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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S34
Incidence of sport-related sudden cardiac arrest in non-competitive athletes over 12 years of age in an African general
population: The DOUALA-SCD registry
Marcus Ngantcha*, G. Tchanana
#
, S. Tchameni
#
, J.L. Ngo
#
, S. Mbouh
†
, A. Suliman
‡
, A. Bonny
◊
*Cameroon Cardiovascular Research Network, Douala, Cameroon.
#
Université Catholique d’Afrique Centrale, Yaoundé, Cameroon.
†
Institut National de la
Jeunesse et des Sports, Yaoundé, Cameroon.
‡
Department of Internal Medicine, University of Khartoum, Sudan.
◊
District Hospital of Bonassama-University of
Douala, Douala, Cameroon
Introduction:
The incidence of sport-related sudden cardiac arrest (SrSCA) in sub-Saharan Africa is unknown. The objective of this study was to determine
the incidence of sudden cardiac arrest in non-competitive athletes in an urban population in Cameroon.
Methods:
Two sources of information were used. A 12-month multi-source surveillance system of 86 189 inhabitants over 12 years old from 2 districts
recorded all deaths. All sport fields, the emergency medical service (EMS), local medical examiners and the district hospital mortuaries were surveyed. Two
cardiologists, blinded to each other, used a verbal autopsy protocol to determine the cause of death. The physical activity of the victim during the last 3 hours
before death was recorded. The second source was to determine the proportion of people which had practiced a physical activity. This was determined by a
cross-sectional study conducted amongst 796 persons.
Results:
The cross-sectional study showed that 68.71% could be considered as having at least 3 hours of physical activity per week. The surveillance found
that among 288 all-cause deaths, 27 (9.4%) were due to sudden cardiac arrest (SCA). One SrSCA was registered in a 35-year-old female while running. When
both sources were merged an incidence of SrSCA of 1.7 (95% CI 0.2 - 12.0) cases per 100 000 athletes per year were revealed. The average incidence in the
United States, however, is estimated to be 2.17 (95% CI 0.81 - 3.54) per 100 000 athletes per year.
Conclusion:
SrSCA in this sub-Saharan population appears comparable to that in western countries. A nationwide extension of this urban study will provide
further insights into the real SrSCA burden in Africa.
Cardiac arrhythmia services in 22 African countries from 2011 – 2018: The second report of the Pan African Society of
Cardiology (PASCAR)
Marcus Ngantcha*, K. Karaye
#
, W. Scholtz
†
, J. Russel
‡
, M. Houenassi
◊
, A. Niakara
§
, Y. Lubenga
∆
, M. Diakite
+
, A. Moustaghfir**,
A. Damasceno
∞
and E. Okello
∫
*Cameroon Cardiovascular Research Network, Douala, Cameroon.
#
Aminu Kano Teaching Hospital, Kano, Nigeria.
†
PASCAR, Department of Medicine Faculty of
Health Sciences, University of Cape Town, Rondebosch, South Africa.
‡
University Teaching Hospital of Freetown, Freetown, Sierra Leone.
◊
University Teaching
Hospital of Cotonou, Cotonou, Benin.
§
University Teaching Hospital Yalgado, Ouagadougou, Burkina Faso.
∆
University of Kinshasa, Kinshasa, Democratic
Republic of the Congo.
+
CHU Gabriel Toure, Bamako, Mali. **Hassan II University, Casablanca, Morocco.
∞
Eduardo Mondlane University, Maputo, Mozambique.
∫
Uganda Heart Institute, Kampala, Uganda
Introduction:
The aim of this study is to provide comprehensive information regarding the access and use of cardiac arrhythmia treatments in Africa from
2011 to 2018.
Methods:
Member countries of the Pan-African Society of Cardiology (PASCAR) collected data on human resources, drug availability, cardiac implantable
electronic devices (CIED) and ablation procedures. Information on health care systems, demographics, economics and procedure rates were also collected.
Results:
Twenty-two responses from more than 31 cardiologists from different countries were received. Considerable heterogeneity in the access to
arrhythmia care was observed. Non-VKA oral anticoagulants (NOACs) were only available in some countries: rivaroxaban (76%), dabigatran (29%) and
apixaban (23%). Digoxin and amiodarone were available in all countries, flecainide (76%), sotalol (71%), propafenone (21%) and quinidine (14%) followed.
Four countries (18%) did not perform pacemaker implantations, unless facilitated by humanitarian programmes (23%). In 2016, the median pacemaker
implantation rate was 2.866 per million population per country (range: 0.000 - 291.790) which is 200-fold less than in western countries. In 2018, there were
0.144 operators per million population per country. ICD and cardiac re-synchronisation were performed in 11 (50%) and 14 (63%) countries, respectively.
Reconditioned CIED were used in only 7 (32%) countries. Catheter ablations were available in 9 (41%) countries. Marked variation in cost (up to 1 000-fold)
was observed across countries with an inverse correlation (-0.48) between implant rates and the procedure fees standardised to the gross domestic product
per capita.
Conclusion:
Access to invasive cardiac arrhythmia procedures in Africa was limited. Drug therapies remained a big challenge. Pacemakers were not available
in some sub-Saharan countries. Owing to the high cost of device implantation, more than 200 million people did not have access to the treatment of
life-threatening heart blocks. Lack of economic resources and facilities as well as a scarcity of trained physicians were the other main drivers of poor cardiac
arrhythmia services.
Optimising fibrin as a scaffold for regenerative medicine
Silindile Ngcobo, Deon Bezuidenhout and Neil Davies
University of Cape Town, Rondebosch, South Africa
Introduction:
Fibrinogen is an attractive candidate for regenerative medicine due to its inherent bioactivity and FDA approval. In this study we sought to
modify fibrinogen through covalent attachment of heparin, for growth factor delivery. Heparin binds a significant number of growth factors and its anti-
coagulative characteristic plays a role in minimising thrombotic events.
Methods:
Fibrinogen was conjugated to NHS-PEG-SH through NHS ester reaction chemistry. After dialysis, bound thiols were quantified with a maleimide
fluorescent assay. Acrylate heparin was conjugated to thiols through Michael-type reaction, forming Fibrinogen-PEG(FP)-Heparin (FPH). The FPH was dialysed
and bound heparin quantified with heparin red and MBTH assays. Subsequently, FPH was polymerised with thrombin and characterised using rheology for
viscoelastic properties and scanning electron microscopy for microstructure. Growth factor entrapment and release were assayed with ELISAs. The gel was
further assessed in vitro with a 3D endothelial cell spheroid angiogenesis assay.
Results:
Binding of 1 heparin molecule in 3 fibrinogens was achieved. Frequency sweeps at 1Hz showed reduced mechanical stiffness for FPH (23 ± 5.3Pa)
compared to normal fibrin (50 ± 4.5Pa) but degraded slower. The FPH reduced VEGF burst release and bound 67 ± 1.2%, compared to 42 ± 6.9% fibrin and