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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S31
AFRICA
Coping, copeptin and cardiac stress: The SABPA study
Catharina Myburgh*, Leoné Malan*, Marisa Möller
#
, Martin Magnusson
†
, Olle Melander
‡
, Henri Guise Laurie Rauch
◊
, Faans Steyn
§
and
Nicolaas Malan*
*Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.
#
Centre of Excellence for Pharmaceutical Sciences,
School of Pharmacy, North-West University, Potchefstroom, South Africa.
†
Department of Clinical Sciences, Lund University, Clinical Research Centre, Malmö,
Sweden. Department of Cardiology, Skåne University Hospital Malmö, Sweden; Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden.
‡
Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden. Department of Emergency and Internal Medicine, Skåne University Hospital,
Malmö, Sweden.
◊
Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town,
Rondebosch, South Africa.
§
Statistical Consultation Services, North-West University, Potchefstroom, South Africa
Introduction:
Defensive coping (DefS) is associated with a vulnerable cardiovascular profile in Blacks. The copeptin/vasopressin system is a manifestation
of hypothalamic-pituitary-adrenal-axis (HPA-axis) activity and may act as an acute compensatory mechanism when there is a disruption in volume-loading
homeostasis, i.e. when cardiac stress is evident. Whether DefS will influence associations between copeptin and cardiac stress markers, remains unclear. Our
aim was to determine associations between acute mental stress responses of copeptin, vascular responsiveness and biomarkers of cardiomyocyte injury
[cardiac troponin T (cTnT)] and cardiac wall-stress [N-terminal pro-brain natriuretic peptide (NT-proBNP)] in DefS race groups.
Methods:
South African black and white teachers (n=378), of both sexes, participated in this target population study. Cases with a history of myocardial
infarction, stroke and atrial fibrillation were excluded. We obtained coping scores (Coping Strategy Indicator), beat-to-beat blood pressure (stress-BP) and
fasting blood samples at rest and after 1-minute exposure to the Stroop-Colour-Word-Conflict-test (Stroop-CWT).
Results:
Interaction effects (p<0.05) for copeptin percentage change (%) during the Stroop-CWT determined stratification of participants into race and
DefS (≥26, above-median score) groups. In DefS Blacks, Stroop-CWT exposure elicited increases in cTnT%, NT-proBNP%, diastolic-BP% and total peripheral
resistance (TPR)%. Again, in these individuals, multiple regression analyses showed positive associations between copeptin% and TPR%; with inverse
associations between copeptin% and cTnT% (p<0.05). None of these associations were found in DefS Whites.
Conclusion:
DefS in Blacks elicited vascular hyper-responsiveness and cardiac wall-stress via the copeptin/vasopressin system. However, presumably
hypo-responsive HPA-axis activity during stress exposure could not counteract coronary hypoperfusion via copeptin/vasopressin release. The presence of
defensiveness may have clinical implications in preventive cardiology.
Personality, chronic defensive coping and S100B: New insights into the brain-heart link as per the SABPA prospective study
Catharina Myburgh and Leoné Malan
Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
Introduction:
Certain personality traits can contribute to chronic ineffective coping and cardiac morbidity. Ineffective coping may influence astrocyte
plasticity, followed by S100 calcium-binding protein B (S100B) release. High serum S100B levels have been associated with myocardial injury and remodelling.
Therefore, we aim to investigate bi-ethnic gender associations between personality and longitudinal mean percentage differences (%∆) in S100B, myocardial
injury [cardiac troponin T (cTnT)], stress [N-terminal pro-brain natriuretic peptide (NT-proBNP)] and remodelling (R wave of the aVL lead) when chronically
utilising a certain coping strategy.
Methods:
South African black and white teachers (n=378), of both genders, were followed for 3 years. Cases with a history of myocardial infarction, stroke and
left ventricular hypertrophy at baseline were excluded, as well as beta-blocker users and participants lost to follow-up. Coping (Coping Strategy Indicator) and
personality (Basic Traits Inventory) scores were determined. Fasting serum samples for S100B, cTnT and NT-proBNP and 10-lead ECG recordings were obtained.
Results:
Interaction effects (p<0.05) for personality traits determined stratification of participants into race, gender and defensive coping (DefS) (≥26, above-
median score) groups. DefS black men scored lower in conscientiousness compared to DefS white men. In DefS black men, NT-proBNP increased significantly
(p<0.05) over 3 years. In multiple regression analyses, %∆S100B associated positively with %∆NT-proBNP (adjusted R2=0.32, ß=0.26), but inversely with %∆cTnT
(adjusted R2=0.22, ß=-0.32) and %∆RaVL (adjusted R2=0.16 ß=-0.33) in DefS black men only. Again in this cohort, 3 personality traits [conscientiousness (adjusted
R2=0.22, ß=-0.25), openness to experience (adjusted R2=0.22, ß=-0.28) and agreeableness adjusted R2=0.22, ß=0.-0.30)] associated inversely with %∆cTnT.
Conclusion:
Ineffective DefS in black men appears to be driven by certain personality traits, posing as a risk for cardiac morbidity. Chronic defensiveness
contributed to lasting high serum S100B levels. S100B may accelerate the progression of ischaemic heart disease in DefS black men, as it appears to inhibit
left ventricular hypertrophy and increase myocardial stress.
Cost effectiveness analysis of new and prior generation transcatheter aortic valve replacement compared to surgical valve
replacement in a South African context
Tiffany Naidoo
#
, JanBenjamin Pietzsch*, Angelica Oyuyi
#
, Eline Visser
#
, Beatrice Ceronio
#
, Alaa Badarneh
#
and Willie Koen
†
*Wing Tech Inc, Xuhui District, Shanghai, China.
#
Medtronic Africa, Midrand, Gauteng, South Africa.
‡
Netcare Christiaan Barnard Hospital, Cape Town, South Africa
Introduction:
The cost of the transcatheter aortic valve implant (TAVI) procedure is assumed to be higher than surgical aortic valve replacement (SAVR)
for private medical insurance in South Africa. Previous health economic research, conducted in 2014, showed TAVI to be cost-effective when compared to
SAVR. Our objective was to estimate the cost-effectiveness of a contemporary self-expanding TAVI device in patients at high surgical risk in the South African
healthcare system.
Methods:
A previously developed decision-analytic Markov model, based on the CoreValve HR study, was used to estimate the lifetime gain in quality adjusted-
life years (QALY) and lifetime incremental cost-effectiveness. Cost and resource utilisation for South Africa was derived from the SA SHARE-TAVI registry, hospital
billing data, fee schedules and published literature. A scenario analysis based on second-generation self-expanding TAVI devices was conducted.
Results:
Over the patient’s lifetime, TAVI was projected to add 0.32 QALYs. Resource use in terms of hospital length of stay was found to be markedly lower for
TAVI compared to SAVR (2.6 vs. 6.2 days ICU; 5.7 vs. 12.1 days total), offsetting the higher TAVI procedure costs. Total estimated costs were R51 434 higher in the
TAVI strategy, leading to an approximated ICER of R161 236. Using second-generation devices reduced the cost difference to R41 954. These ICERs estimates
suggest TAVI is cost effective relative to a SA willingness to pay threshold of ~R300 000/QALY.
Conclusion:
Our analysis suggests TAVI using self-expandable devices in patients at high surgical risk is a cost-effective intervention in the South African
healthcare system. The use of second-generation devices may further improve this favourable value proposition.