CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
AFRICA
329
Letter to the Editor
Cardiomyopathies and myocardial disorders in Africa:
present status and the way forward
Response to Prof Bongani Mayosi
Dear Sir
We are grateful to Prof Bongani Mayosi
1
for his comments
on our article ‘Cardiomyopathies and myocardial disorders in
Africa’.
2
We thank him for bringing to our attention previous
publications from Africa on left ventricular non-compaction and
ion channelopathies. These publications were not available to us
when we wrote the article. It however shows that these diseases
also exist in Africa.
Interestingly we have, since our publication, encountered a
case of Brugada syndrome in our practice, although we are yet to
report the case. We therefore agree that many of the myocardial
diseases reported from the rest of the world probably also exist
here in Africa.
The current problem however is how to define and classify
the cardiomyopathies. One of us (AF) was part of the group
that first proposed the name cardiomyopathy for this group of
diseases.
3,4
We also classified them at the time, based on existing
knowledge. The key principle we agreed upon at our meeting
was to name any disease of the myocardium according to the
disease that caused it. Those that we did not know the cause or
causes of were the ones we regarded as cardiomyopathies.
In our view, subsequent attempts at classifying these disorders
of the myocardium have disregarded this basic principle and
have labelled virtually all diseases of the myocardium as
cardiomyopathy. Such assumptions have made classification
of the diseases more complex and difficult to use in routine
clinical practice. They also ignore geographic differences in the
causation and presentation of the diseases, especially in Africa
where the problem of the cardiomyopathies is most profound.
We do not think that the current European Society of
Cardiology classification is suitable for clinicians working in
Africa.
5
We therefore believe that it is time for Africa to develop
its own classification based on the realities on the continent.
Our classification was designed to trigger a debate in
Africa towards this end and in so doing we have continued to
maintain that basic philosophy of calling every disorder of the
myocardium by the disease that caused the disorder. We have
through that avoided the unending controversies surrounding the
definition of cardiomyopathy and have attempted to bring all the
disorders of the myocardium under one classification. We agree
that the Pan-African Society of Cardiology (PASCAR) should
take further steps to either adopt or modify this classification to
suit the clinical realities of Africa.
AYODELE FALASE, MD, FMCP, FWACP, FRCP, FAS,
NNOM,
OKECHUKWU OGAH, MBBS, MSc, FWACP
Division of Cardiology, Department of Medicine, University
College Hospital, Ibadan, Nigeria
References
1.
Mayosi BM. Cardiomyopathies and myocardial disorders in Africa:
present status and the way forward.
Cardiovasc J Afr
2013;
24
: 65–71.
2.
Falase AO, Ogah OS. Cardiomyopathies and myocardial disorders in
Africa: present status and the way forward.
Cardiovasc J Afr
2012;
23
:
552–62.
3.
Report of the WHO/ISFC task force on the definition and classification
of cardiomyopathies.
Br Heart J
1980;
44
: 672–673.
4.
Cardiomyopathies. Report of a WHO Expert Committee. World Health
Organization technical report series 1984;
697
: 7–64.
5.
Elliott P, Andersson B, Arbustini E,
et al
. Classification of the
cardiomyopathies: a position statement from the European Society of
Cardiology Working Group on Myocardial and Pericardial Diseases.
Eur Heart J
2008;
29
: 270–276.
EXAMINE Cardiovascular Safety Outcomes Trial
Data from the global EXAMINE (Examination of Cardiovascular
Outcomes: Alogliptin vs Standard of Care in Patients with Type 2
Diabetes Mellitus and Acute Coronary Syndrome) cardiovascu-
lar safety outcomes trial was recently presented at the European
Association for the Study of Diabetes: 49th annual meeting,
23–27 September 2013, in Barcelona, Spain.
Results indicated that alogliptin did not increase
cardiovascular ischaemic events including all-cause mortality,
non-fatal myocardial infarction, non-fatal stroke and urgent
revascularisation due to unstable angina. Exploratory data
also showed that rates of hospitalisation for heart failure were
comparable across alogliptin and placebo groups.
The EXAMINE trial evaluated a total of 5 380 patients with
type 2 diabetes and a recent acute coronary syndrome (within
15 to 90 days prior to randomisation). Alogliptin doses were
adjusted according to renal function and the median duration of
alogliptin exposure was 533 days.
At study end, mean HbA
1c
change in level from baseline
was –0.33 and 0.03% in the alogliptin and placebo groups,
respectively.
