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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016



Acquired von Willebrand syndrome (AVWS) is a rare clinical

condition characterised by prolonged bleeding time and

decreased levels of factor VIII and von Willebrand factor. It has

been reported to occur in patients with severe aortic stenosis and

other cardiac conditions associated with high shear stress, such

as para-valvar leaks after prosthetic valve replacement surgery.

First reported decades ago, the mechanism was initially unclear

but it has now become known. In this issue, Binneto


lu and

colleagues (page 222) report on a prospective series of children

with aortic and pulmonary stenosis, and describe the frequency

of occurrence and underlying pathophysiology.

There is general agreement on the considerable variation in

the prevalence of various cardiac diseases among the different

ethnic groups in Africa and there may also be differences in the

manner in which the diseases express themselves. There is less

clarity about the contributions of intrinsic ‘genetic’ differences to

that variability compared to acquired or environmental factors.

Sirtuin 1 (SIRT1) has been identified as a candidate molecule

affecting the epigenetic mechanisms of cardiovascular disease

(CVD). Previous studies have shown that some SIRT1 single-

nucleotide polymorphisms (SNPs) are associated with body

mass index, diabetes, blood pressure, cholesterol metabolism

and coronary artery calcification. An investigation conducted by

Ramkaran and co-workers (page 213) in young South African

Indians with coronary disease concluded that SNP variant alleles

occurred more frequently in South African Indians than in black

South Africans. The study is not large enough to definitively

assess whether these variants may serve as risk factors that

contribute to Indians developing early-onset CVD but the results

are intriguing and warrant further investigation.

Technological advances in many aspects of the management

of CVD continue to amaze those of us who have been privileged

to witness their evolution and development. Left ventricular

assist devices (LVADs) and two- and three-dimensional

echocardiography were the stuff of dreams when many of us

were training but now are part of routine care in some parts

of the world. Demirozu and co-workers (page 208) elegantly

demonstrate how the use of advanced imaging techniques of

echocardiography can be used to fine-tune the functioning of


Intravascular stenting was equally unthinkable only a few

decades ago but has now revolutionised much of the management

of CVD. The way in which a new generation of biodegradable

stents promises to advance this area even further is described by


et al

. (page 238).

Cardiologists and physicians trained in an era prior to the

introduction of the technological advances mentioned above

will be pleased to see that the old stalwart, electrocardiography

(ECG) continues to be widely used. Some consider it does not

receive the recognition it deserves as a cheap, non-invasive

adjunct to the clinical examination. A cross-sectional study

carried out on adults in Nigeria examined the ECGs of 100

HIV-infected patients on highly active anti-retroviral therapy

(HAART), 100 HIV-infected HAART-naïve patients and 100

HIV-negative controls (Njoko

et al

., page 252). The clinical

relevance of these findings and that of similar findings reported

by others and discussed by the authors, remains unclear and

requires long-term follow up studies accompanied by imaging,

either by echocardiography or perhaps more helpfully, by cardiac

magnetic resonance imaging.

PJ Commerford


From the Editor’s Desk

Professor PJ Commerford