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| PVRI TASKFORCE ACTIVITIES - REPORT |
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| Year : 2010 | Volume
: 2
| Issue : 2 | Page : 93-95 |
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Inaugural meeting of the PVRI Sub-Saharan African Task Force - Report
Karen Sliwa
Hatter Cardiovascular Research Institute, University of Cape Town and leader of the SSA Region taskforce on the PVRI, South Africa
| Date of Web Publication | 16-Aug-2010 |
Correspondence Address:
Karen Sliwa
Hatter Cardiovascular Research Institute, Cape Heart Centre, 4th floor, Chris Barnard Building, Faculty of Health Sciences, Karen
South Africa
 DOI: 10.4103/0974-6013.68485
How to cite this article:
Sliwa K. Inaugural meeting of the PVRI Sub-Saharan African Task Force - Report. PVRI Review 2010;2:93-5 |
The Sub-Saharan Task Force, under the leadership of Dr. Ana Olga Mocumbi and myself, was established in January 2010. The primary aim of this Task Force was to establish a Sub-Saharan African Registry of Pulmonary Hypertension (PHT) and, subsequently, other research and educational awareness projects.
PHT is a devastating, progressive disease, with increasingly debilitating symptoms and, usually, with a shortened overall life expectancy. The epidemiology of PHT in sub-Saharan Africa has not yet been determined, but limited reports suggest that the incidence is higher than that reported from developing countries, owing to the pattern of diseases prevalent in the region. [1],[2],[3] Many known factors for PHT are hyperendemic in this part of the world, including Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, Schistosomiasis, chronic hepatitis B and C, and Sickle-Cell Disease. On the other hand, a high prevalence of tuberculosis, poorly treated asthma, high levels of pollution in the urban areas, and exposure to mining, subsequently lead to various forms of PHT and, often, to right heart failure with premature death. The lack of adequate pediatric services to deal with congenital heart disease that leads to PHT, and secondary PHT, is commonly seen, due to the high prevalence of rheumatic heart disease and endomyocardial fibrosis. [4],[5],[6],[7]
However, more detailed information is currently not available, thus also leading to poor awareness of these devastating problems, not only in the sub-Saharan Africa, but worldwide. There is, therefore, an urgent need for research into the demographics, natural history, and survival of patients with PHT.
Filling these gaps in knowledge is needed to effectively detect, manage, and prevent PHT in this region.
However, important lessons for the developing world can be learned by understanding the pathophysiologic basis of rarer conditions, which might be applicable to mechanisms of understanding in other diseases. An interesting example is the recent understanding of the importance of increased oxidative stress leading, via the activation of cardiac signaling pathways, to an abnormal breast-feeding hormone (16 kDa prolactin), possibly contributing in a major way to Peripartum cardiomyopathy, a disease particularly common in African women, but prevalent in all other ethnic groups. [8],[9]
The first Sub-Saharan Pulmonary Vascular Hypertension Workshop took place on Friday 23rd and Saturday 24th April 2010, at the Hatter Cardiovascular Research Institute, Chris Barnard Building, Faculty of Health Sciences, University of Cape Town.
We had colleagues from South Africa, Africa (Zimbabwe, Mozambique, Nigeria, Kenya, Sudan, Tanzania), United Kingdom (Prof Butrous), Australia (Prof Simon Stewart), and United States (Dr Lori Blauwet) participating in the workshop. The areas of discipline of the participating members ranged from basic scientists, adult and pediatric cardiologists, pulmonologists to cardiothoracic surgeons.
Although a few colleagues were not able to participate in the workshop, they expressed keen interest in participating in the registry and case-control studies.
Others, namely, Prof. Sheila Haworth (PVRI, UK), Prof. Denise Hilfiker-Kleiner from Hannover University, Germany, and Dr. Dirk Otto from Bayer-Schering, Germany, could not travel to the meeting due to the after-effects of the volcanic ash from Iceland. We were, however, pleased to have Tanja Steenekamp and her colleagues from Bayer-Schering, South Africa, in attendance.
We used the workshop to plan a PHT registry in Africa, under the auspices of the Pulmonary Vascular Research Institute-Sub-Saharan Taskforce.
The main objective of this research is to describe the epidemiology of PHT among patients attending referral units for cardiovascular and pulmonary diseases in African countries. This information will be crucial to the development of effective and resource-sensitive strategies to tackle PHT in sub-Saharan Africa. The first step in this direction will be to build a registry of patients with PHT, attending a range of hospitals in several countries from this region.
Prof. Ghazwan Butrous, Professor of Cardiopulmonary Science, University of Kent, Canterbury, gave an overview on the PVRI Institute and its global role. His talk was followed by a Skype presentation, given by Prof Sheila Haworth, on her work with the PVRI India group.
This session was followed by presentations on PHT with a focus on Sub-Saharan Africa.[Additional file 1]
Prof Simon Stewart, from the Baker IDI Heart and Diabetes Institute presented unpublished data on our collaborative project from the Heart of Soweto Study (University of the Witwatersrand). As presented recently at the European Cardiac Society Heart Failure meeting in Berlin, Germany, from a tertiary hospital registry at CH Baragwanath Hospital in Soweto, South Africa, 2505 cases presented overall with de novo heart failure among more than 5000 cases diagnosed with new cardiac disease, between 2006 and 2008. Of those 2505 cases, almost 700 cases had right heart failure. The majority presented with dyspnea (New York Heart Association Class II-IV), with a mean right ventricular systolic pressure of more than 50%. Right heart failure was independently associated with being black African, having a lower body mass index, a history of smoking, and having no history of cardiovascular disease. Among those cases with right heart failure, pulmonary arterial hypertension due to idiopathic form HIV, connective tissue disease, and congenital heart disease caused 28% of right heart failure in women and 15% in men.
Dr. Rosie Burton, Consultant in Medicine, University of Cape Town, presented an excellent overview on HIV as an independent risk factor for PHT, highlighting the lack of association of onset and progression of PHT with the CD4 count, viral load and clinical stage of HIV presentation. She describes, in the attached report, that HIV-associated PHT has almost exclusively been studied in the United States and European populations, with only isolated reports from African countries.
Dr. Ana Olga Mocumbi, my Co-Chair Task Force Leader of the Sub-Saharan Task Force of the PVRI, describes, in the attached summary, the broad range of PHT in the young African, highlighting the high incidence of untreated congenital heart disease with left-to-right shunt, schistosomiasis, HIV/AIDS, rheumatic heart valve disease, endomyocardial fibrosis, sickle-cell disease, and tuberculosis.
Dr. O. Ogah gave an excellent overview on the available data on PHT published from Nigeria.
Dr. Friedrich Thienemann, from the University of cape Town, Institute of Infectious Diseases and Molecular Medicine, presented a Web-based data collection system, AIDSS-ORG, that could, possibly, be used for the PVRI registry, if funding could be secured.
After lunch the group agreed on the format of the registry, number of cases to be studied (n = 1000), and substudies. The infrastructure of the centers was summarized by Dr. Ana Mocumbi, and the format for possible blood collection was presented by Prof. Sliwa and Prof. Sandrine Lecour.
The importance of securing research funding was highlighted.
A dedicated echocardiography group (Drs. Riaz Garda, Ahmed Suliman, Neil Hendricks, Lori Blauwet, and others), who will design the one-page echo assessment, was formed.
We ended the day with a group photograph being taken and later met for an interactive buffet dinner continuing our discussions.
We ended the meeting by agreeing to have a follow-up meeting in Cape Town in March 2011 or, alternatively, to coincide with the Pan African Cardiac Society meeting in Uganda in May 2011.
 References | |  |
| 1. | Sliwa K, Wilkinson D, Hansen C, Ntyinyane L, Tibazarwa K, Becker A, et al. A broad spectrum of heart disease and risk factors in a black urban population in South Africa: results from The Heart of Soweto study clinical registry. Lancet 2008;371:915-22.  |
| 2. | Stewart S, Wilkinson D, Hansen C, Vaghela J, Mvungi R, McMurray J, et al. A predominance of heart failure in The Heart of Soweto cohort: emerging challenges for an African cohort. Circulation 2008;118:2360-74. |
| 3. | Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (The Bold Study): a population-based prevalence study. Lancet 2007;370:741-50. [PUBMED] [FULLTEXT] |
| 4. | Sliwa K, Carrington M, Mayosi BM, Zigriadis E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: Insights from the Heart of Soweto Study. Eur Heart J 2010;31:719-27. |
| 5. | Mocumbi AO, Lameira E, Yaksh A, Paul L, Ferreira MB, Sidi D. Challenges on the Management of Congenital Heart Disease in developing countries. Int J Cardiol 2010. |
| 6. | Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, et al. Prevalence of Rheumatic Heart Disease detected by echocardiographic screening. N Engl J Med 2007;357:470-6. [PUBMED] [FULLTEXT] |
| 7. | Sliwa K, Mocumbi AO. Forgotten cardiovascular diseases in Africa. Clin Res Cardiol 2010;99:65-74. [PUBMED] [FULLTEXT] |
| 8. | Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, et al. A cathepsin D-cleaved 16 kDA form of prolactin mediates postpartum cardiomyopathy. Cell 2007;128:589-600. [PUBMED] [FULLTEXT] |
| 9. | Sliwa K, Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, et al. Evaluation of bromocriptine in the treatment of acute severe Peripartum Cardiomyopathy: a proof of concept pilot study. Circulation 2010;121:1465-73. [PUBMED] [FULLTEXT] |
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