, the SYNTAX Score I is linked to an increase in LAVI. LAVI is a simple and practical echocardiographic parameter, and it may play a role in risk assessment before the procedure in patients undergoing elective coronary angiography due to SAP.

Background: Depolarisation parameters obtained from electrocardiography are the basic parameters in cardiac resynchronisation treatment planning. This study examined the relationship of repolarisation parameters obtained before and after the procedure with ventricular arrhythmias and cardiovascular death in patients who underwent cardiac resynchronisation therapy (CRT)- implantable cardioverter defibrillators (ICD) implantation.

Methods: Patients who applied to have CRT-ICD implantation were included in the study. ECG records taken at the time of hospitalisation for CRT-ICD implantation and after CRT-ICD implantation were obtained. The time from the peak of the T wave to the intersection between the tangent at the steepest point of the T wave and the isoelectric line was measured digitally in milliseconds.

Results: A total of 80 patients with CRT-ICD due to heart failure and bundle branch block were included in the study. Etiology was ischemic in 43 patients (54%) and non- ischemic in 37 patients (46%). The mean age of the patients was 64.9 ± 9.9 years and 77% were male (n = 62). Seventy (87%) of the patients with CRT were in sinus rhythm, and the mean left ventricular ejection fraction (LV EF) was 29.2 ± 5.8%. In ICD interrogation, VT was detected in 26 patients (32%) and VF in 2 patients (2%). It was determined that 5 (6%) of ventricular arrhythmias were terminated with anti-tachycardia pacing (ATP), and 6 (7%) with shock. A total of 20 (25%) patients died during the mean follow-up period of 43.1 ± 18.4 (7- 114) months after CRT-ICD implantation. Tp-Te values were compared and it was observed that there was a statistically significant prolongation after CRT in leads V5, V6, D1, D2, D3, aVF, aVR, and aVL compared to before CRT. In univariate logistic regression analysis, independent predictors of mortality were LV EF (OR: 0.898, CI: 0.810- 0.994; p = 0.038) and post-CRTQRS duration (OR: 0.978,CI: 0.957-0.999; p = 0.046), whereas in multivariate analysis LV EF was (OR: 0.902, CI: 0.814- 1.000; p = 0.050).Astatistically significant predictive effect of Tp-Te times in leads V2 and V4, which is one of the electrocardiographic parameters after CRT, on ventricular arrhythmia was determined. Tp-Te time in V2 greater than 98.4 ms predicted VT with 57% sensitivity and 68% specificity (AUC: 0.610, 95% CI 0.463-0.757). A Tp-Te time in V4 greater than 100.2 ms predicted VT with 50% sensitivity and 71% specificity (AUC: 0.631, 95% CI 0.487-0.775).

Conclusion: In this study, Tp-Te times in leads V2 and V4 after CRT were found to have a predictive effect on ventricular arrhythmia. Clinical studies with larger series are needed to evaluate the Tp-Te interval as a potential modifiable risk factor for the evaluation of ventricular arrhythmias in patients with CRT-ICD implantation and to demonstrate its effectiveness.

Introduction: In patients undergoing cardiopulmonary bypass-guided cardiac surgery, knowledge of the preoperative effects of platelet distribution width (PDW), red cell distribution width - standard deviation (RDW-SD), and platelet large cell ratio (P-LCR) factors strongly suggests that they may predict unfavourable outcomes.

Objectives: This retrospective study aimed to evaluate the effects of cardiopulmonary bypass (CPB) on PDW,RDW-SD, P-LCR and their relationship with early clinical outcomes.

Methods: This retrospective study included patients who underwent CPB-guided cardiac surgery after fulfilment of the exclusion criteria. Preoperative and postoperative routine PDW, RDW-SD, and P-LCR parameters were compared. In addition, the relationships between PDW, RDW-SD, and PLCR parameters and pre- and postoperative variables of the patients were evaluated.

Results: Data from 240 patients were included in the study. The mean age of the patients was 64.15 years; 143 were male and 97 were female. 12 patients underwent a single coronary artery bypass graft (CABGx1), 35 underwent CABGx2, 50 underwent CABGx3, 54 underwent CABGx4, 46 underwent CABGx5, 22 underwent mitral valve replacement (MVR), and 21 underwent aortic valve replacement (AVR). RDW-SD and P-LCR levels of the patients were significantly increased in the postoperative period compared to the preoperative period (p = 0.000 and p = 0.009, respectively). However, there was no significant difference between preoperative and postoperative PDW values (p = 0.251). Correlation analysis showed that there was a correlation between PDW level and intraoperative bleeding rate, ICU length of stay, and hospital stay. There was also a correlation between P-LCRlevel and intraoperative bleeding rate, and a correlation between RDW-SD level and intubation time, ICU length of stay, and hospital stay.

Conclusions: We postulate that CPB affects RDW-SD and P-LCR levels, and that there is a significant relationship between PDW, RDW-SD, and P-LCR levels and early post-CPB clinical data. We also postulate that PDW,RDW-SD, and P-LCRhave important prognostic values in predicting adverse events.

Background: Renal impairment following contrast exposure can sometimes become permanent, and data on the long-term impact of coronary computed tomography angiography (CTA) on renal dysfunction are limited. We aimed to examine the incidence and long-term outcome of persistent renal dysfunction after coronary CTA.

Methods: We identified 3500 patients with creatinine levels measured before and six months after coronary CTA. A total of 2054 patients were included in the final analysis for contrast-induced nephropathy (CIN) diagnosis, defined as a serum creatinine increase of 0.5mg/dl or a relative increase of 25% from baseline. Persistent renal dysfunction was defined as an absolute increase of 0.5 mg/dl or a relative increase of 25% in creatinine levels after at least six months of follow-up.

Results: The incidence of CIN was 1.0% and 40 (1.9%) patients had persistent renal dysfunction at median 2.5-year follow-up. Mortality rate was 2.0% (41 patients) and four patients (0.2%) required permanent dialysis during the same period. In multivariate regression analysis; age (odds ratio [OR]: 1.050, p = 0.027), diabetes (OR: 2.769, p = 0.004), baseline renal function (OR: 0.967, p = 0.003), and occurrence of CIN (OR: 7.760, p = 0.002) were identified as independent predictors of persistent renal dysfunction. Furthermore, occurrence of CIN and persistent renal dysfunction were found as independent predictors of long-term mortality.

Conclusion: During follow-up after coronary CTA, the incidence of persistent renal dysfunction was 1.9%, and the occurrence of CIN was the most important risk factor. In addition, both CIN and persistent renal dysfunction were associated with long-term mortality.

Background: The prevalence of patients requiring cardiac surgery with concurrent active cancer or a history of cancer is rising. This study aimed to evaluate the differences in postcardiac surgery long-term survival between these patients and those without cancer and to identify the factors influencing survival.

Methods: This retrospective study included 38 patients with active cancer or a history of cancer (Group 1) and 45 patients without cancer (Group 2) who underwent cardiac surgery. Demographical and perioperative clinical data of the patients were retrieved from electronic patient records. Patients/relatives were contacted by phone to check their survival status.

Results: Postoperative in-hospital mortality was 5.3% (2/38) and 0.0% (0/45) in the Group 1 and Group 2, respectively (p = 0.207). The mean survival was significantly shorter for Group 1 when compared to Group 2 (93.6 ± 11.6 [95% CI, 70.8-116.4] vs. 156.8 ± 9.7months [95% CI, 137.7-175.9], p < 0.001). Multivariate analysis identified the presence of cancer (HR: 7.7, 95% CI: 1.6 - 36.8, p = 0.010), hospitalisation longer than one week (HR: 4.2, 95% CI: 1.2 - 14.9, p = 0.028), and fresh frozen plasma need (HR: 7.0, 95% CI: 1.8-27.5, p = 0.006) as significant independent predictors of worse survival outcome.

Conclusion: Patients with a history of cancer or active cancer can be operated with acceptable risk. The findings of this study suggest that cancer affects long-term survival after cardiac surgery, primarily due to cancer progression. It emphasises the need for a multidisciplinary approach to balance benefits of cardiac surgery with the prognosis of cancer and underlines the importance of future research for better clinical decision making in these patients.

Background: To study survival rates and incidence of adverse effects after off-pump coronary artery bypass grafting (CABG) in women over 65 years, who are reported to have higher morbidity and mortality rates than men.

Methods: Health records were reviewed for 117 women over 65 years who underwent off-pump CABG from November 2014 to December 2022. Data were collected for demographic characteristics, pre-existing comorbidities, perioperative status, and postoperative and clinical outcomes.

Results: The mean (SD) age of patients was 74.4 (5.8%) years. Thirty-one (26.5%) patients were in emergent condition preoperatively. Postoperatively, 18 (15.4%) patients had atrial fibrillation. Thirty-two (27.4%) patients were extubated in the operating room. Artificial ventilation was required for 6.6 (9.3) hours, and patients remained in the cardiovascular intensive care unit for 41.6 (97.6) hours (median, 24 hours). Four patients required reexploration for bleeding (postoperative drainage, 582.5 [246.3] mL). No patients had postoperative renal failure or required dialysis, required intra-aortic balloon pump support, suffered stroke/transient ischemic attack, nor were diagnosed with postoperative myocardial infarction. Three patients (2.6%) died in the hospital, and 4 (3.4%) with obesity and diabetes had deep sternal wound infections which were treated successfully. The Kaplan-Meier 1-year survival rate was 96.5%; both the 3-year and 5-year survival rate was 95.3%.

Conclusions: Older women successfully underwent off-pump CABG and total arterial revascularisation with low rates of major adverse events, mortality, and morbidity. We attribute the good long-term survival to shorter lengths of stay in both the intensive care unit and hospital and less need for blood products after off-pump CABG.

Abbreviation: AF: atrial fibrillation, BIMA: bilateral internal mammary artery, BMI: body mass index, CABG: coronary artery bypass grafting, CAD: coronary artery disease, ICU: intensive care unit, ERAS: Enhanced Recovery After Surgery, EuroSCORE: European System for Cardiac Operative Risk Evaluation, GOPCABE: German Off-Pump Coronary Artery Bypass Grafting in the Elderly, LIMA: left internal mammary artery, NYHA: New York Heart Association, RIMA: right internal mammary artery, TIA: transient ischemic attack.

Objective: The Symptoms, history of Vascular disease, Electrocardiography, Age, and Troponin (SVEAT) score is a novel clinical risk scoring system that is used for non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. The objective of this study is to evaluate whether a relationship between SVEAT and the Synergy Between Percutaneous Coronary Intervention (SYNTAX) scores in patients who have acute coronary syndrome without ST-segment elevation is present.

Methods: 300 NSTE-ACS patients were enrolled in the study. SVEAT scores were calculated in an emergency room. After coronary angiography was performed for each patient, SYNTAX scores were calculated and the results compared.

Results: The total population was 300 patients, with a mean age of 60.35 ± 12.07, 68.7% of whom were of the male sex (n = 206). The median SYNTAX score of the study group was 8.00 (3.00-16.00). SVEAT scores showed a profound positive correlation with SYNTAX scores (r = 0.702, p < 0.001). An SVEAT score ≥ 5 predicted higher SYNTAX scores with 83% specificity and 73% sensitivity. Lower ejection fraction (r = -0.355, p < 0.001) and lower high-density lipoprotein (r = -0.174, p = 0.004) were linked to higher SYNTAX scores.

Conclusion: This study is a first for the presentation of the SVEAT score as a reliable tool for estimating the SYNTAX score in NSTE-ACS patients. It will provide valuable insight to clinicians for risk stratification.

Introduction: During cardiopulmonary bypass (CPB), adequate prime solution allows pre-treatment of the tubing line, oxygenator and blood pump, evacuation of air from the arterial conduit, and appropriate blood dilution. However, the volume of prime solution may also affect the blood transfusion rate.

Objective: This study evaluated the effect of different volumes of CPB prime solution used in two different cardiac surgery centres on blood transfusion rate, as well as the relationship between the volume of CPB prime solution and early clinical outcomes.

Methods: A total of 323 patients who underwent CPB-guided cardiac surgery were included in this retrospective study. Patients with different prime solution volumes in two different cardiac surgery centres were included in the study. Each centre was considered as a separate study group. The data of the groups were compared statistically.

Results: There were 195 patients in group 1 and 128 patients in group 2. The preoperative characteristics and laboratory variables of the two groups were similar (p > 0.05). The amount of additional fluid given during CPB, the amount of urine and haemofiltrate removed by the patients, intraoperative bleeding drainage rate, postoperative platelet and erythrocyte values, need for intracardiac defibrillation, need for inotropic support and intra-aortic balloon pump (IABP) requirement during CPB weaning, duration of postoperative mechanical ventilation support, and duration of intensive care unit (ICU) stay were similar in both groups (p > 0.05). However, intraoperative erythrocyte transfusion rates, postoperative bleeding drainage rates, postoperative erythrocyte transfusion rates, postoperative leukocyte value and length of hospital stay were significantly higher in group 2 (p = 0.000; p = 0.006; p = 0.000; p = 0.009; p = 0.037, respectively). Additionally, postoperative haemoglobin and haematocrit values were significantly lower in group 2 (p = 0.034; p = 0.047, respectively).

Conclusion: As a result of this study, we observed that low prime solution volume vs. high prime solution volume impacts the negative variables of CPB patients. We believe that perfusionists avoiding high prime solution volumes in fluid management during CPB will positively reduce the blood transfusion rate/amount, and also reduce other negative variables.

Background: The primary objective of this study was to evaluate changes in complete blood count (CBC) values in patients diagnosed with primary Raynaud's phenomenon (PRP). Most diagnostic tests for Raynaud's phenomenon (RP) aim to identify underlying diseases. When no such disease is detected, the condition is termed primary Raynaud's phenomenon (PRP).

Methods: Data were collected from a single-centre database, consisting of 2215 patients evaluated between 2010 and 2019. This study included 471 patients diagnosed with PRP and 339 healthy controls. A total of 1069 patients diagnosed with RP at our hospital were initially considered. Exclusion criteria were applied, resulting in the selection of 471 PRP patients for the study group. During the same period, 1146 healthy individuals with similar demographic characteristics were also evaluated, and 339 were included as the control group after applying exclusion criteria. CBC data of both groups were compared. The study retrospectively analysed patients diagnosed with PRP. Statistical analyses were performed using the SPSS software.

Results: Significant differences were observed between the PRP and control groups in platelet distribution width (PDW), red cell distribution width (RDW), platelet count (PLT), and mean platelet volume (MPV) (p < 0.00001). PRP patients exhibited increased PDW, RDW, and PLT values, and decreased MPV values. Regression analysis identified PDW (CI = 0.958-0.988) as the best predictive parameter for PRP, followed by RDW (CI = 0.769-0.835). Other parameters showed lower predictive power.

Conclusion: The pathophysiology of PRP remains unclear. However, the observed changes in CBC values may enhance understanding of PRP mechanisms. These haematological parameters could potentially serve as biomarkers for PRP diagnosis and prognosis.