Cardiovascular Journal of Africa最新文献

Background: Antithrombotic therapy in atrial fibrillation is generally managed with the CHA₂DS₂-VASc score. Aortic valve sclerosis (AVS) is a focal thickening of the aortic valve without a restriction of motion. AVS is related to several cardiovascular risk factors. Our study was performed to evaluate whether the presence of AVS was associated with the CHA₂DS₂-VASc score.

Methods: This cross-sectional, observational study comprised 411 patients with AVS grades 1-3 [AVS (+)] and 102 patients with AVS grade 0 [AVS (-)]. We compared CHA₂DS₂-VASc scores between the AVS (+) and AVS (-) groups.

Results: We determined that the AVS (+) group had a higher CHA₂DS₂-VASc score than the AVS (-) group [3 (0-8) vs 1 (0-4), p < 0.001) ].

Conclusions: In our study, the CHA₂DS₂-VASc score was found to be higher in patients with AVS than in those without AVS. AVS may predict cardiovascular risk in the general population.

Background: Inflammation in acute coronary syndrome (ACS) involves neutrophil activation and oxidative stress. Here, we studied the production of reactive oxygen species (ROS) by neutrophils in ACS.

Methods: The study included 42 patients, men and women aged 46-91 years with ischaemic heart disease (IHD), non-ST-segment elevation ACS and ST-segment elevation ACS. Neutrophil-derived ROS were quantified with double-step stimulated luminol-enhanced chemiluminometry.

Results: The specific indices of spontaneous and double-step stimulated chemiluminescence did not differ in the subgroups of IHD, non-ST-segment elevation ACS and ST-segment elevation ACS. The total double-step stimulated ROS production by neutrophils was significantly higher in ST-segment elevation ACS than in non-ST-segment elevation ACS and IHD.

Conclusions: In ACS, special activation mechanisms of peripherical neutrophils were not triggered in our study. The significant increase in free radical production by neutrophils in acute myocardial infarction was presumably a consequence of an increase in their number.

Background: Dilated cardiomyopathy (DCM) is often familial and screening of relatives is recommended. However, studies on the yield of screening are scarce in developing countries.

Aim: The aim of the study was to identify and characterise First-degree relatives of patients with DCM in Tanzania.

Methods: We recruited first-degree relatives of 57 DCM patients. DCM in the relatives was diagnosed using the 2016 revised definition by the European Society of Cardiology working group on myocardial and pericardial diseases.

Results: We screened 120 first-degree relatives. All were asymptomatic (100%) with a median age of 39.0 years (29.5-49.0), slightly over a half (53.3%) were females and 17 (14.1%) were found to have previously unknown DCM. The mean (± SD) indexed left ventricular end-diastolic volume was significantly higher in relatives with DCM (71 ± 11.5 ml) compared to relatives without DCM (50 ± 11.5) (p = 0.001).

Conclusion: First-degree relatives of patients with DCM are at risk of developing asymptomatic DCM at a young age.

His bundle pacing (HBP) has been shown to be a good alternative to conventional cardiac resynchronisation therapy (CRT) and may theoretically provide an additional benefit where CRT has a response deficit of at least 30%. HBP requires mapping and identification of the His bundle, and to this purpose the lead delivery is challenging. This first-reported case series from Africa shares early experience with different pacing indications (complete heart block and pre-existing right ventricular pacing; heart failure with left bundle branch block) for using a standard 5.6F, Solia S 60, IS-1, ProMRI bipolar pacing lead and an 8.7F Selectra 3D introducer guide, 32-39-cm working length with 40/55/65-mm proximal radii (Biotronik). These cases highlighted the importance of appropriate programming when implanting HBP and of assessing the conduction system to predict patients who might benefit from HBP and additional left ventricular lead implant. The Biotronik Solia lead and delivery guide were found to be feasible and reliable in these cases. The Biotronik conduction system pacing tools were used with good acute outcomes in patients with different pacing indications.

Background: This improvement report presents a hospital blood-management programme, a hospital-specific model that differs from patient blood managment and was aimed at improving operational standards of transfusion. We identified the challenges of the transfusion process and suggest practical strategies for improving them. The aim of this article was to investigate the effect of the programme on the transfusion of blood components.

Methods: In January 2019, the programme was started to improve the transfusion process. The data before and after the start of the programme were compared. Frequency distribution was obtained for each variable for statistical analysis and the chi-squared test with continuity correction was used to compare these variables for the years 2018 and 2019.

Results: Transfusion of total blood components decreased by 23.2%, fresh whole blood by 46.7%, fresh frozen plasma by 38.4%, pooled platelets by 14.0% and red blood cells by 9.66%. Autologous transfusion increased 11.7-fold. The emergency department (76.0%) and intensive care unit transfusion rate (9.26%) decreased significantly.

Conclusion: This programme is an example for hospitals where patient blood management cannot be applied. The programme can be considered the first step for blood management and may be applied to blood management in institutions worldwide. The difficulty of blood supply and increased cost will increase the importance of hospital blood-management programmes in the coming years.

Aim: The aim of this research was to evaluate the prognostic value of myocardial scar using cardiac magnetic resonance (CMR) imaging in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM).

Methods: One hundred and fifty-four patients with either ICM or NICM underwent CMR with late gadolinium enhancement sequences for assessment of left ventricular ejection fraction (LVEF), and detection and quantification of any myocardial scar using three methods: manual, number of segments involved, and percentage of scarred myocardium. Patients were followed up for at least six months for clinical cardiac events.

Results: Patients were divided into two groups: group I, patients with ICM (58%) and group II, those with NICM (42%). Clinical presentation ranged from eventless lpar;10%) to chest pain (18%), heart failure (15%), hospitalisation (35%), syncope (1%), ventricular tachycardia (< 1%) and cardiac arrest (< 1%). The scar mass was larger in size in group I (17 ± 15%) than in group II (8 ± 13%). A direct relationship was observed between scar size and event severity (p < 0.001). An inverse relationship between LVEF and event severity was found in group I (p < 0.001) but not in group II (p = 0.128).

Conclusions: Myocardial scar size was a strong predictor of clinical outcome in both the ICM and NICM patients. LVEF was less reliable in predicting morbidity in cardiomyopathy patients.

Background: Sub-Saharan Africa has been shown to have a high prevalence of hypertension (58% in rural black South Africans) with an accelerated course ending in end-stage renal disease. We sought to determine whether the prevalence of elevated blood pressure (EBP) in early adulthood was associated with any risk factors and/or renal target-organ damage in young adulthood, which could prevent development of these cardiorenal sequelae.

Methods: Data including risk factors for hypertension and markers of kidney damage were collected from young adults (n = 933; age 28 years; 52% female) participating in the Birth to Twenty Plus (BT20) cohort in Soweto, South Africa. Blood pressure was measured on one occasion.

Results: Fifty-four per cent of the study sample had EBP with more men affected (62%) than women (47%) (p < 0.001). Body mass index (BMI), hyperuricaemia and albuminuria had significant associations with EBP in men. In women, BMI, hyperuricaemia and a self-reported history of gestational hypertension had significant associations.

Conclusions: Our findings suggest that the pathophysiology of EBP in young adults differs between the genders and highlights a number of modifiable factors in its development.

Aim: In young patients without atherosclerotic coronary artery disease, the aetiology of sudden cardiac death (SCD) has been described in Europe and North America. However, there are important regional variations and there are limited data on the aetiology and outcome of SCD in South Africa. The objective of this study was to determine the profile and outcomes of young patients treated with implantable cardioverter defibrillators (ICDs) at a South African tertiary hospital.

Methods: This study was designed as a retrospective review of patients aged 35 years or younger implanted with ICDs at Groote Schuur Hospital.

Results: During the study period, 38 patients younger than 35 years were implanted with ICDs. The mean (standard deviation) age at ICD implantation was 25.1 (7.6) years and 63.2% were male. A secondary-prevention ICD was implanted in 57.9% of the patient population, and primary prevention in the remaining 42.1%. Patients with secondary-prevention ICDs presented with ventricular tachycardia (59.1%), ventricular fibrillation (31.8%) and receipt of cardiopulmonary resuscitation but no recorded electrocardiograms (9.1%). Arrhythmogenic right ventricular cardiomyopathy (ARVC) was the leading cause of SCD in the secondary-prevention patient population (36.4%). Idiopathic dilated cardiomyopathy accounted for 50% of the primary-prevention patient population. After a median (interquartile range) follow up 32 (14-90) months, 7.9% died and 5.2% received a heart transplant; 42.1% of the study population received appropriate ICD shock therapies and 18.4% received inappropriate shock therapies.

Conclusions: In this single-centre study from South Africa, ARVC and repaired congenital heart disease were the leading causes of SCD in patients younger than 35 years treated with secondary-prevention ICDs. Primary-prevention ICDs were frequently implanted for idiopathic dilated cardiomyopathy.

Objectives: We aimed to evaluate and compare papillary muscle free strain in hypertrophic cardiomyopathy (HCMP) and hypertensive (HT) patients.

Methods: Global longitudinal strain (GLS), and longitudinal myocardial strain of the anterolateral (ALPM) and posteromedial papillary muscles (PMPM) were obtained in 46 HCMP and 50 HT patients.

Results: Interventricular septum (IVS)/posterior wall (PW) thickness ratio, left ventricular mass index (LVMI), left atrial anteroposterior diameter (LAAP) and mitral E/E' were found to be increased in patients with HCMP compared to HT patients. Left ventricular cavity dimensions were smaller in HCMP patients. GLS of HCMP and HT patients were - 14.52 ± 3.01 and -16.85 ± 1.36%, respectively (p < 0.001). Likewise, ALPM and PMPM free strain values were significantly reduced in HCMP patients over HT patients [-14.00% (-22 to -11%) and -15.5% (-24.02 to -10.16%) vs -23.00% (-24.99 to -19.01%) and -22.30% (-26.48 to -15.95%) (p = 0.016 and p = 0.010)], respectively. ALPM free strain showed a statistically significant correlation with GLS, maximal wall thickness, IVS thickness and LVMI. PMPM free strain showed a significant correlation with GLS, IVS thickness and LAAP. The GLS value of - 13.05 had a sensitivity of 61.9% and a specificity of 97.4% for predicting HCMP. ALPM and PMPM free strain values of -15.31 and -17.17% had 63 and 76.9% sensitivity and 85.7 and 76.9% specificity for prediction of HCMP.

Conclusions: Besides other echocardiographic variables, which were investigated in earlier studies, papillary muscle free strain also could be used in HCMP to distinguish HCMP- from HT-associated hypertrophy.

Aim: Recent research has demonstrated that the contractile characteristics of the right ventricular outflow tract (RVOT) play a significant role in right ventricular function. Pulmonary annular motion velocity (PAMVUT) is a reliable marker of RVOT function. Also, combined systolic velocity [PAMVUT added to tricuspid annular systolic velocity (St)] has been revealed as a suitable parameter for right ventricular systolic function. In this study, we examined the association between the severity of the illness in cirrhotic patients and the combined S velocities (CSV).

Methods: Seventy-four patients with cirrhosis went to the echocardiography laboratory of the Cardiology Department in our centre. Traditional echocardiographic measurements, PAMVUT and CSV values were recorded. The Child-Pugh classes of the patients were determined.

Results: Receiver operating characteristic curve analysis demonstrated that a CSV of 23 cm/s constituted the cut-off value for predicting a moderate-to-severe form of cirrhosis with 76% sensitivity and 65.3% specificity (area uder the curve = 0.735, p < 0.001).

Conclusion: CSV values could predict the severity of cirrhosis more precisely than traditional right ventricular systolic function parameters.