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Smoking is a public health problem. Physicians have an important role in the fight against smoking, particularly by means of the brief advice they can give. The aim of this work was to study the prevalence of brief advice application by medical residents and to identify factors that may condition its practice.We conducted a descriptive and analytical study with prospective data collection that included 302 residents practicing in Tunisia who had agreed to respond to an online questionnaire submitted in February and March 2020.Residents' mean age was 28±2 years and the gender ratio was 0.65. Sixty-four percent of them were non-smokers. During their practice, 94% systematically identified their patients' smoking status, but 61.9% were unfamiliar with the concept of brief advice. Residents' brief advice application rate was 57.6%. In multivariate analysis, the factors impacting brief advice application were: gender (OR=0.321, p=0.0001), familiarity with brief counseling (OR=2.808, p=0.002) and having observed brief advice being given by a senior physician (OR=2.328, p=0.0001).The rate of brief advice application remains low. On this subject, improved theoretical and practical teaching during medical studies is essential.

Funding Acknowledgements Type of funding sources: None. Introduction Anxio-depressive disorders represent one of the psychiatric manifestations most frequently observed in hospitalized patients. Different factors can be involved in the onset or worsening of these disorders. Purpose The aim of our study was to evaluate the prevalence of of anxiety and depression in hospitalized cardiology patients and to determine their predictors. Methods This was a cross-sectional and descriptive study with a prospective data collection that included 150 patients hospitalized in the cardiology department of Habib Thameur hospital between November and December 2016. Anxiety and depression were assessed using the Hospital Anxiety Depression questionnaire validated in Arabic. Results Patients mean age was 60 ± 11.2 years with a gender ratio of 2.7. Seventy-nine percent of the patients had a school education, 85.3% were married and 46% were active workers. Cardiovascular risk factors were dominated by arterial hypertension found in 56.7% of patients, followed by diabetes in 55.3%, dyslipidemia in 54.7% and active smoking in 43.3%. The most frequent reason for hospitalization was acute coronary syndrome, which was found in 52.7% of cases. The mean length of hospital stay was 13.7 ± 9.3 days. The prevalence of anxiety symptoms and depression symptoms was 55.3% and 40%, respectively. In multivariate analysis, age over 65 and active smoking were significantly associated with anxiety symptoms (OR = 0.345, 95% CI 0.150-0.790; p = 0.012 and OR = 0.44, 95% CI, respectively 0.194-0.90; p = 0.045). Independent factors significantly associated with depression symptoms in hospitalized cardiology patients were age greater than 65 years and a hospital stay of more than 7 days (OR = 0.171, respectively, 95% CI 0.067-0.438; p = 0.0001 and OR = 0.462, 95% CI 0.08-0.466; p = 0.001). Conclusion Given the high prevalence of anxiety and depression in patients hospitalized in cardiology, the systematic identification of the factors associated with these disorders would facilitate screening and ensure their early management.

Funding Acknowledgements Type of funding sources: None. Introduction Smoking is a public health problem. Doctors have an important role in the fight against smoking, in particular through the minimum advice they can give. Purpose The aim of this work was to study the prevalence of the application of minimal advice by medical residents and to identify factors that may influence its practice. Methods We conducted a descriptive and analytical study with a prospective data collection that included 302 residents practicing in Tunisia and who agreed to respond to an online questionnaire submitted between February and March 2020. Results Residents mean age was of 28 ± 2 years and the gender ratio was 0.65. Sixty-four percent of residents were non-smokers. During their practice, 94% of residents systematically identified the patient"s smoking status and 61.9% were unfamiliar with the concept of minimal advice. The rate of application of the minimum advice by residents was 57.6%. In multivariate analysis, the factors influencing the application of minimum counseling were: gender (OR =0.321, p = 0.0001), knowledge of minimum counseling (OR = 2.808, p = 0.002) and having attended the minimum advice given by a senior (OR = 2.328, p = 0.0001). Conclusion The rate of application of the minimum advice remains low. Improving one"s theoretical and practical teaching during medical studies is essential.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac intensive care unit is an environment that induces a high rate of stress, anxiety and sleep disorders in hospitalized patients. All these elements can create an obstacle in the continuity of care and increase cardiovascular risk. Purpose The purpose of our study was to evaluate the anxiety and sleep disorders in patients admitted to the ICUU and to evaluate nurses’ behavior to these disorders. Materials and methods We conducted a descriptive, transversal, observational, prospective study in the cardiology department of Habib Thameur Hospital, which included 37 patients admitted to the ICU and 11 nurses practicing in the department. A questionnaire including two validated scales (HADS-A for anxiety and RCSQ for sleep) was submitted to patients and a self-questionnaire was administered to nurses. Results Patients mean age was 61.24 ± 13.41 years with a sex ratio of 2.36. Eight patients (22%) admitted to the ICU had anxiety disorder. In univariate analysis, female gender and mean hospital stay were significantly associated with anxiety among patients admitted to the ICU. In multivariate analysis, female gender was the only independent factor associated with anxiety at ICU hospitalization (relative risk = 3, 95% confidence interval 2.25-3.37, p = 0.005). Seventeen patients (40%) were afraid of death. The majority of patients (92%, n = 34) felt safe with the health care team. Most patients (92%, n = 34) responded to their visitors (through the window), 97% of whom were family members. Seven patients (19%) had poor sleep. The item with the lowest average was the quality of sleep (53.86 ± 15.65). In univariate analysis, urban living and the average number of sleep hours were significantly associated with poor sleep. Surveillance of vital signs, noise and monitor alarms were the main factors of sleep disturbance. Eleven nurses were included in our study. Seven nurses considered the management of anxiety as not important, and six answered that the management of sleep disorders was not important. The most used medication by nurses to relieve both symptoms was Hydroxyzine tablets. The most common non-medical way to relieve anxiety was privacy. The most common non-medication way to improve sleep was brightness reduction. Conclusion Our study shows that despite the prevalence of anxiety and sleep disorders in patients admitted to the ICU, their care by nurses was not adequate. Specific training on assessment and coping with these disorders could improve nursing care.

Funding Acknowledgements Type of funding sources: None. Background The electrocardiogram (ECG) is a tool to evaluate cardiac function. Its interpretation depends on age, sex and race. Aims to evaluate the association between body mass index (BMI) and electrocardiogram parameters in healthy adults. Methods We conducted a prospective study that included apparently healthy volunteers aged between 18 and 65 years. Body mass index was calculated and standard 12-lead ECG was recorded for all participants. Subjects were classified into four groups according to BMI: underweight ( Results One hundred seventy-four apparently healthy volunteers (99 women and 75 men; age ranged from 18 to 65 years) were included in this study. The mean BMI was 26,36 ± 6,04 kg/m² with a minimum of 14,53 and a maximum of 49,27. Twenty-two (12,6%) subjects were in the underweight range; 53 (30,5%) in the normal weight range, 54 (31%) in the overweight range and 45 (25,9%) were obese. The results of our study showed a significant positive correlation between the ECG variables studied and the BMI except for HR and Sokolow index (table 1). Conclusion We concluded that BMI caused a significant modification in several ECG parameters in healthy adults. Increased BMI leads to lengthening of conduction times and ventricular repolarization. Largest investigation on the use of BMI-specific ECG norms is warranted. Table 1 ECG parameters BMI R-value P value HR -0,041 0,590 P wave duration 0,222 0,003 PR Interval 0,200 0,008 QRS duration 0,235 0,002 QT Interval 0,152 0,045 QTcorrected (QTc) 0,150 0,049 Sokolow index 0,102 0,182 Pearson correlation coefficients of various ECG parameters with BMI in the study population (n = 174)

Funding Acknowledgements Type of funding sources: None. Background Hypertension is a major cardiovascular risk factor, responsible for significant morbidity and mortality. Despite therapeutic progress, blood pressure control remains insufficient. Purpose The aim of our study was to identify the factors associated with poor blood pressure control in the elderly. Methods This was a descriptive study with a prospective data collection including 101 hypertensive treated subjects, aged 65 years and over, followed on outpatient basis between November and December 2019 at the cardiology consultation either at the Habib Thameur hospital or at the Materi hospital. Results Median age was 73 and sex ratio 0.57. The major cardiovascular risk factor was diabetes in 60.4% of cases, followed by dyslipidaemia 48.5% and smoking 40.6%. A history of coronary syndrome was present in 36.6% of cases, followed by atrial fibrillation in 19.8% and 12.9% had a history of ischemic stroke. Thirty-three percent realized regular physical activity and 31% had a high-sodium diet. Four percent of our patients were completely dependent. Among our patients aged 80 and over, 68.2% were frail. The prevalence of poor blood pressure control was 59%. Adherence to treatment was satisfactory in 75.2% of cases. Twelve percent of patients had information about their condition and 89% knew the dosage and schedule for their medication. In multivariate analysis, the factors associated with poor blood pressure control were: non-compliance with treatment (adjusted OR = 0.19; p = 0.013), frailty (adjusted OR = 7.194; p = 0.004), the number of antihypertensive tablets (Adjusted OR = 0.382; p = 0.008), non-use of thiazide diuretics (adjusted OR = 25.903; p = 0.001) and the patient"s lack of knowledge of antihypertensive treatment (adjusted OR = 0.56; p = 0.008). Conclusion Detection of the risk of non-compliance, the use of thiazide diuretics, reducing the number of antihypertensive tablets, screening for frailty and informing the patient about his treatment are necessary to improve blood pressure control in the elderly.

Funding Acknowledgements Type of funding sources: None. Background During Ramadan, alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive subjects taking their treatment once daily. Methods The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of our Hospital. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. Results We studied 29 women and 15 men, mean age was 58.7 years. 34% of the patients were diabetics and 16% had coronaropathy. 46% of the patients were on monotherapy, 43% on dual therapy and 11% on a triple antihypertensive therapy. During Ramadan, 57% of the patients took their treatment during the dinner (group1), whereas 43% took their treatment during the Shour (group 2). Average 24hour blood pressure in the whole group was 129 ± 18/74 ± 10 mmHg before Ramadan and 129 ± 19/74 ± 10 mmHg during Ramadan (p > 0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significant higher values of 24 hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the shour (p Conclusion In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the shour is observed. Average values of BP and heart rate Group 1 Group 2 p 24 hour SBP (mmHg) 134 ± 23 122 ± 6 0.017 24 hour DBP (mmHg) 76 ± 12 70 ± 5 0.052 Awake SBP (mmHg) 138 ± 23 125 ± 6 0.012 Awake DBP (mmHg) 79 ± 12 73 ± 5 0.044 Asleep SBP (mmHg) 127 ± 26 114 ± 12 0.030 Asleep DBP (mmHg) 71 ± 13 65 ± 7 0.045 24 hour average heart rate (bpm) 71 ± 7 70 ± 6 0.524 Awake average heart rate (bpm) 76 ± 7 74 ± 7 0.322 Asleep average heart rate (bpm) 65 ± 7 65 ± 7 0.931 Average values of blood pressure and heart rate in both groups Abstract Figure. 24hour course of blood pressure

BackgroundChronic inflammatory process seems to be the underlying cause contributing to atherosclerosis in spondyloarthritis. Epicardial adipose tissue (EAT) which is the accumulation of visceral fat between the myocardium and the visceral layer of pericardium, is actually considered a novel cardiometabolic risk predictor (1). Recent studies have shown its association with the development of coronary atherosclerosis.ObjectivesThe aim of our study was to assess the epicardial fat thickness (EFT) in patients with spondyloarthritis (SpA) in comparaison with healthy subjects.MethodsWe performed a prospective study including 47 patients meeting ASAS 2009 criteria for SpA compared to 47 healthy controls matched for age, gender and body mass index (BMI). Patients with history of cardiovascular risk factors or diseases were not included. Sociodemographic, clinical, biological and radiographic features related to the disease were recorded. All subjects underwent transthoracic echocardiography with measurement of EFT.ResultsSpA group included 33 men and 14 women, with a median age of 36 years (IQR: 28-46). Median BMI was 24.5 kg/m2 (IQR: 20.7-26.8). Median systolic (SBP) and diastolic (DBP) blood pressure were respectively 121 mmHg (IQR: 110-130) and 71 mmHg (IQR: 67-78).Median disease duration was 11 years (IQR: 5-16). Median disease activity scores BASDAI and ASDAS-CRP were 2.6 (IQR: 1.8-3.8) and 2.18 (IQR: 1.62-2.91) respectively. Median CRP level was 6.45 mg/l (IQR: 1.5-19.9). Median BASFI and BASMI were 3 (IQR: 1.5-5.1) and 1.5 (IQR: 0-4) respectively. Coxitis was found in 53% of patients. SpA patients received: NSAIDs (92%), csDMARDs (51%) and TNF inhibitors (38 %).EFT was significantly increased in SpA patients compared with healthy controls; median EFT value was 3.1 mm (IQR: 2.5-4) versus 2.4 mm (IQR: 2-3) (p=0.001).ConclusionAs an early marker of atherosclerosis, EFT was significantly higher in SpA patients, supporting clinical evidence of increased cardiovascular risk in SpA. Thus, more studies that involve larger samples should be conducted, using EFT to cardiovascular risk stratification in SpA.References[1]Katsiki N, Mikhailidis DP. Epicardial fat: a novel marker of subclinical atherosclerosis in clinical practice? Anatol J Cardiol. 2017 Jan;17(1):64–5.Disclosure of InterestsNone declared

Resume Introduction Le retrecissement mitral (RM) est la cardiopathie valvulaire la plus frequemment revelee ou aggravee par la gestation. La commissurotomie mitrale percutanee (CMP) est actuellement le traitement de choix. But de l’etude Le but de l’etude etait d’evaluer les resultats a court, moyen et long terme de la commissurotomie mitrale percutanee chez des femmes enceintes presentant un retrecissement mitral serre symptomatique. Patients et methodes Il s’agit d’une etude retrospective incluant 12 patientes enceintes porteuses de retrecissement mitral serre, hospitalisees dans le service de cardiologie de l’hopital Habib Thameur entre 1994 et 2014 et ayant beneficie d’une commissurotomie mitrale percutanee par ballon d’Inoue avec un suivi de plus de 15 ans. Resultats L’âge moyen des patientes etait de 31,5 ± 4,4 ans. Toutes nos patientes etaient symptomatiques et une insuffisance mitrale moderee etait notee dans quatre cas. Immediatement apres la procedure, une amelioration fonctionnelle etait constatee dans tous les cas et la surface mitrale est passee de 1,02 ± 0,5 cm2 a 2 ± 0,35 cm2. L’insuffisance mitrale etait aggravee dans trois cas et nouvellement creee dans deux cas. Toutes les patientes ont accouche a terme. Les nouveau-nes etaient tous en bonne sante apparente et seulement deux d’entre eux etaient hypotrophes. Avec un recul moyen de 95,58 ± 64,1 mois, cinq patientes ont presente une restenose mitrale dont deux ont eu un remplacement valvulaire et trois ont beneficie de redilatation percutanee. Conclusion L’efficacite de la commissurotomie mitrale percutanee est clairement documentee par l’evaluation clinique et echocardiographique. Dans le cas particulier de la grossesse, le but n’est pas tant d’obtenir un resultat optimal que d’entrainer une amelioration hemodynamique autorisant la poursuite de la grossesse et l’accouchement.

Introduction Epicardial adipose tissue (EAT) is a small but biologically active ectopic fat depot that surrounds the heart. Given its rapid metabolism, secretory profile, and simple measurability, epicardial fat has drawn attention among researchers. It has been suggested that an increased thickness and volume of EAT is associated with increase risk of cardiovascular disease. Objective To quantify the relation between cardiovascular risk factors and epicardial adipose tissue measured by echocardiography in patients undergoing invasive coronary angiography for suspected coronaropaphy. Method Sixty patients (64.5 ± 10.9 years, 58% men) undergoing invasive coronary angiography for suspected coronaropathy were enrolled prospectively, in the period between January 2020 and October 2020. Transthoracic echocardiography was performed. EAT thickness was measured perpendicular to the right ventricular free wall at end-diastole. Cradiovascular risk was estimated based on the levels of cardiovascular risk suggested in the guidelines of dyslipidemia published in 2019 by the European Society Of Cardiology. Association of EAT with cardiovascular risk factors and cardiovascular risk levels were studied. Results Overall average thickness was 9.2 ± 2.2 mm (range 4.4–15.1). The bivariate analysis showed positive associations of the EAT with age, blood pressure, smoking, glycemia, insulin dose, and triglyceride (P 5 mm, had higher cardiovascular risk (P = 0.02), and higher prevalence of obstructive coronary artery disease (P = 0.004). Conclusion Increased EAT thickness is associated with cardiovascular risks factors and coronary artery disease.

Introduction Peu de travaux ont porte sur l’impact de l’IMC sur les parametres de la repolarisation ventriculaire en dehors de l’obesite. But Etudier l’impact de l’IMC sur les parametres de la repolarisation ventriculaire chez l’adulte en bonne sante apparente. Methodes Il s’agissait d’une etude prospective sur 173 volontaires, en bonne sante apparente et âges entre 18 et 65 ans. Les sujets ont ete repartis en quatre groupes selon la classe d’IMC. Resultats L’âge moyen etait de 36,8 ± 12,7 ans [18–65]. Il s’agissait de 75 hommes (43,1 %) et 99 femmes (56,9 %) soit un sex-ratio de 0,75. L’âge moyen des hommes etait de 32,8 ± 10,4 ans et celui des femmes etait de 39,9 ± 12,7 ans. Nous avons reparti notre population en quatre groupes en fonction de la classe d’IMC : 22 personnes (12,6 %) maigres ; 53 personnes (30,5 %) de poids normal ; 54 personnes (31 %) en surpoids et 45 personnes (25,9 %) obeses. Quatre-vingt-dix-neuf sujets (56,9 %) avaient un IMC ≥ 25 kg/m2. Une obesite abdominale a ete observee chez 56 sujets (32,2 %) dont 71,43 % etaient de sexe feminin. Nous avons trouve une correlation positive statistiquement significative entre les intervalles QT et QTc d’une part et l’IMC d’autre part (r = 0,452, p Conclusion L’allongement de l’espace QT est-il un facteur de risque d’arythmies et de mort subite chez l’obese en bonne sante ? Les patients obeses presentant un allongement de l’espace QT meritent-ils une exploration cardiaque plus poussee ?

Introduction Le taux des complications precoces liees a l’implantation d’un pacemaker ou d’un defibrillateur est non negligeable. Il est important de connaitre les facteurs de risque. But Etudier les facteurs predictifs de complications precoces liees a l’implantation d’un pacemaker ou defibrillateur. Methodes Il s’agit d’une etude transversale de la cohorte des patients appareilles entre janvier 2011 et janvier 2018 au service de cardiologie de l’hopital Habib Thameur de Tunis. Resultats Nous avons inclus 441 patients. L’âge moyen etait de 66,5 ± 11,1 ans, 53,5 % des patients etaient de sexe masculin et 54 % des patients etaient diabetiques. Il s’agissait d’un diabete de type 2 dans tous les cas. Les taux de mortalite et de morbidite precoces etaient respectivement de 0,22 % (n = 1) et de 7,48 % (n = 33). Les complications etaient a type de pneumothorax dans 18 cas (4,08 %), d’infection de la loge dans 5 cas (1,13 %), d’hematome dans 3 cas (0,68 %) et de deplacement de sonde dans 3 cas (0,68 %), de perforation cardiaque dans 2 cas (0,45 %) et de complications thromboemboliques dans 2 cas (0,45 %). En analyse multivariee, le diabete etait le facteur predictif independant le puissant de survenue de complication infectieuse (OR = 2,23 [IC : 1,04–4,77], p = 0,038). Conclusion Le diabete est le facteur de risque le plus important de complication infectieuse post-implantation. La prevention repose avant tout sur une asepsie rigoureuse.

Introduction L’interpretation de l’electrocardiogramme (ECG) depend de l’âge, du genre, de l’origine ethnique et du niveau de l’activite physique. Il a ete demontre que le poids et la taille peuvent influencer les variables electrocardiographiques. But Etudier l’impact de l’IMC sur la duree de l’onde P chez l’adulte en bonne sante apparente. Materiels Il s’agissait d’une etude prospective sur 173 volontaires en bonne sante apparente âges entre 18 et 65 ans repartis en quatre groupes selon la classe d’IMC. Resultats L’âge moyen etait de 36,8 ± 12,7 ans [18–65]. Il s’agissait de 75 hommes (43,1 %) et 99 femmes (56,9 %). L’IMC moyen etait de 26,32 ± 5,88 kg/m2 [14,52 kg/m2 41,25 kg/m2]. Les sujets ont ete repartis en quatre classes d’IMC : 22 personnes (12,6 %) maigres ; 53 personnes (30,5 %) de poids normal ; 54 personnes (31 %) en surpoids et 45 personnes (25,9 %) obeses. Nous avons trouve une correlation positive statistiquement significative entre la duree de l’onde P et l’IMC (R = 0,194 ; p = 0,010). Cet allongement de l’onde P etait independant de l’âge, du genre et de la pression arterielle. Une difference statistiquement significative a ete observee entre le groupe obese et les autres groupes d’IMC (p Conclusion L’obesite modifie le myocarde atrial gauche. L’alteration des proprietes electrophysiologiques des cardiomyocytes qui en resulte entraine une heterogeneite de l’activation atriale et allonge la depolarisation atriale.

Background Around 25 million people around the world are suffering from heart failure (HF), and each year 2 million new cases of HF are diagnosed. Despite the therapeutic improvement in the treatment of HF, its incidence and prevalence is still increasing. Evidence from the literature showed that gender discrepancies in HF management may exist. The aim of our study was to compare the management of HF between the genders. Patients and methods NATURE HF is a prospective registry including 2040 patients diagnosed with HF from October 2017 to January 2019. Management of HF was compared between genders at one-year follow-up. Results 2040 patients were included: 70.9% male patients and 29.1% female patients. Women were older than men (mean age 65.69 ± 12 vs. 62.6 ± 12; P Conclusion Gender differences were detected in clinical presentation and management of HF. Female patients with HF were undertreated by Beta-blockers, Digoxin and Furosemid.

Background Patients with heart failure and renal impairment have poor outcomes and variable quality of care. Aims The present study aimed to evaluate whether chronic kidney disease (CKD) could have adverse effects on mortality, morbidity rates and optimal treatment prescription in patients with a diagnosis of heart failure. Methods This is an ancillary analysis of the prospective NATURE HF registry (NAtional TUnisian REgistry of Heart Failure). Between October 2017 and January 2018, we prospectively registered information of patients with heart failure and followed them for one year. Results We registered information of 2040 patients with heart failure. Prevalence of CKD (eGFR There were 19.9% patients in Stage 3a/b (cl 59–30 mL/min) and 3.6% in Stage 4/5 (cl CKD patients’ have more re-hospitalizations and mortality rates compared to those without CKD, respectively 12% vs. 5,8% (P = 0,001) and 16% vs. 12% (P = 0,003). The prescription of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was more important in CKD patients’ (72% vs. 67,5%, P There was no difference in ICD implantation rates between the two groups. Conclusions Patients with heart failure and chronic renal impairment had poor outcomes but received recommended therapy as patients without CKD. This study highlights the need for multidisciplinary approach and better evidence for treatment, to improve morbidity and mortality.

Background Mitral valve resistance (MVR) is a hemodynamic consequence of mitral stenosis but it has no clear threshold and it has a shortage of data to be reliable. Purpose is to investigate match and mismatch between opening area and resistance especially in patients with moderate and mild mitral stenosis. Materials This cross section case control study comprised 88 patients with moderate and mild rheumatic mitral stenosis. Transthorathic echocardiographic study estimated: mitral valve area (MVA) both by planimerty (2D) and pressure half time (PHT), mitral valve score (MVS), mean transmitral pressure gradient (MPG), diastolic filling time(DFT), left ventricular out flow tract diameter (LVOTd) and velocity time integral (LVOT vti) , the MVR was calculated as: MPG/aortic flow ratio [(LVOTd) (LVOTvti)/ DFT] in dynes.sec.cm5, NYHA function class of all patients was estimated. We classified our patients into 2 groups, group 1 (51 patients) with matched MVR and group 2 (37 patients) with unmatched MVR (unexpected high MVR in relation to valve area). Methods Patients with moderate mitral stenosis have MVR less than 105 dynes.sec/cm5, while patient with mild mitral stenosis have MVR less than 76 dynes.sec/cm5 this is in the matched group, but there are patients with unmatched higher MVR. Group 2 compared to group 1; had higher NYHA function class (1.4±0.6 vs. 1.2±0.4, P < 0.05), MVS (8.1±1.8 vs 7±0.9, P < 0.05), MPG (11,3±3.7 vs.7.8±2.5 mmHg, P < 0.01) and higher MVR (122.37±29.87 vs. 67.18±20.12 dynes.sec/cm5 , P < 0.01), MVR showed positive correlation with MVS (r=0.5, P < 0.05), Step wise logistic regression analysis showed that MVS is the only independent predictor of the MVR severity in the mismatched (unexpected high) group , so the higher the MVS the higher the expected MVR whatever the MVA is ; (B±SE=6.997±2.826, t=2.476, 95% CI 1.241±12.752 with an odds ratio=0.412, P < 0.05). Conclusion It would make much more sense to investigate match and mismatch between opening area and resistance in rheumatic mitral stenosis, the only independent predictor of mismatch is the mitral valve score.

Human hydatidosis occurs mainly as a result of infection with the larvae of Echinococcus granulosus. Cardiac echinococcosis is an uncommon disease and the interventricular septum is rarely involved. This article is a review of all of the literature related to hydatid cyst in the interventricular septum included in the PubMed database. Forty-five cases reported between 1964 and 2019 were identified. Keywords: Echinococcosis, Cardiac hydatid cyst, Interventricular septum

Introduction Anxiety has been shown to lead to high levels of stress and increased length of stay within the hospital. The cardiac catheter laboratory is an unfamiliar environment for most people. It has been demonstrated that a psychoeducational nursing intervention can reduce anxiety. Objective The aim of the study was to evaluate the anxiety of the patients who enter the cathlab. Method The study prospectively recruited patients waiting for a coronary angiogram in February 2021, in the cardiology department of Habib Thameur Hospital. Patients responded to an anxiety assessment survey (STAI: State and Trait Anxiety Index). Results We included 100 patients (30 women and 70 men), mean age was 61 ± 9 year. Cardiovascular risk factors were dominated by high blood pressure (65%) and diabetes (54%). The coronary angiography was carried out as part of the exploration of an acute coronary syndrome in 68.8% of cases with an average waiting time of 3 days in the hospital. Among the patients, 30% had high to very high anxiety levels according to the STAI. They were worried about complications and pain. Only fifty-two percent of patients reported receiving pre-intervention information and 65% said they signed consent without reading it. Sixty-seven percent of the patients were satisfied with the staff care. Conclusion Our results showed a high prevalence of anxiety before a cardiac catheterization exam. This suggests the need to take into consideration the patients worries in order to reduce their anxiety through education.

Background The EU-CaRE study is a prospective study comparing cardiac rehabilitation (CR) in 7 European countries including consecutive elderly patients (> 65 years) with coronary disease and/or cardiac surgery. Aim To evaluate the results on exercise capacity at one year follow up of different CR programmes. Methods We compared results of the French (Paris) CR program with Denmark (Copenhagen), Germany (Ludwigshafen), Italy (Parma), Netherlands (Zwolle, Nijmegen), Spain (Santiago), Switzerland (Bern). These programs differ by referral delay, number of sessions and the program duration. Results A total of 1633 patients were included, 219 for France. French patients were males (79%), aged by 73.2 ± 5.5 years, similarly to other countries. We included more CABG/valve replacement (67%) like Italy (61%) than non-surgical patients (33% in Paris vs. 50% in Netherlands, 62% in Denmark, 71% in Germany, 83% in Switzerland and 97% in Spain). In France, patients were referred early (15 days;11–23), enrolled in a short program (14 ± 3 sessions during 38 ± 15 days) compared to others. Results on gain of exercise capacity were obtained faster, without affecting the long-term (1 year) results ( Table 1 ). Conclusion Cardiac rehabilitation delay after index event, number of sessions and duration do not seem to impact long-term exercise capacity in coronary patients. We can presume that long-term results might be more due to the adherence/compliance and the educational measures during the CR program which have sustainable effects.

Introduction Every year, millions of Muslims all over the world practice religious fasting, from sunrise to sunset, during Ramadan. Very few data is available about Ramadan fasting and coronary disease. Purpose The aim of our study was to establish prevalence and particularities of patients admitted for an acute coronary syndrome (ACS) before, during and after Ramadan. Methods Data was collected in a descriptive and prospective cohort study within the Cardiology department of Habib Thamer Hospital. The study included all patients admitted for ACS during April, May and June of 2019 (Ramadan, one month earlier and one month later). We collected all relevant epidemiological, clinical and biological data. Results Our study included 111 patients. Prevalence of ACS during each month was comparable: 19.7% (n = 43) before, 18.8% (n = 37) during, and 19% (n = 31) after Ramadan. The epidemiological profile of patients, the prevalence of cardiovascular risk factors and their medical histories were also similar. Patient's daily lifestyle changed during the month of Ramadan. Significant decrease in smoking was noted [20 ± 7.6 cigarettes per day vs. 10 cigarettes per day (P = 0.001)]. Sleep hours were fewer [7.86 ± 1.62 hours per day vs. 6.46 ± 1.53 hours per day (P = 0.001)]. There were significantly fewer meals [3.05 ± 0.3 vs. 2.46 ± 0.5 meals per day (P = 0.001)]. Furthermore, significant metabolic changes occurring in Ramadan were revealed. HDL cholesterol decreased [73% vs. 28%(P = 0.000)]. Total blood cholesterol was higher [43% vs. 14% (P = 0.003)], and fasting blood sugar was also higher [43% vs. 18% (P = 0,016)]. After Ramadan, prevalence of ACS decreased significantly for women: 13% (n = 4) after Ramadan vs. 32% (n = 12) during Ramadan (P = 0.001). Conclusion There was no increase in ACS occurrence during Ramadan. Changes occurred mainly on metabolical level, affecting sugar and fat metabolism.

Background Improvement in autonomic responses is part of the benefits from the cardiac rehabilitation (CR). Acute effects during exercise on cardiac autonomy nervous activity in cardiac patients and their evolution after an exercise training program are not known. The aim of our study was to assess the evolution and the relation between parameters of cardiopulmonary exercise test (CPET) and markers of heart rate variability (HRV). Methods Prospective cohort study (French cohort from EU-CaRE study) of elderly patients with ischemic or valvular disease enrolled in CR. Only patients in sinus rhythm are included. The analysis of HRV include heart rate, SDNN and HF/LF ratio using a first 24-hours Holter-ECG performed at inclusion on the CR program including the CPET time and a second short Holter ECG (during CPET) at the end of CR. Results One hundred and eighteen patients (72.7 years, 79% male) who complete the CR program and had full data available were included. We define two groups: 74 patients after cardiac surgery (CABG, valve replacement), 44 patients in post-acute coronary syndrome (ACS). We found no correlation between the baseline 24-hours HRV parameters and the gain of peak VO2 for the whole population, but an r = 0.45 (P Table 1 ). Correlations between SDNN and HRR were found statistically significant (P Conclusion Exercise training improves HRV in elderly cardiac patients. Cardiac autonomic function recovery seems more pronounced after cardiac surgery than after an acute coronary syndrome.

Background The benefits of exercise based cardiac rehabilitation (CR) have been documented in elderly patients. The EUCaRE project included elderly patients (> 65 years) in 7 European countries, however in France, patient > 75 years were considered as elderly. Aim To compare the results of CR in patients aged ≤ or > 75 years old. Methods The prospective French cohort study from EU-CaRE study included 220 consecutive elderly patients (65+ years old) with coronary artery disease and/or heart valve replacement undergoing CR. All patients underwent cardiopulmonary exercise test (CPET) at baseline, at the end of CR and after 1 year of follow up. Results Of 217 patients with complete data, 71 were older than 75 years (32.72 %). Demographic characteristics, cardiac risk factors and comorbidities were similar between the 2 groups except for age, and the mean BMI that was lower in the > 75 years group. Rate of residential vs. ambulatory and the mean time from index event to start CR were comparable between older and ≤ 75 years (73.3 % vs. 67.6 % ; P = 0.385 and 18.8 ± 13 I vs. 20.9 ± 16 days ; P = 0.689, respectively). CPET results are displayed in the Table 1 . We found that the gain of exercise capacity after CR is similar between the two groups (P = ns), with a same sustainability at one year. Conclusion Patients older than 75 years improved functional capacity after CR similarly to youngers and should not be excluded if they are able to perform an exercise training program.

Introduction During Ramadan, repeated cycles of fasting and feeding might contribute to changes in blood pressure and heart rate among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are scarce, and have provided inconclusive results. Objective The aim of this study was to examine the effect of fasting on ambulatory blood pressure and heart rate in treated hypertensive subjects. Method The study prospectively recruited 40 hypertensive patients between April and June 2019, and followed up at the cardiology department of Habib Thameur Hospital of Tunis. A 24 hour pressure monitoring was carried out during three periods: prior to Ramadan, during Ramadan, and one month after. SPSS version 20 was used to perform the statistical analysis. The paired Student's t-test was used to compare data within the 3 periods. Results We studied 40 hypertensive subjects (65% women, 35% men), mean age was 57 ± 11years. Patients in the study group were using ACE inhibitors (15%), AT2 receptor blockers (17.5%), calcium channel blockers(17.5%), b-blockers(2.5%) and a combination treatment (47.5%). Average 24 h ambulatory blood pressure in the whole group was 129 ± 15/75 ± 8 mmHg before Ramadan, 127 ± 17/74 ± 8 mmHg during Ramadan and 126 ± 13/74 ± 7 in the following month (P > 0.05). Daytime and night time mean values of systolic and diastolic blood pressure were not different between the three periods. This study showed a significant improvement in the heart rate during the second period in comparison with the first one (P = 0.03). Conclusion In this study, there were no significant changes in systolic and diastolic blood pressures during the 3 periods. There was a significant improvement in the heart rate during the ten last days of Ramadan, in comparison with the pre-Ramadan period. This suggest that fasting during the month of Ramadan, using the same medication might be non-threatening for patients with hypertension.

Introduction La nephropathie induite par les produits de contraste iodes est une complication grave mais rare. Les mesures de prevention bases sur une hydratation optimale sont controversees. Description Le but de notre etude est de comparer l’efficacite de l’hydratation par solution de chlorure de sodium par rapport a l’hydratation par bicarbonate de sodium (NaHCO3) dans la prevention de la nephropathie au produit de contraste iode. Methodes Nous avons recrute prospectivement 158 patients avec un debit de filtration glomerulaire (DFG) Resultats Aucune difference n’a ete notee concernant les proprietes demographiques et les facteurs de risque de nephropathie entre les groupes. La nephropathie induite par le produit de contraste a ete notee, respectivement, chez 5 (3,2 %) et 10 (6,3 %) patients des groupes NaHCO3 et NaCl, ce qui n’etait pas statistiquement significatif (p = 0,19 ; taux d’incidence 1,11 ; IC95 % : 0,37–3,30). Conclusion L’hydratation par le bicarbonate de sodium ne confere pas de meilleure protection par rapport au chlorure de sodium concernant la prevention de la nephropathie induite par le produit de contraste.

Introduction The aim of this study was to document clinical practice in Tunisia regarding the use of electronic cardiac devices in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). Methods This is an ancillary analysis of the prospective NATURE HF registry (National TUnisian REgistry of Heart Failure). Between October 2017 and January 2019, we prospectively registered information of patients with heart failure and they were followed for one year. We analyzed data of patients with a diagnosis of HF, LVEF Results A total of 2040 patients were included in the registry. Fifty-six of them received a CRT pacemaker (CRT-P; 40 patients) or CRT defibrillator (CRT-D; 16 patients). Mean age was 62 years and the most frequent causes of HF were ischemic. Overall mortality at one year was 16.1%. The hospitalization rate was 19.6%, significantly higher in patients with CRT-D than with CRT- P (12.5% vs. 37,5%, P = 0.03). The mortality rate was 16.1%, without any statistically significant difference in patients with CRT-P or CRT-D (12.5% vs. 25%, P = 0.25) ( Fig. 1 ). Conclusion The NATURE HF registry shows that the use of cardiac resynchronization therapy in HF with reduced LVEF in Tunisia is in accordance with international recommendations but with lower rates which could be explained by the low income of the population.

Background Atrial fibrillation (AF) and heart failure (HF) often coexist aggravating prognosis and constituting a major public health problem. The prevalence of AF especially in patients with chronic HF remains poorly understood in our country. Aim To assess the prevalence of AF in patients with HF recruited from the prospective NATURE-HF registry (NAtional TUnisian REgistry of Heart Failure).and to determine the clinical profile as well as the evolutionary modalities of this group. Materials and methods Between October and November 2017, we prospectively registered 2040 patients with a history of HF. Patients with AF were picked. Clinical features, etiological characteristics, management as well as outcome were recorded within one year of follow-up. Results Among 2040 patients with HF, 337 patients with a mean age of 65 ± 13 years old presented with AF (16.5%). The frequency of cardiovascular risk factors associated with AF was: hypertension, diabetes, dyslipidemia and tobacco in respectively 42.9%, 29.8%, 20.8% and 19.7% of patients. The causes of underlying heart disease of HF associated with AF were: coronary artery diseases (30.4%), heart valve diseases (30.1%), primitive heart disease (24.7%); rythmic cardiopathy (12.8%) and hypertensive (1.2%). Over a follow-up of 12 months, there was no significant difference in terms of hospitalisation between HF patients with or without associated AF (6.3% vs. 7.5%, P = 0.4). However, the presence of AF was associated with a worse prognosis in terms of mortality (17.9% in patients with AF compared to 12% in patients without AF, P = 0.004) despite comparable clinical features to baseline with patients without AF. Conclusion NATURE HF showed that AF frequently appears in patients with HF and it occurs at an average age lower than that found in the literature. Otherwise, the results of NATURE HF emphasize that AF seems to worsen the prognosis in patients followed for HF.

Background Contemporary data on the epidemiology of heart failure (HF) in Tunisia are scarce. Purpose The Nature-HF Registry was designed to investigate clinical characteristics, management, and outcomes of patients hospitalized for HF in Tunisia. Methods Data were collected prospectively on patients with a primary discharge diagnosis of HF who were enrolled from 19 participating hospitals from OCTOBER 2017 to January 2019. Results A total of 2040 patients were enrolled. The mean age was 63.6 ± 12.6 years, 70.9% were male, and 7.7% had preserved ejection fraction. Common comorbidities included hypertension (42.1%), coronary artery disease (46.2%), and atrial fibrillation (19.5%). The overall use of diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), and β-blockers at admission was 55%, 67.8%, and 65.1%, respectively, which was lower than in other registries. For patients discharged alive, ACEI/ARB, β-blocker, and mineralocorticoid receptor antagonist use in patients with reduced ejection fraction was 35.0%, 37.2%, and 21.5%, respectively; device use was much lower. The median length of hospital stay was 6 days (range 2 days-55 days) days, and in-hospital mortality at inclusion was 0.25%. Predictors of mortality included age, diuretics use, low use of ACE or ARB, QRS length > 120 ms and rehospitzalisation. Conclusions Several important findings in patient profile and treatment patterns among Tunisian patients with HF were noted. We identified key areas for improving hospital-based HF medical care in Tunisia. These data also underscore the need for specific regional characterization of HF.

Background The 2D-speckle tracking is a new echocardiographic tool to have an objective and angle-independent quantification of myocardial deformation. Recent developments were performed for the quantification of longitudinal dynamic right ventricular deformation. We aimed to evaluate the role of two-dimensional (2D) strain imaging in the assessment of subclinical RV dysfunction. Methods Fifty patients with rheumatic mitral stenosis (MS group) and 20 control healthy patients were recruited and had had standard echocardiography and Doppler echocardiography. The right ventricular functions were determined by conventional methods and two-dimensional (2D) longitudinal strain. Results There were no significant differences in age, sex, Body mass index and Left ventricular ejection fraction. Mitral valve area in MS group (1.38 ± 0.5 cm vs. 3 ± 0 cm), left atrial surface (31.68 ± 8.5 cm2 vs. 13.5 ± 1.4 cm2), and Pulmonary systolic arterial pression (44.64 ± 12.4 mmHg vs. 22.7 ± 2.7 mmHg) were higher in MS group. Conventional echocardiographic modalities of RV function were analysed: Peak systolic velocity at the lateral tricuspid annulus (S’: 12.24 ± 2.8 cm/s vs. 18.6 ± 1 cm/s) and tricuspid annular systolic excursion (TAPSE) were lower in MS group (18.7 ± 4.07 vs. 26.7 ± 0.7). Two-dimensional longitudinal strain was significantly decreased in MS group (−14.1 ± 4.2 vs. −19.3 ± 1.6) and was correlated to mitral valve area (P = 0.03). There was a correlation between conventional methods (S’ and TAPSE) and RV-strain (RV-strain- S’: P = 0.001; RV strain-TAPSE: P = 0.01). Conclusion We demonstrated that patients with MS had lower RV functions using 2D strain imaging. 2D strain imaging appears to be useful in the detection of subclinical RV dysfunction in patients with MS.

Systemic sclerosis is a multisystem disorder characterized by tissue fibrosis and organ damage. Heart involvement is one of the main factors shortening survival, which may be underestimated by conventional echocardiography measurements. Two-dimensional speckle-tracking echocardiography is a powerful novel modality to assess subclinical myocardial dysfunction.The aim of this study is to investigate heart involvement in systemic sclerosis patients, and to determine the usefulness of ventricular longitudinal deformation using the Two-dimensional speckle tracking technology for an early detection of ventricular dysfunction.Between May 2016 and September 2016, 25 patients with systemic sclerosis and 25 healthy subjects underwent echocardiography to assess heart abnormalities and the strain of the two ventricles using two dimensions' speckle tracking echography.The two groups were comparable in age and gender. Despite comparable left ventricle systolic function (left ventricular ejection fraction patients 64.58±8.87 vs. in healthy 68.2±7.41, P=0.19), patients presented altered longitudinal peak systolic strain values (global longitudinal strain: patients -17.42±1.62 vs. healthy -19.24±8.85, P0.0001). Despite comparable pulmonary artery systolic pressure, there was a significant alteration in right ventricular systolic and diastolic function assessed by standard measurement. Longitudinal peak systolic strain of the right ventricle was significantly lower in patients compared with controls (P0.01).Ventricular deformation analysis by two dimensions' speckle tracking echocardiography appears to be a sensitive method to detect early ventricular impairment in patients with systemic sclerosis.

Resume Plusieurs travaux ont montre une mortalite paradoxalement plus faible chez les fumeurs ayant beneficie d’une thrombolyse a la phase aigue de l’infarctus du myocarde (IDM) comparativement aux non-fumeurs. Ce « paradoxe des fumeurs » a ete par ailleurs peu etudie en cas d’angioplastie primaire. But du travail Etudier l’impact du tabagisme sur la mortalite a 30 jours des patients admis pour un IDM selon la strategie de reperfusion. Patients et methodes Etude realisee a partir du registre des IDM avec sus-decalage ST incluant 688 patients ayant beneficie, soit d’une thrombolyse hospitaliere ou prehospitaliere (n = 397) ou d’une angioplastie primaire (n = 291). Parmi ces patients, 482 (70,1 %) etaient des fumeurs actifs. Resultats Dans le groupe thrombolyse, la prevalence de l’hypertension arterielle, du diabete et des IDM anterieurs etait significativement plus faible chez les patients tabagiques. Dans le groupe angioplastie primaire, le diabete et l’hypertension arterielle etaient moins frequents. La mortalite a j30 des patients tabagiques etait significativement plus faible chez les fumeurs en cas de thrombolyse comparativement aux non-fumeurs (5,3 vs 13 % ; p = 0,008). En analyse multivariee, l’etat de choc (p

Mitral stenosis (MS) is the most common valvular heart disease revealed or exacerbated by pregnancy. Percutaneous mitral balloon commissurotomy (PMC) is currently the treatment of choice when mitral valve morphology is favorable.The purpose of this study is to evaluate the immediate, medium and long term results of percutaneous mitral balloon commissurotomy in pregnant women with a severe symptomatic mitral stenosis despite medical treatment.It is a retrospective study including 12 pregnant patients diagnosed with severe mitral stenosis and hospitalized in the cardiology department of Habib Thameur hospital between 1994 and 2014. A clinical and ultrasonographic monitoring was performed for over 15 years.Mean patients age was 31.5±4.4 years. All patients were in NYHA class III or IV despite medical treatment. Mitral regurgitation was rated as moderate in four cases. Functional improvement was observed in all cases immediately after the procedure. Mitral valve area increased from 1.02±0.5cmThe effectiveness of the percutaneous mitral balloon commissurotomy is clearly documented by clinical and echocardiographic evaluation. In the case of pregnancy, the goal is not so much to obtain an optimal result but to cause hemodynamic improvement authorizing the continuation of pregnancy and childbirth.

Introduction Echocardiographic measurement of mitral valve area (MVA) in the mitral stenosis (MS) is done by several methods including the proximal isovelocity surface area (PISA). The aim of our study is to verify the validity of a simplified formula (simplified PISA) based on a fixed value of angle alpha by comparing in a group of patients with rheumatic MS the reliability of the simplified PISA method versus the two-dimensional planimetry, to determine the effect of the presence of atrial fibrillation (AF), a mitral regurgitation (MR) >2, an aortic insufficiency (AI) >2, the valvular redesign and the degree of MS on the accuracy of the simplified PISA method. Material and methods This is a prospective study of 110 patients (78 females and 32 males) having rheumatic MS with a mean age of 47 years [22; 89]. 65 of them (59%) were in sinus rhythm, 25 patients (23%) had an MR >2, four patients (1.8%) had an AI >2, seventy patients (63.6%) had a Wilkins score >8 and 35 patients (32%) had non severe MS (SM >1.5cm2). The MVA was measured by planimetry then by PISA in all patients. The simplified PISA was calculated based on an angle alpha=100° in all our patients. Results There is no statistically significant difference (p 2 (r=0,833; p 8 (r=0.86; p 2 because of the reduced number of patients. The correlation between the simplified PISA and planimetry is rather bad in the case of non severe MS (r=0.22). We found a good correlation between the MVA measured by simplified PISA compared to the PISA with corrected angle (r=0.86; p =0.04). Conclusion The simplified PISA provides a reliable measurement of the MVA during the MS whatever the anatomic and clinical conditions of MS. T

Introduction L’opacification vasculaire par produit de contraste iode (PCI) constitue en cardiologie l’unique alternative diagnostique et therapeutique dans la plupart des cas. Le risque de nephrotoxicite post-injection de PCI (NPCI) est particulierement accru chez les patients tares. De ce fait, l’evaluation, la preparation et le suivi des malades doivent etre codifies et appliques de facon systematique. Patients et methodes Il s’agit d’une etude prospective ayant porte sur 28 malades hospitalises au service de cardiologie de l’hopital Habib Thameur de Tunis durant les mois de janvier et fevrier 2016, ayant beneficie d’une coronarographie et/ou une angioplastie, en urgence ou a froid. Tous les malades ont ete hydrates par 1000 mL de serum physiologique avant l’opacification. Les PCI utilises etaient iso-osmolaires. Une alteration de la fonction renale a ete definie par une elevation de la creatinine allant de 10 a 26 μmol/L. Une NPCI etait definie par une ascension de la creatinemie depassant 26,5 μmol/L. Resultats Notre population incluait 19 hommes et 9 femmes (sex-ratio H/F 2,1) avec une moyenne d’âge de 66,3 ans. Treize patients etaient hypertendus (46,4 %) et 17 etaient diabetiques (60,7 %). La creatinine initiale avait une valeur moyenne de 87,2 μmol/L avec un debit de filtration glomerulaire estime (DFGe) moyen de 81,5 mL/min. Ce dernier etait inferieur a 60 mL/min dans 5 cas (17,8 %). Le score de Mehran etait de 3,3 en moyenne [0–11]. Une alteration de la fonction renale a ete rapportee chez 9 patients (32,1 %) dont 8 avaient un score inferieur a 5 et 6 etaient diabetiques. Un seul patient avait recu un volume de PCI superieur au volume theorique calcule. Trois malades ont developpe une NPCI (10,7 %). Le score de Mehran etait inferieur a 5 chez 2 malades sur 3. Aucun patient n’a necessite une epuration extra-renale. Discussion Les modeles pronostiques ne sont pas toujours en concordance avec l’evolution du malade. Un echantillon de patients plus important ameliorerait l’interpretabilite des donnees. Conclusion La NPCI constitue de plus en plus une cause frequente d’insuffisance renale aigue en raison de l’augmentation des procedures de cardiologie interventionnelle surtout dans un contexte d’urgence.

Atrial fibrillation is a common entity and can be associated with thromboembolic complications as many as 18% of patients per year. A coronary thromboembolus with subsequent myocardial infarction, however, is rare. Methods and results We conducted a retrospective descriptive study of 12 patients hospitalized for myocardial infarction with angiographically normal coronary arteries and atrial fibrillation. This study aims to investigate the epidemiological, clinical, and prognostic factors. We conclude that the prevalence of these ACS was 0.56%. The average age was 57 years with a female predominance. Family history of early coronaropathy was the most frequently risk factor (33%), followed by Smoking (16%), dyslipidemia (16%), obesity (16%) and hypertension (8%). Diabetes was not found in any patient. These patients had an ST elevation myocardial infarction (STEMI) in 16% of cases vs 84% without ST elevation MI. The lateral location was the most prevalent in 41% of cases. The mean peak of troponin was 8.6ng/ml. The left ventricular dysfunction was detected in 5 cases. The echocardiography showed a case of mitral valve prosthesis dysfunction, a case of hypertrophic cardiomyopathy. Aortic and mitral valvulopathy was detected in 5 cases and an excellent hemodynamic profile was found in two cases. The trans esophageal echocardiography showed 5 cases of left intra auricular thrombus. The coronarography was normal in all patients. They received the basic treatment of acute coronary syndrom. Atrial fibrillation wasn’t tolerate in one case requiring pharmacologic cardioversion with good evolution. Hyperthyroidism was detected in two patients and required antithyroid therapy. Conclusion Coronary artery thromboembolism as a nonatherosclerotic cause of acute coronary syndrom is a rare finding with unknown prevalence. The cardiologist should be aware of possible coronary artery embolism when the angiographic images are typical together with important thromboembolic risk factors.

Background Ramadan fasting is one of the five fundamental rituals of Islam. Heart rate variability (HRV) is an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure. The effects of fasting on the HRV are not known. Aim: To study the effects of Ramadan fasting on HRV in hypertensive patients. Methods Our study is a prospective study that includes a total of 20 hypertensive patients, with sinus rhythm and without coronary artery disease, between July and October 2014. HRV was determined twice by ambulatory 24-hour Holter recordings at fasting in the middle of Ramadan and two months after Ramadan. Informed consent was obtained from each study subject prior to participation in study. Mean values of continuous variables were compared by using the Student t-test. Results The mean age of patients was 55,2 ± 4,4 years with 8 women and 12 men. The mean BMI was 27,9 ± 4,4. When two groups compared, statistically significant differences were found in terms of heart rate (during Ramadan 70,5 ± 9,4, post-Ramadan 76,3 ± 9,7, p = 0.001), SDNN (during Ramadan 51,6 ± 13,7, post-Ramadan 52,2 ± 16,4, p = 0.000), SDNNI (during Ramadan 105,5 ± 44,4, post-Ramadan 131,7 ± 48,7, p = 0.001) RMSSD (during Ramadan 38,1 ± 14,4, post-Ramadan 39,9 ± 18,5, p = 0.02), T power (during Ramadan 2327,5 ± 1151, post-Ramadan 2597,5 ± 1678,3, p = 0.001), LF (during Ramadan 539,9 ± 301, post-Ramadan 591,2 ± 476,3, p = 0.001), HF (during Ramadan 276 ± 173,2, post-Ramadan 304 ± 325,3, p = 0.015) and LF/HF (during Ramadan 2,9 ± 2,3, post-Ramadan 3,6 ± 3,5, p = 0.000) values. Conclusions In our study, HRV parameters were found to be decreased in Ramadan month compared to after Ramadan in hypertensive patients. So we think that Ramadan fasting enhances the activity of the sympathetic system in hypertensive patients.

Previous studies have shown that smokers with acute myocardial infarction (AMI) treated by thrombolysis have lower mortality rates than nonsmokers, a phenomenon often termed "smoker's paradox". This "smoker's paradox" has been rarely studied in case of primary angioplasty.To evaluate the impact of smoking status on the early mortality of patients admitted with AMI with regard to the strategy of reperfusion (intravenous thrombolysis versus primary angioplasty).Study undertaken from the Monsatir registry of ST elevation MI including 688 patients having had either a hospital or a prehospital thrombolysis (n=397) or a primary angioplasty (n=291). Among those patients, 482 (70.1%) were active smokers.In the thrombolysis group, the prevalence of hypertension, diabetes and anterior location of MI was significantly less among smokers. In the group primary angioplasty, only diabetes and hypertension were less frequent. The immediate mortality was significantly less among smokers in case of thrombolysis comparatively to non-smokers (5.3 vs 13%; p=0.008). By multivariate analysis, cardiogenic shock (p0.0001), anterior MI (p=0.03) and active smoking (p=0.03) were independent predictive factors of mortality in case of thrombolysis. A trend toward a lower mortality among smokers was observed in the primary angioplasty group (10 vs 17.6%; p=0.07)."The smoker's paradox" seems to be observed mainly among patients having had thrombolysis.

IntroductionThe evaluation of the prognosis of patients with dilated cardiomyopathy (DCM) is an essential step in their care but the study ultrasound of the right ventricle (RV) is not a part of the practice of the cardiologist.PurposeDetermine which of the RV echocardiographic parameters those predicting the occurrence of secondary cardiac events (death, hospitalization for decompensated heart failure and ventricular arrhythmias poorly tolerated) in patients with DCM.Materials and methodsProspective study in 61 patients with DCM. All patients received a conventional echocardiographic examination with emphasis on studying the RV parameters: fractional shortening surface (FRSRV), the systolic excursion of the tricuspid annulus inTM (TAPS) and systolic pulmonary artery pressure (SPAP), completed by a tissue pulsed Doppler study at the tricuspid annulus (Sa, Ea and Aa). We studied the correlation between echocardiographic parameters of RV and the occurrence of secondary cardiac events.ResultsThe average age of patients was 62±9 years with a sex-ratio of 2/1. Forty-eight percent of patients were in NYHA class III. The average fractional ejection of left ventricle was 29±7,2%. DCM was ischemic in 59% of cases. During follow-up (11±5 months), 5 patients died, 22 were hospitalized for decompensated heart failure and 2 patients had a ventricular tachycardia. We have shown that the parameters predictors of mortality are: TAPS < 12mm and FRSRV < 33%. Parameters predictive of hospitalization for decompensated heart failure: SPAP > 42mmHg, RV FRS < 39%, TAPS < 15mm and wave velocities Sa, Ea and Aa or DTI tricuspid annulus < respectivly 10,1cm/s to 6,09cm/s and 12,75cm/s. Those predictive of cardiac events overall: SPAP >42mmHg, a TAPS < 11,5, a FRSRV < 38%, Sa and Aa waves to the DTI tricuspid lower respectively at 10,2cm/s and 14cm/s. In multivariate analysis, only the FRSRV < 38% was a factor directly related to the occurrence of cardiac events overall.

Introduction It is unknown whether patients who developed symptomatic mitral restenosis after percutaneous mitral valvuloplasty (PMV) may benefit from repeat PMV (re-PMV).The purpose of this study is to assess the immediate and long-term results of the re-PMV in patients with mitral restenosis following to previous PMV. Methods Retrospective study from a series of 40 procedures of re-PMV with the Inoue balloon at 8±4 years after prior procedure, performed between 1996 and 2012. A clinical and ultrasound follow-up was achieved in 31 patients with a mean follow-up period of 43±26 months. Results The mean age of patients was 43±11 years [23; 63]. 87,5% of the population being female (5 men and 35 women). The immediate procedural success was achieved in 31 patients (77.5%). A severe mitral regurgitation (MR) was observed in 3 patients (7.5%). A cerebrovascular stroke occurred in 1 patient (2.5%). No death or cardiac tamponade were noted. Class III or IV of NYHA, a pre-procedural MR, pulmonary hypertension and a Padial score >10 were identified as predictors of failure. More the score of Wilkins is high (>8), more it is predictive of failure. Only a left atrial area ≤ 25 cm 2 was linked to high risk of severe MR. At long-term, most patients (84%) had no functional impairment, the mean mitral valve area was 1,5±0,33 cm 2 [0,9;2,2], mitral restenosis was observed in 13 patients (42%) at 53±30 months [9;128] after re-PMV. 9 patients had mitral valve replacement (32%), 4 patients underwent a re-PMV (13%), 2 patients presented thromboembolic events (6%) and no death. Only the male had been identified as a predictor of restenosis. Conclusion Re-PMV in patients with restenosis after a prior PMV is feasible, effective and achieves interesting immediate and long-term results.

Introduction The double-chambered right ventricle (DCRV) is a rare congenital heart disease in which anomalous muscle bundles divide the right ventricle into two cavities, causing variable degrees of obstruction. Typically, DCRV is diagnosed at childhood or adolescence, and most DCRV patients have associated congenital anomalies, such as ventricular septal defect, pulmonary stenosis, and subaortic stenosis. The aim of this study is to determinate the clinical presentation, the echocardiographic patterns and the outcome of DCRV with intact ventricular septum in 4 adults. Materials and results : They were 3 men and one woman. The mean age was 29 years [17;43]. The clinical manifestations were a class II of NYHA dyspnea in 3 patients and right congestive heart failure was observed in one patient. A systolic ejection murmur was heard on the left parasternal border in all cases. Electrocardiogram revealed atrial fibrillation in 2 cases, incomplete right bundle block in 3 patients and right ventricular hypertrophy in all patients. Transthoracic echocardiography established the diagnosis in all cases. It objectified right cavities enlargement in 2 patients and right ventricular hypertrophy in all patients. Moderate tricuspid regurgitation was found in one patient and it was severe in one other patient. The pressure gradient in the right ventricle was evaluated at 72, 80, 80 and 75 mmHg. DCRV was an isolated lesion in all patients. Cardiac catheterization was performed in all patients; it confirmed echocardiographic findings in them. The 4 patients were referred to surgery. Surgical inspection confirmed echocardiographic and catheterisation data in all subjects. They underwent a resection of the obstructing muscle bundles. The postoperative course was uneventful in all patients with no death. Conclusion DCRV should be suspected in adults when there is a RV outflow tract obstruction with unusual symptoms. Echocardiography is considered as a useful method for the diagnosis of isolated DCRV. Cardiac catheterisation is performed in difficult cases. DCRV should in general be treated surgically, because the obstruction is progressive and ends in heart failure. Operative results and long-term outcomes are usually excellent.

Background Stress echocardiography (SEC) is emerging as an important component of stress testing in patients with valvular heart disease (VHD). The aim of this study is to determinate the indications, proven prognostic values and potential influence on clinical decisions of SEC in left VHD Materials and results Retrospective study conducted between January 2008 and December 2013. SEC was performed in 12 patients having left VHD. The mean age was 50 years [41; 60]. There were 9 women and 3 men. SEC was realized to study the contractile reserve in 3 patients having severe aortic stenosis with left ventricular systolic dysfunction (LVSD) and in 2 patients of aortic regurgitation with LVSD and to assess the severity of mitral stenosis in 7 very symptomatic patients having moderate mitral stenosis (mean mitral area =1,6 cm 2 ). It was a dobutamine SEC in 9 patients and exercise SEC in 3 patients. We objectified a contractile reserve in the 3 patients with aortic stenosis; subaortic ITV had increased by more than 20%. The mean LV–aortic gradient had increased in 2 patients and decreased in one patient. The 3 patients underwent aortic valve replacement and 2 of them died 2 days after surgery. For the 2 patients presenting aortic regurgitation, we found a contractile reserve in only one patient. The 2 patients were operated with favourable outcome. Concerning patients with mitral stenosis, SEC showed an increase in transmitral mean gradient in 2 patients (from 7 to 12 mmHg and 15 mmHg respectively) with increase of systolic PAP (45 and 46 mmHg to 65 mmHg respectively). Hence, the 2 patients underwent a percutaneous mitral commissurotomy (PMC) which was done with good results. For the other cases, PMC was recused by the lack of significant change in the hemodynamic profile (moderate increase of transmitral mean gradient and systolic PAP). Conclusion Dynamic evaluation of the severity and hemodynamic effects of VHD can provide the clinician with additional diagnostic and prognostic information that can contribute to subsequent clinical decisions.

Background Cardiac resynchronization therapy (CRT) is a well established treatment in selected patients with heart failure. The non physiological ventricular activation sequence has been implicated in the occurrence of sudden death after CRT. There is conflicting date concerning the effect of different pacing modes on ventricular repolarization in heart failure patients. Purpose Assessing the effects of biventicular (Bi V), left ventricular (LV) epicardial pacing and right ventricular endocardial pacing (RV) on QT intervals (QT end, QT apex, JT) and transmural dispersion of repolarization (TDR) in patients with heart failure having CRT. Methods 20 patients (15 men and 5 women, age = 63.4 ± 11 years) with NYHA III-IV heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony received CRT. We measured QT end intervals, JT intervals and TDR according to recommended methods on a 12 lead ECG recorded at baseline and after implant. After implant, ECG was recorded with temporary right ventricular pacing, temporary left ventricular pacing and then the final pacing mode : simultaneous biventricular pacing. Results There was no significant difference between QT end interval, JT interval and TDR at baseline and after implant with different pacing modes. Conclusion In our study, we noticed no effect of pacing modes on repolarization in patients with heart failure. The high incidence of sudden death observed in CRT may be explained by competitvity of modes of death rather than induced abnormal repolarization.