Cystatin C: a prognostic marker after myocardial infarction in patients without chronic kidney disease

Aims: cystatin C is an endogenous marker of renal function. It is a well established better marker of glomerular filtration rate than serum creatinine. There is also evidence that cystatin C is associated with atherosclerotic disease. The present prospective study evaluated the prognostic value of cystatin C after myocardial infarction in patients without chronic kidney disease

Methods and results: a total of 127 patients who underwent coronary angiography after an acute coronary syndrome [ACS] were included. Cystatin C was associated with the severity of coronary artery disease [CAD]. Cystatin C levels were significantly higher in patients with 3-vessels disease and severe CAD according to GENSINI score [p = 0.01 and p < 0.001 respectively]. Among the patients admitted for ST elevation myocardial infarction, Cystatin C concentration was correlated with the initial TIMI flow in the culprit artery [p < 0.001]. Mean duration of the follow-up period was 10.76 [thorn] 2.1 months. High Cystatin C concentrations were associated to the occurrence of unfavourable outcomes and cardiovascular mortality during follow-up [1.19 [thorn] 0.4 vs. 1.01 [thorn] 0.35 mg/L, p = 0.01 and 1.21 [thorn] 0.36 vs. 0.96 [thorn] 0.27 mg/L, p = 0.03]. Among different laboratory parameters, cystatin C was the best marker to predict the occurrence of major adverse cardiovascular events during the follow-up [Area under the receiveroperating characteristic curve = 0.743]

Conclusion: high cystatin C levels are associated with the severity of coronary artery disease in patients presenting an acute coronary syndrome and a normal renal function. Cystatin C is also associated to unfavourable cardiovascular outcomes during follow-up and appears as a strong predictor for risk of cardiovascular events and death

Isolated Streptococcus agalactiae tricuspid endocarditis in elderly patient without known predisposing factors: case report and review of the literature

Group B streptococcal [GBS] tricuspid infective endocarditis is a very rare clinical entity. It affects intravenous drug users, pregnant, postpartum women, and the elderly. We report the case of a 68-year-old patient without known predisposing factors who presented a GBS tricuspid endocarditis treated by penicillin and aminoglycosides with no response. The patient was operated with a good evolution. Our case is the 25th reported in the literature. GBS disease is increasing in the elderly and is mainly associated to comorbid conditions. Tricuspid infective endocarditis with Group B streptococcus predominantly presents as a persistent fever with respiratory symptoms due to pulmonary embolism. Therefore, it requires a medicosurgical treatment and close follow-up

huge cardiac hydatid cyst: an unusual cause of chest pain revealing multivisceral hydatidosis in a young woman

Hydatid disease remains endemic in some parts of the world. Cardiac hydatidosis with multivisceral involvement is uncommon but potentially fatal. We report the case of a 36-year-old Tunisian woman admitted with chest pain and T-wave inversion in the inferior leads on her electrocardiogram. Transthoracic echocardiography revealed a large hydatid cyst in the epicardium throughout the left ventricle. Thoraco-abdominal computerized tomography [CT] scan showed several hydatid cysts in the left lung, the liver, and in both breasts. After one week of albendazole treatment, surgical excision of the cardiac cyst on cardiopulmonary bypass was carried out as well as excision of the pulmonary and breast cysts. The postoperative course was uneventful and albendazole treatment was continued for six months. Though hydatid cardiac involvement is very rare, it should be considered in the differential diagnosis of atypical chest pain in young patients, especially those living in regions where hydatid disease is endemic

Percutaneous closure of using Occlusion DeviceOstium Secundum Septal defect amplatzer occlusion device: Experience of cardiology department, Hedi Chaker Hospital, Sfax, Tunisia

To report our clinical experience with transcatheter closure of ostium secundum atrial septal defects [OS ASDs] using Amplatzer septal occluder. It's a retrospective study conducted between October 2005 and April 2010 and involving 34 patients. The procedures were conducted in the hemodynamic laboratory under general anesthesia with transthoracic [TTE] and transoesophageal echocardiographic [TEE] monitoring. Clinical and echocardiography assessments of the patients were conducted within 24 hours post procedure and several months after the procedure. From the 34 patients, 28 [82%] were females. The middle age was 27.5 years. The mean ASD diameter was 19.4 mm by TTE; 18.1 mm [12-38] by TEE, and 23.4 by angiography. The average size of the implanted devices was 23.2 mm ranging from 10 to 34 mm. The final success rate of the procedure was 90.9% [30/33]. One patient was excluded from transcatheter occlusion and three patients [8,6%] had complications including two prosthesis migrations and one large residual shunting. A total of 4 patients [11.7%] underwent surgery. No major complication [thromboembolic events, obstruction of intracardiac structures, cardiac perforation, device embolization and endocarditis] or death has occurred during follow-up and all devices were securely anchored without any persistent residual shunts. Compared to previous data of the literature, percutaneous closure of OS ASDs using Amplatzer device appears safe and effective according to our experience of the cardiology department of Hedi Chaker Hospital

[Role of the psychosocial factors in blood pressure balance; Cross-sectional study including 100 ambulatory hypertensive patients]

Hypertension is a real public health problem. His pathogenesis involves a combination of several factors including environmental and psychosocial factors. We focus on the links between the blood pressure imbalance and some psychosocial factors in a population of ambulatory patients with hypertension. It was a cross-sectional study on 100 patients with hypertension followed up in Cardiology in Sfax [Tunisia]. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale [HADS]. Behavioral pattern was evaluated by a clinical interview, referring to the model of Friedman and Rosenman. We also collected socio-environmental, clinical, therapeutic and prognostic data. The most predictive factors of an unbalanced blood pressure were independently: personality type [A] or unspecified [p = 0002], high fat diet [p = 0026], poor drug adherence [p = 0038] and depression [p = 0015]. Several sociodemographic and lifestyle factors are interrelated and implicated in the blood pressure imbalance, suggesting the need of a hygienic behavior joining the international recommendations. We insist on the treatment of the anxious and depressive disease and the psychotherapeutic approach of some personality patterns in the management of hypertension

Torsade de pointes a couplage court compliquee d'une mort subite

A case report of 38 years old man who exprerienced syncope and torsade de pointes is presented with the short coupled variant. The patient had a normal QT interval [QTC 0,37 secondes] and multiform ventricular premature beats on the resting electrocardiogram. Under antiarrhythmic treatment [intavenous xylocain], torsades de pointes suddenly appeared and cardiac arrest was followed, After cordioversion, sinus rythm was restored. A cardiovascular disease was excluded, the echocordiography, the left and right venlncular angiography and coronarography were normal, Three months after, the patient presented at home a sudden cardiac death

Percutaneous implantation under local anesthesia of implantable automatic defibrillator: one case report

We report the case of a 58 years old male affected by a severe relapsing ventricular tachycardia despite a well administered anti arythmic therapy. Etiology is an arythmogene right ventricular dysplasia. Considering the severity of this arythmia we proceed to percutaneous implantation of an automatically implantable defibrillator under local anesthesia. Evolution was favorable with a follow-up of 3 months

Remplacement valvulaire Tricuspidien dans une transposition corrigee des gros vaisseaux

The authors report the case of [tricuspid] valve replacement in a thirteen old girl, who had corrected Transposition of Great arteries with ventricular septal defect, mitral and tricuspid insufficiency. After she was clinically well for few years, tricuspid valve regurgitation became severe [class IV of the New York Association]. She required a tricuspid valve replacement with prothetic valve [carbomedics]. Associated lesions were repaired at the same time. Early result was slowly favorable. The result at two years is good. If spontaneous outcome of isolated congenital corrected transposition of great arteries is good, we must not forget severity of associated forms. A regular follow up is necessary