World Journal of Cardiovascular Diseases

Journal Information
ISSN / EISSN : 2164-5329 / 2164-5337
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 631
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Modibo Coulibaly, Dramane Samaké, Sonfo Boubacar, Lamine Sidibé, Moussa Diawara, Mamoudou Barry, Valentin Sagara, Bréhima Traoré, Oumar Guindo, Bakary Maiga, et al.
World Journal of Cardiovascular Diseases, Volume 11, pp 181-194; doi:10.4236/wjcd.2021.113019

Background: Noncommunicable diseases are the leading cause of death in the world and low and middle-income countries suffer from preventable premature death. The aim of this study was to assess the risk factors for non- communicable disease (NCDs) in general and particular cardiovascular diseases (CVDs) among the outpatients of our department of medicine. Methods: We performed a cross-sectional study from April to December 2017 by the consecutive enrollment of outpatients who attended in our department of medicine of Hôpital Sominé DOLO de Mopti, Mali. Clinical and laboratory data were measured for cardiovascular risk assessment. Framingham Risk Score (FRS) and Systemic Coronary Risk Estimation (SCORES) were computed by using Framingham and SCORE equations. Metabolic syndrome was defined using the harmonized criteria from the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). Data were captured in excel and analyzed with R version 4.0.3. The statistical significance was set at p = 0.05. Results: A total of 292 patients were enrolled in this study. The prevalence of traditional cardiovascular risk factors was 36.64%, 21.57%, 14.04%, and 13.01% for high blood pressure, hyperglycemia, smoking, and alcohol consumption, respectively. The metabolic syndrome accounted for 23.63%. The mean body mass index was 26.10 ± 7 kg/m2. The overall 10-year risk for cardiovascular events or death was 26.3% and 8.6% according to the FRS and SCORE equation, respectively. The 10-year risk of cardiovascular events according to the FRS was significantly higher in subjects aged 50 and above compared to subjects aged under 50 years, 34.46% vs 13.16%, p Conclusion: Our data corroborate the increasing prevalence of cardiovascular risk factors in SSA. A comprehensive cardiovascular risk factors assessment should be implemented in all stages of health facilities and a longitudinal follow-up could help shed a light on the epidemiology of NCDs in general and particularly CVDs and thereby improve their control policies in SSA.
Mame Madjiguène Ka, Serigne Cheikh Tidiane Ndao, Kana Sonia Babaka, Abu Bakr Fafa Cissé, Abdallah Ould Béchir, Isabelle Kouamé, Malick Ndiaye, Dior Diagne Sow, Moussa Kane, Bouna Diack, et al.
World Journal of Cardiovascular Diseases, Volume 11, pp 69-81; doi:10.4236/wjcd.2021.111009

Introduction: Cardiovascular disease is a global public health problem. In Africa, they are increasingly common, however, data on the control of cardiovascular risk factors in the general Senegalese population are rare. The aim of this work was to assess the level of control of cardiovascular risk factors in semi-urban areas in the municipality of Guéoul in Senegal. Patients and methods: This is a cross-sectional, descriptive and exhaustive survey carried out from 3 November to 3 December 2012 among the population aged at least 35 years and living for more than 6 months in the commune of Gueoul. It was conducted using the WHO STEPS approach to study the prevalence of cardiovascular risk factors and assess their level of control. We looked at clinical history, lifestyle, and anthropometric data. Blood pressure was measured at both arms and fasting blood samples were taken for blood glucose, cholesterol and triglycerides. Results: We examined 1.411 subjects (1052 women) averaging 48.5 ± 12.7 years of age. The main cardiovascular risk factors were dyslipidemia (61%), sedentary (56%), abdominal obesity (53.9%), high blood pressure (46.4%) and diabetes (7.2%). Dyslipidemia was known in 22 subjects, 6 of whom were on treatment with dyslipidemia control in 1 subject (16.7%). Hypertension was known in 266 subjects. Of these, 205 subjects were prescribed medical treatment, 26 of whom were well controlled (12.7%). The level of hypertension control was lower in subjects at high cardiovascular risk (p = 0.0001) and those with a family history of hypertension (p = 0.001). The male gender (p = 0.24), the short duration of progression of hypertension (p = 0.95) and the noncompliance of the diet (p = 0.176) were not significantly associated with poor control of hypertension. In diabetics, subjects on oral antidiabetic drugs had met fasting glucose targets in 65.5% of cases according to the recommendations of the American Diabetes Association and in 58.6% according to those of the International Diabetes Federation (p = 0.0001). Age, regular physical activity and insulin treatment were not significantly related to fasting blood sugar control. Conclusion: Our study found inadequate control and high prevalence of cardiovascular risk factors in the general Senegalese population. This situation could be a cause of aggravation of cardiovascular diseases in Senegal and should promote to improve their management.
John Pham, Stephen Nageotte, Jon Detterich, Grace Kung
World Journal of Cardiovascular Diseases, Volume 11, pp 34-44; doi:10.4236/wjcd.2021.111005

Background: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in patients with a history of prematurity and congenital heart disease (CHD). In 2014, the guidelines for Palivizumab became more restrictive for this population. We hypothesized the percentage of RSV+ admissions would increase overall and in this target group (TG) specifically. Methods: We conducted a retrospective review of patients under age 2 years admitted with bronchiolitis two seasons prior to the change (Pre) and two seasons after (Post). Our TG included patients who were eligible prior to the 2014 changes but currently no longer eligible. We used chi-square analysis to answer the two main hypotheses: 1) Percent RSV+/total bronchiolitis Pre vs Post and 2) Percent of TG/RSV+ Pre vs Post. Results: 1283 patients (546 pre, 737 post) were admitted with the diagnosis of RSV between 2012-2016, 866 actually tested positive for RSV (367 Pre, 499 Post). There was no significant difference in the number of total patients admitted with RSV (Pre = 67.2%, Post = 67.7%) or in our TG (Pre 7.1% vs Post 8.2%). TG overall had a more complicated course: longer length of stay, median 5 days, IQR 2 - 12 vs 3 days, IQR 1 - 5, (p , but there was no difference Pre vs Post. Conclusion: The TG had an overall higher acuity, but there was no increase in the number of patients hospitalized with RSV or severity as a result of the Palivizumab guideline changes.
Fryxell Jenni, Olofsson Mona, Brännström Margareta, Boman Kurt
World Journal of Cardiovascular Diseases, Volume 11, pp 1-10; doi:10.4236/wjcd.2021.111001

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design. Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36; 26 males, 10 females, mean age: 81.9 years) or control group (n = 36; 25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study. Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074); NT-proBNP increased 4% in the control group. Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.
Ozge Cetinarslan, Aysem Kaya, Alev Arat Ozkan
World Journal of Cardiovascular Diseases, Volume 11, pp 99-105; doi:10.4236/wjcd.2021.112011

Background: Most of the institutions accept the Transradial Access (TRA) as the first approach for patients undergoing Coronary Angiography (CAG) and Percutaneous Coronary Interventions (PCI). Several studies clearly revealed endothelial injury of coronary arteries triggers inflammatory response. In this study, we aimed to evaluate inflammatory respond to CAG and to compare the inflammatory response of TRA and Transfemoral Access (TFA). Methods: In this single-center prospective study 140 consecutive patients presenting with (Chronical Coronary Syndrome) CCS and underwent transradial or transfemoral CAG between December 2017 and December 2018 were included. After exclusions, left 92 patients were divided into two equal groups as TRA and TFA. The primary endpoints were 2nd hour Tumor Necrosis Factor alpha (TNFα), 48th hour high-sensitivity C-Reactive Protein (hs-CRP), complication rates, amount of contrast medium, procedure time and fluoroscopy time. Results: Basal characteristics of TRA and TFA groups were similar. A comparison of variables demonstrated that there was no statistical significance in increase in inflammatory markers (TNFα, hs-CRP), complication rates, amount of contrast media and procedure time. In contrast, TRA was associated longer fluoroscopy time and higher X-ray dosage, although statistically insignificant. CAG caused a similar increase in hs-CRP in both groups, insignificantly. Conclusion: In contrast to previous studies reporting a higher inflammatory response with TRA, this study demonstrates that inflammatory response caused by CAG is unrelated to access site and similar in TRA and TFA. Longer fluoroscopy time, higher X-ray dosage and longer procedure time in the TRA group indicate the importance of carefully selecting the angiographic route especially in patients with chronic heart failure, chronic renal impairment and malignancy risk. Also, these parameters place importance for physicians own health and woman planning pregnancy.
Ayman Abdulwahed Saif Mohammed, Xin Lin, Ekhlas Al Hashedi, Runmin Sun, Jing Yu
World Journal of Cardiovascular Diseases, Volume 11, pp 231-241; doi:10.4236/wjcd.2021.114023

Background: Hypertension is associated with an increased risk of cardiovascular events, cardiovascular and all-cause mortality. However, the diagnostic ability of hypertension for the presence and severity of CAD (coronary artery disease) has not been elucidated. This study investigates the relationship between hypertension and CAD complexity using the SYNTAX score to determine hypertension’s roles in coronary heart disease progression. Method: This is a prospective study that includes consecutive 410 adult patients at mean age (61 ± 11 years) who are admitted to Cardiology Department and undergo invasive coronary angiography (CAG) where a significant coronary lesion (SCL) is defined as stenosis ≥50% in vessel diameter ≥ 1.5 mm. The SYNTAX scores were calculated using the SYNTAX score algorithm. Results: The mean rank of SYNTAX score was significantly higher among hypertension than non-hypertension (mean rank: 279, 184, p = 0.006) groups. SYNTAX score was positively correlated with age (r: 0.263, p significantly independent predictor of increase or decrease probability of falling in high syntax score group. Conclusion Hypertension affects the distribution of SYNTAX score among patients with and without hypertension, and the prevalence of significant coronary lesions was more frequent in hypertensive patients. Hypertension was not a predictor of significant or complex coronary artery lesion, but advanced age, being a male, HDL, LDL and BMI are considered as independent risk factors for high SYNTAX score, Subsequently and the complexity of CAD. Therefore, when patients with CAD have these factors, we expect that the Patient’s CAD complexity will be high.
Souleymane Mariko, Massama Konaté, Samba Sidibé, Karamoko Kantako, Charles Dara, Djibril Kassogué, Nouhoum Diallo, Coumba A. Thiam, Aniessa Kodio, Mariam Sako, et al.
World Journal of Cardiovascular Diseases, Volume 11, pp 167-180; doi:10.4236/wjcd.2021.113018

Introduction: Peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. The aim of work was to study peripartum cardiomyopathy in its epidemiological, clinical, paraclinical and therapeutic aspects at the Tombouctou hospital. Methods: This is a descriptive cross-sectional study carried out in the Medicine Department of the Timbuktu hospital from January 1 to December 31, 2019. It concerned patients who presented heart failure between the 8th month of pregnancy and the first 5 months postpartum. Results: During the study,23 patients were collected. Average age of the patients was 23.50 ± 3.50 years with extremes of 16 and 34 years. Incidence of Peripartum cardiomyopathy (PPCM) was 1/345 pregnancies. Average parity was 3.20 with extremes of 1 and 8. Symptoms appeared at postpartum with 87% of cases. A significant delay in diagnosis was observed. Global heart failure was the mode of decompensation with 70%. Electrocardiographic signs were mainly sinus tachycardia (87%) and left ventricular hypertrophy (83%). Cardiac ultrasound showed in all cases dilated cardiomyopathy and it was associated with thrombus in left ventricle cavity for three cases. Left ventricular ejection fraction was severely impaired in 70% of cases. Pulmonary hypertension was significant in 52%. Most commonly drugs we used in our series at acute stage were duretics: furosemide 100% and spironolactone 70% (100% and 70%) and ACE inhibitors (90%). Beta-blockers (bisoprolol and carvedilol) were used in 15 patients. Bromocriptine (prolactin inhibitor) was used for 2 patients. Conclusion: Peripartum cardiomyopathy is a serious cardiac complication of pregnancy of unknown cause, common in the African population.
Ahmed Ashraf Reda, Mahmoud Ali Soliman, Ahmed Mokhtar Elkersh, Sabry Rasmy Yousef
World Journal of Cardiovascular Diseases, Volume 11, pp 195-209; doi:10.4236/wjcd.2021.113020

Background: Heterozygous familial hypercholesterolemia is an autosomal dominant genetic disorder with an estimated prevalence of 1/200 - 1/500 in the general population. Early identification of patient with familial hypercholesterolemia is important, because appropriate treatment may reduce the risk of premature atherosclerosis. Objective: Assessment of the prevalence of different modifiable cardiovascular risk factors and clinical diagnosis of heterozygous familial hypercholesterolemia. Methods: One hundred patients were enrolled, included young patients (males less than 50 years and females less than 60 years old) presented with first attack of acute coronary syndrome either ST elevation myocardial infarction (STEMI), non ST elevation myocardial infarction (NSTEMI) or unstable angina (UA). All patients were subjected to full history taking, general and local examination, Electrocardiogram, transthoracic Echocardiography, laboratory investigations, coronary angiography and Dutch score calculation for familial hyperlipidemias. Results: The mean level of serum cholesterol among studied group was 268.31 ± 59.33, HDL-C was 39.63 ± 7.52, LDL was 192.27 ± 60.61 and TG was 180.10 ± 39.64. With application of Dutch score, 20% of patients diagnosed definite familial hypercholesterolemia with Dutch score > 8. Twenty-six percent of patients diagnosed as probable familial hypercholesterolemia with Dutch score 6 - 8. Thirty-nine percent patients diagnosed as possible familial hypercholesterolemia with Dutch score 3 - 5 and 15% of patients were unlikely familial hypercholesterolemia with Dutch score 3 with significant correlation between Dutch score and age, total cholesterol, LDL-C, serum creatinine. Conclusion: Familial hypercholesterolemia (FH) is one of the most common serious genetic disorders of cholesterol metabolism. The early identification of heterogynous FH patients is crucial to start an effective prevention strategy.
John G. Kingma Jr.
World Journal of Cardiovascular Diseases, Volume 11, pp 210-222; doi:10.4236/wjcd.2021.113021

Background: Myocardial ischemia is a dynamic process whereby a cascade of events is initiated to stimulate transition from reversible to irreversible cellular injury. Non-pharmacologic approaches to cellular protection, such as ischemic conditioning, delay onset of cellular injury in most organs in a host of animal species; however the degree of protection is limited to rather short durations of ischemia. In the present study, we examined whether protection afforded by ischemic conditioning could be extended beyond currently established limits of coronary occlusion in an in situ animal model. Methods: Rabbits (n = 106) were exposed to 30-, 60-, 120-, 180-, 240-, or 360-min coronary occlusion followed by 180-min coronary reperfusion (i.e. non-conditioned control groups). Ischemic conditioned rabbits were pre-treated by ischemic conditioning (i.e. 2-cycles of 5-min coronary occlusion and 5-min reperfusion) prior to a prolonged period of ischemia as described above. Area at risk (AR; by fluorescent microparticles) and area of necrosis (AN; by tetrazolium staining) were quantified by planimetry. Serum troponin I levels were assessed at baseline (i.e. before experimental protocol) and at the end of the experiment. Results: Changes in heart rate and hemodyamic indices were similar for all groups regardless of duration of ischemia and regardless of treatment (i.e. non-conditioned vs. ischemic conditioned). Infarcts (as percent AR) were markedly smaller (~35%) in ischemic conditioned rabbits (vs. controls) for the 30-min coronary occlusion group. With longer durations of coronary occlusion (60-, 120-, 180-, 240-min) infarcts were smaller (~20%) in ischemic conditioned groups but protection afforded was not statistically significant. With 360-min coronary occlusion, infarct size was the same for both treatment groups. Serum troponin I levels were greater in relation to infarct size as expected but no differences were detected between treatments regardless of ischemic duration. Conclusions: Ischemic conditioning limits infarct development; however, protection is limited when the duration of ischemia is extended beyond 4 hours. These findings provide further support for the concept that ischemic conditioning can delay, but does not limit myocyte necrosis. Underlying mechanisms for cellular protection remain to be established.
Baldé Elhadj Yaya, Bah Mamadou Bassirou, Barry Ibrahima Sory, Béavogui Mariama, Sylla Ibrahima Sory, Baldé Mamadou Aliou, Koné Alpha, Diallo Mamadou, Camara Abdoulaye, Baldé Siradiou, et al.
World Journal of Cardiovascular Diseases, Volume 11, pp 223-229; doi:10.4236/wjcd.2021.113022

When blood pressure values remain above the target in a hypertensive patient treated concomitantly with three anti-hypertensive drugs including a diuretic, maximum well-tolerated doses, this is a resistant arterial hypertension. In this case, it is advisable to look for a secondary cause such as a drug intake that influencing the blood pressure or the presence of obstructive sleeping syndrome (OSAS). We report a clinical case of a patient with a high cardiovascular risk at the age of 50, hypertensive and diabetic, with dyslipidemia and obesity. He was on anti-hypertensive triple therapy at an optimal dose. Her diabetes was balanced with 6.4% glycated hemoglobin. Dyslipidemia has being treated. Despite healthy diet including a low sodium diet and weight loss, blood pres- sure target was not reached. With self-measurement, the mean arterial pressure was 180/110 mmHg and on ABPM it was 167/113 mmHg. The ventilatory polygraphy finds a severe OSA with an IAH = 56.6. Treatment with PCP (Con- tinuous positive pressure) allowed this patient to control blood pressure. The search for OSA should be systematic in face of resistant hypertension, in par- ticular in overweight or obese patients.
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