Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015

AFRICA

ECHOCARDIOGRAPHIC PREDICTORS OF OUTCOME

IN ACUTE HEART FAILURE PATIENTS IN SUB-SAHA-

RAN AFRICA: INSIGHTS FROM THESUS-HF

Sani Mahmoud U,*

Davison Beth A,

Cotter Gad,

Damasceno

Albertino,

Mayosi Bongani M,

Ogah Okechukwu S,

Mondo

Charles,

Dzudie Anastase,

Ojji Dike B,

KouamKouamCharles,

Suliman Ahmed,

Yonga Gerald,

Abdou Ba Sergine,

Maru

Fikru,

Alemayehu Bekele,

Edwards Christopher,

Sliwa Karen

Department of Medicine, Bayero University Kano; Aminu

Kano Teaching Hospital, Kano, Nigeria; sanimahmoud@

yahoo.com

Momentum Research Inc, Durham, North Carolina, USA

Faculty of Medicine, Eduardo Mondlane University, Maputo,

Mozambique

Department of Medicine, GF Jooste and Groote Schuur

Hospitals, University of Cape Town, Cape Town, South Africa

Department of Medicine, University College Hospital Ibadan

and Ministry of Health, Abia State, Nigeria

Uganda Heart Institute, Kampala, Uganda

Department of Internal Medicine, Douala General Hospital

and Buea Faculty of Health Sciences, Douala, Cameroon

Department of Medicine, University of Abuja Teaching

Hospital, Abuja, Nigeria

Faculty of Medicine, University of Khartoum, Khartoum,

Sudan

Department of Medicine, Aga Khan University, Nairobi,

Kenya

Service de Cardiologie, Faculte de medecine de Dakar, Dakar,

Senegal

Addis Cardiac Hospital, Addis Ababa, Ethiopia

Hatter Institute for Cardiovascular Research in Africa,

Department of Medicine, Faculty of Health Sciences, University

of Cape Town, South Africa

Background:

The role of echocardiography in the risk stratifica-

tion of acute heart failure (HF) is unknown. Some small studies

and retrospective analyses have found little change in echocar-

diographic variables during acute HF admission and some echo-

cardiographic parameters were not found to be associated with

outcomes. It is unknown which echocardiographic variables

will predict outcomes in sub-Saharan African patients admit-

ted with acute HF. Using echocardiograms, this study aimed

to determine the predictors of death and readmissions within

60 days and deaths within 180 days in patients with acute HF.

Methods and Results:

Out of the 1 006 patients in the THESUS-

HF registry, 954 had an echocardiogram performed with-

in a few weeks of admission. Echocardiographic measure-

ments were performed according to the American Society of

Echocardiography guidelines. We examined the associations

between each echocardiographic predictor and outcome using

regression models. Heart rate and left atrial size predicted death

within 60 days or readmission. Heart rate, left ventricular poste-

rior wall thickness (PWTd) and presence of aortic stenosis were

associated with the risk of death within 180 days. PTWd added

to the clinical variables in predicting 180-day mortality.

Conclusions:

Echocardiographic variables, especially those of

left ventricular size and function, were not found to have

additional predictive value in patients admitted for acute HF.

Left atrial size, aortic stenosis, heart rate and measures of

hypertrophy (LV PWTd) had some predictive value, suggesting

the importance of early treatment of hypertension and severe

valvular heart disease.

ROLE OF AMP-ACTIVATED PROTEIN KINASE (AMPK)

IN VASCULAR ENDOTHELIAL PROTECTION

Shamsi Aamir, Martin Justin

Imperial College, London, UK;

a.shamsi@doctors.org.uk

Background:

Adenosine monophosphate-activated protein

kinase (AMPK), although known for its role in regulating cellu-

lar metabolism, has recently emerged as an important kinase

involved in vascular endothelial protection. We noted it to have

similar actions to those of

MnSOD

HO-1

and

DAF

, genes

that protect the endothelium from inflammatory and oxidative

stress. Therefore we investigated whether AMPK’s cytoprotec-

tive activity includes the induction of these genes, and explored

the signalling pathways that may be involved.

Methods:

Human umbilical vein endothelial cells first under-

went a flow perfusion assay. They were then treated with

AICAR (an AMPK activator) for 24 hours, AMPK adenovirus

(Ad CA-AMPK) for 18 hours or a combination of atorvastatin

and rapamycin for two hours, and either immunoblotted for

various proteins or analysed via flow cytometry. Transcription

factor CREB was silenced using siRNA.

Results:

In this study we showed that oscillatory shear stress may

be responsible for down-regulating levels of phospho-AMPK

and

HO-1

. Cells treated with AICAR had a significant increase

MnSOD

HO-1

and

DAF

protein expression. Ad CA-AMPK

was shown to deliver active forms of AMPK into the cells and

infection of this adenovirus also up-regulated the levels of

MnSOD

HO-1

and

DAF

. We also showed that AMPK activates

CREB. Our results suggest that depletion of CREB with siRNA

reduces

MnSOD

protein induction by Ad CA-AMPK.

Conclusion:

We showed that AMPK activation induces the cyto-

protective genes

MnSOD

HO-1

, and for the first time,

DAF

. We

have also suggested that CREB may be involved in the pathway

for AMPK-dependent induction of

MnSOD

and that AMPK

activation may be a future therapy target.

PROTOCOL: WHAT FACTORS INFLUENCE HEALTH-

SEEKING BEHAVIOR AND ADHERENCE TO SECOND-

ARY PROPHYLAXIS FOR PATIENTS WITH SORE

THROAT, ACUTE RHEUMATIC FEVER AND RHEUMAT-

IC HEART DISEASE?

Shato Thembekile*

, Hermanus Tayla

, Engel Mark

, De Vries

Jantina

, Zühlke Liesl

1,2

Department of Paediatrics, Faculty of Health Sciences,

University of Cape Town, South Africa;

tlcpython@gmail.com

Department of Medicine, Faculty of Health Sciences, University

of Cape Town, South Africa