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Pericardial effusions are a frequent cause of hospitalization in cardiology. Thepopulation of patients presenting a pericardial effusion is very heterogeneous. Theetiological diagnosis presents a real problem in view of the diversity of the causesand the high cost of an exhaustive investigation. The aim of the study is to assess the etiological profil and survival of patients whohave undergone pericardiocentesis in our cardiology department. We realized a retrospective observational study of all patients who underwentpericardiocentesis for pericardial effusion between 2017 and 2021 with a follow-up of4 years at the cardiology department of university hospital Ibn Rochd of Casablanca. 215 patients were included. The average age is 42 years. The sex ratio was 1.01 (71women, 70 men). Several etiologies were identified: idiopathic (39.8%), malignancy (23%), tuberculosis (12%), ischemic(4.9%), autoimmune (3.5%), hypothyroidism (2.1%), uremic (2.1%),Rheumatic heart disease (1.4%), bacterial (2.1%), traumatic (1.4%) and iatrogenicity (4.9%). The most frequent malignancies originated from thebreast (34%), the lung (31%) or lymphome(20%). A new cancer was diagnosed withmalignant pericardial effusion as the main event in 12% of patients, thus, thepericardium was the first metastatic site of a known malignancy in 6% of patients.Death pourcentage was 12% dominated by neoplasic origin with 47%. Pericardial effusion is one of the most frequent reasons for consultation in thecardiology department, the majority of patients benefit from pericardiocentesis.The neoplasic etiology has exceeded the tuberculous etiology with poor prognostic,responsible for a significantly higher mortality rate, thus joining the epidemiologicalprofile of developed countries. [ABSTRACT FROM AUTHOR]

Conduction system abnormalities and myocardial dysfunction are observed in patients with myotonic dystrophy type 1 (DM1) and may represent the initial manifestations of the disease. Some studies have shown improvements of outcomes with use of early cardiac resynchronization therapy (CRT) in DM1 patients. Two-dimensional speckle tracking echocardiography (2D-STE) has recently emerged as a non-invasive biomarker for early detection of dyssynchrony. The aim of this study is to assess a left ventricle (LV) dyssynchrony using 2D-STE analysis in this population. This is a prospective study, conducted from March 2020 to October 2022 which included DM1 with normal LV ejection fraction (LVEF) and control patients with comprehensive resting echocardiography. Three measures were performed to assess LV mechanical dyssynchrony: opposing-wall delays (longitudinal and radial analyses), modified Yu index, and time to-peak delays of each segment. Mean age was 23 ± 7 years. All three mechanical dyssynchrony criteria were significantly higher in the DM1 group than in healthy subjects: opposing-wall delays in basal inferoseptal to basal anterolateral segments (61.4 ± 45.3 msec vs. 18.3 ± 50.4 msec, P < 0.001, respectively) and in mid inferoseptal to mid anterolateral segments (58.6 ± 35.3 msec vs. 42.4 ± 36.4 msec, P < 0.05, respectively) (Fig. 1), modified Yu index (33.3 ± 10.1 msec vs. 28.5 ± 8.1 msec, P < 0.05, respectively), and most of time-to-peak values, especially in basal and mid anterolateral segments. The existence of an early LV mechanical dyssynchrony using 2D-STE analysis in DM1 patients before the onset of cardiomyopathy represents a perspective for early prediction of sudden heart death. However, are ICDs really beneficial in terms of improving overall survival, in patients with conduction system disease often presenting more severe forms of myotonic dystrophy itself. Mean corrected time-to-peak delays. [ABSTRACT FROM AUTHOR]

Heart failure is a common reason for emergency room admissions. A major public health problem, it is associated with high morbidity and mortality despite a high variety of therapies. The clinical complexity of the presentations essentially depends on the various incriminated risk factors, in particular the presence of diabetes. Several studies have evaluated the relationship between acute heart failure and diabetes. The aim of this study is to evaluate the predictors of morbidity and mortality in diabetics with acute decompensated heart failure in our Moroccan context. This is a retrospective study including patients hospitalized in the cardiology department of the Ibn Rochd University Hospital in Casablanca, for acute decompensated heart failure from January 2017 to December 2020. The median age is 62.7 ± 10.4 years old. Sex ratio is 1.43. The three main triggers of cardiac decompensation in diabetics were the onset of coronary syndrome (35.9%), followed by infection (25.6%) and then deviation from diet (15.4%). 53.8% of the patients were not followed for chronic heart failure. Diabetes was significantly associated with overall mortality [risk ratio [HR] 1.24, 95% confidence interval (CI) 0.95–1.17]. The following parameters have been identified as being the predictors of hospital mortality in diabetic patients admitted for acute heart failure: advanced age, triggering factor: ischemia, systolic blood pressure < 90 mmHg, Hyperglycemia on admission, left ventricular fraction ejection (LVEF) < 50%, hyponatremia on admission and worsening of renal function during hospitalization. Acute heart failure, especially in diabetics, remains a common cause of emergency room admissions and characterized by a high rate of mortality and morbidity. The identification of predictors of mortality and morbidity makes it possible to stratify the population at risk in order to ensure more rigorous care. [ABSTRACT FROM AUTHOR]

Left bundle branch block (LBBB) occurs in up to 30% of patients with heart failure (HF). The detrimental effect of LBBB on left ventricular systolic and diastolic function caused by regional delays of electrical activity leads to dyssynchronous left ventricular function and has been established in HF patients. Some studies have reported LBBB as an independent predictor of mortality in HF patients. To study the impact of LBBB on heart failure with reduced ejection fraction (HFrEF) symptoms and outcomes. Transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with HFrEF, followed-up in the therapeutic unit of HF of our department. We studied 2 groups of patients: group 1 with complete LBBB and group 2 without complete LBBB. We compared clinical, echocardiographic and prognostic features. We collected 3412 patients. Six hundred and ninety-three patients (20.31%) in group1 and 2719 patients (79.69%) in group 2. Male gender was represented in 63 versus 63.7 years (P = 0.857). Mean age was 68.82 ± 12.47 years versus 64.79 ± 12.88 years (P < 0.001). Regarding etiologies: ischemic heart disease in 50.1% versus 59.4%, dilated cardiomyopathy in 9.3%vs5.9%, valvular heart disease in 3% versus 3.8%, chemotherapy induced cardiomyopathy in 2.8% versus 2.1% (P < 0.001). Class IV NYHA in 3.8% vs. 1.9% (P < 0.001). Echocardiographic features: LVEDD was 61.29 ± 9.24 mm versus 57.06 ± 8.99 mm (P < 0.001), mean LVEF was 32.24 ± 13.15% versus 35.87 ± 12.98% (P = 0.022), elevated left ventricle filling pressures in 29.4% versus 21.6% (P < 0.001), severe secondary mitral regurgitation in 9.6% vs. 5.8% (P < 0.001). Hospitalization for HF rate in 22.7% vs. 16.5% (P < 0.001). LBBB patients are more symptomatic, have lower LVEF, more severe secondary mitral regurgitation, higher hospitalization rate and higher mortality rate. These results are important to consider in order to justify the importance of cardiac resynchronization therapy. [ABSTRACT FROM AUTHOR]

Medical education worldwide is undergoing a pedagogical renovation movement; medical simulation is one of the revolutionary educational tools whose aim is to improve the medical knowledge, technical and non-technical skills of health professionals, while ensuring patient safety. Many studies have dealt with the contribution of simulation in cardiology, however no studies have been done on the management of cardiovascular emergencies in pregnant women by simulation. The purpose of our work is to evaluate a simulation-based educational training program on cardiovascular emergencies in pregnant women by comparing it to a "traditional" training program and to assess the students' satisfaction with this teaching method. We conducted anexperimental, comparative, randomized and multicentric studyon 60 medical students (≥ 6th year), the study started with a pre-test, followed by a theoretical training session on cardiovascular emergencies in pregnant women, a randomization of students into two groups, according to whether they had benefited or not from simulation sessions before taking a post-test. We selected 57 students: 29 in group 1 (SIM+) and 28 in group 2 (SIM−), both groups were comparable regarding their level of medical studies, hospital training in cardiology or gynecology and prior participation at simulation sessions. The pre-test results were comparable for both training groups. The progression of the marks between the pre-test and the post-test was significant P < 0.001 for both training groups, However a better progression of the marks in group 1 compared to group 2 has been observed P = 0.001. This preliminary study has demonstrated the considerable interest of medical simulation as an innovative teaching tool in training on cardiovascular emergencies in pregnant women and its added value compared to "traditional" training programs. [ABSTRACT FROM AUTHOR]

Complete atrioventricular septal defect (CAVSD) is a common congenital heart disease among children with Donw syndrome Investigate the impact of Down syndrome on atrioventricular valve morphology and haemodynamics as well as on outcomes in children with CAVSD. We performed a single-centre, retrospective, analytic study with a prospective follow-up in the Congenital Heart Disease Unit of cardiology department over a 9-year period (from December 2008 to September 2017).We compared 2 groups of patients with CAVSD: Down syndrome patients (group 1) and non-Down syndrome patients (group 2). Among the 2778 patients registered in our CHD Unit during the study period, 225 (8%) were diagnosed with CAVSD, 121 (54%) in group 1 and 104 (46%) in group 2. Median age at diagnosis was 5 months [0–17 years] in group 1 versus 5 months [1month–10 years] in group 2. The situs was solitus in all group 1 patients. However, in group 2, the situs was inversus in 4 patients (3.8%) and ambiguous in 17 (16.3%) (P < 0.001). Ventricles were unbalanced in 4 patients (3.3%) in group 1 versus 30patients (28.8%)in group 2 (P < 0.001). Atrioventricular valve annulus was hypoplastic in 6 patients (5.8%) of group 2 whereas all patients in group 1 had a normally developed atrioventricular valve annulus (P = 0.024). Papillary muscles were abnormal in 8 patients (6.6%) in group 1 versus 15 patients (14.4%) of group 2 (P = 0.048). Significant preoperative left atrioventricular valve regurgitation was lower in group 1 patients: 11 (9.1%) versus 23 (22.1%) (P = 0.02). Median age at surgery was 6 months [1month–7 years] in group 1 versus 7 months [1month–11 years] in group 2 (P = 0.023). Mortality rate was lower in group 1; 14 (11.5%) versus 23 (22.1%) (P = 0.03). Down syndrome patients have a better atrioventricular valve anatomy, fewer preoperative left atrioventricular valve regurgitation and a lower long-term mortality rate after surgery. [ABSTRACT FROM AUTHOR]

Sudden unexplained death is common in patients with hemoglobinopathies including sickle cell disease and thalassemia. The prolongation of the QTc interval is a risk factor for fatal arrhythmia in adults. To study the prevalence of QT prolongation in patients with sickle cell anemia or thalassemia followed at Ibn-Rochd CHU in Casablanca and to study the association between QT prolongation and the risk of sudden death. We examined electrocardiograms (ECG) of 52 consecutive patients (> 14 years) carrying hemoglobinopathies (sickle cell anemia or thalassemia) followed at the Ibn-Rochd university hospital in Casablanca between February 2017 and July 2018. The duration of the interval QTc was calculated using Bazett's formula and classified into three categories by sex (normal, long, short). The Chi-square test was used to study the association between prolonged QTc and sudden death. The statistical analysis was univariate and the significance level was set at (P < 0.05). Among the 52 ECGs examined, there were 3 cases of prolongation of the QT interval, including 2 patients with homozygous thalassemia and one patient with homozygous sickle cell disease, representing a percentage of 5.78% of all followed patients. The study of the association between prolonged QTc and the risk of mortality revealed a mortality rate of 66,7% with long QTc interval vs. 2% in normal QTc interval (P = 0.007). Prolonged QT in patients with sickle cell anemia or thalassemia is a risk factor for increased mortality. [ABSTRACT FROM AUTHOR]

Morocco has one of the largest population of heart failure (HF) patients in the world; yet only limited information is available about HF in Morocco. In May 2016, a new version of the European Society of Cardiology (ESC) Guidelines for the management of heart failure (HF) was released. The objectives of the study were to evaluate pharmacotherapy prescription in patients with HFrEF and impact of adherence on prognosis. Transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with HFrEF followed-up in the therapeutic unit of HF of cardiology Department of Ibn Rochd University hospital. We studied betablocker, Angiotensin converting enzyme inhibitors (ACE-I), Angiotensin receptor blockers (ARB), Mineralocorticoides receptor antagonists (MRA) prescription and correlation with symptoms and prognostic features. Data were collected on Excel and analyzed using SPSS 2.0 software. Our population included 3412 patients, mean age 64.92 ± 12.95 yo, 63.7% of patients were male. Regarding cardiovascular risk factors: hypertension was represented in 38.9%, diabetes mellitus in 30.4%, dyslipidemia in 9.9%, tobacco use in 31.9%. Regarding comorbidities: 10.1% of patients had history of stroke and 5.5% history of end-stage chronic kidney disease. Regarding etiologies of HFrEF: ischemic heart disease in 76.81%, dilated cardiomyopathy in 13.47%, valvular heart disease in 4.83%, chemotherapy induced cardiomyopathy in 2.38%. Adherence to pharmacotherapy was evaluated as follows: 86.98% to betablocker, 80.04% to ACE-I, 56.7% to MRA. Mean HR was 62 bpm ± 16, mean SBP was 128mmHg ± 23, mean DBP was 74mmHg ± 13. 74% of all of our patients were receiving optimal medical therapy according to ESC 2016 guidelines. Hospitalization for HF rate was 46.37% and overall mortality was 8.1%. Our registry shows an appropriate adherence to pharmacological recommendations from ESC HF Guidelines. [ABSTRACT FROM AUTHOR]

Cardiovascular complications of hemoglobinopathies are more and more frequent and therefore constitute a prognostic factor. Assess the impact of hemoglobinopathies on left ventricular diastolic function Prospective cross-sectional study conducted between May and October 2018, including patients above 14 years old, with sickle cell disease and/or thalassemia followed in the adult and pediatric hematology department at IbnRochd University Hospital-Casablanca-Morocco. Diastolic function was studies using TDI at the mitral annulus, Pulsed wave Doppler of the mitral valve, left atrial (LA) volume, and Velocity of tricuspid regurgitation (Vmax TR). Evaluation of left ventricular filling pressure were decided on the basis of recommandations of ASE/EACVI 2016. 52 patients were included, the average age was 24,19 ± 9,55 years. Females accounted for 49.1% of patients. 30.2% of patients had homozygous thalassemia, 24.5% had heterozygous thalassemia, 22.6% had homozygous sickle cell disease, 17% had heterozygous sickle cell disease, and 5.7% had sickle cell disease and thalassemia. median of ferritine was 3128 [411; 10124]. Echocardiographic analysis of diastolic function revealed an average value of the E/A ratio of 1.57 ± 0.46 [0.7; 3]. The mitral profile was normal in 76% of our patients, restrictive in 20%, relaxation abnormality in 2% and uninterpretable in 2% of patients that had atrial fibrillation. Average volume of LA was 42.88 ± 16.15 ml/m2. LA was dilated in 36.5%. Vmax TR was >2.8 m/s in 17,30%. LV filling pressure were considered elevated in 2 patients (Fig. 1). Systolic and diastolic heart dysfunction remains a common complication of hemoglobinopathies; The progressive dilation of the left ventricle leads to an increase in its mass and consequently an alteration in diastolic function.This diastolic heart failure can also be explained by damage to the vascular microcirculation and iron overload. [ABSTRACT FROM AUTHOR]

Congestive heart failure (CHF) is a leading cause of death and a major health problem accross the world. The incidence is increasing with the aging og population. CHF and stroke share the same risk factors, particularly hypertension and atrial fibrillation. The objective of this study is to investigate the clinical, electrical and echocardiographic profile of CHF patients with stroke. It is a transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with CHF and diabetes followed-up in the therapeutic unit of heart failure of our department. The data were collected on Excel and analyzed using SPSS 2.0 software. We studied the profile of CHF patients with stroke. 344 patients were collected (10% of all CHF patients). Mean age was 68,85 ± 12,60 years, male predominance (66,9%). The main cardiovascular risk factor was hypertension (46,5%), smoking in 40,1% and diabetes in 32,8%. The leading cause of CHF was ischemic heart disease in 76,4%, valvular heart disease in 15,5%, dilated cardiomyopathy in 5,5%. Permanent atrial fibrillation was present in 17,3% of cases. Mean LVEF was 36,27 ± 10,61% with no statistical difference with CHF patients without stroke (P = 0.057). The left ventricle was dilated in 76,7%, 2% of patients had an intra-cavitary thrombus. 53,8% of patients were anticoagulated. CHF and stroke share the same risk factors. CHF with reduced LVEF is at risk of stroke. Secondary prevention may improve the prognosis and the benefit of anticoagulation is still controversial. [ABSTRACT FROM AUTHOR]

Cardiovascular complications of hemoglobinopathiesare more and more common, including rhythm and conduction disorders, heart failure (HF), vascular disease and pulmonary hypertension. They constitute a prognostic factor. Study the associatuon between hemoglobinopathies and dilated cardiomyopathy. Prospective cross-sectional study conducted between May and October 2018, including patients > 14 years old, with sickle cell disease and/or thalassemia followed in the adult and pediatric hematology department at Ibn Rochd University Hospital-Casablanca-Morocco. All patients had a complete clinical examination with an electrocardiogram and a cardiac ultrasound. 52 patients were included, the average age was 24,19 (± 9,55) years. Females accounted for 49.1% of patients. 30.2% of patients had homozygous thalassemia, 24.5% had heterozygous thalassemia, 22.6% had homozygous sickle cell disease, 17% had heterozygous sickle cell disease, and 5.7% had sickle cell disease and thalassemia. Echocardiographic analysis revealed dilated LV in 27,5% of cases. The mean value of tele-diastolic-diameter of LV was 50,04 (± 6,94)mm, homozygous sickle cell patients had significantly a (57 ± 7,63 mm) and heterozygous sickle cell patients had a larger diameter compared to the other groupes (51,25 ± 5,50 mm) p = 0,008. The mean LVEF was 59.64%(± 4.09) and was impaired in one case with a LVEF of 48%. Mean LGS was -21.23%(± 3.19). SGL was impaired in 5 patients. The RV was dilated in 2 homozygous sickle cell patients with systolic dysfunction in one case.The left atrium(LA) was dilated in 26,7% of cases the average volume of LA was 42,88(± 16,14)ml/m2 with no statistic significant difference between the groupes. RA was dilated in 19,23% of cases. The dilation of the LV is related to the increase in its volume caused by cardiac output elevation, which is explained by the severity of anemia in these patients that can leads to HF. [ABSTRACT FROM AUTHOR]

Evidence from several observational studies suggests sex-related differences in the incidence and prognosis of CHF. The main objective of the study is to report clinical, electrical, echocardiographic, etiological and therapeutic aspects of CHF in women. It is a transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with congestive heart failure followed-up in the therapeutic unit of heart failure of our department. We studied clinical, electrical, echocardiographic and etiological aspects of CHF among women compared to men. Among 3412 CHF patients: 1237 were women (36.25%), women mean age was 64.96 ± 12.96 years vs. 64.89 ± 12.79 years in men (P = 0,068). A total of 37.8% of women were diabetic vs. 26,1% of men (P < 0.001), 49.6% were hypertensive vs. 32.7% (P < 0.001), 4% were smokers vs. 42.5% (P < 0.001), 12.3%vs 8.4% were dyslipidemic (P = 0.002). 25.8% had a history of myocardial infarctionvs 32.6%. CHF in women compared to men was due to ischemic heart disease in 50.6% vs. 63.2%, dilated cardiomyopathy in 13% vs. 8.8%, valvular heart disease in 4.4%vs 3.3%, cardiac toxicity in 3.5%vs 0,8%, peripartum cardiomyopathy in 0,8% (P < 0.001). Dyspnea in women compared to men was classified mostly class II NYHA in 59.7% vs. 57.3%, class III in 22%vs 17,9%, class IV in 1,9%vs 2%. Mean heart rate was 79.06 ± 16.65 bpm and mean blood pressure was 131.51 ± 24,89/75,27 ± 13,69 mmHg. 12,8% of women had atrial fibrillation vs. 12.5% in men (P = 0.860). Mean LVEF was 37.43 ± 15.85% vs. 35.65 ± 10.07% in men P < 0.001. No impact of gender on hospitalization for HF was observed (P = 0.867) Several clinical and epidemiological studies, in particular the Framingham and MILIS trials, indicate an increased long-term risk of CHF following myocardial infarction in women. This may be explained by a greater prevalence of risk factors for coronary atherosclerosis as well as by female gender. [ABSTRACT FROM AUTHOR]

It has been shown in several studies that despite being an independent risk factor for the development of HF, obesity is associated with lower mortality in patients with established HF, giving rise to the phrase "obesity paradox." Does that paradox apply to the Moroccan population? To study the impact of obesity on chronic heart failure with reduced ejection fraction (HFrEF) features and outcomes. Transversal study conducted between May 2006 and June 2019 including patients > 14 years with HFrEF, followed-up in our department. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m2. We studied 2 groups of patients: group1 of obese patients and group2 of patients with normal BMI. We collected 3412 patients: 723 (21.20%) in group 1, 2689 (78.8%) in group 2. Male gender rate was 62.1% vs. 62.2% (P = 0.9). Mean age was 63.34 ± 11.60 versus 66.90 ± 13.15 years (P < 0.001). Regarding cardiovascular risk factors: hypertension in 47.4% vs. 39% (P < 0.001), diabetes mellitus in 37.5% vs. 30% (P < 0.001), dyslipidemia in 20.2% vs. 10.4% (P < 0.001), Smoking in 31.3% vs. 33.1% (P < 0.001). Stroke in 12.6% vs. 14.6% (P < 0.001), thyroid dysfunction in 2.3% vs. 1.5% (P < 0.001), end stage CKD in 5.7% vs. 7.1% (P < 0.001). Ischemic heart disease was represented in 61.1% vs. 54.6%, dilated cardiomyopathy in 6% vs. 5.8%, valvular heart disease in 2.8% vs. 4.3%, hypertrophic cardiomyopathy in 0.9% vs. 0% (P < 0.001). Atrial fibrillation in 14.2% vs. 11% (P < 0.001). Echocardiographic features: LVEDDD was 57.87 ± 8.24 mm vs. 57.78 ± 8.94 mm (P = 0.875), mean LVEF was 34.52 ± 13.02% vs. 34.73 ± 13.10% (P = 0.884), elevated left ventricle filling pressures in 17.5% vs. 25.5% (P < 0.001), severe secondary mitral regurgitation in 4.6% vs. 7% (P < 0.001). H:F hospitalization rate was 20.4% vs. 25.7% (P < 0.001). Obesity paradox is confirmed in our population as obese HF patients are less symptomatic and have lower rates of hospitalization for HF and lower mortality rate. [ABSTRACT FROM AUTHOR]

Atrioventricular septal defect (AVSD) is a complex heart malformation affecting the lower part of atrial septum, the highest part of ventricular septum, mitral and tricuspid valves.It represents 3 to 7.3 of congenital heart diseasesand it is the congenital heart disease which is mostly associated with chromosomic abnormalities especially trisomy 21. The mane objective of this study is to assess features of AVSD in trisomic patientsand the prognostic impact of trisomy 21 in AVSD. Descriptive transversal retrospective and monocentric study conducted on a period of 10 years betweenDecember 2008 and December 2018. Were included all patientspresenting with AVSD confirmed by echocardiographyand followed-up in the congenital heart diseases unit of our department. 313 patients were included. ACSD was associated with trisomy 21 in 30.2%. The comparison of frequency of trisomy 21 regarding the type of AVSD and according to Rastelli classificationfor complete AVSDwas not significant with p values respectively of 0,110 and 0,086. We noted less pulmonary arterial hypertensions in trisomic patients (33%), par rapport compared to non trisomic patients (33% vs. 67%; P = 0,026).The study of the association between trisomy 21 and Eisenmenger syndromehasn't shown a statistical difference (P = 1,000), the presence of trisomy 21 didn't cause more mortality compared to eusomic patients (P = 0,110), trisomic patients who did benefit from surgical curehad less mortality compared to non treated patients (28,6% vs. 87,5%; P = 0,005). AVSD, particularly in its complete for is a pathology which is strongly associated with trisomy 21. This shows the importance of the diagnosis and genetic counselling. The treatment is essentially surgical and should be done early. [ABSTRACT FROM AUTHOR]

Atrioventricular septal defect (AVSD) is a complex heart malformation affecting the lower part of atrial septum, the highest part of ventricular septum, mitral and tricuspid valves.It represents 3 to 7.3 of congenital heart diseases and it is the congenital heart disease which is mostly associated with chromosomic abnormalities especially trisomy 21. The main objective of this study is to assess the prognostic factors and the overall mortality rate of patients with AVSD. Descriptive transversal retrospective and monocentric study conducted on a period of 10 years between December 2008 and December 2018. Were included all patients presenting with AVSD confirmed by echocardiography and followed-up in the congenital heart diseases unit of our department. A total of 313 patients were included. The median age was 9 months [3 days;56 years]. Female gender represented 51.4%. Complete ACSD was more common (77%), followed by partial ACSD (19.2%). Overall mortality was 44.7%. Among these deaths 50.8% occurred during the first 6 months of life. Complete ACSD was associated with higher mortality (52.5% of deaths) compared to other types of ACSD P = 0.002. Operated patients had a mortality of 28.9%, significantly lower than non-operated (64.9%) P < 0.001. Survival is as much improved as the surgical cure was conducted earlier. Before the age of 3 months: 50% of survivors if operated vs. 10% if not operated P = 0.025. Deceased patients had lower oxygen saturation than the survivors P = 0.048. Pulmonary arterial hypertension or T21 had no effect on mortality. The combination with other congenital heart defects with ACSD did not show a statistically significant impact on mortality. AVSD, particularly in its complete form is a serious condition with a poor prognosis. This shows the importance of the diagnosis and genetic counselling. The treatment is essentially surgical and when it is early, it considerably improves the prognosis. [ABSTRACT FROM AUTHOR]

Atrioventricular septal defect (AVSD)is a complex heart malformation affecting the lower part of atrial septum, the highest aprt of ventricular septum, mitral and tricuspid valves. It represents 3 to 7.3 % of congenital heart diseases. It is responsible for an important part of early death. The objective of this study is to precise clinical, echocardiographic and prognostic profile of AVSD in adults. Descriptive, retrospective, transversal and monocentric study conducted in a period of 10 years between December 2008 and December 2018. Were included all patients of more than 18 years presenting with an AVSD confirmed by echocardiography and followed in the congenital heart disease unit of our department. Three hundred and thirteen patients were collected. Among them, 31 were adults (9,9 %).16 patients were aged more than 30. The oldest patient had 56 years old. Sex ratio was H/F = 0,48. One patient was trisomic 21. The mean SpO2 was 91,87 ± 8,25%. Partial AVSD was mostly represented (17 cases), then complete AVSD (12 cases among which 8 type C et 4 type A of Rastelli), then intermediate AVSD (2 cases). Pulmonary arterial hypertension was present in 16 patients (51,6%) of cases, one patient was diagnosed Eisenmeger syndrome. 22,6% underwent curative surgery. Amogn +the 31 patients, 4 deaths, mortality was statistically lower than in younger patients (P < 0,001). AVSD, particularly in its complete form, is a dangerous pathology. The diagnosis at adult age seems to have a better prognosis. Treatment is essentially surgical, the nit is important to assess the diagnosis earlier. [ABSTRACT FROM AUTHOR]

Congestive heart failure (CHF) is a major and growing health problem around the world. In Africa, heart failure seems to be attributable mostly to systolic dysfunction and occurs as a major complication of high blood pressure. As a contribution to decreasing mortality of acute myocardial infarction and better treatment of high blood pressure as well as congestive heart failure the number of patients in heart failure have increased substantially. In contrast to the Framingham Study, nowadays coronary artery disease is the most prevalent etiology of congestive heart failure followed by hypertensive heart disease. The main objective of the study is to relate the principle causes leading to heart failure in our department. It is a transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with congestive heart failure followed-up in the therapeutic unit of heart failure of our department. The data were collected on Excel and analyzed using SPSS 2.0 software. We studied cardiovascular risk factors prevalence and causes repartition among these patients. The mean age was 64,92 ± 12,95 years, sex ratio H/F was 1,7, the prevalence of hypertension was 38,9%, 30,4% were diabetic, 31,9% were smokers, 9,9% were dyslipidemic. The leading cause of CHF among our patients was ischemic heart disease (76,81%), 13,47% dilated cardiomyopathy, 4,83% valvular heart disease, 2,38% cardiac toxicity, 0,9% of heart failure with preserved ejection fraction, 0,4% peripartum cardiomyopathy, 0,3% arrhythmia–induced cardiomyopathy. Our data show a high incidence of ischemic heart disease. Despite advances in our therapies for ischemic heart disease and hypertension, CHF remains a common and highly lethal condition. There is accumulating evidence that treatment of hypertension and ischemic heart disease can decrease the incidence of clinical CHF, related morbidity and mortality. [ABSTRACT FROM AUTHOR]

The prevalence of CHF increases greatly as the patient's renal function deteriorates, and, at end-stage CKD, can reach 65–70%. There is evidence that CKD is a major contributor to severe cardiac damage. Purpose is to determine whether end-stage CKD is a prognostic factor in CHF. Transversal retrospective study conducted between May 2006 and June 2019 including patients beyond age of 14 with CHF followed-up in therapeutic unit of heart failure of our department. Data were collected on Excel and statistical analysis was made using SPSS statistics 2.0.We define 2 groups of patients. Group A with end-stage CKD and group B without end-stage CKD.We studied demographic, clinical and paraclinical characteristics among these 2 groups. We collected 3412 patients, 439 (12%) in group A and 2973 (82%) in group B. Main etiology of CHF was ischemic heart disease in both groups. Hypertension and dyslipidemia were more prevalent in group A. Diabetes was as prevalent in 2 groups. Comorbidities were more prevalent in group A as we observe more strokes (20% vs. 8%, P = 0,0001) and myocardial infarctions (31% vs. 28%, P = 0,0001). Group A patients were more symptomatic: stage III and IV NYHA in 30% vs. 19%, P = 0,0001. Patients of group A were more at risk of acute decompensated heart failure (21% vs. 9%, P = 0,005). Atrial fibrillation was more prevalent in group A (14% vs. 9%, P = 0,0001). Elevated left ventricle filling pressure was more prevalent in group A (40% vs. 34%, P = 0,003). Mean LVEF was 35,69 ± 12,56% in group A vs. 33,46 ± 10,42% in group B (P = 0,63). Left ventricle was more dilated in group A (59,24 ± 8,2 mm vs. 57,91 ± 9,31 mm, P = 0,020). Cooperation between nephrologists and cardiologists may improve quality of care and subsequent prognosis for CHF and CKD. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is nowadays an important health problem. However, epidemiology and outcomes of HF is not well established in Morocco despite the prevalent socioeconomic impact on health system. We conducted a nationwide register-based study to investigate demographics, risk factors, comorbid conditions and outcomes associated with heart failure in adults in Morocco. To our knowledge, this is the first epidemiological study aiming to address the profile of chronic heart failure in Moroccan individuals. A cross-sectional, retrospective, descriptive, multicentric study including patients beyond 14 years old with HF was conducted in Cardiology departments of 4 University Hospitals: University Hospital IbnRochd in Casablanca [May 2006 to June 2019], University Hospital Arrazi and Avicenne Military Hospital for Instruction in Marrakesh [January 2012 to June 2019] and University Hospital IbnSina in Rabat [March 2018 to June 2019] Prevalence of cardiovascular risk factors was: hypertension (41.73%), diabetes (36.73%), smoking (36%), dyslipidemia (12.5%), and obesity (41.73%). An important proportion of patients has experienced a previous cardiovascular event: acute myocardial infarction (36.73%) or stroke (12.5%). End-stage chronic kidney disease was associated to HF in 5.25% of cases. Etiologies were as follows: ischemic heart disease (59%), non-ischemic dilated cardiomyopathy (26%), valvular heart disease (10%). Atrial fibrillation (paroxysmal or permanent) was represented in 18.36% of cases. HF was classified HFrEF in 68% of cases, HFmrEF in 19% of cases and HFpEF in 13% of cases. Mean LVEF was 33.3 ± 10.83%. Optimal medical therapy was reached in 74% of cases.Mortality rate was 8.4% and re-hospitalization for HF rate was 39.08%. People living with HF require services that meet their changing needs.In order to develop appropriate care, it is imperative to generate evidence to inform policy and practice. [ABSTRACT FROM AUTHOR]

The impact of chronic kidney disease (CKD) and hemodialysis (HD) on heart function is not fully understood. Assess the influence of different grades of chronic nephropathy and HD on the cardiac function using myocardial deformation: Longitudinal global strain (LGS) Descriptive cross-sectional study conducted between January 2017 and January 2018, concerning patients followed for CKD sent for cardiac evaluation. The patients were classified into 3 subgroups (Control: without CKD; Medium to advanced CKD: stages 3, 4 or 5, and terminal CKD on HD. The systolic function of the LV was evaluated by echocardiography with the analysis of the LGS. The study included 100 patients, According to the subgroups: 33 did not have CKD (control), 27 had moderate to advanced CKD (stages 3, 4 or 5) and 40 had terminal CKD on HD. There was no significant difference in gender, age and LVEF among the groups. Compared to control group, the absolute value of SLG was decreased in the CKD groups, this decrease is parallel to the decline in renal function. In addition, compared to moderate CKD patients, LV systolic function was better in patients with CKD on HD. Myocardial strain analysis is much more sensitive for predicting and detecting LV systolic dysfunction in patients with CKD. The decline in kidney function parallels the deterioration in heart function which may indicate that toxins play an important role in LV dysfunction, HD helps clarify toxins and improve LV function. [ABSTRACT FROM AUTHOR]

Heart failure with reduced ejection fraction (HFrEF) is an important clinical syndrome. Evidence from several observational studies suggests sex-related differences in the incidence and prognosis of HFrEF, particularly in the setting of coronary artery disease. Women appear more prone to develop heart failure. Objective of the study is to report clinical, electrical, echocardiographic, etiological and therapeutic aspects of HFrEF in women versus men. Transversal retrospective study conducted between May 2006 and June 2019 including all patients beyond the age of 14 with HFrEF followed-up in therapeutic unit of heart failure of our department. Data were collected on Excel and analyzed using SPSS 2.0. We studied clinical, electrical, echocardiographic and etiological aspects of CHF among women compared to men. 1237 women among 3412 HFrEF patients were included, women mean age was 64,96 ± 12,96 years vs. 64,89 ± 12,79 years in men (P = 0,068). 37,8% of women were diabetic vs. 26,1% of men (P < 0,001), 49,6% were hypertensive vs. 32,7% (P < 0,001), 4% were smokers vs. 42,5% (P < 0,001). 9,2% had a history of stroke vs. 10,6% (P = 0,205), 25,8% had a history of myocardial infarction vs. 32,6% (P < 0,001), 5,3% were at end-stage chronic kidney disease vs. 5,5% (P = 0,822). HFrEF in women compared to men was due to ischemic heart disease in 50,6% vs. 63,2% (P < 0,001). Dyspnea in women compared to men was classified mostly class II NYHA in 59,7% vs. 57,3%. 12,8% of women had atrial fibrillation vs. 12,5% in men (P = 0,860). Mean LVEF was 37,43 ± 15,85% vs. 35,65 ± 10,07% in men P < 0,001. No impact of gender on hospitalization for HF was observed (P = 0,867) Myocardial infarction was significantly more prevalent in women. Several studies indicate an increased long-term risk of HFrEF following myocardial infarction in women. This may be explained by a greater prevalence of risk factors for coronary atherosclerosis as well as by female gender. [ABSTRACT FROM AUTHOR]

Despide advances in the treatment of heart failure with reduced LVEF, rates of hospitalization and mortality remain relatively high. With the discovery of If channels and ivabradine, an approach of slowing heart rate not related to betablockers became possible. The main objective of this study is to report symptoms and quality of life improvement in heart failure patients with reduced LVEF taking ivabradine. A prospective and descriptive study was lead during a period of 3 months (from November 2017 to January 2018), including heart failure patients with LVEF of less than 35%, in sinus rhythm and a heart rate of more than 70 bpm and still symptomatic class III to IV NYHA despide an optimal medical therapy including a betablocker, an angiotensin renin system antagonist and a mineralocorticoid receptor antagonist for at least 3 months. Statistical analysis was performed using the SPSS 2.0 software. Thirty-tree patients were collected. Regarding symptoms, relief of angina was obtained in 87.9%, 72.7% of patients were brought to class II NYHA and 12.1% to class I NYHA. Also, slowing heart rate under 70 bpm was possible in 69.7% of patients. Ischemic aetiology was the most represented (69.7%). 81.8% of patients were taking the dose of 10 mg of ivabradine. Ivabradine reduces hospitalization and mortality rates in patients with heart failure and LVEF of less than 35%, in sinus rhythm and a heart rate of more than 70 bpm. [ABSTRACT FROM AUTHOR]

Echocardiography is the most performed imaging modality to evaluate heart failure patients. Right ventricular (RV) systolic dysfunction is a major prognostic factor. Evaluate the prevalence of RV systolic dysfunction in heart failure patients with reduced LVEF as well as their clinical, electrical and echocardiographic profile and prognosis. Retrospective and descriptive study collecting heart failure patients with reduced LVEF during a period of 5 months (between October 2017 and February 2018). Our population was divided into 2 groups, the group 1 has a normal RV function and the group 2 has an RV systolic dysfunction defined as TAPSE using M mode imaging of less than 15 mm and systolic velocity S' of lateral tricuspid annulus using tissue Doppler imaging of less than 9.5 cm/s. Then, were studied clinical, electrical and echocardiographic characteristics of each group. Statistical analysis was performed using SPSS 2.0 software. One hundred and four patients were collected. The group 1 is made of 83 patients (79.8%), 42.2% are diabetic, 45.8% are hypertensive, 4.8% are dyslipidemic, 33.7% are smokers, 26.5% are class I NYHA, 60.2% class II NYHA, 13.3% class III NYHA, no patient is class IV NYHA, 7.2% in atrial fibrillation, mean LVEF is of 35% and mean systolic pulmonary artery pressure is of 45 mmHg. The group 2 is made of 21 patients (20.2%), 33.3% are diabetic, 42.9% are hypertensive, 4.8% are dyslipidemic, 57.1% are smokers, 9.5% in class I NYHA, 57.1% in class II NYHA, 28.6% in class II NYHA, 4.8% in class IV NYHA, 33.3% are in atrial fibrillation, mean LVEF is of 27%, all patients are in pulmonary artery hypertension and mean systolic pulmonary artery pressure is of 45 mmHg. In heart failure with reduced LVEF, RV systolic dysfunction is a prognostic factor. Actually, RV free wall strain gives the most accurate prognostic value. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE or lupus) is a disease in which the immune system attacks healthy cells and tissues throughout the body. Lupus myocarditis is a life-threatening condition, observed clinically in 3–9 % of patients with SLE. We report the case of a patient followed for multisystem SLE, presenting with de novo heart failure with severe left ventricular dysfunction revealing lupus myocarditis. [ABSTRACT FROM AUTHOR]

Atrial myxoma is a rare and benign clinical entity. It remains common in women and mainly affects the left atrium. Its clinical picture is polymorphic. We report the case of a 53-year-old woman who consulted for dyspnea with cardiac failure's picture. The diagnosis of myxoma of the left atrium was made on echocardiography which also objectified the existence of mitral stenosis. The patient underwent surgical excision and mitral valve replacement with good postoperative outcomes. [ABSTRACT FROM AUTHOR]