SA Heart Journal

Kogel Bay, Cape Town

Photo: Ruchika Meel — 2025-06-26

This magical spot boasts the most incredible views of the Kogelberg mountains and Indian Ocean coastline.

Living with heart failure

S. Allie — 2025-06-19

Heart failure (HF) remains a global health concern affecting approximately 64.3 million people worldwide. In sub-Saharan Africa the pattern of HF is diverse and different to what is reported by the Global North, such as the relatively young age of participants reported in The Sub-Saharan African Survey of HF (THESUS-HF) study. Despite notable progress over the past 2 decades in advancing the understanding of HF in Africa, important knowledge gaps persist. These include outdated data on access to care and a lack of information regarding the incidence,
aetiology, availability, and affordability of HF medications. The THESUS-HF II study, under the umbrella of the Pan African Cardiac Society is currently underway. So far 16 countries participate, and more than 1 400 patients have been recruited (Figure 1). It is expected that the study will provide more understanding into access to care as well as comorbidities, risk factors and outcomes of HF.

Reflecting on 20 years of collaboration: A tribute to the SA Heart® Journal

I. de Kock — 2025-06-26

Clinical profile and outcomes of patients receiving acute renal replacement therapy in the cardiac intensive care unit at a South African referral centre

L.C. Mbanga — 2025-06-19

Background: At least a quarter of patients admitted to the cardiac intensive care unit (CICU) will develop acute
kidney injury (AKI), and some of these patients receive renal replacement therapy (RRT). The clinical profiles and outcomes of CICU patients receiving RRT in resource constraint settings like South Africa are unknown.

Objectives: The objectives of this study were to determine the clinical profiles and outcomes of patients receiving RRT in the CICU in a South African tertiary centre.

Methods: In this retrospective study, we included consecutive patients admitted and receiving RRT at the Groote Schuur Hospital CICU from 1 January 2012 - 31 December 2016.

Results: During the study period, 3 247 patients were admitted to the CICU, and 46 (1.4%) received RRT. The RRT patients had a mean (SD) age of 52 (17) years, 56% were males, and 65% had a background history of systemic hypertension. Heart failure syndromes accounted for 60.9% of CICU admission in the RRT patient group, followed by acute coronary syndromes and arrhythmias, which accounted for 26.1% and 13.0%, respectively. The RRT patient population had in-hospital and 30-day mortality rates of 58.7% and 60.9%, respectively. Baseline use of angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was associated with a reduced 30-day mortality rate, hazards ratio (HR) 0.43; 95% confidence interval (95% CI) 0.20 - 0.93; p=0.031. In addition, heart failure was associated with an increased 30-day mortality rate, HR 2.52; 95% CI 1.10 - 5.78; p=0.029.

Conclusion: In this single-centre study from an upper middle-income country, a small proportion of CICU patients receive RRT. Heart failure syndrome is associated with most RRT patients admitted to the CICU. Patients receiving RRT in CICU have a high inhospital and 30-day mortality.

Heart failure in persons with HIV: A scoping review

S. Maharaj — 2025-06-19

Introduction: Human immunodeficiency virus (HIV) infection remains a global health challenge, marked by substantial morbidity and mortality. The introduction of antiretroviral therapy (ART) has dramatically extended life expectancy for people living with HIV (PLWH), but this increased longevity exposes them to long-term conditions such as cardiovascular diseases, particularly HIV associated cardiomyopathy leading to heart failure (HF). HF in PLWH is a rising cause of morbidity and mortality, yet remains poorly understood. This scoping review aims to systematically examine and synthesise the existing literature on the relationship between HIV and heart failure.

Methods: The review followed the Arksey and O’Malley 6-stage methodological framework for scoping reviews. A systematic search was conducted using Boolean search strings across 4 databases: Scopus, Cochrane, PubMed, and ScienceDirect. The search was restricted to studies published between 2019 - 2023. Core articles yielded from data base search total 83. Twenty additional articles included in references do not form part of those yielded from Boolean string search. Total references 103. The results were analysed and synthesised to explore the prevalence, risk factors, and pathophysiology of heart failure in PLWH. Data analysis included descriptive statistics and thematic organisation.

Results: The scoping review highlights a significant association between HIV and heart failure, with PLWH having a 2-fold increased risk of developing HF compared to HIV-negative individuals (p<0.001). Studies report a shift from heart failure with reduced ejection fraction (HFrEF) to heart failure with preserved ejection fraction (HFpEF) in aging PLWH populations on ART (p=0.05). Additionally, elevated N-terminal pro b-type natriuretic peptide (NT-proBNP) levels were consistently found in PLWH with low CD4 counts, suggesting a persistent inflammatory state affecting the heart (p=0.02). Other significant predictors of heart failure include high viral load (p=0.03), low CD4 counts (p=0.01), and traditional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia (p=0.001). Protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs) were identified as ART classes associated with a higher cardiovascular risk (OR 1.8, 95% CI: 1.5-2.2).

Conclusion: Heart failuare is an emerging clinical entity among PLWH, driven by both HIV-related and traditional cardiovascular risk factors. This review underscores the need for integrated cardiovascular management strategies that encompass regular cardiac monitoring, advanced diagnostic tools, and careful selection of ART regimens. Ongoing research is crucial to develop tailored prevention and management approaches for cardiovascular complications in PLWH, ensuring improved clinical outcomes and quality of life for this vulnerable
population.

Viruses identified in endomyocardial biopsy samples in idiopathic dilated cardiomyopathy patients in central South Africa

H.A. Hanekom — 2025-06-19

Background: Heart failure and cardiomyopathy are problematic in South Africa. Viruses are important causes of myocarditis and cardiomyopathy. This study aimed to determine the distribution of viruses in endomyocardial heart biopsy samples in patients with dilated cardiomyopathy.

Methods: Endomyocardial biopsies (EMB) were analysed using histology, immunohistochemical staining, and polymerase chain reaction. The level of fibrosis, presence and type of cellular infiltration, and the prevalence of viral genomes with their replication activity were determined.

Results: Viral genomes were found in 73.7% of patients, with parvovirus B19 (B19V) present in 96.4%. No Coxsackievirus was identified, and 2 patients presented with transcriptional intermediates, which indicated active B19V viral replication. Most patients (71.4%) presented with single infections, but some (28.6%) with co-infections. Three patients presented with acute myocardial inflammation and moderate / severe increased lymphocytic infiltration.

Conclusions: This study found B19V predominant and present in almost all virus-positive EMB samples. Our results support the possible virus etiological shift towards B19V. These findings underscore the need to further investigate the pathophysiological role of B19V in the development and progression of DCM.

Ironing out the iron profile in heart failure patients: A single centre, outpatient-based cross-sectional study in South Africa

A. Gerber — 2025-06-19

Background: Iron deficiency is the most common nutritional deficiency globally, affecting up to 55% of patients with heart failure. Iron deficiency is an independent predictor of poor outcomes in heart failure patients. Screening for iron deficiency is recommended by the European Society of Cardiology (ESC) and adopted locally.

Objectives: To provide insight into the burden of iron deficiency in patients with heart failure in South Africa by measuring the iron profile and analysing differences in the iron profile between sexes and subgroups of heart failure.

Methods: A single-centre descriptive cross-sectional study was performed. Demographic, clinical, echocardiographic and laboratory data of patients with heart failure attending Universitas Academic Hospital in Bloemfontein for 3 months in 2023 were collected and analysed.

Results: We included 147 patients, 127 of whom had iron profile results. Over half (60.6%, 77/127) had iron deficiency, while the majority (74.0%, 57/77) had nonanaemic iron deficiency. Iron deficiency was more prevalent in females than males (p-value = 0.0006).

Conclusion: A high prevalence of iron deficiency in heart failure was noted. Even though their haemoglobin levels were normal, most patients were iron deficient. Routine screening of heart failure patients, as adopted from the ESC Guidelines 2021, is recommended.

Common atrium with single ventricle in a newborn: A case report

I.E. Akhigbe — 2025-06-19

The presence of a common atrium, a common atrioventricular valve in combination with a single ventricle, occurs very rarely, accounting for 1% - 2% of all congenital heart malformations. We report a rare case of a 21-day old male neonate diagnosed with a common atrium, single ventricle, a common atrioventricular valve and a patent ductus arteriosus. High index of suspicion and early diagnosis is vital for appropriate management and timely surgical interventions as required.

ECG Quiz 68 question

R. Scott Millar — 2025-06-19

ECG Quiz 68 answers

R. Scott Millar — 2025-06-19

Cardiac Imaging Quiz

R. Meel — 2025-06-19

Instructions for Authors

SA Heart — 2025-06-26