CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
AFRICA
3
Editorial
From the economics of TAVI and the pathophysiology of
heart and vessel disease to metabolic disease in Africa
and the developing world
The editor and staff of the journal welcome you, our readers,
back in 2014. We trust that you enjoy the spread before your
eyes.
Hailing from Angola, Magalhães
et al
. (page 27) looked at
the prevalence of the metabolic syndrome in employees of a
university, and emphasise the importance of waist circumference
(WC) cut-off values that are appropriate for a specific ethnic
group. The investigators used the clinical chemistry data obtained
to derive WC values for this group. One should keep in mind that
in Africa over the longer term, what we need is epidemiological
studies to determine the extent to which the metabolic syndrome,
in whatever way we define it, predicts cardiovascular events such
as myocardial infarction, stroke and other events.
In one of two South African studies, health economics
feature prominently. Mabin and Candolfi (page 21) compare
costing of the relatively new intervention, transcatheter aortic
valve implantation (TAVI), with conventional surgical aortic
valve replacement (cAVR). Data were derived from these
interventions in a private hospital group, a group where TAVI has
been pioneered in South Africa, albeit with a major input from
clinicians from university-associated public hospitals (Weich
et
al.
1
, Weich
et al.
2
).
The second article (Freercks
et al.
, page 4) estimated central
aortic systolic pressure (CASP) using a peripheral wrist-watch-
like device BPro (HealthStats, Singapore). They found that
CASP did not correlate with the degree of vascular calcification
(VC), which is a risk factor for mortality in dialysis patients.
Authors from Iran and the Netherlands (Sattarzad
et al
., page
34) tackled one of the holy grails in cardiac medicine using tissue
Doppler, namely, an often-asked question: Is it the heart, the
valves or the lungs that are responsible for a patient’s symptoms?
In this instance they developed a Doppler-derived prediction
model of left ventricular end-diastolic pressure (LVEDP) in the
presence of known mitral valve stenosis.
Two articles emanate from Turkey. Gazi and fellow workers
(page 9) examined endothelial function and dysfunction, and the
association with polymorphisms in genes involved in endothelial
function in patients with coronary slow flow (CSF). CSF is an
angiographic phenomenon of delayed passage of contrast along
the coronary arteries in the absence of stenosis in the epicardial
arteries. As a proxy for endothelial function they used flow-
mediated dilatation (FMD) of the brachial artery.
Altun
et al
. (page 15)worked fromthe premise that an increased
risk of atrial fibrillation may be related to cardiac changes
during pregnancy. They showed that P-wave dispersion and
certain tissue Doppler-derived parameters of electromechanical
coupling were different from those in the controls.
The issue is complemented by online publication of three case
reports. All in all a nice little feast with which to start the year.
PAUL A BRINK, MB ChB, PhD,
Department of Internal Medicine, Faculty of Health Sciences,
University of Stellenbosch and Tygerberg Hospital, Tygerberg
References
1.
Weich H, Janson J, van Wyk J, Herbst P, le Roux P, Doubell A.
Transjugular tricuspid valve-in-valve replacement.
Circulation
2011;
124
(5): e157–e160.
2.
Weich H, Ackermann C, Viljoen H, van Wyk J, Mabin T, Doubell AF.
Transcatheter aortic valve replacement in a patient with an anomalous
origin of the right coronary artery.
Cathet Cardiovasc Intervent
2011;
78
(7): 1013–1016.
