Browsing by Author "Naidoo, Datshana Prakesh."

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Cardiovascular evaluation of hypertensive disorders of pregnancy by echocardiography.
(2004) Desai, Dushyant K.; Moodley, Jagidesa.; Naidoo, Datshana Prakesh.
Background: Preliminary observations suggest that aberrations in maternal central hemodynamics and uterine artery Doppler velocimetry reflect the severity of hypertensive disorders of pregnancy. In addition, the precise changes of cardiac output in normal pregnancy, particularly in the third trimester, have remained controversial. Aims and Objective: To measure concomitantly Doppler echocardiographic maternal central hemodynamics and uterine artery Doppler velocimetry and evaluate their association with adverse feto-neonatal outcome in hypertensive pregnant women. To evaluate cardiac output longitudinally in the latter half of pregnancy in normal healthy women. Design and Setting: Prospective study conducted at the Obstetric Unit, King Edward VIII Hospital, Durban, South Africa. Study sample: forty (40) pregnant hypertensives without any prior therapy and a further group of pre-eclamptic women (n=22) treated with stat dose sodium gardinal and alpha-methyldopa were studied. Results: i) A trend to a higher cardiac output was seen in the hypertensives compared to the normotensives. Hypertensive women were of larger stature; there was no difference in cardiac index. Fetal birthweight correlated poorly with cardiac index in pre-eclamptic women (r =0.21). A better correlation was seen with uterine artery resistance index (r = - 0.65) and systemic vascular resistance index (r = -0.49). Critical values for cardiac index and systemic vascular resistance index to predict poor adverse feto-neonatal outcome with good predictive values were not identified. ii) Pre-eclamptics treated with stat dose of sodium gardinal and/or methyldopa prior to echocardiography had a significantly lower systemic vascular resistance index and uterine artery resistance index compared to the untreated group. The lower systemic vascular resistance index in this treated cohort occurred from a combination of non-significant lower blood pressure and higher cardiac index. iii) Compared to normotensive women, untreated pre-eclamptics had a significantly lower heart rate (p< 0.001), a higher stroke index (p=0.018) and no difference in resultant cardiac index (p=0.452). iv) In gestational apoteinuric hypertensives presenting after 34 weeks gestation, maternal hemodynamics and uterine artery resistance index did not help define a higher risk group. v) In chronic hypertensives pregnancies, left ventricular hypertrophy correlated with severity of blood pressure. Higher risk chronic hypertensives were better selected by proteinuria than maternal central hemodynamics or uterine artery resistance index. vi) In normal pregnancy, maternal cardiac output peaked in early to mid third trimester and was maintained till term. Significant correlations were observed among maternal cardiac output, maternal body surface area and fetal birth weight. Discussion: i) This study shows that cardiac index and systemic vascular resistance index measured in the latter part of the second and third trimesters in hypertensive pregnant women were not associated with adverse fetal outcome. Large variations in cardiac index values were observed that restricted detection of satisfactory critical values for cardiac index and systemic vascular resistance index to predict adverse outcome. ii) An improved correlation of uterine artery resistance index with maternal hemodynamics and fetal birthweight in pre-eclampsia supports the hypothesis that poor placentation does not allow for a normal increase in uterine blood flow. iii) The poor correlation between uterine artery resistance index and maternal central hemodynamics, does not support the hypothesis that elevated cardiac output in hypertensive pregnancies (hyperdynamic disease model) occurs as a compensatory response to maintain adequate perfusion in a utero-placental bed with high resistance that did not decrease.
The changing spectrum of coronary artery disease in black African patients at a tertiary institution : a one year experience.
(2014) Dela, Sapna Shivani.; Naidoo, Datshana Prakesh.
The spectrum of coronary artery disease among Black African patients in South Africa is not completely known. Previous reports have described acute coronary syndrome (ACS) in Blacks as uncommon. Studies have shown that Blacks have milder coronary artery disease compared to other population groups. More recently, reports are showing a rising number of cardiovascular risk factors and myocardial infarction in this population group. There is currently a paucity of local data looking at the growing burden of this disease and the spectrum of presentation in Black African populations. The aim of this study was to describe the spectrum of coronary artery disease in Blacks and determine if there were significant differences in severity and outcome as compared to more usually affected population groups with coronary artery disease. A retrospective chart review of Black African patients with acute coronary syndrome was conducted at Grey’s Hospital, with data obtained over a twenty month period at our tertiary referral centre. Blacks were compared with an equivalent number of Indian and Caucasian subjects presenting with acute coronary syndrome during the same period. The clinical presentation, biochemistry and angiographic findings were examined. The prevalence of acute coronary syndrome in Blacks was similar to Caucasians (17% v. 19%) but lower than Indians (64%). Except for family history (5%), traditional risk factors occurred as frequently in Blacks as in Indians and Caucasians. The prevalence of diabetes mellitus in Blacks (46.8%) was almost identical to Indians (50%). Hypertension (67%) was similar to Indians and Caucasians, but dyslipidaemia (56%) and smoking (41%) was lower among Blacks. Metabolic syndrome occurred as frequently in Blacks as in Indians. Black African patients had comparable coronary vessel involvement to Caucasians (single and double vessel disease), but less three vessel disease (18%). They were more likely to present, ab initio, at a younger age compared to Caucasians, with less preceding angina and with anterior ST segment elevation myocardial infarction. In conclusion, the study shows that Black African patients have become a high risk group with coronary artery disease than previously thought. It shows that coronary artery disease in Blacks is no longer an uncommon problem and that they should be considered a high risk group of patients with a cardiovascular risk that is comparable to Indians and Caucasians. Aggressive screening and treatment of cardiovascular risk factors should be undertaken with the same seriousness as in other usually affected population groups.
The clinical and angiographic profile of very young patients with coronary artery disease.
(2016) Pillay, Ashegan Kandasamy.; Naidoo, Datshana Prakesh.
Overview of thesis in a PDF.
Echocardiographic features of the complications of infective endocarditis, with special reference to patients with HIV.
(2008) Nel, Samantha Heidi.; Naidoo, Datshana Prakesh.
Purpose: The aim was to determine the echocardiographic features of patients with infective endocarditis, and to compare the findings in HIV positive versus HIV negative patients. Methods: This was a prospective study, conducted over three years using the modified Duke criteria in diagnoses. A control group of age-matched patients with clinical and echocardiographic evidence of valvular regurgitation, who did not satisfy the criteria and who underwent surgery was used in comparison. Results: During this period 91 patients were screened for infective endocarditis. 77 satisfied the criteria for a definite diagnosis of IE. Blood cultures were positive in 46% cases. The commonest organism was S. aureus. Most patients had advanced valve disruption with heart failure and a high peri-operative mortality. The clinical features in the two groups of patients was similar. The incidence of echocardiographic complications was 50.6% in the whole group. Except for leaflet aneurysms in four HIV positive cases, complications were not more frequent in this group. Conclusion: There was a high rate of culture negative cases in this study, probably related to prior antibiotic usage; in this setting the modified Duke criteria have diagnostic limitations. There was no difference in the clinical presentation of infective endocarditis between HIV positive and HIV negative patients. Leaflet aneurysms were more common in the HIV positive patients.
The echocardiographic manifestations of an urban, working class community with a high cardiovascular risk profile.
(2013) Prakaschandra, Dorcas Rosaley.; Naidoo, Datshana Prakesh.; Gordon, Michelle Lucille.
The metabolic syndrome (MS), consequent upon the pandemic of obesity and diabetes, is associated with an increased risk for cardiovascular (CV) disease. Development of sub-clinical cardiac structural and functional changes associated with CV disease risk factors may be detected on echocardiography. The extent to which these structural changes and CV risk factors are dependent on genetic factors is not clearly established. This project was designed to investigate the relationship between CV disease risk factors, cardiac structural and functional changes and underlying genetic abnormalities. Specifically, the risk factor profile and the presence of the MS were determined. This was then correlated with the echocardiographic findings and gene polymorphisms. Method: A randomly selected cohort of 1428 subjects from the Phoenix community was studied. Demographic data was collected using the WHO STEPS instrument. Blood samples for biochemistry and genetic analysis, together with anthropometric measurements, were collected. Blood pressure and echocardiography was performed on all subjects. The metabolic syndrome was classified according to the National Cholesterol Education Panel (NECP) Adult Treatment Panel III (ATP III) and International Diabetes Federation (IDF) criteria. The Lipoprotein Lipase and Human Paraoxonase-1 genes were genotyped on a Light Cycler 480 Real-Time PCR instrument, using allele-specific probes and sequencing. Results: There was a high prevalence of CV risk factors in this sample; particularly increased waist circumference (79%), obesity (64%) insulin resistance (58%) and hypertension (50%) across the age groups. This translated into a high prevalence of MS (38% using NCEP ATPIII and 46% using IDF criteria). There were significant echocardiographic differences between subjects with and without MS for chamber dimensions (p<0.001), left ventricular wall thickness (p<0.001) and mass (p<0.001), diastolic indices (E-wave {p<0.001}, trans-mitral ratio {p=0.017}) and sub-epicardial adipose tissue (SEAT) thickness (p<0.001). Stepwise multivariate analysis identified age (95% CI 0.975; 0.998), gender (95%CI 0.48; 0.9) and hypertension (95% CI 0.53; 0.99) as independent risk factors for diastolic abnormalities. Logistic regression identified age as the most significant contributor to diastolic abnormalities (OR=1.02; 95%CI 1.009; 1.03; Wald=13.4), followed by the waist circumference (OR=1.025; 95%CI 1.014; 1.037) and BMI (OR=1.075; 95% CI 1.035; 1.117). Genetic analysis showed significant associations between the heterozygous variant of Q192R genotype (PON-1 gene) and elevated HDL levels and also between this variant and obese women (p= <0.05). Conclusion: The high prevalence of CV risk factors and MS in this community has reached epidemic proportions. Although the MS was associated with significant remodelling of cardiac structure, alteration of diastolic indices and increased sub-epicardial adipose tissue thickness, BMI and waist circumference were stronger promoters of altered cardiac physiology. This augurs poorly for this population group unless intervention is introduced to address the markedly high prevalence of these culprit drivers.
The effect of lifestyle modification on depression amongst myocardial infarction patients after revascularization.
(2020) Arzet, Aminu.; Naidoo, Datshana Prakesh.
Background: Patients with Coronary Artery Disease (CAD) are prone to depression, and its presence is associated with poor adverse cardiac outcomes. Although lifestyle modification (LSM) has been shown to be beneficial in managing depression in patients with CAD, it is not known whether the mode of cardiac intervention (coronary artery bypass graft surgery {CABG} vs percutaneous coronary intervention {PCI}) influences the outcome Objectives: We examined the prevalence of depression and depression traits amongst myocardial infarction (MI) patients after revascularisation and compared the effect of LSM on incidence of depression and depression traits in patients who underwent CABG versus PCI Method: We evaluated the risk factor profile, depression characteristics and lifestyle changes of 100 consecutive participants undergoing coronary revascularization over a 15-month period (Jan 2017 to March 2018). The Beck Depression Inventory II (BDI-II) was used to assess depression and the Goldin leisure-time exercise (GLTE) questionnaire to assess physical activity (PA). Results: 100 patients were recruited (mean age males 60.73±4.52 yr and females 60.29±3.64 yr), with 5 dropouts leaving 95 patients for complete analysis. Most of the patients were low-income earners 53 (53.0%) and 21.0% had tertiary level education. The majority had multiple CAD risk factors and comorbidities (79.0%). Prior to the LSM program 51 patients (51.0%) had depression and depression traits {CABG 34 (66.7%) vs PCI 17 (33.3%), p = 0.047)}. After LSM the overall prevalence of depression and depression traits fell to 33 patients (34.7%), {PCI 8 (23.0%) vs CABG 25 patients (72.0%), p = 0.001}. The mean depression scores also fell from 21.11±7.75 to 14.98±9.61 (p = 0.002). At baseline PCI patients were more physically active compared to CABG {3 (60.0%) vs 2 patients (40.0%), P = 0.715} respectively. After the LSM, more PCI patients undertook PA compared to CABG {24 (60.0%) vs 14 patients (35.0%) respectively, p = 0.012}. The PA score was also higher amongst the PCI group compared to CABG {14.16±9.73 vs 9.40±10.94 respectively, p = 0.024}. In fully compliant subjects the benefit derived was similar regardless of the mode of intervention {OR 1.10, CI 0.98-4.23,P = 0.191}. Using multivariate analysis the main predictors of depression and depression traits were female gender (OR 3.29, 95% CI 1.51-11.03, p = 0.008), CABG (OR 1.86, 95% CI 1.68-5.77, p = 0.003), heart failure (OR 2.65, 95% CI 5.87-13.62, p = 0.000), Kidney failure (OR 1.41, 95% CI 1.30-5.23, P = 0.041), atrial fibrillation (OR 1.60, 95% CI 1.40-4.77, P = 0.023), low PA (OR 1.97, 95%, CI 11.23- 33.20, P = 0.000), previous history of depression (OR 8.99,95% CI 1.90-7.89, p = 0.002) and low income (OR 2.21, 95% CI 1.40-2.85, p = 0.000). Conclusions: Depression and depression traits are common among subjects undergoing coronary revascularization, more so amongst CABG compared to PCI participants. Lifestyle modification reduces the prevalence of depression and depression traits, with fully compliant CABG vs PCI groups deriving nearly the same benefits from the LSM regime. No significant reduction in depression and depression was recorded amongst LSM partlycompliant patients. This study suggests that failure to implement lifestyle changes and engage in PA are major barriers to managing depression after coronary revascularisation.
Effect of mitral valve replacement on left ventricular function in subjects with severe rheumatic mitral regurgitation.
(2019) Maharaj, Sharen.; Naidoo, Datshana Prakesh.
Background. The outcome in patients with severe mitral regurgitation (MR) and impaired ejection fraction (EF) is poorly described in the developing world where rheumatic heart disease is endemic. Objective. This study describes the effects of mitral valve replacement (MVR) on left ventricular (LV) function in patients with rheumatic MR. Methods. This is a retrospective analysis of all subjects with severe rheumatic MR undergoing MVR over a 9 year period (2005-2013). Clinical and echocardiographic parameters were recorded pre-operatively, at 2 weeks, 6 weeks to 3 months and 6 months to 2 years following MVR. Results. Of 132 patients included in the study, 66% (n=87) were NYHA class III-IV, 38% (n=50) presented with clinical features of heart failure and 14% (n=19) had atrial fibrillation prior to MVR. The echocardiogram showed increased end systolic diameter (ESD, 39.9±7.2mm), left atrial size (LA, 61.2±12.6mm), and pulmonary artery systolic pressures (PASP, 59.5mmHg, IQR 45-80mmHg). Pre-operatively, 28% (n=37) of subjects had impaired LV function (EF <60%). At 6 months to 2 years following MVR (n=93), 1% of subjects were NYHA III-IV, 1% were in heart failure, and 7.6% had atrial fibrillation. Paired analysis of 83 patients with complete datasets revealed that the EF was >55% in 87% (n=72) pre-operatively, the number of patients with EF >55% dropped to 20% (n=17) at 2 weeks postoperatively (p<0.001, 95% CI 0.02-0.09) and thereafter an EF > 55% was recorded in 60% (n=53) at the 6 months to 2 year follow up (p<0.001, 95% CI 0.1-0.5). After feeding all clinical and echocardiographic variables into a predictive model only the ESD emerged as a significant predictor of postoperative LV dysfunction (EF< 50%) both on uni- and multivariate analysis. Conclusion. Most subjects with severe rheumatic MR who were subjected to surgery had advanced disease with heart failure, indicating that preoperatively, impairment of LV function was a frequent finding. The preoperative ESD was the only predictor of postoperative LV dysfunction. This study calls for careful clinical assessment with regular imaging and early referral for surgery in subjects with severe MR according to established guidelines in order to ensure preservation of ventricular function.
The effects of HIV/AIDS on the clinical profile and outcomes post pericardectomy of patients with constrictive pericarditis : a retrospective review.
(2016) Laurence, Graham.; Naidoo, Datshana Prakesh.
Constrictive Pericarditis (CP) is an uncommon condition which is a known treatable cause of heart failure. It is a condition that affects people from both developed and developing countries. In developed countries the aetiology of CP has undergone a paradigm shift away from infectious causes such as tuberculosis to acquired causes such as previous cardiac surgery and mediastinal radiotherapy for cancer. In the developing world by far the commonest cause remains tuberculosis. All aspects of CP have been widely studies in developed countries however there is limited data and studies on the condition from developing countries and more specifically African countries where tuberculosis is endemic. In South Africa the HIV/AIDS pandemic in association with persistent widespread poverty and poor socio-economic conditions has ensured that the incidence of tuberculosis infection remains exceedingly high. There have been numerous studies done evaluating the incidence, pathophysiology and treatment of tuberculous pericarditis in the HIV era. There however very limited data available describing CP in a South African setting. The objectives of this single centre study are to contrast the clinical profiles; surgical outcomes and short term follow up of patients diagnosed with CP at Inkosi Albert Luthuli Hospital. Through this study we hope to gain insight into the effects of HIV on patients with CP and determine whether it has any influence on the natural history and outcomes when compared to HIV uninfected individuals. It is hoped that information gained from this study will serve to further assist medical professionals in their understanding of CP and aim to improve both our management of patients with this debilitating condition and ultimately there life expectancy. In addition it is hoped that that study might serve as a catalyst for larger prospective studies in this field. Results missing (abstract) i.e aim, method, conclusion.
Genetic contribution to the risk for metabolic syndrome : an investigation of candidate gene polymorphisms related to lipid and carbohydrate metabolism.
(2015) Maistry, Tanya.; Gordon, Michelle Lucille.; Naidoo, Datshana Prakesh.
Abstract available in PDF file.
The outcome of patients undergoing simultaneous tricuspid and left-sided valve surgery in a rheumatic population.
(2014) Munasur, Mandhir.; Naidoo, Datshana Prakesh.
Background In the context of endemic left-sided rheumatic heart disease, tricuspid valve disease requiring surgical intervention merits closer scrutiny in order to analyse surgical outcomes with presently employed techniques. Aims To evaluate the results of simultaneous tricuspid valve surgery for severe functional tricuspid regurgitation in rheumatic heart disease at the time of left-sided valve surgery. Materials and methods A retrospective analysis of the perioperative and follow-up data of 30 patients who underwent tricuspid valve surgery with concomitant mitral and/or aortic valve replacement between July 2003 and December 2011 was undertaken. Patients referred for left-sided valve replacement surgery with clinically and echocardiographically documented severe functional tricuspid regurgitation in the presence of tricuspid annular dilatation, were submitted for combined valvular procedures. Outcomes were analysed by evaluation of the perioperative and 2-year follow-up clinical and echocardiographic data. Results There was a statistically significant improvement in the following parameters at 6 weeks postoperatively: New York Heart Association functional class, tricuspid annular diameter (p 0.001), pulmonary artery systolic pressure (p 0.001), severity of tricuspid regurgitation (p<0.001) and tricuspid transvalvular gradient (p 0.004). Preoperative (p 0.013) and postoperative pulmonary hypertension (p<0.002) were demonstrated to be associated with the development of major adverse cardiovascular events. There were no identifiable predictors for the development of severe residual postoperative tricuspid regurgitation. The development of severe residual postoperative tricuspid regurgitation was not associated with the occurrence of major adverse cardiovascular events. The technique of tricuspid valve repair did not impact on the occurrence of major adverse cardiovascular events or on the development of severe residual postoperative tricuspid regurgitation. A satisfactory outcome was observed in 40% of the study population. Conclusion The immediate results of tricuspid valve surgery for severe functional tricuspid regurgitation in rheumatic heart disease favour surgical intervention. However, the persistence of severe tricuspid regurgitation adversely influenced long-term outcomes. Therefore, the management of rheumatic patients with functional tricuspid regurgitation should encompass surgical strategies which result in a lower incidence of severe residual postoperative tricuspid regurgitation.
The prevalence and severity of retinopathy in patients with coronary artery disease at a tertiary hospital in Durban, South Africa.
(2021) De Jager, Johannes Frederik.; Naidoo, Datshana Prakesh.; Ponnusamy, Somalingum.
Background Studies have described the prognostic value of retinopathy in coronary artery disease (CAD), but few have examined the relationship between retinopathy and CAD severity. Aim The study investigated the prevalence of retinopathy in CAD patients [acute coronary syndrome (ACS) and chronic stable CAD] and determined the association of retinopathy and other clinical factors with the extent of coronary artery disease as assessed by the number of epicardial vessels involved. Methods A cross-sectional prospective study of 121 in-patients was undertaken over a ten-month period at Inkosi Albert Luthuli Central Hospital. One hundred and nine patients (12 stable CAD, 97 acute coronary syndromes) had angiographically confirmed CAD, and the remaining 12 patients with normal angiograms served as controls. All participants had a comprehensive systemic evaluation and fasting biochemistry. Retinopathy was assessed using five to seven wide-field fundus photographs. Macular thickness, vessel density and macular perfusion were assessed with optical coherence tomography (OCT) and OCT angiography. Results Compared to subjects with normal angiograms (controls), those with CAD had more frequent diabetes (67.9% vs 16.7%, p<0.001). Triple vessel disease (TVD) was present in 43.4% of diabetic patients compared to 35.6% of non-diabetics (p=0.004). Multivessel involvement was more frequent in diabetics (79%) compared to nondiabetics (58%) (p=0.002).
The profile of rheumatic heart disease at a tertiary hospital, KwaZulu-Natal, South Africa.
(2021) Shange, Kwenzakwenkosi Siyabonga.; Naidoo, Datshana Prakesh.; Paruk, Farhanah.
Abstract not available.
Relationship of body anthropometry with cardiovascular risk factors in a random community sample in Phoenix, KwaZulu-Natal.
(2014) Duki, Yajna.; Naidoo, Datshana Prakesh.
Abstract available in print copy.
The role of genetic factors in early onset coronary heart disease in the Natal Indian.
(2000) Naidoo, Datshana Prakesh.; Chetty, R.; Sharma, Arya.
Objective: To determine the role of candidate gene polymorphisms in patients who sustained myocardial infarction at a young age and examine their relationship, if any, to risk factors. Since angiotensin II is known to play a pathophysiological role at the myocardial and vascular level, the genes to be studied are those regulating the renin angiotensin system and tissue metabolism. Design: The risk factors and genetic profile is described in 117 young Indians with myocardial infarction recruited over a period of thirty months (Dec 1997 - Jun 1999). Controls comprised 80 normal subjects with no clinical evidence of coronary heart disease (CHD) and with a normal effort response. The key features of this study are the selection of young subjects with myocardial infarction, (mean age 43 ± 6.8 years) in whom the possibility of a genetic basis for the disease was felt to be more likely since the confounding effect of age as a risk factor was reduced. Setting: Patients recruited 3 -12 months after myocardial infarction from Addington Hospital, Durban. This hospital subserves the Indian community in the north of Durban. The majority of patients were from the Phoenix settlement area. Results: 1. The clinical profile of the young Indian with myocardial infarction is a young man, slightly overweight with a high prevalence of risk factors, particularly smoking and diabetes, coupled with sedentary behaviour and risk-prone dietary patterns characterised by high red meat intake and low fruit and vegetable consumption, resulting in increased BMI and W/H ratios. 2. There were no differences in the patterns of gene polymorphism in the reninangiotensin system between the study and control groups. This finding extended across all candidate gene loci studied i.e. those involving aldosterone, G-protein, TGF-B and homocysteine metabolism. Serum triglycerides, haemoglobin AlC and urine microalbumin levels were elevated in the probands together with low HDL-C levels (p = 0.001). 3. A striking finding of this study was the substantial proportion of patients found to have diabetes mellitus, totalling 47% of the proband group. Of the 53 diabetic patients, (45 males and 8 females) four (3 males, 1 female) had impaired glucose tolerance. Cigarette smoking, a positive family history of hypertension/diabetes and a family history for premature CHD emerged as important risk predictors for MI. Conclusion: This study, the first to report candidate gene polymorphisms in young Indians with coronary heart disease, has shown no obvious association between the genetic loci studied and acute myocardial infarction. Instead a high prevalence of risk factors, particularly smoking and diabetes mellitus, coupled with coronary-prone behavioural patterns was observed. In the light of these findings, genome-wide screening of unaffected siblings of subjects with early onset CHD cannot be recommended in this population until common polymorphisms can be clearly identified as risk factors. Indeed this study again supports the dire need for early, school level, education in behavioural lifestyle patterns and disease predisposition. The Indian community is a very high-risk group who should be targeted, not for secondary, but for primordial disease prevention measures. The study does not rule out the role of other candidate gene polymorphisms in the pathogenesis of CHD in these subjects. The high prevalence of diabetes and insulin resistance suggests that studies of genes regulating glucose and lipid metabolism should be pursued. Such candidate genes should include genes for lipoprotein lipase and paraoxonase polymorphisms which may explain the dyslipidaemia patterns in this group.
A ten-year retrospective review of patients presenting to Inkosi Albert Luthuli Central Hospital with infective endocarditis with special reference to HIV positive patients.
(2021) Naidoo, Nerissa Sanrisha.; Naidoo, Datshana Prakesh.
Abstract available in PDF.
Time-course changes in the echocardiographic parameters and NT-proBNP levels in patients with severe mitral regurgitation undergoing valve replacement.
(2007) Prakaschandra, Dorcas Rosaley.; Naidoo, Datshana Prakesh.
Conventional echocardiographic parameters are currently used in determining the timing for surgery in patients with mitral regurgitation. Since brain natriuretic peptide (BNP) rises in response to ventricular muscle stretch, and is to detect early heart failure, we hypothesized that BNP would be activated in patients with regurgitant valvular heart disease and concomitant left ventricular dilatation. Aim/Objectives: We therefore studied the pattern of changes in NT-pro BNP in patients with chronic severe rheumatic mitral regurgitation who were undergoing mitral valve replacement and compared this with the newer modality of tissue Doppler imaging (TDI). Setting: Patients submitted to surgery were prospectively evaluated over 8 months at Inkosi Albert Luthuli Central Hospital, Department of Cardiology. Controls were obtained from the outpatients' follow-up clinic. Methods: Simultaneous quantification of the severity of mitral regurgitation (MR), left ventricular (LV) end systolic volume (ESV), left atrial (LA) volume and Doppler filling ratios (mitral (E)/annulus (Ea)) were performed at baseline in all patients and was repeated at 1-week and at the six-week follow-up visit in surgical patients. Results: Both groups were similar for age and gender and echo-Doppler parameters in all patients preoperatively except LA size (p< 0.01) and volume (p<0.004) which were more elevated in the surgical group. Mean NT-pro BNP levels were markedly elevated preoperatively (262 pmolll) in all surgical cases compared to controls (57 pmol/l; p=0.0001). NT-pro BNP levels increased further at one week post surgery (395 pmol/l) and subsided at the six week follow-up visit (94 pmol/I). These changes were accompanied by significant reduction in LA (p= 0.003) and LV chamber dimensions (EDD = 0.004) with an increase in the ejection fraction from 42% at one week to 52 % at six weeks. Four patients had abnormally elevated NT-pro BNP levels (>53pmol/l) at the 6-week follow-up visit. A ROC curve was constructed for all variables to separate surgical cases from controls. The area under the curve was highest for NT-pro BNP (sensitivity= 96%, specificity 45 %). Conclusion: 1. There was a significant difference in the left atrial chamber size and volume, as well as Em/Ea (TDI) and NT-proBNP levels preoperatively between the two groups. The lack of a significant difference in the LV parameters between surgical and control groups suggest an almost total reliance on symptoms in deciding the timing of surgery which was reflected by markedly elevated NT-pro BNP in all surgical patients. 2. Postoperatively, there was a significant reduction in LA and LV dimensions. 3. The high false positivity rate for NT-pro BNP suggests that the test is most likely reflecting early LV decompensation in the less symptomatic control patients who rightly need surgery. 4. Tissue Doppler indices had similar sensitivity but low specificity compared to NT-proBNP. 5. Serial estimations of NT-pro BNP may prove useful in selecting patients for surgery.
To identify the changes in the haemodynamics in patients with pre-eclampsia using brain natriuretic peptide and doppler studies.
(2011) Fayers, Samantha Bernice.; Naidoo, Datshana Prakesh.
Abstract available in PDF file.