ABSTRACT
Background:Obstructive sleep apnea syndrome (OSA) is a common but often under diagnosed condition.According to literature,OSA prevalence in atrialfibrillation (AF) patients varies from 21 to 85%. OSA is increasingly recognized as a risk factor for biventricular dysfunction. The present study aimed to compare left and right ventricular functions, assessed by conventional echocardiographic parametersand speckle tracking imaging, in non-valvular atrial fibrillation (NVAF) patients with and without severe OSA.Methods: Across-sectional analytic study was conducted. Forty successive patients with NVAF were included. All of them had a clinical screeningfor symptoms suggestive of OSA and underwent polysomnographic study. Patients were divided into two groups (group 1: without severe OSA with an apnea-hypopnea index (AHI) < 30 events per hour (e/h), and group 2: having severe OSA with an AHI ≥ 30 e/h). Echocardiography was performed in all patients. Left and right ventricular function parameters were measured including global longitudinal strain (GLS) and myocardial performance index (MPI).Results: OSA was diagnosed in 90% of NVAF patients. The average AHI was 22.1 ± 13 e/h.Eleven patients (27.5%) had mild OSA, 9 patients (22.5%) had moderate OSA, and 16 patients (40%) had severe OSA.General clinical characteristics were comparable between groups.A statistically significant association was demonstrated between severe OSA and impairment of left ventricular GLS (-17.3 ± 4.5 vs. -14.9 ± 3%, in group 1 and 2 respectively, p = 0.02) and left ventricular MPI (0.37 ± 0.09 vs. 0.49 ± 0.13, in group 1 and 2 respectively, p = 0.01).Right ventricular lateral wall strain was non significantly lower in group 1 compared to group 2 (-22.5 ± 8.4 vs. -18.4 ± 5.8%, in group 1 and 2 respectively, p = 0.15).On multivariate logistic regression analysis, left ventricular GLS impairment (> -18%) and MPI > 0.37 were independent predictors of severe OSA.Conclusion: Severe OSA was diagnosed in 40% of NVAF patients. Impairment of left ventricular GLS and left MPI were statistically associated with severe OSA
ABSTRACT
Contrast-induced nephropathy [CIN] is associated with an increased cardiovascular morbi-mortality. Little is known about the incidence and risk factors of CIN after cardiac catheterization in Tunisian patients. To determine the incidence of CIN and its predictors after coronary angiography as well as its prognostic and therapeutic repercussions in a Tunisian patients' cohort. In this prospective single center study, 180 consecutive patients who underwent cardiac catheterization were enrolled; all patients were followed-up for 3 months. The incidence of CIN defined as an absolute increase in serum creatinine >/= 5 mg/l [44micromol/l] and/or a relative increase in serum creatinine >/= 25%, was 17.2%. In multivariate logistic regression, independent predictors of CIN were: diabetes mellitus [Odds Ratio [OR]=2.26 ; 95% confidence interval [95%CI]: 1.29-3.98, p=0.005], creatinine clearance < 80ml/mn [OR=2.87 ; 95%CI: 1.59-5.19, p<0.001], left ventricular ejection fraction [LVEF] < 45% [OR=2.03 ; 95%CI: 1.22-3.39, p=0.007] and use of a volume of contrast media > 90ml [1.72 ; 95%CI: 0.99-2.99, p=0.05]. Perprocedural hypotension was the strongest independent predictor of CIN in our study [OR=3.99; 95% CI: 1.65-9.66, p=0.002]. CIN was totally regressive within one month in 27 patients [86.7%] while 3 patients [10%] had a residual renal dysfunction at the end of the follow-up period [3 months]. More than one angiocoronarography on 6 resulted in CIN in our population. CIN affects cardiovascular prognosis even if renal function normalization is usually obtained within one month after the investigation. Besides identifying risk factors of CIN in order to apply preventive measures in risky patients, we stress the necessity of insuring a good hemodynamic status while achieving the procedure