Assessment of Biventricular Function in Patients with Obstructive Sleep Apnea and Atrial Fibrillation: A Cross-sectional Study Using Two-dimensional Speckle Tracking Imaging

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

[Late stent thrombosis in a young patient who had ulcerative colitis]

Arterial and venous thrombosis are well recognized systemic complications of inflammatory bowel disease predominantly in patients with Crohn's colitis and in those with ulcerative colitis [UC]. report a new case We describe the case of a 35 years old man presenting previously an anterior infarct with a tighten stenosis in the middle part of the left anterior descending artery [LAD]. The stenosis was treated percutaneously with a bare stent deployment. During an acute exacerbation of UC, the patient developed an acute coronary syndrome with ST elevation secondary to a late stent thrombosis, needing a primary coronary angioplasty. Following course is favorable. Based on this case, we'll discuss the relationship between UC and thrombosis, and therapeutic considerations inherent to thrombotic and bleeding risks

[Assessment of endothelial function reliably predicts the existence and the severity of coronary disease]

Endothelial dysfunction has been proven to be. a cornerstone of atherosclerosis occurrence, development and progression. However, its use in clinical practice is still unclearly defined, this study was to prospectively assess how accurately endothelial function assessment predicts the existence and the extensiveness of significant coronary artery disease. Fifty adults [37 men and 13 women, mean age of 59.9 +1-12.6 years] were randomly included among candidates for a coronary angiography. They previously underwent endothelial function assessment by the Flow-mediated dilation technique [FMD] according to ACC guidelines. The FMD%was expressed as maximal percent change in brachial artery diameter from baseline and the test was considered positive when FMD%was below 5%. Endothelial function impairment has been diagnosed in 36 patients and at least one significant coronary artery stenosis [>50%] in 38 patients. Endothelial dysfunction predicted significant coronary stenosis with a sensibility and a specificity of 89.5%and 83%respectively; positive predictive and negative predictive values were 94.4%and 71.4%respectively. Statistical correlation has been found between FMD%and the number of significantly diseased coronary vessels [rs-0.44; p=0.001].An FMD%less than 8%reliably predicted all multivessel coronary-diseased patients. In multivariate analysis, endothelial dysfunction was the only independent predictive factor of coronary disease [p=0.02]. Endothelial dysfunction has been proven to be highly correlated to the existence of significant coronary stenosis at coronary angiography [PPV=94 .4%]. The severity of endothelial dysfunction assessed by the FMD%has also been significantly correlated to the extensiveness of coronary disease

Rdial access for concomitant coronary, subclavin and renal artery angioplasty: one case report]

Concomitant coronary and peripheral angioplasty is a more frequently reported situation. Patient's outcome is significantly conditioned by access site complications especially in femoral and brachial approaches. The radial artery access is a safe and a well established alternative in coronary interventions and could be suitable for many peripheral angioplasty cases, thanks to devices enhancement. Rport a new case. We report the case of a 56-year-old woman with multivessel coronary artery disease, significant left subclavian [SCA] and bilateral renal arteries stenoses. Because of a severe resistant hypertension and prior to scheduled coronary bypass surgery a triple angioplasty of left renal artery, SCA, and left anterior descending [LAD] was attempted. Stenting of the three sites was successful in the same procedure through the left radial artery route. Radial artery access in peripheral, combined and complex percutaneous transluminal angioplasty seems to be suitable and safe. However, prospective clinical trials are still lacking

[Immediate and 12 month outcomes of interventional reperfusion strategy in acute ST elevation myocardial infarction. about 208 successive patients]

Percutaneous coronary intervention [PCI] has been proven to be the gold standard of reperfusion therapies in acute ST-elevation myocardial infarction [STEMI] in the west world. Highly trained teams and good logistical management of cathlabs may be limiting factors in developing countries and data about outcomes following PCI in such areas is scarce. The objectives of this study were to describe the procedural and clinical outcomes of patients undergoing PCI for STEMI 51 a university hospital in Tunisia and make a comparison with outcomes from the West. We conducted a retrospective cohort study at a tertiary care university hospital in Tunis, Tunisia. A total of 208 consecutive patients undergoing PCI between January 2005 and June 2007 were reviewed. Univariate, multivariate and Kaplan meier analyses were constructed. The primary outcome was mortality: in-hospital 30 days, and 12 months later. Cardiovascular risk factors were mainly smoking [63ck and diabetes [35.1%]. The mean patient's TIMI score was 3.8-s412 [10%were in cardiogenic shok]. Procedural success was 75.5%. In-hospital, 30 days and 12-month mortality were respectively 53%. 6.7%and 8.2%, comparing favorably with TIMI's score predicted mortality and the published registries from developed countries. Multivariate predictors of in-hospital death included age>70 years, mutivessel disease and PCI failure. Multivariate predictors of 12-month death were killip score>2 at admission [odds ratio=2.1] and PCI failure [odds ratio=2.9]. We conclude that, despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in a developing country, possibly similar t those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions

[Anomalous origin of coronary arteries from the aorta]

The authors report the series of 9 patients [6 male and 3 female, aged from 32 to 64 years] with anomalous origin of coronary arteries from the aorta discovered at coronary arteriography. In 4 cases, the circumflex artery aries from the right coronary sinus and in 5 cases, the right coronary artery arises from the left coronary sinus. Severe atherosclerotic coronary disease was discovered in 5 cases. We conclude that aberrant coronary origin from the aorta is a rare congenital anomalous discovered usually at coronary angiography and certain patients with this anomalous can develop severe myocardial ischemia especially when a vessel runs between the aorta and pulmonary artery

Fistules coronaires multiples dans la cavite ventriculaire gauche. A propos d'un cas

The authors report the case of a patient with multiple coronary artery-left ventricular fistulae discovered in coronary angiography for exertional angina

Resultat a 20 ans d'une reparation complete d'une tetralogie de fallot chez une femme de 50 ans

The authors report the case of a woman operated at 50 years of age for a tetralogy of Fallot with a good late result

Retrecissement valvulaire aortique congenital avec dysfonction ventriculaire gauche: effet de la dilatation percutanee

Two girls aged 6 ans 1 5 years with severe congenital valvular aortic stenosis and left ventricular [LV] dysfunction underwent successful balloon aortic valvotomy [BAV]. Both patients had severe symptoms at the time of initial evaluation. The electrocardiograms showed LV hypertrophy and cardiac enlargement [cardiothoracic ratio 0,7 and 0,65] was evident in the chest roentgenograms. Immediately after BAV, the aortic valve peak-to-peak gradients decreased from 60 to 8 mmHg and 120 to 30 mmHg respectively, the LV end-diastolic pressures decreased from 47 to 13 mmHg and 40 to 15 mmHg, the LV ejection fractions improved from 40 to 65% in the second girl. On follow-up [30 and 36 ms respectively], both patients were asymptomatic with normalization of LV function and without a change in the residual gradient a cross the aortic valve

effet immediat de l'atrioseptostomie de Rashkind sur la saturation systemique dans la transposition des gros vaisseaux

The purpose of this prospective study is to analyse the immediate effect of Rashkind's atrioseptostomy on systemic saturation in transposition of the great arteries [TGA]. Thirteen neonates and infants [10 males and 3 females] with TCIA underwent balloon atrial septostomy [BAS] at a median age of 20 days [range 2 ans 60 days]. The mean atrial septal defect diameter apter BAS was 6.5 +/- 1.1 mm. The right ventricular saturation increased from 37 +/- 17% to 67 +/- 13% [p<0.001]. there was no correlation between the atrial septal defect diameter and the increase of systemic saturation aiter BAS