Open Access Case Report

Intravascular Imaging-guided Percutaneous Coronary Intervention for Braid-like Coronary Stenosis in a Patient with Prior Myocardial Infarction

Shigenori Ito

Cardiology and Angiology: An International Journal, Page 1-7
DOI: 10.9734/CA/2017/35792

A 77-year-old man was admitted to our hospital because of chest oppression on efforts.  He had developed an inferior acute myocardial infarction and had undergone percutaneous coronary intervention (PCI) for the right coronary artery (RCA) 10 years earlier.  Significant stenoses were detected in the proximal left anterior descending artery (LAD), obtuse marginal artery (OM), and proximal RCA by coronary angiography.  The coronary angiography revealed a braid-like stenosis in the proximal RCA. Because his symptoms continued even after PCI for LAD and OM lesions, we performed PCI for the RCA lesion.  OCT revealed the most severe stenosis located proximally and a stenosis with multiple channels located distally.  The proximal stenosis had thick homogeneous and high -intensity septum.  In contrast, the distal stenosis had multiple lumens separated by high-intensity thin septa. On the other hand, IVUS clearly showed that different channels were connected to the different side branches at both edges of the stenosis, and they converged into a single lumen proximally and distally. IVUS and OCT proved beneficial for the evaluation of coronary artery structure with a braid-like appearance. We performed PCI under the guidance of OCT.


Open Access Case Study

A Non-Atherogenic Cause of Critical Limb Ischemia in a Young Adult

Jagadeesh K. Kalavakunta, Yashwant Agrawal, Elizabeth Sayers, Fadi Saab, J. A. Mustapha

Cardiology and Angiology: An International Journal, Page 1-5
DOI: 10.9734/CA/2017/36638

Aim: Atherosclerosis is the most common etiology of obstruction of the arteries leading to limb ischemia. Critical limb ischemia (CLI) in a young adult we need to consider non-atherosclerotic diseases.

Case Presentation: We present a rare of cause CLI in a 35-year-old man who presented with Rutherford class VI symptoms of non-healing gangrenous right great toe. His angiograms revealed medial type of fibromuscular dysplasia (FMD) and underwent endovascular therapy. Multiple interventions with balloon angioplasty, laser atherectomy and Ultrasound-accelerated catheter-directed thrombolysis in three different settings were needed to achieve desired results.

Discussion and Conclusion: In most cases of FMD balloon angioplasty itself is sufficient. But below knee arteries might need more than one intervention as noted in this case.  


Open Access Case Study

Cavitary Pulmonary Aspergilloma after Norwood-I-Procedure - A Rare Complication after Delayed Sternal Closure in a Patient with HLHS

Robert Wagner, Marcel Vollroth, Martin Kostelka, Christian Paech, Reinhard Berner, Ingo Daehnert, Michael Weidenbach

Cardiology and Angiology: An International Journal, Page 1-4
DOI: 10.9734/CA/2017/37814

The presented case is the first to report on a child with hypoplastic left heart syndrome (HLHS) with invasive aspergillosis (IA) progressing to cavitary pulmonary aspergillosis after Norwood stage I procedure.


Open Access Minireview Article

Can We Predict Preeclampsia?

Jayavelan Ramkumar, Nidhi Sharma

Cardiology and Angiology: An International Journal, Page 1-10
DOI: 10.9734/CA/2017/36708

Hypertensive disorders in pregnancy are a leading cause of peripartum morbidity and mortality. Preeclampsia is a heterogeneous maternal syndrome.

Large studies have pointed out the association of impaired spiral artery remodeling at the fetomaternal interphase in preeclampsia, but how exactly is the fetomaternal dialogue mediated and what are the biomarkers to detect the subclinical disease in various subsets of high-risk pregnancies is still a challenge. These biomarkers can finally be used to diagnose renal function (Kallikrein-creatinine ratio), vascular resistance (uterine artery Doppler), coagulation disorders (platelet volume, fibronectin, prostacyclin, thromboxane, oxidant stress (lipid peroxidase, 8-isoprostane, antioxidants, anticardiolipin antibodies, homocysteine, serum uric acid), vascular adaptation (Placental growth factor, Vascular endothelial growth factor, s flut, s eng) and markers of placental function and ischemia (placental CRH, CRH bp, activin, inhibin,hCG).Post partum preeclampsia can be predicted by identifying the factors preventing the excretion of sodium, puerperal diuresis  and shift of intravascular fluid into the extra vascular compartment compartment(atrial natriuretic peptide in the first week after delivery, natriuresis and inhibition of aldosterone, angiotensin II, vasopressin)


Open Access Original Research Article

Correlations between Anthropometrics and Electrocardiographic Variables in Japanese University Students: Investigation by Annual Health Screening

Toru Maruyama, Noriko Yamamoto, Kousuke Kajitani, Rikako Tsuchimoto, Yoshinori Masaki, Jun Nagano, Masahiro Irie, Atsushi Ichimiya, Kazuhiko Yamamoto, Keiko Uezono

Cardiology and Angiology: An International Journal, Page 1-12
DOI: 10.9734/CA/2017/36193

Aims: Anthropometrics provide important health and fitness indicators in University students and have potential impacts on electrocardiographic (ECG) abnormalities leading to cardiac events. However, the correlations between anthropometrics and ECG data are controversial in young adults. This study aimed to investigate the effects on ECG of body mass index (BMI) in Japanese University students which shows unique distribution differing from that in the western youths.

Place of the Study: Infirmaries of Kyushu University Campus, Fukuoka, Japan.

Methodology: Participants (n = 6,786) were recruited from legal Annual Health Screening Program of a Japanese University (2014 and 2015), and 6,649 participants (4,693 males and 1,956 females) were the subjects of the study protocol. Anthropometric and blood pressure (BP) measurements and ECG recording were conducted.

Results: This study demonstrated age-matched gender difference of BP, anthropometrics and ECG, i.e., PR interval and QRS duration in males were longer than corresponding parameters in females but the opposite was found in the QT interval corrected by heart rate (QTc). BP and some ECG variables were dependent on BMI but the dependence of each ECG parameter on BMI differed individually in regression analyses. Positive linearity was found in PR interval and QRS duration, and negative linearity was obtained in frontal QRS axis, i.e., lengthening of PR interval and QRS duration and leftward shift of QRS axis were observed by BMI increment. Concaved parabolic correlation between QTc and BMI may indicate that lean and high BMI groups with relative QTc prolongation require lifestyle intervention.

Conclusions: The findings obtained by this mass screening are helpful in healthcare management of Japanese University students showing anthropometrics quite different from those in westerners.


Open Access Original Research Article

Carotid Intima-media Thickness and Risk of Cardiovascular Disease among Healthy Adult Volunteers in North Eastern Nigeria

Mohammed Abdullahi Talle, Mohammed Musa Baba, Philip Oluleke Ibinaiye, Habu Abdul, Faruk Buba

Cardiology and Angiology: An International Journal, Page 1-8
DOI: 10.9734/CA/2017/35807

Background: Assessment of carotid intima media thickness (CIMT) have evolved over the years to assume a key role in assessment of cardiovascular risk. However, there is paucity of data on CIMT among Nigerian. We assessed CIMT and its association with cardiovascular risk factors among apparently healthy individuals.

Methods: Apparently healthy adults were consecutively recruited from July 2013 through March 2014 at the Federal Medical Centre Nguru. Anthropometric variables were measured and blood samples collected. CIMT was determined at the common carotid, carotid bifurcation, and proximal internal carotid artery levels using a high-resolution 2-D USS scanner, and values above 0.9mm considered abnormal. Means of continuous variables were compared using Student t-test or Mann-Whitney U test, while between groups mean was compared using one-way ANOVA. Association of CIMT other continuous variable was assessed using bivariate correlation and multivariable linear regression models. A p value of <0.05 was considered significant for all statistical analysis.

Results: Ninety nine apparently healthy consenting adults comprising 63(63.6%) males and 36(36.4%) females were consecutively recruited. Their median (interquartile range) age was 34(27) years.  Mean left CIMT at common carotid, carotid bifurcation and internal carotid artery levels were 0.82(0.22), 0.91(0.23) and 0.85(0.21) respectively (F=3.57, p=0.029). There was no difference in CIMT between the left and the right sides. Thirty one (31.3%) had CIMT above 0.9mm. Significant correlation was found between CIMT and age (r2=0.33, p<0.001), body mass index (BMI) (r2=0.06, p<0.001), systolic blood pressure (r2=0.11, p=0.001), glycated haemoglobin (r2=0.34, p<0.001), total cholesterol (r2=0.42, p<0.001), LDL-c (r2=0.47, p<0.001) and HDL-c (r2=-0.14, p<0.001). Age, BMI, blood pressures, total cholesterol, LDL-c and HDL-c independently predicted CIMT.

Conclusion: The prevalence of increased CIMT is high among healthy adults, and CIMT correlated positively with other cardiovascular risk factors. Routine assessment of CIMT may identify individuals with increased risk for cardiovascular diseases and result in more targeted preventive measures.


Open Access Original Research Article

Kunyima Relations Establishment on SS Sickle Cell Anaemia Women Investigation in Democratic Republic of Congo

A. B. Kunyima, S. N. Lusamba, M. B. Kunyima

Cardiology and Angiology: An International Journal, Page 1-25
DOI: 10.9734/CA/2017/36517

Background: The sickle cell anaemia is a genetics sickness, autosomal, recessive, secondary to a punctual mutation at sixth codon level of  globine gene with substitution of glutamic acid by valine. The prevalence of S hemoglobin is relatively high, reaching 40 % of central Africa population.

Aim and objective: The overall purpose of this paper is to show that the cardiac exergetic yield depends only on differential pressure while  is greatly depending on cardiac frequency.

Methodology: The sickle cell anaemia persons were the target population. The experiments have been performed in Centre of Mixte Medicine and SS anaemia in Kinshasa (DRC) called Centre MABANGA. The blood pressure measurements and calculations are our methodology of work. The calculations have been done individually on the sample of 82 females whose the age varies between 13-57 years. The figures have been plotted by means of Origin 8 program. The Visio 2010 software was used for equations.

Results: The investigation on sickle cell anaemia women allowed to establish the relations between cardiac exergetic yield ( ) and differential pressure ( ) called KUNYIMA Relations from the name of Dr. KUNYIMA BADIBANGA Anaclet, the designer of this research project. The sickle cell population under medical treatment exhibited in general very weak cardiac yield. Details in this paper show the linear dependence of cardiac yield on differential pressure as well for healthy persons as for sickle cell persons evidencing this ancient hypothesis according which the healthy person cardiac yield in the healthy environment remains constant (because  is constant). The difference between the healthy persons and sick persons resides in the slopes of straight lines.

Conclusion: So all biological system which is not in transient state works at constant cardiac yield. Also KUNYIMA Equation and KUNYIMA Formula have been successfully verified. An outstanding fact should be branded on memory: differential enthalpy is the total enthalpy accompanying the blood in its motion. With this paper the content of Physical Cardiochemistry as a research field is forthcoming and becomes a burning desire.


Open Access Original Research Article

Acute Rheumatic Fever among Primary School Students in Harari Region, Eastern Ethiopia

Aklilu Abrham Roba, Tekabe Abdosh Ahmed, Nega Assefa, Jelalu Kemal Birmeka, Eskindr Demissie Zergaw

Cardiology and Angiology: An International Journal, Page 1-8
DOI: 10.9734/CA/2017/37725

Background: In many developed countries, acute rheumatic fever is eradicated through strong health promotion and prevention efforts; yet, it continues to cause serious health problems in many developing countries including Ethiopia. The main aim of the study was to assess the prevalence and factors associated with acute rheumatic fever among primary school students in Harari region, Eastern Ethiopia.

Methodology: A cross-sectional study was conducted among students of four primary schools from November, 2015 to April, 2016.  Data were collected according to modified Jones criteria with confirmation of preceding infection by anti-streptolysin –O titre. Factors associated with the outcome were identified using logistic regression. Odds ratios and the corresponding confidence intervals were used to report the findings.

Results: Out of 1739 school children with the mean age of 11.5 years (6-19 years), 21 had Acute Rheumatic Fever (ARF). The two week prevalence of acute rheumatic fever and tonsillopharyngitis were 21/1739 (1.2%) and 231/1739 (13.2%) respectively.  Regarding awareness towards causes of tonsillitis, 78% perceived consumption of cold foods and drinks. Factors associated with ARF were maternal illiteracy (AOR 5.54, 95% CI 1.07, 28.662) and urban school (AOR 0.254, 95% CI 0.084, 0.769).

Conclusion: The prevalence of ARF among primary school children was high. School health education program focused on acute rheumatic fever causes and consequences are needed to increase awareness among children and their parents.


Open Access Original Research Article

Clinical Significance of Creatine Kinase-MB Elevation in Patients with Chronic Kidney Disease before Initiation of Hemodialysis

Ehimen Phyllis Odum, Victor Chukwuma Wakwe

Cardiology and Angiology: An International Journal, Page 1-7
DOI: 10.9734/CA/2017/38020

Aim: To measure creatine kinase – myocardial band (CK-MB) concentration in stable patients with chronic kidney disease who had not commenced hemodialysis and determine its relationship with cardiac Troponin I and cardiovascular risk factors.

Study Design: Cross-sectional study.

Place and Duration of Study: Renal Unit, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria from January 2014 to December 2015.

Methodology: Blood pressure, serum CK-MB, cardiac Troponin I, HDL-cholesterol, total cholesterol, triglyceride, fasting plasma glucose, urine and serum albumin, urine and serum creatinine concentrations were analysed in 83 diagnosed chronic kidney disease patients attending the renal clinic and 83 age- and sex-matched healthy control subjects. Body mass index (BMI), estimated GFR (eGFR), urinary albumin-creatinine ratio (UACR) and LDL-cholesterol were calculated. 

Results: CKD patients had higher CK-MB, higher cardiac troponin I, higher blood pressure, higher serum creatinine, higher triglyceride, higher UACR, lower serum albumin, lower HDL and lower eGFR compared to controls. Sixteen (19.3%) patients versus 11 (13.3%) controls had elevated CK-MB. Among patients, CK-MB was positively associated with UACR, low HDL and dyslipidemia but not associated with cardiac Troponin I.

Conclusion: CK-MB elevation was associated with albuminuria, low HDL and dyslipidemia. However, CK-MB lacked association with cardiac troponin I, which is a more cardiac-specific biomarker. This shows that serum CK-MB levels may not be suitable for diagnosing myocardial injury in CKD patients.


Open Access Original Research Article

One-year Follow-up of the Distribution of Dyslipidemias among Cameroonian Diabetic Patients in Ngaoundere, 2014-2015

Olivier Pancha Mbouemboue, Alvine Motche Touko, Habibah Salamath Haman, Pelagie Djenabou Amanissa, Fadimatou Bello Damdam, Jacques Olivier Ngoufack, Marcel Tangyi Tamanji

Cardiology and Angiology: An International Journal, Page 1-9
DOI: 10.9734/CA/2017/37773

Background: Diabetes constitutes an important faction of the health and economic burden worldwide and its occurrence continues to rise especially in developing countries.

Aim: To study the distribution in dyslipidemia occurrence over a period of 1 year in a diabetic and non-diabetic population in Ngaoundere.

Methodology: This was a cross sectional case control study carried out at the Hypertension and Diabetes units of the Ngaoundere Regional and Protestant Hospitals from June 2015 to February 2016. All participants provided a written consent and were subjected to a questionnaire. Blood pressure and anthropometric parameters were measured and venous blood collected for fasting blood glucose, lipid profile, glycated hemoglobin and uric acid analysis using commercially acquired kits. Data were organized and analyzed using an Excel spreadsheet and SPSS version 20.0. respectively, with statistical significance considered at p < 0.05.

Results: Of the 321 participants enrolled, 191 were diabetic and 130 non-diabetic having sex ratios (F/M) of 1.3 and 1.1 respectively. Compared to the 73.3% dyslipidemia, 28.9% hypercholesterolemia, 15.6% hypertriglyceridemia and 28.9% mixed hyperlipidemia reported by the authors in the same diabetic population a year earlier, the occurrence of dyslipidemias, hypercholesterolemia, hypertriglyceridemia and mixed hyperlipidemia were 59.7%, 49.5%, 7.0% and 3.2%. Likewise, similar trends were observed with the corresponding non-diabetic control groups. 39 patients (20.4%) and 29 controls (22.3%) had knowledge on cholesterol, while 9.9% of diabetic participants had tested for blood cholesterol levels at some point.

Conclusion: We observed meaningful drops in the occurrence of hypertriglyceridemia, mixed hyperlipidemia, and a rise in hypercholesterolemia among diabetics and nondiabetics, with a low level of awareness on dyslipidemias. Much is needed in sensitizing and controlling cardiometabolic risks towards improving the management of diabetic patients in our context.


Open Access Original Research Article

Comparison of Cardiovascular Risk in Microalbuminuric and Normoalbuminuric Type 2 Diabetic Patients in Nigeria

Ehimen Phyllis Odum, Asuquo Bassey Ene

Cardiology and Angiology: An International Journal, Page 1-7
DOI: 10.9734/CA/2017/38212

Aim: To compare cardiovascular risk in microalbuminuric and normoalbuminuric type 2 diabetic patients.

Study Design: Cross-sectional study.

Methodology: Blood pressure, body mass index (BMI), electrolytes, fasting plasma glucose, lipid profile and renal profile were determined in 120 type 2 diabetic patients attending the Medical Outpatient Clinic from January 2017 to August 2017, and in 120 age-matched control subjects. Semi-quantitative determination of microalbuminuria was done using the “MICRAL test” strip. Microalbuminuria was defined as urinary albumin-creatinine ratio (UACR) of 30 – 300 mg/g (3.4-33.9 mg/mmol).

Results: Twenty-seven (22.5%) diabetic patients had microalbuminuria but 93 (77.5%) patients did not have microalbuminuria. Microalbuminuric diabetic patients had significantly longer duration of diabetes, higher mean BMI, higher blood pressure, higher creatinine, lower estimated glomerular filtration rate (eGFR), higher urea, higher potassium, higher total cholesterol, higher LDL and lower HDL, as well as higher prevalence of cardiovascular risk factors including hypertension, dyslipidemia, hypercholesterolemia, high LDL and low HDL, compared to diabetics without microalbuminuria.

Conclusion: Microalbuminuric patients had more adverse levels and higher prevalence of cardiovascular risk factors compared to normoalbuminuric patients. Microalbuminuria is known to be an adverse prognostic indicator for clinical cardiovascular outcomes and all-cause mortality in diabetic patients.


Open Access Original Research Article

Impact of Cardiovascular Exercise on Antibody Isotypes of Healthy Individuals in Eastern Nigeria

Saheed Opeyemi Usman, Samuel Chukwuemeka Meludu, Chudi Emmanuel Dioka, Ubuo Kalu Amah, John E. Okwara, Obiageli Bridget Onyema-Iloh, Rosemary Adamma Analike, Blessing Myke-Mbata

Cardiology and Angiology: An International Journal, Page 1-6
DOI: 10.9734/CA/2017/38468

Background: Cardiovascular disease is a major public health problem & a leading cause of mortality in Nigeria, which has been largely attributed to the decline in physical exercise predisposing people to various forms of chronic ailments in general. The objective of this study was to determine the more preferred form of cardio-exercise and compare results of moderate and vigorous exercises on antibody-isotypes IgG & IgM before exercise, four weeks after exercise, eight weeks after exercise and twelve weeks after exercise.

Methods: Serum concentration of antibody-isotypes IgG & IgM of both vigorous exercise group (30 male individuals who played football for 40 minutes daily for 3 days/week) and moderate exercise group (30 male individuals who engaged in mild jogging for 30 minutes daily for 5 days/week) were determined using Enzyme Linked Immunosorbent Assay (ELISA) technique. All data were expressed as Mean ± Standard Deviation (SD) and analyzed with Analysis of Variance (ANOVA) while multiple comparisons were done using Post Hoc test. Pearson’s correlation coefficient was used for correlational analysis.  

Results: In the moderate exercise group, the mean serum Immunoglobulin M (IgM) was significantly increased (P<0.05) all through with exception of the 8 weeks result compared with the result 4 weeks after exercise while the mean serum Immunoglobulin G (IgG) was significantly increased (P<0.05) 12 weeks after exercise as compared with the result before exercise. In the vigorous exercise group, the mean serum IgM was significantly increased (P<0.05) all through while the mean serum IgG was significantly increased (P<0.05) 8 weeks & 12 weeks after exercise as compared with the result before exercise as well as 12 weeks after exercise as compared with the results 4 weeks after exercise.

Conclusion: Physical exercise leads to transitory elevation in antibody-isotypes, though only after an extended period of physical exercise indicating that a moderate intensity cardio-exercise is preferred as it produces enhanced immune response and reduced risks of cardiovascular disease.


Open Access Review Article

Low Dose Aspirin and Omega 3 Fatty Acids in the Pro Resolving Pathway of Cardiovascular Disorders

Jayavelan Ramkumar, Nidhi Sharma

Cardiology and Angiology: An International Journal, Page 1-12
DOI: 10.9734/CA/2017/36200

Newer mechanisms of action of Acetyl Salicylic acid have been discovered in proresolving pathway of various disorders. Omega 3 fatty acids are also involved in the synthesis of resolvins via an aspirin triggered pathway. The present review aims to discuss the role of recently discovered aspirin triggered lipoxins, resolvins, protectins, maresins in understanding the pathophysiology of endothelial dysfunction in various cardiovascular disorders, especially hypertension. The concept of aspirin triggered lipoxins (15-epi-LXA4 and 15-epi-LX4) counteracting the action of LTB 4.PGE 2, and TXA2 is discussed. Aspirin triggered lipoxins also block the expression of IL-8 gene. Aspirin is the only known NSAID to induce NO in a dose dependent manner. In this narrative review, we describe role of acetyl salicylic acid in the pro-resolution pathways that might prevent or reduce complications in patients with high blood pressure.