[Management of patients treated for acute ST-elevation myocardial infarction in Tunisia: Preliminary results of FAST-MI Tunisia Registry from Tunisian Society of Cardiology and Cardiovascular Surgery]. / Prise en charge de l'infarctus du myocarde en Tunisie : résultats préliminaires du registre FAST-MI Tunisie de la Société tunisienne de cardiologie et de chirurgie cardiovasculaire.

UNLABELLED: FAST-MI Tunisian registry was initiated by the Tunisian Society of Cardiology and Cardio-vascular Surgery to assess characteristics, management, and hospital outcomes in patients with ST-elevation myocardial infarction (STEMI). METHODS: We prospectively collected data from 203 consecutive patients (mean age 60.3 years, 79.8 % male) with STEMI who were treated in 15 public hospitals (representing 68.2 % of Tunisian public centres treating STEMI patients) during a 3-month period at the end of 2014. The most common risk factor was tobacco (64.9 %), hypertension (38.6 %), diabetes (36.9 %) and dyslipidemia (24.6 %). RESULTS: Among these patients, 66 % received reperfusion therapy, 35 % with primary percutaneous coronary interventions (PAMI), 31 % with thrombolysis (28.6 % of them by pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 and 358 min for PAMI, respectively. The in-hospital mortality was 7.0 %. Patients enrolled in interventional centers (n=156) were more likely to receive any reperfusion therapy (19.8 % vs 44.6 %; p<0.001) than at the regional system of care with less thrombolysis (26.9 % vs 44.6 %; p=0.008) and more PAMI (52.8 % vs 8.5 %; p<0.0001). Also the in-hospital mortality was lower (6.4 % vs 9.3 %) but not significant. CONCLUSIONS: Preliminary results from FAST-MI in Tunisia show that the pharmaco- invasive strategy should be promoted in non-interventional centers.

[The QT interval: standardization, limits and interpretation]. / L'intervalle QT: standardisation, limites et interprétation.

Despite clinical importance of ventricular repolarisation, it remains difficult to analyse. Conventionally, quantification of the electrocardiographic ventricular repolarization is usually performed with reference to axis of the T wave and QT interval duration. A variety of factors can prolong the QT interval, such as drug effects, electrolyte imbalances, and myocardial ischemia. The biggest risk with prolongation of the QT interval is the development of torsades de pointes. Commonly accepted reference ranges for the electrocardiogram (ECG) have been in use, with little change, for many years. Populations throughout the world present several differences: age, ethnic compositions, and are exposed to different environmental factors. Recent studies have reported reference data for QT interval in healthy population and have evaluated the influence of age, gender, QRS duration and heart rate on this interval. In this review, we address several issues relative to the measurement, and interpretation of QT interval and its adjustment for rate, age, gender and QRS duration.

[Correlation of TIMI risk score with angiographic extent and severity of coronary artery disease in non-ST-elevation acute coronary syndromes]. / Corrélation du score TIMI avec l'étendue et la sévérité de l'atteinte coronaire dans les syndromes coronariens aigus sans sus-décalage de ST.

AIM OF STUDY: To determine whether the TIMI risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization. PATIENTS AND METHOD: We conducted a retrospective review of 239 medical records of patients who underwent coronary angiography secondary to non-ST-elevation acute coronary syndrome between 2002 and 2006. Patients were classified into three groups according to TIMI risk score: TIMI scores 0 to 2 (group 1: n=121), 3 to 4 (group 2: n=100), and 5 to 7 (group 3: n=18). We compared the coronary angiography findings of the three groups. RESULTS: Patients of group 1 had a greater likelihood of normal or non significant CAD than patients of group 2 (36.3 % vs 13 %, P<0.001) and than patients of group 3 (36.3 % vs 0 %, P=0.002). One-vessel disease was found more often in patients with TIMI score 0 to 2 than in patients with TIMI score 5 to 7 (28.9 % vs 0 %; P=0.01), and in patients with TIMI score 3 to 4 than in those with score 5 to 7 (35 % vs 0 %, P=0.006). However, 1-vessel disease was found in patients of group 1 as often as in patients of group 2. The frequency of two-vessel disease was similar whatever the level of TIMI score was low, intermediate or high. Three-vessel or left main disease was more likely found in patients of group 3 than in patients of group 2 (66.7 % vs 26 %; P=0.01), and than patients of group 1 (66.7 % vs 13.2 %; P<0.001). Chronic coronary occlusions and coronary calcifications were also more likely found in patients with TIMI score 5 to 7. CONCLUSION: In patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score correlated with the extent and severity of coronary artery disease.

[Influence of diabetes mellitus on the prognosis of non-ST-elevation acute coronary syndromes]. / Influence du diabète sucré sur le pronostic des syndromes coronariens aigus sans sus décalage de ST.

AIM OF STUDY: Analyze the influence of diabetes mellitus on the prognosis, at short and middle term of patients with non-ST-segment-elevation acute coronary syndrome. PATIENTS AND METHOD: We conducted a retrospective review of 308 consecutive medical records of patients admitted to the care unit of our department with a non-ST-segment-elevation acute coronary syndrome. One hundred and fifty-six patients were diabetics (group 1) and 152 were not (group 2). We compared the demographic, clinical, angiographic and therapeutic characteristics of the two groups and we analyzed the prognosis of diabetic and non-diabetic patients at short term (30 days) and at middle term (average: 28 months; extreme: 12 months, 72 months). RESULTS: The mean age was similar into both groups (60.8 years). Diabetic patients were more often women (42.1% vs 23.1%) and presented a higher prevalence of systemic hypertension, dyslipidemia and family history of coronary artery disease. Smoking was more frequent in group 2. The rates of coronary angiography, percutaneous transluminal coronary angioplasty, and coronary bypass surgery were similar in the two groups. At 30 days, diabetic patients were at increased risk for acute heart failure (19.1% vs 6.4%) and for major cardiac events (12.5% vs 6.4%). A pejorative prognosis was also observed at middle term among diabetic patients. They were at greater risk for readmissions for non-ST-segment-elevation acute coronary syndrome (42% vs 25%), for major cardiac events (49.3% vs 31.6%) and for new revascularizations (17.3% vs 7.2%). In a Cox multivariate analysis, diabetes mellitus remains an independent risk factor for major cardiac events at middle term. CONCLUSION: Our study confirms the pejorative prognosis of acute coronary syndromes without ST elevation at short and middle term in diabetic patients.

[Takayasu's disease in central Tunisia: 27 cases]. / La maladie de Takayasu dans la région centre de la Tunisie. A propos de 27 cas.

BACKGROUND: Takayasu's arteritis is a rare inflammatory disease and few data are available in Tunisia. The aim of this study is to evaluate clinical and radiological features of the disease in the centre of Tunisia. METHODS: We retrospectively studied medical records of patients treated in departments of internal medicine or cardiology from three university hospitals in Sousse and Monastir over the period 1985-2005. The criteria for inclusion were those proposed by the American College of Rheumatology. RESULTS: Twenty-seven patients were identified. The mean age at presentation was 33.2 years (range 16-68 years) and 88.9% were female. The mean delay from the onset of the symptoms to the time of diagnosis was 4.2 years. Intermittent claudication was the most common presentation (81.5%) and hypertension was noted in 40.7% of cases. Arterial localization most frequently involved was subclavian artery. The aorta was involved in 52.3% and renal arteries in 36.3% of cases. Stenosis or occlusions was constant but aneurysms were noted in 7.4%. Functional difficulty was the main complaint in the follow-up, death related to Takayasu's disease was noted in 3.7%. The mean follow-up time was 75.8 months (6.3 years). CONCLUSION: There is no epidemiologic particularity of Takayasu's disease in Tunisia, however involvement of the subclavian artery was more frequent than the aortic localization.

[Effects of acute decrease in preload on echocardiographic indices of systolic and diastolic function of the left ventricle in children with end-stage renal disease (ESRD). Comparative study before and after hemodialysis]. / Effets de la réduction de la précharge sur les paramètres échographiques de la fonction systolique et diastolique du ventricule gauche de l'enfant en insuffisance rénale terminale: étude comparative avant et après hémodialyse.

PURPOSE: Contrasting data exist about the hemodialysis induced changes of ventricular diastolic and systolic functions in adults. Few data in children with end-stage renal disease (ESRD) are reported. The aim of the present study was to evaluate the effect of a single hemodialysis (HD) session on left ventricular (LV) systolic and diastolic function using conventional pulsed-Doppler echocardiography and pulsed tissue Doppler imaging (TDI) in hemodialysis children. METHODS: Thirty-five children with chronic renal failure (15 males, aged 12.8+/-3.8 years) on maintenance hemodialysis underwent conventional 2D and Doppler Echo together with measurement of longitudinal mitral annular motion velocities. Echocardiographic parameters were obtained 30 minutes before and 30 minutes after HD. Paired data were compared. RESULTS: Hemodialysis led to reduction in LV end-diastolic volume (p=0.001), end-systolic volume (p=0.05), left atrium area (p<0.0001), peak early (E wave) transmitral flow velocity (p=0.005), peak S velocity of pulmonary vein flow (p=0.002), aortic time velocity integral (p<0.0001) and aortic ejection time (p<0.0001). No significant change in Tei Index was observed after HD. Regarding TDI measures, velocities were not affected by preload reduction. Only the early diastolic velocities on the septal side of the mitral annulus decreased significantly (p=0.001) and the systolic velocities on the lateral side of the mitral annulus increased significantly (p=0.042) after hemodialysis. CONCLUSIONS: Most of Doppler-derived indices of diastolic function are preload-dependent. TDI velocities and Tei Index were not or minimally affected by preload reduction in hemodialysis children.

[Infectious endocarditis with negative blood cultures]. / Endocardites infectieuses à hémocultures négatives. A propos de 48 cas.

Blood culture is a key investigation for the diagnosis of infectious endocarditis (IE). When negative, there are diagnostic and therapeutic problems. The aim of this study was to determine the frequency, the clinical features and the aetiological factors of IE with negative blood cultures compared with IE with positive blood cultures compared with IE with positive blood cultures. The authors undertook a retrospective review of 98 cases of patients admitted for IE from 1991 to 2000 to the Department of Infectious Diseases and Cardiology of Sousse (Tunisia). Of the 98 patients, 48 (48.9%), 29 men and 19 women with an average age of 34.3 years, had negative blood cultures. An infectious agent was identified in 7 cases (14.5%) by serology, valve culture or cerebrospinal fluid including Brucella (2), Coxiella (1) and Candida (1). Therefore, in 41 cases (42%), the cause of IE was not determined. Transthoracic echocardiography was of diagnostic value in 96% of cases and transoesophageal echocardiography showed disease not observed on transthoracic echocardiography in 5 cases. The main complication was cardiac failure (27 cases). The mortality was 14.5%. Comparison of the two groups showed that negative blood cultures were associated with a higher incidence of previous antibiotic therapy, extracardiac signs of IE and cardiac failure. Early surgical indications and mortality were the same in both groups. This report confirmed the high frequency of IE with negative blood cultures. Previous antibiotic therapy seems to be an important aetiological factor but cannot explain this high frequency. Methodological problems of blood cultures and the absence of systematic investigation for rare infectious agents are other possible factors.

[Primary cardiac sarcoma: report of 3 cases and review of the literature]. / Les sarcomes primitifs du coeur: revue de la littérature, illustrée par 3 cas.

Primary cardiac sarcoma is a rare tumor with a poor prognosis. We report 3 cases with a review of literature about this disease. There were 2 males and 1 woman. The main symptoms were thoracic pain. The clinical features were various and the thoracic ultra sonography exam allowed the diagnosis in the 3 cases. All patients had surgical remove of their cardiac tumor followed by chemotherapy. All of them died within 13 to 36 months after the diagnosis. Primary cardiac sarcoma has a poor prognosis with a mean survival less than 12 months.

[Myocardial infarction and abnormal origin of the circumflex coronary artery]. / Infarctus du myocarde et anomalie de naissance de la circonflexe.

Abnormal origin of the circumflex coronary artery without any stenosis is generally considered benign and without any particular ischemic risk. We report a case of a 21 year old man who suffered a posterior lateral myocardial infarction with objective criteria: electrocardiographic, echocardiographic and isotopic. The patient received thrombolytic therapy at H2. Angiography showed an abnormal origin of the circumflex coronary artery which was free of any stenosis. Certain cases of the circumflex artery anomaly can, therefore, be complicated by myocardial infarction, and the benign nature of the anomaly needs to be re-examined.

[Effort phlebitis of the upper limb. Report of 5 cases]. / Phlébite d'effort du membre supérieur. A propos de cinq observations.

Deep venous thrombosis (DVT) of upper limbs is extremely rare. DVT related to physical stress is a less known form. The purpose of this study was to outline the clinical pattern and laboratory features as well as the clinical course and outcome of this disease. The authors report 5 documented cases of upper limb DVT related to physical stress: 4 patients were hand workers and 1 was a young athletic man. None of the patients developed pulmonary embolism. Two patients had late sequelae. Treatment is based on prompt and early anticoagulation. Prevention can be achieved by contention, active physiotherapy and professional rehabilitation.

[Infectious endocarditis surgically-treated in the active phase. Apropos of 46 cases]. / Endocardites infectieuses opérées à la phase active. A propos de 46 cas.

The clinical and microbiological characteristics, the surgical indications and procedures, the evolution and the principal prognostic factors were reviewed in 46 cases of infectious endocarditis operated in the active phase. Using this date, the authors try to determine the optimal time for surgery during the acute active phase of infectious endocarditis. The study population comprised 28 men and 18 women aged 7 to 64 years (average age: 30). The patients were selected on strict criteria: positive blood cultures during the 48 hours prior to surgery (29 cases), positive valve or valve prosthesis culture (15 cases), the presence of an active cardiac abscess at surgery (7 cases), the presence of a large number of bacteria on histological examination of the valve (17 cases). The patients were divided into two groups: those with endocarditis of native valves (27 cases) and those with endocarditis on prosthetic valves (19 cases). The preoperative clinical features included all the classical signs of IE but congestive cardiac failure was particularly prevalent (62% of cases). Microbiologically, most cases of native valve endocarditis (67%) were due to sensitive organisms (streptococci) whilst the more virulent organisms (staphylococci, gram-negative bacteria and fungi) were observed in prosthetic valve endocarditis (64% of cases). The commonest surgical indication was haemodynamic deterioration (30 cases). The indications were mixed in 15 cases but only one case was operated for uncontrolled infection alone in this series. The surgical procedure was technically complex in 6 cases. Operative mortality was high (18 cases, 39%). The main cause of death was low cardiac output (13 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

[Thromboembolic accidents in patients with mechanical prostheses and heterografts]. / Accidents thrombo-emboliques (ATE) chez les porteurs de prothèses mécaniques et d'hétérogreffes.

759 patients with a prosthetic valve replacement (335 mitral prostheses, 184 aortic prostheses and 240 double or triple valve replacements) were regularly followed-up for a total duration of 3 715 patient years. The mean age of these patients was 30 years. 681 (90%) of these patients were treated by long term anticoagulants, which were effective in only 320 patients. 78 patients did not receive anticoagulant treatment. 97 patients presented a total of 129 thrombo-embolic episodes (TEE), i.e. a frequency of 12.7 p. cent or 3.4 embolisms per 100 patients-year. The rate of TEE was influenced by the site of the prosthesis and by the presence or absence of complete arrhythmia due to atrial fibrillation, but it was not influenced by the quality of the anticoagulant treatment. In the patients with a heterograft, the rate of TEE varied according to the site of the prosthesis. In the aortic position, the rate of TEE in our series of prostheses was essentially similar to that reported in series of heterografts by Davila, Oyer and lonescu. This rate is generally higher for the mechanical prostheses in the mitral position and in the case of double valve replacement. The aim of this study was to deduce the current operative indications in relation to the choice of the type of valve replacement.