Early screening of cardiotoxicity of chemotherapy by echocardiography and myocardial biomarkers.

INTRODUCTION: cardiotoxicity remains the most serious complication of anticancer chemotherapy, especially if it manifests by heart failure. Early detection of myocardial involvement, before alteration of LVEF, would involve the necessary measures to be taken to prevent progression to heart failure. AIM: Early detection of the cadiotoxicity of anti-cancer chemotherapy, through clinical, echocardiographic and biological parameters. METHODS: Prospective comparative study in a cohort of 100 patients treated with anti-cancer cardiotoxic chemotherapy for any type of cancer. Each patient received before his first course of chemotherapy, as well as three weeks after, a clinical evaluation, electrocardiography, echocardiography and an assay of biological markers. RESULTS: for the LV study (LVEF (Tei): before CT: 67.75 ± 5.53, after CT 64.7 ± 5.6%, p = 0.002; LVEF (SBP): before CT: 64.5 ± 3.83, after CT 61.85 ± 1.9%, p <0.001; SLGVG: before CT: -21.85 ± 1.9, after CT: -20.08 ± 1.63%, p <0.001) and for the study of the DV (TAPSE: before CT: 22.9 ± 3.02, after CT: 21 ± 2.86, p = 0.014; SLGVD: before CT: -23.42 ± 2.69, after CT: -21.67 ± 2.6%, p = 0.004). Variations in troponin levels and BNP was not significant. CONCLUSION: anticancer chemotherapy has harmful cardiovascular effects which can be detected and controlled p by echocardiographic monitoring and  biological markers and prevented by the use of protective agents.

Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry.

BACKGROUND: The FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI). METHODS: Data for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%). RESULTS: Among the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals (n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; p<0.001), with less IF (28.6% vs. 43.1%; p = 0.002) but more PPCI (37.8% vs. 3.9%; p<0.0001). However, in-hospital mortality in the two types of hospitals was similar (5.3% vs. 5.1%; p = 0.866). CONCLUSIONS: Data from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals.

Echinococcosis of the heart: clinical and echocardiographic features in 12 patients.

UNLABELLED: We describe the clinical and echocardiographic features in 12 patients with hydatid cyst of the heart who were screened between 1985 and 2001. Presenting symptoms have a wide variability but the main symptom was precordial pain. The electrocardiogram was always abnormal and showed T wave inversion in 8 cases, ST depression in 5 cases, incomplete right bundle-branch block in one case and atrial fibrillation in one case. Transthoracic echocardiography and transoesophageal echocardiography constitute the imaging procedure of choice for the diagnosis of cardiac hydatid cyst with a high sensibility, specificity. Computed tomography (CT) was performed in all patients and confirmed the echocardiographic data. MRI was performed in one patient with right atrium hydatid cyst location and confirmed the echocardiographic data. CONCLUSION: In the presence of atypical symptomatology in a patient coming from an endemic area of hydatid cyst, the diagnosis of cardiac echinococcosis is possible.TTE and TEE are the imaging procedure of choice and sufficient for the diagnosis of cardiac hydatid cyst. CT and/or MRI provide more information about the extension of echinococcus disease in other intra- or extrathoracic locations.