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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
AFRICA
31
ECHOCARDIOGRAPHIC PREDICTORS OF OUTCOME
IN ACUTE HEART FAILURE PATIENTS IN SUB-SAHA-
RAN AFRICA: INSIGHTS FROM THESUS-HF
Sani Mahmoud U,*
1
Davison Beth A,
2
Cotter Gad,
2
Damasceno
Albertino,
3
Mayosi Bongani M,
4
Ogah Okechukwu S,
5
Mondo
Charles,
6
Dzudie Anastase,
7
Ojji Dike B,
8
KouamKouamCharles,
7
Suliman Ahmed,
9
Yonga Gerald,
10
Abdou Ba Sergine,
11
Maru
Fikru,
12
Alemayehu Bekele,
12
Edwards Christopher,
2
Sliwa Karen
13
1
Department of Medicine, Bayero University Kano; Aminu
Kano Teaching Hospital, Kano, Nigeria; sanimahmoud@
yahoo.com2
Momentum Research Inc, Durham, North Carolina, USA
3
Faculty of Medicine, Eduardo Mondlane University, Maputo,
Mozambique
4
Department of Medicine, GF Jooste and Groote Schuur
Hospitals, University of Cape Town, Cape Town, South Africa
5
Department of Medicine, University College Hospital Ibadan
and Ministry of Health, Abia State, Nigeria
6
Uganda Heart Institute, Kampala, Uganda
7
Department of Internal Medicine, Douala General Hospital
and Buea Faculty of Health Sciences, Douala, Cameroon
8
Department of Medicine, University of Abuja Teaching
Hospital, Abuja, Nigeria
9
Faculty of Medicine, University of Khartoum, Khartoum,
Sudan
10
Department of Medicine, Aga Khan University, Nairobi,
Kenya
11
Service de Cardiologie, Faculte de medecine de Dakar, Dakar,
Senegal
12
Addis Cardiac Hospital, Addis Ababa, Ethiopia
13
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.ukBackground:
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
in
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*
1
, Hermanus Tayla
2
, Engel Mark
2
, De Vries
Jantina
2
, Zühlke Liesl
1,2
1
Department of Paediatrics, Faculty of Health Sciences,
University of Cape Town, South Africa;
tlcpython@gmail.com2
Department of Medicine, Faculty of Health Sciences, University
of Cape Town, South Africa