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During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?

Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

Patients with ferromagnetic cardiac devices, particularly cardiac implantable electronic devices (CIED) such as pacemakers or implantable cardioverter defibrillators, are often inappropriately deprived of magnetic resonance imaging (MRI) for safety reasons. This consensus document is written by a multidisciplinary working group involving rhythmologists, interventional cardiologists, echocardiographists and radiologists. Its objective is to establish good practice recommendations to optimize the management of patients with cardiac devices requiring MRI examination, while ensuring their safety and facilitating their access to MRI.

International audience; The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Introduction Only few echocardiographic data are available in literature concerning the impact of the systemic hypertension on the right ventricle (RV) comparing to the left ventricle's impact. Objective To describe the echocardiographic parameters concerning the impact of the systemic hypertension on the RV. Method Prospective and comparative study including 100 patients from June 2016 to June 2017, subdivided into two groups: Group A (50 patients, systemic hypertension) and group B (50 healthy patient, a control group). We compared the echocardiography parameters of the RV identified in both groups. Results The RV diameter, the RV ejection fraction (RVEF) and the right ventricular fractional area change (RV-FAC) were preserved and comparable in both groups. RV wall thickness was more increased in group A. The tricuspid annular plane systolic excursion (TAPSE) were comparable in both groups. TEI index was significantly higher (P Conclusion Our study confirms that the impact of the systemic hypertension includes the RV as is well known about the LV. Therefore, the functional and morphological analysis of the RV must be evaluated during the regular echocardiographic follow-up of patients with hypertension to allow an early identification of subclinical systolic and diastolic RV dysfunction in order to revise the current therapeutic strategy.

A mother presented with a fetus at 22±1 weeks of gestation with a sustained supraventricular tachycardia (SVT) at initially 186 beat per minute (bpm). The fetal M-mode echocardiography showed a 1/1 atrio ventricular ratio (with short atrioventricular (AV) interval and a long ventriculo-atrial (VA) interval, suggesting a Persistent junctional reciprocating tachycardia (PJRT) . Upon initial present no signs of heart failure or hydrops were noted and treament was initiated with amiodarone and digoxin . Fetus heart rate slowed .Postnatal electrocardiogram Confirmed the diagnosis of PJRT New born was put on amiodarone and proparonal). Sinus rhythm was rapidly achieved 9 days later .The patient doing well at 10 months of age with maintain of sinus rhythm. Conclusion: our case report illustrates a particular form of JRT diagnosed prenatal PJRT , characterized by a good clinical tolerance, its absence of evolution towards cardiomyopathy and its rapid and unusual response to antiarrhythmics.

Echocardiography is a non invasive tool for the assessment of systemic lupus erythematesus (SLE) involvement .to investigate the cardiac involvement in patients diagnosed with SLE assessed by echocardiography and to study relationship between several factors and cardiac manifestation .retrospective study of 76 patients with diagnosis of SLE between 2008 and 2017. All patients were asssesed by echocardiography .Patients were assigned into cardiac abnormalities group and non cardiac abnormmalties and compared to study relations between several factors and cardiac manifestation .Cardiac involvement was found in echocardiography in 52% of patients (40 patients. Echocardiographic findings showed 12 cases ( 38 %) of pericardial effusion . Valvular abnormalities were observed in 19 cases (48 %), Myocardium was involved in 5 cases ( 12.5 %). there were no cases of myocarditis , High arterial pulmonary hypertension was reported in 4 cases (10%). Men were more vulnerable to cardiac involvement in lupus , there was signifiant relationship between disease duration and cardiac abnormalities (p 0.04 ), age was not associated significantly to echocardiographic abnormalites ,positif antiphospholipid antibodies(aPL+) was observed in higher frequency in cardiac involvement group with p0.01 and especially in valvular anomalies Conclusion : Echocardiography should be routinely indicated for evaluation of cardiac involvement during SLE. These manifestations are most often moderate and asymptomatic. Pericardial effusion, and valvular involvement were the most frequent abnormalities.

Therapeutic approach of heart failure (HF) has evolved considerably to improve the prognosis that remains dark .The purpose of our study was to analyze the evolution of the ejection fraction (FE) heart failure and to identify predictors factors of mortality and re-hospitalization.Our study is prospective including 200 consecutive cases of HF patients with EF ≤ 40% during the period from 2012 to 2015. Clinical, para-clinical, evolultive data were collected at admission and atb3 months. The main study criteria is the occurrence of a major event: cardiac death and or rehospitalization for HF.The mean age of our patients was 56 + - 12. with male predominance. Ischemic etiology was the main causes (45%). All patients had pharmacological treatment of HF , 88% patients were put on ACE inhibitors, 91% on beta-blockers(BB) and 49% on spiranolactone, loop diuretics were prescribed in 95% of cases. The optimal dose was reached for the main molecules (IEC, BB and spiranolactone) only in respectively 12%, 15% and 10% patients . Myocardial revascularization was performed in 36 patients (40%). Among the 45 patients with valvulopathy surgical treatment was indicatetd for _ patients(17%). A cardiac resynchronization theray with defibrillator was implanted in 30 patients, an automatic defibrillator without resynchronization was implanted in 15 patients (7.5%). No patients from our study had a cardiac transplantation or rehabilitation.Hospital and 3-months mortality was 5% and 17.5% respectively, .Hospitalization rate was 36% and was highest in the first three months after discharge. The multi-variable analysis revealed four independent mortality factors: diabetes, EF , ischemic etiology, and TAPSE. Age, stage IV dyspnea, atrial fibrillation , and SLG-12.were independent predictors factors of rehospitalization.is a serious disease associated with poor prognosis despite advanced therapeutics.

Introduction Cardiac disease is common among patients with systemic lupus erythematosus (SLE) even when clinically asymptomatic but diastolic dysfunction is infrequently reported. Purpose The aim of our study was to assess diastolic left ventricular dysfunction at a subclinical stage and to compare the obtained results with a control population. Methods We conducted a prospective study over a period of seven years from 2008 to 2015 in the echocardiography laboratory of the adult cardiology department of La Rabta Hospital. Thirty consecutive SLE patients without evidence of cardiac disease were enrolled (group A), and were compared with 30 age-matched healthy control subjects (group B). Results The average age of our patients was 41 ± 8 years old. There were 25 women (83.3%) and 5 men (16.66%). All had normal LV systolic function; There were no statistically significant differences between SLE patients and controls in such parameters as; peak early diastolic filling velocity (E) LV between the 2 groups A and B (90 ± 12 cm/s vs. 85 ± 10 cm/s), the peak late diastolic velocity A, (66 ± 9 cm/s vs. 60 ± 9 cm/s), the Ratio of Peak Early to Late Diastolic Filling Velocity of Transmitral Flow E/A (1.32 ± 0.3 vs. 1.4 ± 0.4) and the E wave deceleration (181 ± 8ms vs. 200 ± 22 ms). Early diastolic mitral annular velocity (Ea) was decreased in lupus patients compared to controls (7.0 ± 0.5 cm/s vs. 11.5 ± 2.4 cm/s, P Table 1 ). Conclusion Echocardiography seems to be an excellent non-invasive tool for early detection of subclinical impaired diastolic cardiac function. So we suggest that patients with SLE, should better undergo an echocardiographic evaluation, and be followed periodically.

Background Heart failure (HF) has a dark prognosis due to the high rate of mortality and re-hospitalization. The aim of our study was to compare the HF- ischemic versus non- ischemic in order to identify the prognosis impact of the etiology. Methods A prospective and comparative study including 150 patients, hospitalized for HF with ejection fraction Results Group A patients were older and had significantly more frequent history of diabetes dyslipidemia and tobacco, renal failure and anemia were more common in group A. Atrial fibrillation (AF) and left bundle branch block were more often noted in the group B. Both groups were comparable according to echocardiography parameters and prescription of beta-blockesr, Spironolactone and Angiotensin-converting enzyme inhibitors. However, more patients from group B underwent cardiac resynchronization and cardioverter-defibrillator implantation. Hospital mortality and 6 months mortality was 6% and 13% and was higher in group A. Re-hospitalization and MACE rate was similar in both groups. Ischemic etiology of HF was predictor of mortality with (HR = 1.9, P Conclusion The ischemic etiology seems to have a worse prognosis compared to other etiologies. In order to evaluate the global prognosis, and since prognosis factors are different and related to the etiology.

Introduction Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that manifests with multiorgan inflammation. Cardiac involvement is one of the major concerns in the management of patients suffering from Systemic lupus erythematosus. Purpose The aim of our study was to assess systolic left ventricular dysfunction at a subclinical stage and to compare the obtained results with a control population using new echocardiographic imaging modalities like tissue Doppler imaging (TDI), and strain (SRI) imaging. Methods We conducted a prospective study over a period of seven years from 2008 to 2015 in the echocardiography laboratory of the adult cardiology department of La Rabta Hospital. Our series enrolled two groups; group A: thirty patients with asymptomatic SLE and group B: thirty healthy subjects. Results The demographic and clinical characteristics of our patients were quite similar to those of the controls. The average age of our patients was 41 ± 8 years old. There were 25 women (83.33%) and 5 men (16.66%). There was no significant difference in the ejection fraction between the two groups. The Tei index was significantly higher than that recorded in the control group. The systolic mitral annular velocity S measured with the Doppler tissue imaging and the global longitudinal strain (GLS) were definitely lowered in the group A compared to those found in the controls (5.2 ± 0.4 cm/s vs. 8.3 ± 0.6 cm/s, P Table 1 ). Conclusion SLE is associated with a significant impairment of systolic function in patients without cardiac symptoms. Transthoracic echocardiography (TTE) associated with the new imaging modalities (TDI and SRI) can be helpful as a noninvasive diagnostic tool for early detection of subclinical myocardial disease.

Introduction Cardiac involvement is the first cause of mortality in systemic lupus erythematosus (SLE). Echocardiography can be used as a non-invasive tool for the assessment of this involvement. Aim of study To investigate the cardiac involvement in patients diagnosed with SLE assessed by echocardiography and to study relationship between several factors and cardiac manifestation. Methods An echocardiographic study of 76 patients with diagnosis of SLE between 2005 and 2017. We also collected epidemiological characteristic of population, data related to lupus disease. Patients were assigned into cardiac abnormalities group (40 patients) and non-cardiac abnormalities group (30 patients) and compared to study relations between several factors and cardiac manifestation. Result Cardiac involvement was found in echocardiography in 52% of patients (40 patients). Echocardiographic findings showed 12 cases (38%) of pericardial effusion. Valvular abnormalities were observed in 19 cases (48%), Myocardium was involved in 5 cases (12.5%). High arterial pulmonary hypertension was reported in 4 cases (10%). Men were more vulnerable to cardiac involvement in lupus, there was significant relationship between disease duration and cardiac abnormalities (P: 0.04), age was not associated significantly to echocardiographic abnormalities, positive antiphospholipid antibodies (aPL+) was observed in higher frequency in cardiac involvement group with P Conclusion Echocardiography can be helpful tool for early detection of the cardiac involvement in SLE. Men gender, longer disease duration and a PL+ are to be associated to these cardiac abnormalities.

This is a retrospective study including 47 patients with isthmic coarctation (CoA) diagnosed in ante et postnatal périod, hospitalized in pediatric cardiology departement of la Rabta Hospital-Tunisia during the period from 2000 to 2017.They were 36 girls and 11 boys with an average age of 14 days. The diagnosis of CoA was suspected during the anténatalperiod in eight cases. In postnatal period heart failure was observed in (38.5%), abolition of femoral pulse (74%), a tension asymetry was found in all patients. Antenatal echocardiography suspected indicators of fetal coarctation especially ventriculo-arterial asymmetryechocardiography confirmed the diagnosis of CoA ,The ejection fraction was impaired in 31% of the cases.The abnormalities associated with coarctation were dominated by the patent ductus arteriosus (68%), atrial septal defect (55.5%), aortic hypoplasia, bicuspidia in respectively in 34% and 31% coarctation syndrome in (23.4%). Prostaglandin wasneccessary in (89.3%). forty two patients were operated with good immédiaterésults. the early postoperative mortality was 12.5%. In the long term, we deplored two late deaths, six cases of recoarctation with a follow-up of 14 months treated by percutaneous angioplasty with a result considered good in all cases.Coarctation of the aorta in neonates is a special form of aorticcoarctaion that differs from the child and adult forms in clinical, echocardiographic, and therapeutic characteristics . His clinical diagnosis must be early, if possible in antenatal , to asssure optimal management.

BACKGROUND The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). OBJECTIVE The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. METHODS A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. RESULTS At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. CONCLUSIONS The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. CLINICALTRIAL ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/12262

Background The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). Objective The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. Methods A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. Results At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. Conclusions The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial Registration ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID) DERR1-10.2196/12262

The prosthetic valve endocarditis(PVE) is a serious complication of valve replacement surgery. The aim of this work was to analyze the clinical and echocardiography characters of the PVE, deduce surgery indication, and determinate the prognostic factors Methods :We presented a retrospective descriptive study from 2000 to 2014 which included 30 patients hospitalized in department of cardiology in la Rabta hospital for certain PVE according to DUCKES criteria.Our study consisted of 18 male patients with sex ratio of 1.5 ,the mean age was 44 years; These PVE were early in 6 cases and delayed in 24 cases. Fever was present in 28 patients..splénomegaly was present in 7 patients and cutaneous signs were present in 6 patients Blood cultures were negatives in 16 patients .Staphylococcus was isolated in 7 cases (23.3%), a streptococcus in 5 cases (16.6%), a gram negative bacillus in 1 case (3, 3%) and one enterococci in 1 case (3.3%).The transesophageal and transthoracic echocardiography performed in all patients showed vegetation for 17 patients, a Dishence of prosthetic valve in 14 patients, prosthesis obstruction in two patients and annular abscess in 4 patients . 22 complications were reported in 21 patients; il was an hemodynamic complication in 13 cases , a septic complication (uncontrolled infection ) in three patients, embolic complication (ischemic transit stroke ) in 4 cases and mixed (hemodynamic and septic) in one patient. The indication for surgery was retained in 18 patients; the need for early surgery was because of congestive heart failure in 14 patients and uncontrolled infection in 4 patients ; but it was performed in 13cases with a period between 1 and 30 days the operation the global mortality was about 30%. he predictors factors of mortality released from our study are: the early character of EPV, heart failure, uncontrolled infection, staphylococcal endocarditis and dishence of prosthesis with significant regurgitation.PVE is still a serious complication leading to high mortality . Combined medical and surgical treatment is recommended.

Introduction Heart failure (HF) has a dark prognosis due to the high rate of mortality and re-hospitalization. Objective The aim of our study was to identify among the echocardiographic parameters those predictive of mortality and re-hospitalization in patients with chronic heart failure with reduced ejection fraction after 6 months. Method We performed a prospective cohort involving 110 patients, hospitalized for HF with ejection fraction (EF) Results After 6 months of regular follow-up, 19 patients died and 36 patients were hospitalized. In multivariate analysis, six parameters were identified as independent predictor factors of mortality: an EF Conclusion The evaluation of echocardiographic parameters in patients with chronic heart failure may provide a precise prognosis of this serious disease. This non-invasive exam seems to be extremely valuable and potentially useful for guiding the therapeutic and follow-up strategies in heart failure in order to reduce the problem posed for the global healthcare systems through the increasing rate of mortality and hospitalization caused by this invalid disease.

Introduction Heart failure (HF) doesn’t only describe a failure in the heart's main function, it also causes a deep failure in the global health care system because of its high rate of mortality and its repetitive and highly costive hospitalization. Objective The aim of our study was to compare the ischemic versus non- ischemic cardiomyopathy in order to highlight the prognosis impact of the etiology. Method A prospective and comparative study including 150 patients, hospitalized for HF with ejection fraction (EF) Results Both groups were comparable according to echocardiography parameters and prescription of beta-blockers (BB), Spironolactone and Angiotensin-converting enzyme inhibitors. However, more patients from group B underwent cardiac resynchronization and cardioverter-defibrillator implantation. Hospital mortality and 6 months mortality were 6% and 13% and were higher in group A. Re-hospitalization and MACE rate were similar in both groups. Ischemic etiology of HF was predictor of mortality with HR = 1.9 (P Conclusion The ischemic etiology seems to have a worse prognosis comparing to other etiologies. The cardiologist must be aware of these prognosis factors so he may start a prevention strategy and an early management of the heart failure's etiology in order to reduce the impact of this invalid disease on the health care system.

Introduction. Cardiac involvement in systemic sclerosis (SSc) represents a major cause of morbidity and mortality and constitutes a turning point in this disease. The aim of this study was to describe echocardiographic data in asymptomatic patients with SSc and compare them to results obtained in a control population in order to unmask subclinical cardiac involvement during systemic sclerosis. Material and methods. A prospective study was conducted between 2012 and 2017 including two groups: group A included 25 asymptomatic scleroderma patients without other comorbidities, while group B consisted of 25 control and healthy subjects. The two groups were examined by echocardiography coupled with tissue Doppler and 2D strain. Results. The mean age of our patients was 45 ± 7 years. The sex ratio was 0.8. The control population was epidemiologically similar to the group of patients. The anatomical data of the left ventricle and the ejection fraction were normal and comparable between the two groups, but the Tei index was significantly higher in group A (0.8 ± 0.04 vs. 0.28 ± 0.07, p < 0.01). Tissue Doppler velocity S peak measurement was reduced in group A compared to group B (5.6 ± 0.5 vs. 9.30 ± 0.5, p < 0.01), and global longitudinal strain was also altered in scleroderma patients (–11 ± 0.4 vs. –18 ± 0.3, p < 0.01). There was no significant difference in E/A ratio, however early left ventricular diastolic dysfunction was revealed by a higher E/Ea and E/Vp ratio in group A compared to group B with respectively (13 ± 1.8 vs. 6 ± 1.6, p < 0.01) and (2.2 ± 0.6 vs. 1.5 ± 0.6, p < 0.01), a longer Ap–Am duration (≥ 20 ms), and a higher volume of the left atrium was noted in group A. The mean value of the pulmonary pressions was 37.9 ± 9 mm Hg in patients with scleroderma versus 25 ± 3 mm Hg for the control group (p < 0.01). There was no right ventricular dysfunction. Conclusions. Cardiac involvement during systemic sclerosis precedes clinical expression. Echocardiography coupled with tissue Doppler and 2D strain are useful to detect these abnormalities at a subclinical stage of the disease.

Aim was to report our experience with regard to patients with cardiac rhabdmyomas , focusing on echocardigraphic finding ,cardiac outcome and management Methods Patients with cardiac rhabdomyomas diagnosis were retrospectively analyzed. during the period betwen 2000 and 2017 . Results A total of 17 rhabdomyomas were diagnosed .seven patients were detected prenatally, six patients in the neonatal period and four patient in early infancy. , Tumors were mostly localized in the left ventricle (15/17) , their size ranged from 13*10mm to 55*40mm and it was obstructive in 7 cases. . The tumors were singular in 8 patients and multiple in 9 . We diagnosed tuberous sclerosis (TSC) in 9 babies. we reported 4 deaths , three patients required surgery because of hemodynamic obstruction in two cases and resistant arrythmias in one baby . after a follow up of 45 months , . 5 patients had marked tumor regression and 9 had complete tumor regression ConCLUSION Cardiac rhabdomyoma may have different presentations and clinical course.it thought to be a benign tumor which tend to a spontaneous regression Surgery is only necessary when hemodynamically significant obstruction is present or resistant arrythmia . As these tumors are associated with long-term development of TSC a follow-up was mandatory .

Introduction Prosthetic valve endocarditis (PVE) is still associated with significant mortality and morbidity despite progress in antibiotic therapy and cardiac surgery. The aim of this study is to describe clinical, characteristics, management and outcome of PVE. Methods We conducteded a retrospective reviews of cases of certain infective endocarditis according to Duckes critera .among 135 patients hospitalized with infective endocarditis from 2004 to December 2014, 21 cases of PVE was found. Results Mean age of patients was ± 38.5 years (17 –79 years) with sex ratio=1.4. Mitral prosthesis was affected in 14 cases (67%) and aortic prosthesis in 7 cases (33%). Early prosthetic valve endocarditis was noted in 15 cases. Late PVE was observed in 5 patients; Mean interval of occurrencewas 150 days (extremes=8 days-2 year).Blood cultures were negatives in 55%. Staphylococcus aureus was the most common causative organism patients and occureded in 80%. Transthoracic and trans esophageal echocardiography revealed vegetations in all cases with mean size 14.4 mm (5-40 mm). Abscess was observed in 2 cases of aortic PVE. Desinsertion of prosthesis occurred in 6 patients. Mean duration of ant biotherapy was 20 days. Early surgery was indicated in 17 cases (80%). Essential complications consist in heart failure in 60%; stroke in 15% and cardiac abscess in 10cases.Hospital mortality was high estimated to 52.4%. Severals factor were associated to poor prognosis: age, staphylococal infection, early PVE and complicated PVE. Conclusions PVE accounts for a high percentage of al l cases of infective endocarditis. Staphylococcus aureus is now the leading cause of PVE.High prevalence of negative blood cultures in our population is worring. Hospital mortality of PVE remains high despite prompt diagnosis and the frequent use of surgical intervention. The author hereby declares no conflict of interest

Introduction and objective Arterial hypertension is commonly affected left ventricular structure and function. Our aim was to evaluate the effect of arterial hypertension on right ventricular function (VD). Methods Betwen 2015–2016, we included 60 patients with uncontrolled hypertension and without any associated pathology (group A) and 60 controls (group B). Subjects included in the 2 groups are free from diabetes, ischemic heart disease, and pulmonary affection. Both groups have a comparable mean age and sex ratio. We evaluate morphological and functional of right ventricular (RV) for both groups. Statistical data We calculated (percentages) for the qualitative variables and averages, and standard deviations for quantitative variables. For comparing averages and percentages, the student's “t” test and the Pearson chi-square test were used and in all statistical tests the significance level was set to 0.05. Results Echocardiographic data showed a significant increase in parietal thickness, left atrium diameter, left ventricular mass index in patient group A, but no significant difference in left ventricular function. The diastolic diameter of (RV), the ejection fraction of RV and the pulmonary arterial pressures are comparable between the two study groups. The systolic velocity measured at the tricuspid ring is significantly lower in hypertensive patients (8.3 ± 8 cm/s vs. 14.1 ± 1.8 cm/s, P Conclusion This study shows the presence of subclinical right ventricular dysfunction in poorly controlled hypertensive patients: Tissue Doppler is a very effective tool in the early detection of these subclinical functional abnormalities.

Non-invasive examination of coronary artery disease is an attractive and rapidly evolving possibility. In certain clinical situations ,multi-detector computed tomography coronarography (MDCT) is currently considered as a promising technique alternative to conventional coronary angiography (CCA).We suggest from our personal study and from a review of the literature, to analyze diagnostic accuracy of MDCT , its limits and to deduct, its practical implications and its indications.105 patients underwent 64-slice MDCT . Coronary angiography was performed every time when the MDCT was pathologic. In two cases the MDCT was realized in complement of inconclusive coronary angiography .Study of coronary arteries was based on "per -segment" and "per- patients" analyse Results : The mean age was 63,3 years., sex ratio was 0 ,7. Hypertension was noted in 63% of cases 29 ,9 % of patients had mellitus diabetes.The initial clinical presentation was unusual chest pain in 46 patients, exercise chest pain in 40 cases. the MDCT was done for the detection of silent ischemia In 5 cases, for screening of CAD in patients with dilated cardiomyopathy in 5 cases , before cardiac surgery in 3 case and before non cardiac surgery in 2 cases. MDCT was normal in 30 patients ( 28% ) so coronary angiography was avoided in 60% of patients with unusual chest pain, and in 50% of patients with dilated cardiomyopathy and in also in 50% of patients selected for cardiac or non cardiac surgery. In per-segment study the sensitivity, specificity, positive and negative predictive value of the MDCT in detecting coronary stenosis were respectively 89 %,98% , 91% and 97% versus, 98%,89%,94%, 95% the per-patient evaluation .The MDCT was inclusive in10 patients because .of calcifications in 8 cases and because uncontrolled unchecked heart rate in 40 cases Conclusion : our results for negative predictive value of MDCT are similar to reports from the literature. This suggests that in this clinical setting , MDCT may replace coronary in patients with low probability of coronary artery diseases, its is also useful for assessment of cardiomyopathy and before cardiac or non cardiac surgery.

Infective endocarditis (IE) is a serious pathology which is in a continuum evolution in the setting of diagnosis and therapeutic fieldsTo describe clinical, echocardiographic, microbiological, therapeutic and outcome characteristics of infective endocarditis in a Tunisian population.The records of 135 patients admitted to adult cardiology department of la Rabta hospital between January 1981 and December 2011 were collected. The diagnosis of certain IE was retained according to modified Duke Criteria.The mean age of patients was 38.5 ± 16 years, with a male predominance (sex ratio: 1.4). IE affected native valves in 77% of cases, prosthetic valve in 15.5% of cases, congenital heart disease in 2% and pacemaker in 1.48% of patients. The portal of entry was identified in 43.7% of the patients, the oral origin was predominant. Blood cultures were positive in only 34% of patients. Causative microorganism was staphylococcus in 43.6%, streptococcus in 43.6% and negative bacill gram in 17.4% of patients. Echocardiography showed vegetation in 98% of patients, cardiac abscess in 23.7% of patients and valve mutilation in 17.7% of cases. Prosthesis dehiscence was present in 4.5% of cases. Complications were primarily hemodynamic (57%) followed by embolic events (34%). Surgery occurred in 57.7% of patients, it was early in 69% of cases. The indication was mainly hemodynamic and mixed in 70%of patients. Hospital mortality was 28% with predictor's factors: left heart (p=0.02), prosthesis (p0.05), staphylococcus (p0.005), heart failure (p0.05) and neurological complications (p=0.04).According to our study, infective endocarditis has always touched a young population in Tunisia, rheumatic valve disease is still the predominant underlying heart disease and both streptococcus and staphylococcus are most frequently isolated. Mortality remains high despite considerable progress in terms of diagnosis and therapy.

Introduction Ebstein's disease is a rare congenital malformation with many clinical manifestations depending on the age at diagnosis and the severity of the anatomical pattern. In this study we try to describe the clinical manifestations, the echocardiographic patterns and the outcome of this malformation in adulthood. Methods and results Retrospective study about 8 cases of Ebstein's anomaly in adult patients (5 women and 3 men); the mean age is 34 years old. The clinical manifestations were absent in 6% of cases but the majority of patients have exertional dyspnea or palpitations in 56% of cases. Arrhythmias and congestive heart failure were observed respectively in 6% and 13% of cases. Transthoracic echocardiography demonstrated the presence of Ebstein anomaly in all cases, showing apical displacement of the septal leaflet of the tricuspid valve. Five patients had the A grade of the Carpentier's classification and the others had the grade B. After an outcome of 11 years, one patient died by refractory heart failure. Conclusion Clinical manifestations and outcome of Ebstein's anomaly depend on the degree of tricuspid valve malformation and many cases are discovered in adults. The prognosis is worsening by arrhythmia and heart failure. Surgical intervention with tricuspid valve repair should be proposed for patients with severe heart failure and intractable arrhythmia. Conservative surgery and anti arrhythmic therapy had enhanced the prognosis of this congenital malformation.

Introduction and purpose Scleroderma has been associated with an increase risk of cardiovascular diseases. The aim of this study is to assess the systolic and diastolic function of the left ventricular (LV) in asymptomatic scleroderma patients. Methods We included 25 scleroderma patients without symptoms or signs of heart failure or angina (groupe I) and 25healthy subjects (groupeII); the two groups had similar mean age, sex ratio, mean blood pressure and body mass index. All included subjects had no evidence of diabetes mellitus, valvular or ischemic heart diseases. We used standard echocardiography and tissue Doppler imaging (TDI). Results LV diastolic diameter and LV ejection fraction were similar in both group, however we observed lower mitral annulus systolic velocities measured by TDI in scleroderma patients (5.2±0.7cm/vs 8.6±0.9cm/s, p Conclusion This study shows the presence of systolic and diastolic dysfunction in asymptomatic scleroderma patients. Tissue Doppler imaging may provide a useful tool to monitor the disease process and treatment response of this subclinical myocardial dysfunction. The author hereby declares no conflict of interest