Open Access Original Research Article

Predictive Role of Cardiac Troponin I, Creatine Kinase-Mb and Electrocardiogram in Early Assessment of Acute Cardiotoxicity in Patients Poisoned by Cardiotoxic Drugs and Toxins

Maha A. Hilal, Sharaf E. D. Mahmoud, Meray M. Shokry, Ahmed M. Said

Cardiology and Angiology: An International Journal, Page 18-30
DOI: 10.9734/ca/2020/v9i330136

Background: In spite speedy development of clinical toxicology researches and protocols cardiovascular failure in severe acute intoxication remains a leading cause of death. Early cardiovascular risk assessment in acutely intoxicated patients is a must nowadays.

This study aims to evaluate the role of ECG, serum cardiac troponin I (cTnI) and creatine kinase myocardial band (CK-MB) for early detection of cardio-toxicity in acutely poisoned patients.

Methods: Prospective study was carried on100 patients with acute cardiotoxicity by drugs and toxins known to cause cardiac injury admitted to Sohag University hospitals, informed written consent has been obtained from each patient; ECG and biochemical analysis of serum cTnI and CK-MB were estimated in all studied patients.

Results: (90%) of studied patients had complete free recovery, (4%) discharged with complications and (6%) of patients died. ECG test can be used as a predictor of mortality and had sensitivity 100%, specificity 46.8% and negative predictive value (NPV) 100%. Serum cTnI was highly significantly increased with death hence could be used as predictors of outcome. While serum CK-MB couldn't be used as an outcome predictor. ROC curve analysis to assess serum cTnI as a predictor of mortality of acute cardiovascular toxicity with cut off > 1.0 ng/ml had sensitivity 100%, specificity 89.4% and NPV 100% with excellent diagnostic characteristic (accuracy rate 96.4%). There is no significant difference of serum CK-MB and serum cTnI among cardiac drugs toxicity patients and non-cardiac toxins patients.

Conclusion: the study concluded that ECG and serum cTnI can be used as a predictor of mortality. Also, the protocol of management will be same in acute cardiotoxicity by cardiac drugs and non-cardiac drugs and toxins.

Recommendation: the study recommends combining of ECG changes and serum cTnI as they can early detect acute cardiovascular effects in acutely poisoned patients.

Open Access Original Research Article

Clinical Representativeness of the PARADIGM-HF Study in an Outpatient Cohort of Patients with Heart Failure, Including Chagas Disease, Treated According to Guideline-directed Medical Therapy: Prospective Study, in a Single Center in Brazil

Rose Mary Ferreira Lisboa da Silva, Paulo Vitor Chaves Garcia, Elaine Kimie Iwayama Ikematu

Cardiology and Angiology: An International Journal, Page 38-45
DOI: 10.9734/ca/2020/v9i330138

Background: In the PARADIGM-HF trial there was a 20% reduction in hospitalization and cardiovascular mortality in patients with heart failure (HF) and treated according to guideline-directed medical therapy. Eligibility for the use of sacubitril/valsartan in the real world has varied between 12% and 76%. There are no studies on the national scene on this eligibility.

Aims: To investigate the clinical eligibility of the PARADIGM-HF trial in patients with HF in the outpatient clinic of a university institution, which also includes Chagas disease, and to compare the profile of the two populations.

Study Design: This is a single center, prospective, observational study.

Place and Duration of Study: Department of Internal Medicine, Faculty of Medicine, Hospital das Clínicas, Federal University of Minas Gerais, Brazil, duration 6 consecutive months.

Methods and Results: We included 136 consecutive outpatients with HF, 53 women, and mean age of 54.2 years, underwent clinical and laboratory evaluation. The main etiologies of HF were ischemic, Chagas disease and idiopathic. The means of baseline variables were 117.2 mmHg for systolic blood pressure, 78.4 bpm for heart rate, 1.8 for dyspnea functional class, 0.39 for ejection fraction (EF) and 74.2 mL/min for creatinine clearance. The exclusion criteria considered in the PARADIGM-HF trial and present in this study were systolic blood pressure less than 95 mmHg in 15.4% and creatinine clearance less than 30 mL/min in 5.1% of patients. 22.1% had mid-range EF and 55.9% had reduced EF. Comparing this cohort of patients with the population of the PARADIGM-HF trial, age, systolic blood pressure, proportion of male patients, ischemic etiology, hypertension, patients with atrial fibrillation, use of angiotensin-converting enzyme inhibitor, furosemide and beta-blocker were lower in this study (p ≤ 0.01, chi-square and Student's t tests). The proportion of diabetic patients, use of angiotensin receptor blocker, aldosterone antagonist and digoxin were similar between groups as well as proportion of patients with cardiac resynchronization therapy.

Conclusions: Up to 44% of patients in this study did not meet the main randomized trial criteria. Chagas disease was one of the main etiologies. Furthermore, systolic blood pressure, proportion of hypertensive patients was lower, which may have influenced the underutilization of some medications.

Open Access Original Research Article

An analysis of Atrioventricular Canal Defect (AVCD) in Children in the Niger Delta Region of Nigeria, West Africa

P. N. Tabansi, B. E. Otaigbe

Cardiology and Angiology: An International Journal, Page 46-56
DOI: 10.9734/ca/2020/v9i330142

Aims: This was to determine the demographic and echocardiographic characteristics of AVCD patients and analyse the types of defect associated with the presence or absence of obvious phenotypic syndromes in children in the Niger Delta region of Nigeria.

Methodology: It is a prospective study of children with AVCD seen over a 5 years period. Data on age, gender, presence or absence of chromosomal/genetic syndrome, age at onset of symptoms and age at presentation to the hospital, parental age, echocardiographic description, and outcome were analysed.

Results: Eighty-one cases of AVCD were analyzed with a male to female ratio of 1.1:1. Age ranged from birth to five years with a Mean Age of 5.5 months and Mode 3 months. There were more non-syndromic patients 46(56.8%) compared to 35(43.2%) patients with features of chromosomal syndrome. Complete AVCD with a common atrioventricular valve was the commonest findings in syndromic and non-syndromic children. Transitional AVCD was seen only in syndromic patients. Non-syndromic patients had more complex additional cardiac anomalies.

Conclusion: That more than 50% of cases of AVCD seen were in non-syndromic children in the Niger Delta is worrisome because this is an oil exploratory region known for constant gas flaring and environmental pollutants.

Open Access Original Research Article

Balloon Mitral Valvotomy in Gestational Women with Symptomatic Mitral Stenosis

Prem Krishna Anandan, Arun Kaushik, K. Tamilarasu, G. Rajendran, Shanmuga Sundaram, P. Ramasamy, R. B. Vidyakar

Cardiology and Angiology: An International Journal, Page 1-7
DOI: 10.9734/ca/2020/v9i330134

Background: Rheumatic valvular heart disease, commonly mitral stenosis, complicate 1% of pregnancies. Balloon mitral valvuloplasty (BMV) is an established treatment of rheumatic mitral stenosis. Aim of the study was to assess the safety and efficacy of Balloon mitral valvuloplasty in pregnant women with severe mitral stenosis.

Materials and Methods: 66 patients who failed to respond to medical therapy undergoing BMV during pregnancy were analysed in this retrospective study. Mitral valve area (MVA), transmitral Mean valve gradient (MVG), and mitral regurgitation (MR), Pulmonary artery pressure (PAP) were assessed before and 24 hours after the procedure by transthoracic echocardiography. Patients were followed up to one month post BMV and neonates were monitored for the adverse effect of radiation. 

Results: Mitral valve area increased from 0.83 ± 0.13 cm2 to 1.38 ± 0.29 cm2 (P = 0.007). Mean gradient mitral valve gradient decreased from 15.5 ± 7.4 mmHg to 3.36 ± 2.36 mmHg (P = 0.001). Pulmonary artery pressure decreased from 65.24 ± 17.9 to 50.45 ± 15.33 (P = 0.012). No maternal death, intrauterine growth restriction was observed.

Conclusion: Balloon mitral valvuloplasty has favourable immediate good outcomes for mothers and newborns.

Open Access Original Research Article

Electrocardiographic and Echocardiographic Findings in Patients Older than 60 Years: A One Year Pilot Study

Ajala Aisha Oluwabunmi, Bell-Gam Hope Ilanye

Cardiology and Angiology: An International Journal, Page 8-17
DOI: 10.9734/ca/2020/v9i330135

Background: Cardiovascular disease (CVD) is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years of age. Age-related vulnerability to CVD is compounded by the cumulative effect of the normal aging process and cardiovascular risk factors over a lifetime. The study assessed the prevalence of electrocardiographic and echocardiographic abnormalities in patients older than 60 years at the geriatric unit of the University of Port-Harcourt Teaching Hospital.

Methods: A cross-sectional study was conducted over 50 patients admitted to the geriatric ward over one year. The subjects underwent blood pressure and anthropometric parameters clinical examinations. Evaluation of the cardiovascular system was done using resting electrocardiogram and echocardiography.

Results: The mean age of the subjects was 68.3±6.3 years with a female preponderance. Out of the 50 studied patients, 44 were admitted with a diagnosis of heart failure (HF). Preserved ejection fraction was present in 27 out of the 44 patients admitted for HF. Forty-seven patients had an abnormal LV geometry ranging from concentric remodeling to eccentric LV hypertrophy. Diastolic dysfunction was present in majority of the respondents 42 (84%). Resting ECG showed varying degrees of rhythm disturbances. Sinus tachycardia, bradycardia and left anterior fascicular blocks were the most prevalent rhythm disorders. Electrocardiographic LVH and left atrial abnormalities were present in 21 and 27 patients respectively. Prolonged QTc was present in only 4 patients.

Conclusion: Electrocardiographic and ultrasound abnormalities are common in elderly patients and this also reflects the high prevalence of CVD in these groups of patients. Thus, resting ECG and ultrasound should routinely be incorporated as one of the baseline assessments for elderly patients to identify potentially serious heart conditions and also serves as a basis for comparison during subsequent hospitalization.

Open Access Original Research Article

Protective Effects of Thymus schimperi and Moringa stenopetala Leaf Extracts on Arterial Blood Pressure and Urine Protein Level in Pre-eclampsia Rat Models

Kumlachew Mergiaw, Yoseph A. Mengesha, Tesfaye Tolessa, Eyasu Makonnen, Solomon Genet, Abiy Abebe, Kidist Gebreyesus, Ashenif Tadele, Asfaw Debella, Demeke Ashencho

Cardiology and Angiology: An International Journal, Page 31-37
DOI: 10.9734/ca/2020/v9i330137

Background: Pre-eclampsia (PE) is a common hypertensive disorder during pregnancy and one of the leading causes of perinatal mortality and morbidity. There is no curative modern drug to treat PE. Therefore, researches done on traditional medications have paramount importance in discovering therapeutic and /or protective agents from plant materials. In Ethiopia, there are claims that some indigenous medicinal plants such as Thymus and Moringa can have potential protective functions against PE. The aim of this study was to prove the claims.

Methods: Experiments were performed to investigate the effects of aqueous leaf extracts of Thymus schimperi (ALETS) and Moringa stenopetala (ALEMS) on PE rat models induced by nitro-L-arginine methyl ester (L-NAME); a nitric oxide synthase inhibitor. A non-invasive tail cuff blood pressure recorder (Model 179 Amplifier, IITC INC, Life Science Instruments, Woodland Hills, California) was used to determine the arterial blood pressure from rat tail. Urine  analysis  to determine protein levels  was  performed  using  a  dipstick,  semi-qualitative  method  as  per  manufacturer’s instructions (CYBO DFI Korea).

Results: ALETS treated PE rat models showed significantly reduced mean arterial blood pressure (MAP) in mmHg; 108±3 (P<0.05), 105±1 (P<0.01) and 99±2 (P<0.01); also the same pattern of results were seen in ALEMS treated PE groups with MAP of 106±1 (P<0.05), 103±1 (P<0.05) and 101±1 (P<0.05) at daily doses of 250 mg/kg, 500 mg/kg and 1000 mg/kg, respectively, compared to untreated case group that had 123±3.7 mmHg at gestation day (GD) 19 . Untreated PE rat models showed significant proteinuria (2000±20 mg/L) throughout the gestation period; while PE rat models treated with either ALETS or ALEMS had significantly reduced (p<0.05) proteinuria in dose dependent pattern (150±15 mg/L) at a dose of 1 gm/kg for each plant extract at GD 19.

Conclusion: Aqueous leaf extracts of either Thymus schimperi or Moringa stenopetala might reduce and control arterial pressure in PE rat models in a dose dependent manner.  The extracts also could reduce level of proteinuria in the same pattern. Further investigation should, however, be carried out to confirm their uses in prevention and/or treatment of pregnancy-induced hypertension among human cases.