TABLE OF CONTENT: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb 2009

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1. The development of cardiology in South Africa : editorial
   Authors: Brink, A.J.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 5-6
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   Abstract: The discipline of cardiology in South Africa has advanced rapidly over the last 70 years. This editorial gives a perspective on this process.
   A highlight in the development of the discipline of cardiology was the establishment of the South African Heart Association (SAHA) in 1957. This was the first professional medical association to be formed in South Africa. The founding members were Dr Maurice Nellen and Prof Val Shrire (University of Cape Town), Prof JB Barlow and Prof Leo Schamroth (Wits University) and Prof Andries Brink (University of Stellenbosch). Nellen, a practising cardiologist in Cape Town, drafted the first constitution and devised an emblem for the SAHA.
    
2. Title: WH Craib : a critical account of his work
   With reference to : A study of the electrical field surrounding skeletal muscle, W.H. Craib : historical review article
   Authors: Naidoo, D.P.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 7-10
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   Abstract: One hundred years after its introduction, the ECG remains the most commonly used cardiovascular laboratory procedure. It fulfils all the requirements of a diagnostic test : it is non-invasive, simple to record, highly reproducible and can be applied serially. It is the first laboratory test to be performed in a patient with chest pain, syncope or cardiac arrhythmias. It is also a prognostic tool that aids in risk stratification and clinical management.
   Among the many South Africans who have made remarkable contributions in the field of electrocardiography, Don Craib was the first to investigate the changing patterns of the ECG action potential in isolated skeletal muscle strips under varying conditions. It was during his stay at Johns Hopkins Hospital in Baltimore and Sir Thomas Lewis laboratory in London that Craib made singular observations about the fundamental origins of electrical signals in the skeletal muscle, and from these developed his hypothesis on the generation of the action potential in the electrocardiogram. His proposals went contrary to scientific opinion at the time and he was rebuffed by the scientific community. Frank Wilson subsequently went on to develop Craib's doublet hypothesis into the dipole theory, acknowledging Craib's work.
   Today the dipole theory is fundamental to the understanding of the spread of electrical activation in the myocardium and the genesis of the action potential.
    
3. Title: The contribution of South Africans to the subject of dilated cardiomyopathy
   With reference to : Cardiovascular collagenosis with parietal endocardial thrombosis : a clinicopathologic study of forty cases : historical review article
   Authors: Watkins, D.A.; Mayosi, B.M.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 11-16
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   Abstract: Background : Dilated cardiomyopathy (DCM) is a heart muscle disease that is endemic in Africa. Over the past 50 years, South African investigators have made significant contributions to scientific elucidation of the condition. The objective of this review was to summarise their research on the subject of DCM.
   Methods and results : We searched PubMed for articles originating from South Africa and focusing on DCM or the related condition, peripartum cardiomyopathy (PCM). Reference lists and prominent South African researchers on DCM were also consulted. The prevalence of DCM is comparable in magnitude to that of other endemic heart conditions such as hypertension and rheumatic heart disease, although by comparison, DCM may cause disproportionate morbidity from heart failure. In the African context, malnutrition, excessive alcohol intake, prior myocarditis and genetic make-up have been proposed as aetiologies, and some or all of these factors may play an interrelated role in individual disease expression. The pathogenesis of DCM is partially due to the mechanical effects of fibrosis, and the immune response to myocardial damage likely affects disease progression. Small trials of pentoxifylline plus conventional therapy have demonstrated a trend towards reduced mortality from heart failure.
   Conclusions : Despite half a century of noteworthy research, the pathogenic mechanisms of DCM are still incompletely understood. South Africans have, however, played and should continue to play a critical role in advancing research on DCM.
    
4. Title: Familial hypercholesterolaemia in South Africans : tracking findings and developments over time
   With reference to : Prevalence of hypercholesterolaemia in young Afrikaners with myocardial infarction. Ischaemic heart disease risk factors. : historical review article
   Authors: Delport, R.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 17-22
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   Abstract: This review discusses the 1987 article by Wyndham, Seftel, Pilcher and Baker on familial hypercholesterolaemia (FH) and myocardial infarction (MI) in young Afrikaners, in terms of the significance at the time of publication, as well as the relevance of their findings versus current observations on hypercholesterolaemia in South Africa. Risk factors for coronary heart disease (CHD) were investigated in this study, with specific reference to familial hypercholesterolaemia. The significance of Wyndham's article is evaluated with regard to the contributions on hypercholesterolaemia by other South African researchers that preceded this publication. The clinical diagnostic criteria that were applied to identify possible FH at the time of publication are compared with currently employed criteria and guidelines. This review also acknowledges and honours other clinicians and researchers who, like Wyndham et al., have made significant contributions to the diagnosis and treatment of FH in South Africans.
    
5. Title: Mitral valve billow and prolapse : a brief review at 45 years
   With reference to : Mitral valve billowing and prolapse : perspective at 25 years : historical review article
   Authors: Obel, I.W.P.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 23-26
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   Abstract: Barlow's syndrome has become a regular, often-used and very often misused diagnosis. Its description followed extensive, prolonged and detailed clinical observation by JB Barlow and his co-workers. This major research effort was necessary because of the protean manifestations of the condition. The differentiation of Barlow's syndrome from other conditions with similar and sometimes identical symptoms requires clear and unambiguous criteria. These criteria were identified by penetrative clinical research. Consequently, it became possible to diagnose Barlow's syndrome with a high degree of specificity.
   Almost equally important were the gains made in understanding various conditions with similar symptoms but totally different management. An example of which, understanding some of the electrocardiographic patterns that emerge on effort in patients with ischaemic heart disease. Similarly, understanding mitral valve billow led to a greater knowledge of the entire pathophysiology of the mitral valve closure and important aspects of mitral regurgitation. Primary mitral valve billow, Barlow's syndrome, resulted from clinical research of the highest quality and has had a major application in clinical medicine.
    
6. Title: Leo Schamroth : his contributions to clinical electrocardiography
   With reference to : Incomplete left bundle-branch block : historical review article
   Authors: Scott Millar, R.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 27-29
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   Abstract: Leo Schamroth (1924-1988) was one of the best-known South Africans in the international medical community. His book, An Introduction to Electrocardiography, first published in 1957, was my introduction to the mysteries of the ECG. The first edition was only 90 pages and was a model of clarity and simplicity, with remarkable insight into the needs of a student new to the subject. It has been translated into Spanish, Italian, Greek, Turkish and Japanese, and is said to be the book most often stolen from medical libraries worldwide.
   Schamroth was a superb teacher, not only of the ECG, and will be remembered by generations of students who passed through his hands during his tenure at the Chris Hani-Baragwanath Hospital from 1956 to 1987, occupying the Chair of Medicine there from 1972. As a lecturer who combined unrivalled clarity with showmanship, he held his audiences, at home and all over the world, spellbound. However, it was his ability to wring insights from the most ordinary-appearing ECG, by painstaking analysis, that is his enduring legacy.
    
7. Title: The first human heart transplant and further advances in cardiac transplantation at Groote Schuur Hospital and the University of Cape Town
   With reference to : The operation. A human cardiac transplant : an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town : historical review article
   Authors: Brink, J.G.; Hassoulas, J.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 30-35, 38
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   Abstract: Christiaan (Chris) Barnard was born in 1922 and qualified in medicine at the University of Cape Town in 1946. Following surgical training in South Africa and the USA, Barnard established a successful open-heart surgery programme at Groote Schuur Hospital and the University of Cape Town in 1958. In 1967, he led the team that performed the world's first human-to-human heart transplant. The article describing this remarkable achievement was published in the South African Medical Journal just three weeks after the event and is one of the most cited articles in the cardiovascular field. In the lay media as well, this first transplant remains the most publicised event in world medical history.
   Although the first heart transplant patient survived only 18 days, four of Groote Schuur Hospital's first 10 patients survived for more than one year, two living for 13 and 23 years, respectively. This relative success amid many failures worldwide did much to generate guarded optimism that heart transplantation would eventually become a viable therapeutic option.
   This first heart transplant and subsequent ongoing research in cardiac transplantation at the University of Cape Town and in a few other dedicated centres over the subsequent 15 years laid the foundation for heart transplantation to become a well-established form of therapy for end-stage cardiac disease. During this period from 1968 to 1983, Chris Barnard and his team continued to make major contributions to organ transplantation, notably the development of the heterotopic ('piggy-back') heart transplants; advancing the concept of brain death, organ donation and other related ethical issues; better preservation and protection of the donor heart (including hypothermic perfusion storage of the heart; studies on the haemodynamic and metabolic effects of brain death; and even early attempts at xenotransplantation.
    
8. Title: From Bowditch to beta-blockers : evolution of the understanding of the importance of heart rate and myocardial energetics in cardiomyopathy
   With reference to : A comparison of stimulation frequency and electro-augmentation on myocardial function, extensibility, coronary flow rate, oxygen consumption and glucose metabolism : historical review article
   Authors: Ker, J.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 36-38
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   Abstract: During the past three decades, every aspect of cardiomyopathy has undergone dramatic change. When examining the literature on the physiological aspects of the failing heart, one immediately recognises that South Africa has made a contribution : Brink, Bester and Lochner evaluated the possible therapeutic aspects of the Bowditch phenomenon and myocardial energetics in cardiomyopathy almost four decades ago, at a time when the condition even had another name, myocardiopathy.
    
9. Title: Perspectives on research in hypertension : review article
   Authors: Seedat, Y.K.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
   Published: 2009
   Pages: 39-42
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   Abstract: This is a review of my published research on hypertension over 45 years on the three main racial groups residing in KwaZulu-Natal and its main city Durban. These three groups are blacks - mainly Zulu, whites and Indians. The research focused mainly on epidemiology, determinants of the aetiology of hypertension, clinical features, varying responses to hypotensive agents among the racial groups, complications that result from hypertension and the control of hypertension.
    
10. Title: Protection of the ischaemic heart : investigations into the phenomenon of ischaemic preconditioning : review article
    Authors: Lochner, A.; Marais, E.; Genade, S.; Huisamen, B.; Du Toit, E.F.; Moolman, J.A.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 43-51
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    Abstract: Exposure of the heart to one or more short episodes of ischaemia / reperfusion protects the heart against a subsequent prolonged period of ischaemia, as evidenced by a reduction in infarct size and an improvement in functional recovery during reperfusion. Elucidation of the mechanism of this endogenous protection could lead to the development of pharmacological mimetics to be used in the clinical setting. The aim of our studies was therefore to gain more information regarding the mechanism of ischaemic preconditioning, using the isolated perfused working rat heart as model.
    A preconditioning protocol of 1 x 5 or 3 x 5 min of ischaemia, interspersed with 5 min of reperfusion was found to protect hearts exposed to 25 min of global ischaemia or 35-45 min of regional ischaemia. These models were used throughout our studies.
    In view of the release of catecholamines by ischaemic tissue, our first aim was to evaluate the role of the alphaadrenergic receptor in ischaemic preconditioning. However, using a multi-cycle ischaemic preconditioning protocol, we could not find any evidence for alpha-1 adrenergic or PKC activation in the mechanism of preconditioning. Cyclic increases in the tissue cyclic nucleotides, cAMP and cGMP were found, however, to occur during a multi-cycle preconditioning protocol, suggesting roles for the beta-adrenergic signalling pathway and nitric oxide (NO) as triggers of cardioprotection. This was substantiated by the findings that (1) administration of the beta-adrenergic agonist, isoproterenol, or the NO donors SNAP or SNP before sustained ischaemia also elicited cardioprotection similar to ischaemic preconditioning; (2) beta-adrenergic blockade or nitric oxide synthase inhibition during an ischaemic preconditioning protocol abolished protection. Effectors downstream of cAMP, such as p38MAPK and CREB, were also demonstrated to be involved in the triggering process.
    Our next step was to evaluate intracellular signalling during sustained ischaemia and reperfusion. Our results showed that ischaemic preconditioned-induced cardioprotection was associated with a significant reduction in tissue cAMP, attenuation of p38MAPK activation and increased tissue cGMP levels and HSP27 activation, compared to non-preconditioned hearts. The role of the stress kinase p38MAPK was further investigated by using the inhibitor SB203580. Our results suggested that injury by necrosis and apoptosis share activation of p38MAPK as a common signal transduction pathway and that pharmacological targeting of this kinase offers a tenable option to manipulate both these processes during ischaemia / reperfusion injury.
     
11. Title: ACC.09 scientific session
    Authors: Amoah, A.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 51
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    Abstract: The presidents of the Pan-African Society of Cardiology (PASCAR) and the American College of Cardiology (ACC) invite all participants at the ACC.09 scientific session (http://acc09.acc.org) with an interest in cardiovascular disease in Africa to attend a joint session on Monday 30 March 2009.
     
12. Title: Hypertension, the changing pattern of drug usage : review article
    Authors: Opie, L.H.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 52-56
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    Abstract: Gradually the pattern of use of antihypertensive drug agents has changed, from prime use of diuretics and beta-blockers, to preference for the inhibitors of the renin-angiotensin system and the calcium channel blockers. In assessing the value of potentially conflicting evidence, attention should be paid to the hierarchy of evidence, which works its way up through 10 steps from isolated case reports to integrated knowledge.
     
13. Title: Mendelian-inherited heart disease : a gateway to understanding mechanisms in heart disease
    Update on work done at the University of Stellenbosch : review article
    Authors: Brink, P.A.; Moolman-Smook, J.C.; Corfield, V.A.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 57-63
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    Abstract: The presence of founder effects in South Africa for many single-gene diseases, which include heart diseases such as progressive familial heart block types I and II, hypertrophic cardiomyopathy and the long QT syndromes, afforded us the opportunity to identify causal genes and associated mutations through genetic mapping and positional cloning. From finding the genes, the emphasis has shifted to elucidating how primary defects cause disease and recognising factors that could explain the often pronounced phenotypic variability seen in persons carrying the same inherited defect. In some of these diseases, sudden unexpected death has been a frequent occurrence in young, apparently healthy individuals who had not been aware that they had inherited an underlying risk. Herein, we review progress in identifying genes, mutations and risk factors associated with the diseases mentioned.
     
14. Title: Reflections from our pages on cardiac events over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 64-68, 72, 76, 80, 86, 90
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    Abstract: Reflections from our pages on cardiac events over 20 years.
     
15. Title: From Tritace to Tri-Plen - the South African journey : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 69-70
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    Abstract: Ramipril (Tritace), introduced in 1990, offered for the first time, once-daily ACE inhibition for patients with mild-to-moderate hypertension - an innovation over its then major competitors, captopril and enalapril.
    The South African cardiology community was soon participating in clinical trials of outcomes using this new antihypertensive agent, and in the early 1990s contributed 8% of the 2 000 patients in the AIRE (Acute Infarction Ramipril Efficacy) study. The AIRE study investigated the effect of ramipril on a subset of patients who had shown clinical evidence of heart failure after acute myocardial infarction (MI), were haemodynamically stable and without overt evidence of ongoing ischaemia.
     
16. Title: Solvay addresses unmet needs in the management of hypertensive patients with cardiometabolic and lipid disorders : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 73-74
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    Abstract: In 1999, Solvay Pharmaceuticals launched the centrally acting antihypertensive moxonidine, Physiotens, in South Africa. Soon thereafter, they revived interest in the significant benefits of fenofibrate in the treatment of dyslipidaemias associated with type 2 diabetes, with the introduction both locally and internationally of a once-daily, micronised fenofibrate tablet, Lipanthyl.
     
17. Title: Merck Serono targets convenient, affordable medicines for patients at risk
    Using Cardicor as first-line therapy in heart failure : CiBis iii : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 77-78
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    Abstract: The advent of newer drugs for treating hypertension, myocardial ischaemia and heart failure, such as the angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), had a negative impact on the reputation of beta-blockers, which were once first-line therapy. However, a key factor often overlooked is that most of the trials, e.g. LIFE and ASCOT, proving the apparent superiority of ACEIs and ARBs, compared the new drugs to only one specific beta-blocker, atenolol.
     
18. Title: Protecting the health of patients at cardiovascular and cerebrovascular risk : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 81-82
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    Abstract: Actilyse, the intravenous infusion of recombinant human tissue-type plasminogen activator (rt-PA) was launched on the South African market in 1989 by Boehringer-Ingelheim. The availability of rt-PA revolutionised the treatment of acute myocardial infarction and resulted in a three-fold improvement in patency rates (61 vs 21% in patients who had until then received accepted routine care without rt-PA). Today, Actilyse is used in community hospitals, general practitioner's rooms and in the ambulance en route to hospital.
     
19. Title: Pharma Dynamics : targeting safe, effective and affordable medication for South Africa and neighbouring countries : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 85
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    Abstract: Pharma Dynamics was started in January 2001 by Paul Anley, well-known pharmacist and marketer at Parke-Med, the generics division of what was then Parke Davis Pharmaceutical Company. Pharma Dynamics has shown outstanding growth over the past eight years and now has a considerable cardiovascular presence.
     
20. Title: Atorvastatin and amlodipine : the successful duet that led to Caduet : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 87-88
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    Abstract: Pfizer launched atorvastatin in 1997. Its introduction powered the medical profession's ability to lower lipids even further, achieving :
    
    * 41-50% LDL cholesterol reduction across the dose range of 10-40 mg
    * 23-33% reduction in triglycerides
    * ease of administration day or night, with or without meals.
    
21. Title: Living up to 100 years of Bayer Healthcare cardiovascular protection
    Bayer Healthcare Cardiovascular : 20 years of participation in the South African cardiovascular community : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 91-94
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    Abstract: The launch of once-daily Adalat XL [nifedipine gastro-intestinal therapeutic system (GITS)] in 1992, reported on in the Cardiovascular Journal of Southern Africa, marked the advent of a new drug delivery system for this already well-known calcium channel blocker (CCB). The Adalat XL format provided for :
    
    * improved pharmacokinetics
    * 24-hour control with a single daily dose
    * effective blood pressure control with good tolerability and safety.
    
    In addition, its metabolic neutrality made it an ideal antihypertensive agent for patients at cardiometabolic risk.
    
22. Title: Ivabradine - a first-in-its-class treatment for lowering heart rate : pharmaceutical advances from our pages over 20 years
    From: Cardiovascular Journal of Africa, Vol 20, Issue 1, Jan / Feb
    Published: 2009
    Pages: 96
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    Abstract: Servier Laboratories is proud to announce the launch of Coralan (ivabradine), a first-in-its-class drug that offers a valuable new addition to the armamentarium of treatments for heart disease. It achieves its effects by lowering the heart rate in a specific manner. The consequence of this precise mode of action is that ivabradine has no negative effect on other aspects of cardiovascular functioning, such as blood pressure, heart contraction and conduction.