Idiopathic Dilated Cardiomyopathy and Management of Heart Failure

New PhD study

Dr OS Ogah has registered for his PhD at the University of the Witwatersrand. He is studying the natural history of patients with heart failure in Nigeria and South Africa.

The title of his PhD: A study of the natural history of heart failure in two African populations

Dr OS Ogah. MBBS, Msc, FWACP.
Consultant Physician/Cardiologist
Federal Medical Centre, Idi-Aba Abeokuta
PMB 3031 Sapon PO. Abeokuta, Ogun State
Nigeria
Tel +234(0)8067747121 / +234(0)39202427
Fax +1-215-975-6817
Email: osogah56156@yahoo.com

Research Team

• Dr. Vinesh Vaghela, World Heart Failure Society fellow
• Dr. Kemi Tibazarwa, Metronic fellow
• Prof. Karen Sliwa
• Prof. David Wilkinson, University of Queensland
• Prof. Simon Stewart, Baker Institute, Melbourne, Australia
• Craig Hansen, post doc data management
• Bridget Phooko, research assistant
• Maureen Kubeka, research assistant

Background

Cardiomyopathy, an often irreversible form of heart muscle disease that is associated with a dismal outcome, is endemic in Africa. Since 1996 Karen Sliwa is performing research on epidemiology and etiology of various forms of cardiomyopathy in people living in Africa identifying new avenues for research. Prof Sliwa, Damasceno and Mayosi published December 2005 a review about various forms of cardiomyopathy in Circulation (see PDF file of Publication).

Summary of paper

We searched MEDLINE (January 01, 1966 through February 12, 2005) and reference lists of papers for relevant references. Unlike other parts of the world where cardiomyopathy is rare, dilated cardiomyopathy (DCM) is a major cause of heart failure throughout Africa. Similarly, peripartum cardiomyopathy (PCM) is ubiquitous on the continent, with an incidence ranging from 1:100 to 1:1000 deliveries. There is an apparent marked regional variation in the pathogenesis of DCM and PCM, underlining the heterogeneity of etiological factors in these conditions. By contrast, endomyocardial fibrosis (EMF) is restricted to the tropical regions of East, Central, and West Africa. Although the pathogenesis of EMF is not fully understood, it appears that the conditioning factors are geography and diet, the triggering factor may be an as yet unidentified infective agent, and the perpetuating factor is eosinophilia. Although epidemiological studies are lacking, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy appear to have similar characteristics to other populations elsewhere in the world. There is a need for large scale epidemiological studies of the incidence, prevalence, determinants, and outcome of cardiomyopathy in Africa in order to inform strategies for the treatment and prevention of heart muscle disease on the continent.

Research

Vaghela VP, Sliwa K, Essop MR, Sanderson, JE. Beta-adrenergic receptor blockers as part of management of heart failure therapy in Africa – very little evidence. (Download abstract; PDF 10kb)

Vaghela VP, Sliwa K, Essop MR, Sanderson JE. Beta Adrenergic Receptor Blocking Agents for the Management of Hypertension and Chronic Heart Failure in Africa. (Download poster; PDF 768kb)

Sliwa K, Damasceno A, Mayosi B. Cardiomyopathy in Africa. Circulation 2005; 112:3577-3583. [12.6]

Brooksbank R, Woodiwiss A, Sliwa K, Badenhorst D, Deftereos D, Wadee A, Essop MR, Sareli P, Norton G. Endotoxin-independent white cell cytokine production in heamodynamically stable patients with idiopathic dilated cardiomyopathy. Cardiovasc J South Afr 2005;16:260-265. [1.2]

Brooksbank R, Woodiwiss A, Sliwa K, Deftereos D, Essop MR, Sareli P, Norton G. Sustained white cell cytokine activation in idiopathic dilated cardiomyopathy despite haemodynamic improvement with medical therapy. Cardiovasc J South Afr; 2005;16:200-204. [1.2]

Sliwa K, Essop MR. Reply. J Am Coll Cardiol.2005;5:183. [9.1]

Sliwa K, Norton G, Kone N, Candy G, Kachope J, Woodiwiss J, Libhaber C,Sareli P, Essop R. Impact of initiating carvedilol Before Angiotensin Converting Enzyme inhibitor Therapy on Cardiac Function in newly Diagnosed Heart Failure. J Am Coll Cardiol 2004;44:1825-30. [9.1]

Munclinger M, Thornton AS, Schutte D, Sliwa K. Fatal potential of supraventricular tachycardia in hypertrophic cardiomyopathy. Int J Cardiol 2004 Feb; 93:335-337. [2.1]

Sliwa K, Woodiwiss A, Kone V, Badenhorst D, Norton G, Zambakides C, Peters F, Essop MR. Therapy of ischaemic left ventricular dysfunction with the immuno-modulating agent pentoxifylline: results of a randomised study. Circulation 2004;109:750-755. [12.6]

Sliwa K, Woodiwiss A, Libhaber E, Zhanje F, Motara R, Libhaber C, Essop MR. C-reactive protein predicts improved systolic performance in patients with idiopathic dilated cardiomyopathy treated with Pentoxifylline. Eur J Heart Fail. 2004:6:731-4. [2.8]

Papachan A, Sliwa K, Essop MR. Cardiac Amyloidosis presenting as Pseudo Hypertrophic Cardiomyopathy. Cardiovasc J South Afr 2004;15;136-138.

Sliwa K, Woodiwiss A, Candy G, Badenhorst D, Norton G, Skudicky D, Sareli P. Pentoxifylline modifies cytokine profiles and improves left ventricular performance in patients with decompensated congestive heart failure. Am J Cardiol 2002;90:118-22. [3.2]

Tiago A, Badenhorst D, Skudicky D, Woodiwiss A, Candy G, Brooksbank R, Sliwa K, Sareli P, Norton G. An aldosterone synthase gene variant is associated with improvement in left ventricular ejection fraction in dilated cardiomyopathy. Cardiovascular Research 2002; 54:584-589 (IF=3, R=6/67)

Sliwa K, Skudicky D, Bergemann A, Candy G, Hopley M, Sareli P. The addition of Pentoxifylline to Conventional Therapy Improves Outcome in Patients with Peripartum Cardiomyopathy. European Journal of Heart Failure 2002; 4:305-309. [2.8]

Skudicky D, Bergemann A, Sliwa K, Candy G, Sareli P. Beneficial Effects of Pentoxifylline in Patients with Idiopathic Dilated Cardiomyopathy Treated with Angiotensin-Converting Enzyme Inhibitor and Carvedilol. Results of a Randomized Study. Circulation 2001; Feb 27;103 (8): 1083-1090. [12.6]

Skudicky D, Sliwa K, Bergemann A, Candy G, Sareli P. Reduction in Fas/Apo-1 plasma levels correlates with improvement in left ventricular function in patients with idiopathic dilated Cardiomyopathy treated with pentoxifylline: results of a randomised study. Heart 2000; 84:438-441. [3.3]

Sliwa K, Skudicky D, Bergemann A, Candy G, Sareli P. Peripartum Cardiomyopathy: Analysis of Clinical Outcome, Left ventricular Function, Plasma Levels of Cytokines and Fas/APO-1. J Am Coll Cardiol 2000;35:701-5. [9.1]

Candy G, Skudicky D, Mueller U, Woodiwiss A, Sliwa K, Luker F, Esser J, Sareli P, Norton G. Association of left ventricular systolic performance and cavity size with angiotensin converting enzyme genotype in idiopathic dilated cardiomyopathy. Am J Cardiol 1999: 83: 740-744. [3.2]

Sliwa K, Skudicky D, Candy G, Wisenbaugh T, Sareli P. Effects of Pentoxifylline on the Left Ventricular Performance in Patients with idiopathic dilated cardiomyopathy. Lancet 1998: 351: 1091-1093. [21.7]

Funding:

• Medical Research Council South Africa
• University of the Witwatersrand

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