SA Heart Journal

Factors associated with deep vein thrombosis recurrence at a cardiology department in sub-Saharan Africa

2025-08-11T20:44:16+00:00

Objective: Deep vein thrombosis (DVT), once rare, has become increasingly common in Africa. This study aimed to identify factors associated with DVT recurrence.

Methodology: We conducted a descriptive and analytical cross-sectional study from 1 January 2020 to 31 December 2024 at the cardiology department of Bogodogo University Hospital (CHU-B). Patients admitted to the department for DVT on venous echo-Doppler were included. Epidemiological, clinical, and paraclinical parameters were crossed in univariate and multivariate analyses.

Results: During the study period, 164 cases of DVT were recorded out of 2 637 hospitalised patients, with a 6.22% hospital prevalence rate. The mean age was 51.4 years. Women were predominant (90, 55%), with a sex ratio of 0.8. Recurrences occurred in 27.44% of cases (n = 45). A sedentary lifestyle, prior DVT, and obesity were the most frequent thromboembolic risk factors. Multivariate analysis showed that a personal history of DVT (odds ratio [OR] 3; p = 0.03), obesity (OR 3.8; p = 0.005), and the femoral thrombus location (OR 2; p = 0.004) were significantly associated with DVT recurrence.

Conclusion: DVT recurrences are becoming increasingly frequent, and their management requires accurate identification of the risk factors.

The relationship between clinical parameters and the risk of mortality or requiring the insertion of a pacemaker in patients with bifascicular block

2025-12-02T12:05:13+00:00

Introduction: Patients with bifascicular block (BFB) are at risk of progressing to high-degree atrioventricular block (AVB) and have a higher mortality risk. This study aimed to identify relationships between clinical parameters in patients with BFB and the risk of mortality and/or requiring permanent pacemaker (PPM) insertion, to better risk-stratify and appropriately investigate patients at the time of diagnosis in a resource-limited setting.

Method: A descriptive study was conducted via retrospective review of all patients who received an electrocardiogram (ECG) during 2014 at Tygerberg Hospital (TBH), South Africa. In total, 16 280 ECGs were assessed, accounting for 11 881 patients (some patients had more than 1 ECG), and those with BFB were identified. Patients’ records were assessed at the time of diagnosis and followed for 10 years to identify relationships between clinical parameters in patients with BFB and mortality or requiring a PPM.

Results: Of the 11 881 patient ECGs assessed, 140 patients with BFB were identified. The mean age at diagnosis was 62 ± 17 years. Of these patients, 37 (26%) died, and 9 (6%) required a PPM. The mean age at diagnosis of demised patients was 66 ± 12 years (p = 0.07). Significant relationships with mortality included diabetes mellitus (DM) (p = 0.04) and a reduced left ventricular ejection fraction (LVEF) (p = 0.05), with age and hypertension related at a lower level of significance (p = 0.07 and p = 0.06, respectively). Significant relationships with PPM insertion were symptom presence at diagnosis (p ≤ 0.01) and PR interval prolongation at a lower level of significance (p = 0.08).

Conclusion: In patients with BFB, DM, hypertension, age, and a reduced LVEF had the most significant relationships with mortality. Symptoms and a prolonged PR interval had the most significant relationships with requiring a PPM. Mortality in patients with BFB is more likely to be related to standard risk factors, such as DM, hypertension, age, and a reduced LVEF, than the conduction defect per se.

Myocardial fibrosis and sudden cardiac death (SCD) risk factors in mitral valve prolapse patients deemed to be at low SCD risk

2025-07-10T05:29:48+00:00

Introduction: Mitral valve prolapse (MVP) is associated with risk for sudden cardiac death (SCD); however, there is no consensus regarding risk stratification. Myocardial fibrosis is a substrate for SCD in these patients. Risk markers described for SCD are T wave inversion in the inferior leads and complex ventricular ectopy (ventricular couplets, non-sustained ventricular tachycardia [NSVT], and polymorphic ventricular ectopy), spiked configuration of the lateral annular velocities (Pickelhaube sign), and mitral annular disjunction (MAD).

Purpose: We aimed to investigate the prevalence of these risk factors in our population of MVP patients, a cohort clinically assessed as low risk for SCD. Furthermore, we aimed to investigate the association between these risk factors and myocardial fibrosis and to describe its pattern.

Methods: Our echocardiography database was reviewed from 1 October 2020 to 31 December 2021 for patients with MVP. Patients newly diagnosed from 1 July 2021 to 31 March 2023 were also enrolled. Investigations included a clinical evaluation, assessment for SCD risk markers with electrocardiography (ECG), a 48-hour Holter ECG, a transthoracic echocardiogram, and an assessment for myocardial fibrosis with cardiovascular magnetic resonance (CMR) imaging.

Results: A total of 39 patients, deemed to be at low SCD risk, without prior severe mitral regurgitation, malignant arrhythmias, cardiogenic syncope, or survived SCD, were included for analysis. Of the patients, 66% had areas of replacement fibrosis detected by late gadolinium enhancement (LGE). Segments commonly involved included the basal posterior (39%), basal inferior (39%), and basal lateral (25%). Areas involved were focal, with an average of 1.3 segments involved (± 1.3). No patient had diffuse fibrosis as assessed by extracellular volume (ECV) expansion. Known risk factors in our cohort included inferior T wave inversion (10%), polymorphic ventricular ectopy (18%), NSVT (16%), MAD (49%), and Pickelhaube sign (15%). No correlation was found between replacement fibrosis and any SCD risk marker.

Conclusion: Replacement fibrosis and SCD risk markers were common in this cohort, which was considered low SCD risk. No association was found between fibrosis and risk markers, suggesting poor predictive power for fibrosis. Risk markers for SCD are described in preselected, high-risk MVP populations. The extent to which these risk markers reflect SCD risk in low-risk patients is unclear. Using these risk markers in clinically low-risk patients may over-assess the risk, potentially resulting in medicalising patients and inappropriate therapy.

Case report of a transcatheter tricuspid valve-in-valve replacement

2025-09-29T15:52:35+00:00

Transcatheter valve implantations in the tricuspid position are infrequent. We report a case of an Edwards SAPIEN 3 (S3) implantation in the tricuspid position as a transcatheter valve-in-valve procedure in a 12-year-old patient deemed at high risk for surgical reintervention.

Cardiac dysfunction in patients treated for cancer: a challenge to cardiologists

2025-11-14T07:38:06+00:00

The rapid and extensive development of numerous cancer therapies has led to greatly improved patient survival. In parallel with greater survivorship, the incidence of cancer therapy-related cardiac disease (CTRCD) has increased. Therefore, it behoves cardiologists to anticipate the many manifestations of CTRCD, requiring awareness of the nature and extent of the cancer, its genetic type, detailed insight into the treatment to be applied or already given, its possible side effects, and the intrinsic risk to the patient’s cardiovascular health at baseline.

A mute swan in Birds of Eden

2025-11-14T07:45:17+00:00

A mute swan in Birds of Eden, Plettenbergbay.

Cardiovascular research in South Africa – Past, present, and future

2025-11-27T13:15:43+00:00

Cardiovascular diseases (CVD) remain one of the greatest global health challenges of our time. In the field of cardiology, South Africa (SA) produced several giants and champions whose contributions have been exceptional in their respective spheres. With the complexities required to reduce and prevent such illnesses, we draw inspiration and motivation from our history as we look to overcome future challenges. Here, we share some perspectives on future research priorities, including the usage of several facets of Artificial Intelligence (AI), such as AI-assisted echocardiography, which could unlock pathways to precision medicine, and adopting mobile health (mHealth) technology and wearable instruments for diagnostics, as well as clinical trials investigating the use of polypill interventions. This work echoes calls for health equity, recognising that the future strength of cardiovascular research will require initiatives that promote talent and provide opportunities to grow diverse capabilities within our country. Finally, we highlight the importance of community engagement and co-creation to foster trust and thereby enhance the uptake of interventions, including those aimed at promoting health literacy and education to support positive behaviour change in preventing CVDs and other non-communicable diseases (NCD).

SASCI-Mayo Clinic Fellows webinar: Lifelong management of adults with repaired tetralogy of Fallot

2025-12-12T07:49:45+00:00

This is the second in our series of South African Society of Cardiovascular Intervention (SASCI)-Mayo Clinic summit webinars to be published. This webinar was hosted by the regular faculty, with Dr Anderson, a congenital heart disease expert from the Mayo Clinic, in attendance. He provides background on the lifetime management of repaired tetralogy of Fallot (rToF), followed by a clinical case (presented by Dr Engelbrecht) spanning 3 distinct phases in the patient’s lifetime. The discussants are cardiology fellows from South African universities.

Objective: This manuscript, arising from the webinar series, summarises a multidisciplinary discussion on the lifelong management of rToF.

Design: Edited transcript of an expert webinar jointly hosted by SASCI and the Mayo Clinic faculty.

Case: The management of a female patient is discussed in three stages at different age points of the patient's lifetime. The patient received a surgical rToF as a 1-year-old girl. She was then followed longitudinally into adulthood. At 19 years old, she was asymptomatic at presentation with severe pulmonary regurgitation (PR), progressive right ventricle (RV) remodelling, and borderline functional capacity. The discussion explored thresholds for intervention, imaging strategies where cardiac magnetic resonance imaging (CMR) access is limited, and surgical versus transcatheter valve replacement options. The patient ultimately underwent surgical pulmonary valve replacement (PVR) with a 27 mm bioprosthetic valve. At phase 3, she presented at the age of 29 with degeneration of her bioprosthetic valve. She was evaluated and received a transcatheter valve.

Key messages: (1) Understanding embryology and surgical history informs lifelong surveillance; (2) PRdriven RV remodelling is central to management; (3) objective imaging and functional markers (RV volumes, QRS, cardiopulmonary exercise test [CPET], arrhythmia burden) guide timing more reliably than symptoms alone; (4) procedural choice balances anatomy, concomitant lesions, device availability, and lifetime reintervention planning; and (5) lifelong exercise and structured follow-up are essential.

Online resource: Recorded SASCI fellows webinars (restricted to verified healthcare professionals) are available from: https://www.sasci.co.za/content/page/sasci-educational-videos1.

ECG Quiz 71

2025-12-02T11:59:56+00:00

A 68-year-old man has an electrocardiogram (ECG) performed in the emergency room for an acute episode of palpitations. The patient received an oral antiarrhythmic drug before this ECG.

ECG Quiz 71 Answers

2026-01-07T11:31:49+00:00

Answers

The new frontier of statistics: Modern machine learning approaches as alternatives to traditional statistical tests in biological, clinical, and epidemiological research with a focus on cardiac event prediction

2025-12-08T10:19:17+00:00

As the complexity and volume of biological and clinical data increase, traditional statistical methods, such as logistic regression, discriminant analysis, analysis of variance (ANOVA), and multivariate analysis, often fall short of capturing the intricate patterns needed for accurate prediction and classification. Here, we explore alternative analytical frameworks rooted in modern machine learning (ML) techniques that offer enhanced capabilities for diverse biomedical applications. For example, these frameworks demonstrate superior predictive performance for cardiac events compared with classical logistic regression. However, challenges, interpretability, and future directions are important considerations when facing this new frontier. Moreover, systematically integrating these advanced computational tools into routine clinical and epidemiological research is imperative. This co-authored column forms part of the “Statistics Series” and builds on A simple guide to analyse data by Prof. Libhaber.⁽¹⁾

In memoriam - Dr Cobus Badenhorst

2025-12-12T06:41:44+00:00

Dr Cobus Badenhorst passed away on 27 October 2025 after a short and traumatic illness. It happened too unexpectedly and too soon, leaving his family, friends, colleagues, and patients in deep shock and sorrow.

Cardiac Imaging Quiz

2026-01-14T08:46:13+00:00

Cardiac imaging quiz