[Limits of quantitative coronary angiography [QCA] in intermediate stenosis measuring: a correlation and concordance study with intravascular ultrasound [IVUS]]

Although coronarography is still the gold standard to evaluate coronary lesions, it remains a bidimensional representation of a tridimensional complex structure, which can represent a source of error in measurements. To perform a correlation and concordance study between quantitative coronary angiography [QCA] and intravascular ultrasound measurements for intermediate and ambiguous lesions. We analysed 40 patients' coronary arteries from March 2009 to November 2011 by both QCA and intravascular ultrasound to perform then a correlation and concordance study. The correlation study confirmed the limits of the angiogram in providing accurate measurements. The correlation coefficient was yet high in reference diameters [r=0,78, p<0,001] and minimal lumen diameters [r=0,58, p<0,001], but was middling for stenosis percentages [r=0,23, p=0,03]. This coefficient was also high for lesions lengths [r=0,51, p=0,01]. Bland and Altaman diagrams showed however wide limits of agreement, reflecting possibility of large measurements error and confirming the absence of concordance between the two techniques. Coronarography though being the most widespread mean of evaluating coronary lesions lacks to provide accurate measurements, which can influence patient's management, especially in case of intermediate lesions

[Coronary angiographic characteristics in septuagenarian patients with acute coronary syndrome]

Although the prognosis of acute coronary syndrome [ACS] in elderly patients is bleak, elderly population is less well treated both in medical and interventional terms. To analyse angiographic findings in septuagenarian patients admitted with ACS and its impact on the therapeutic strategy. We retrospectively analysed 250 patients 70 years or older hospitalised for ACS who underwent a coronary angiography between January 2006 to september2010. This population was more likely to be male with mean age 74 years and 93% of ACS were inaugural events [60% N STEM, 40% STEMI].Coronary angiograms showed complex, diffuse coronary lesions with a high incidence of multivessel coronary artery disease, bifurcation lesions, and calcified stenosis. Angiographic findings after ACS in elderly were caracterised by multivessel disease and complex lesions .Surgical or percutaneous coronary revascularizaion was possible in the majority of these patients

[Results of cardiac pacing: about 188 patients]

Indications for permanent pacing are currently well codified. This treatment may, however, present complications. To report the results of cardiac pacing and to identify predictive factors of pacing's complication. We conducted a retrospective study of 188 consecutive patients admitted to the cardiology department of Mongi Slim university hospital in La Marsa between January 2005 and June 2011 and implanted with a single or dual chamber pacemaker. In our study, we had 92 men and 96 women [sexratio= 0.95]. The mean age was 70.21 +/- 13 years. The indication for cardiac pacing was a high degree heart block in 74.46% of cases and a sick sinus syndrome in 15.95% of cases. The degeneration conduction tissue was the main etiology [72.34% of patients]. Success implantation was obtained in 98.4%of cases. The main operative complication was the pneumothorax in 3 patients [1.59% of cases]. At Long term, cumulative survival rate was 78.95%. Only operating time affects significantly the rate of early complications [p<0.001]. Late complications were related to the valvular heart disease [p = 0.007], the ischemic etiology [p = 0.05], the oral antivitamine K treatment [p = 0.04] and the occurrence of early complication [p = 0.002]. Our hospital, which is considered as a small Center of cardiac pacing [less than 80 procedures/year] had a low complication rate as well as big centers

[In hospital mortality of ST segment elevation myocardial infarction treated with primary angioplasty: monocentric Tunisian study of 250 patients]

Myocardial reperfusion is the " corner stone " in the treatment of myocardial infarction. Primary percutaneous coronary intervention has proved its superiority upon intravenous thrombolysis. To evaluate in hospital mortality of acute myocardial infarction treated with primary angioplasty and to determine its predictive factors. We performed a retrospective study including 250 patients admitted to Mongi Slim university Hospital at la Marsa between January the 1st, 2006 and June the 30th, 2011. All these patients had an ST segment elevation myocardial infarction and underwent primary percutaneous coronary intervention within 24 hours after symptom onset. In our study, males were predominant with a sex-ratio of 4.55. Our patients were aged 59.8 +/- 11.19 years old. Diabetes mellitus was present in 42% of our population. In 60.4% of the cases, myocardial infarction was located in the anterior wall. Cardiogenic shock was present in 13.6% of patients. The culprit coronary artery was the left anterior descending artery in 57.6% of the cases. The coronary flow in the culprit artery was TIMI 0 in 64% of the patients and TIMI 1 in 13.2% of the patients. Angiographic success [TIMI 3 flow and residual stenosis <20%] was achieved in 84% of cases. Our in-hospital mortality rate [cardiogenic shock excluded] was 6.9%. Predictive factors of in-hospital mortality were: female gender, diabetes mellitus, hypertension, renal failure, multi-vessel lesion,TIMI flow before percutaneous coronary intervention, proximal left anterior descending artery lesion, initial cardiogenic shock and acute stent thrombosis. In our local context, primary percutaneous coronary intervention is an efficient and safe treatment of myocardial infarction with persistent ST-segment elevation

Comparison of coronary calcifications detections by angiogram versus intravascular ultrasound

The presence, extent and location of calcium in coronary artery lesions are important determinants of the success of per cutaneous coronary intervention [PCI]. Although coronarography remains the gold standard for coronary disease detection, Intravascular ultrasound [IVUS] is proposed as a superior technique for identifying patients with coronary artery calcification .To define sensibility and specificity of coronary angiography in detecting calcifications considering the IVUS as gold standard. Target lesion calcification was assessed in 40 patients [35 men; mean age 57.4 +/- 10 years] by angiography and intravascular ultrasound. Ultrasound detected calcium in 51 of 85 target lesion [60%], whereas angiography showed calcifications in only 16 lesion [19% p<0.001 compared with IVUS]. Coronary angiography detected 8% of 0-45[degree sign] arc calcium category, 7% of 45-90[degree sign] calcium category, 58% of 90-180[degree sign] calcium category, and 80% of more than 180[degree sign] calcium category. The overall sensitivity of angiography in identifying calcium was 31% and increased with an increasing arc of lesion associated calcium. The overall specificity of the angiographic detection of target lesion calcium was 100%. Intra coronary ultrasound analysis shows that target lesion calcification is much more widespread in coronary artery disease than what angiography reveals. The sensitivity of angiography was poor, with although a very high specificity

[Single versus bilateral internal thoracic artery grafts for multi vessel coronary artery bypass grafting: effects on mortality and event-free survival]

The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. The aim of this study was to compare the early results and midterm outcome of single and bilateral internal thoracic artery grafting for multivessel coronary artery bypass grafting. Between January 2005 and March 2010, 196 patients underwent primary coronary artery bypass grafting with at least one internal thoracic artery grafts. Early results and Outcomes of patients undergoing single internal thoracic artery [SIMA] plus saphenous vein grafting [n=145] and bilateral internal thoracic artery [BIMA] plus saphenous vein grafting [n=51] were obtained at a mean follow up of 29 months. Patients with bilateral internal thoracic artery grafting were younger, had less hypertension, higher left main disease and better Euroscore than patients undergoing single internal thoracic artery grafting. In-hospital mortality was similar for the two groups: 6.9% for patients undergoing SIMA versus 5.9% for those undergoing BIMA [p=0.8]. Sternal wound infection was also similar [2.8% versus 3.9% p=0.68]. Mid-term mortality was [4% VS 4.8% p=0.71] and event free survival probability at 28 months was 75% for the single-graft group compared with 85.7% for the bilateral-graft group [P =0.46]. Our study found similar early and mid-term clinical outcomes for patients undergoing SIMA plus saphenous vein grafting and those undergoing BIMA plus saphenous vein grafting for multivessel coronary artery bypass grafting

[Coronary artery bypass grafting in diabetic patients: early and mid-term outcomes]

The outcome of coronary artery bypass grafting [CABG] in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. To evaluate the early and mid term outcomes of diabetic patients compared to non-diabetics following CABG. We retrospectively analyzed the data of 228 CABG patients from January 2005 to December 2010: one hundred and twenty-six diabetics and 102 non-diabetic. Diabetic patients were more likely to be female[27% Vs 12.7% P=0.009] were less smoker [55.6% Vs 80.4% P<0.0001] with higher rate of three vessel disease[67.5% Vs 42.2% P=0.005] compared to non-diabetics. Hospital mortality was significantly higher among diabetic patients [16% Vs 4.1% P=0.005].Length of care unit stay was more important [2.3 days Vs 2.1 days P=0.048], but with a similar rate of sternal wound infection even after bilateral internal thoracic artery grafting. After 28 months mean follow- up, mid-term survival of diabetics was significantly decreased compared to no-diabetics [91% Vs 99% p<0.001] .However, Event-free survival was similar in the two groups [76% Vs 80% p=0.82]. These results suggest that diabetes is associated with poorer early and mid-term outcomes following [CABG]

[Atrial fibrillation following coronary artery bypass grafting: Predictors and mid- term outcome]

Atrial fibrillation [AF] is a frequent complication after coronary artery bypass grafting [CABG] which increase morbidity and hospitalization length. To identify the predictors of atrial fibrillation and its repercussion on hospital and mid-term outcomes in patients undergoing [CABG]. We undertook a retrospective review of the data of 224 patients undergoing CABG. The mean age of the patients was 60.8 years. Atrial fibrillation was diagnosed from serial postoperative electrocardiogram. Twenty two patients developed postoperative atrial fibrillation. Multivariate analysis showed that only: age, left circumflex stenosis, sternal wound infection and low cardiac output were predictors of AF following CABG. Hospital mortality was similar in the two groups [5% Vs 9.6% P=0.7]. In our study, the incidence of post-CABG atrial fibrillation was 9.8%. Multivariate predictors were age, left circumflex lesion, sternal wound infection and low cardiac output. Hospital mortality and mid-term outcome were similar in the two groups

[Sudden cardiac death of rhythmic origin in athletes: literature review]

The sudden death in athletes is, in the vast majority of cases, related to ventricular fibrillation, often in a subject with unknown cardiovascular abnormality; this dramatic event has a significant impact on society and the medical profession. We conducted through a literature review an analysis of data on sudden cardiac death of rhythmic origin in athletes; sudden death may be cardiovascular in 95.3% of cases and related to ventricular arrhythmia in 88% cases. The main causes are: hypertrophic cardiomyopathy, congenital anomalies of coronary arteries, and arhythmogenic right ventricular dysplasia for athletes under 35 years, and atherosclerosis beyond 35 years. Prevention is based on three main areas: the medical assessment and screening for cardiovascular disease; the chain of survival; the education of the athlete and the public. All these measures should improve significantly the survival prognosis of patients suffering from these accidents

[Tricuspid dysfunction during the rheumatic disease]

Rheumatic tricuspid valve dysfunction is the rarest of all valvular disease and is often associated or secondary to left-sided valvular disease. She often realize tricuspid regurgitation. The surgical treatment is generally conservative but also it can be readical generally using bioprotheses. To assess the epidemiology of the rheumatic tricuspid dysfunction, the average diagnoses and its therapeutic. To evaluate the results of the surgical techniques, the factors of prognostis and to determine the therapeutic regarding an in front of important and symptomatic residual tricuspid regurgitation a long time after a valvular surgery first of the left heart. A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur. A retrospective, single center of 84 consecutive patients having one significant tricuspid dysfunction regurgitation and/or significant stenosis of rheumatic origin. Hospitalized and followed between January 1992 and March 2008 in cardiology to the hospital Habib Thameur. The prevalence of the rheumatic tricuspid dysfunction was 8,42%. 70% of the patients had a tricuspid regurgitation. The average Age of our patients was 40 years. Our population consisted of 65,5% women. 21% of the patients had benefited at least from a percutaneous mitral dilation. 31% of the patients had antecedents of valvular cardiac surgery. 53% of the patients presented clinical signs of preoperative right cardiac failure and 58% of the patients were in permanent auricular fibrillation. The tricuspid regurgitation was major at 12% of the patients, severe at 88% of the patients, organics at 21% of the patients and functional at 31% of the patients. The average of the systolic pulmonary blood pressure was with 55 + - 16,8 mm Hg. All the patients had an associated left valvulopathy. The average of the ejection fraction of the left ventricle was 56 + 12,6%. The dilation of the right cavities was noted at 70% of the patients. The patients of our series were subdivided in two distinct groups. The first group gathers 30 patients who were operated of tricuspid in same operational time as the surgery of the left valves. The surgical gesture on the tricuspid was always conservative. 70% of the patients profited from a tricuspid annuloplasty. Hospital mortality is 10%. 26% of the patients presented a significant residual tricuspid regurgitation after 60 months. 26% of the patients presented late cardiac failure. Late mortality was from 30% to 5 years and 43% to 10 years. The second group is represented by 54 patients not operated on the tricuspid. 30 patients [81%] presented one or more episodes of late cardiac failure. 50% of the patients died during the late follow-up. Among operated patients of the tricuspid, the predictive factors of the residual tricuspid regurgitation post operational are the age <35 years and the mitral disease. The stage NYHA = 4 was the only predictive factor of hospital mortality the clinical signs of preoperative right heart failure and the antecedents of mitral replacement. The predictive factors of late right congestive heart failure postoperative 1 are the functional tricuspid regurgitation and stage 4 of the NYHA. The benefit of a systematic initial correction of a voluminous tricuspid regurgitation and even of average importance realized prematurely in same operation time that the left valvular gesture was largely shown. The late appearance of functional tricuspid regurgitation after mitral valve surgery in a prejorative marker in the evolution of these patients

Infarctus du myocarde sur coronaires angiographiquement saines: etude descriptive de 46 cas

This a retrospective study on 46 patients conducted over a 9-year period. These patients had an acute myocardial infarction [AMI] confirmed with changes on the electrocardiogram and raised cardiac enzymes. However, the subsequent coronary angiography was normal in all these patients. The purpose of our study is to assess epidemiologic, clinical, prognostic and therapeutic features of AMI with angiographically normal coronary arteries and compare the results obtained with those of AMI with coronary artery disease. AMI with angiographicalIy normal coronary arteries is a first coronary event in young patients [mean age 47.7 years] having few coronary risk factors [54.3% have only one risk factor] mainly smoking [73.9%]. The anterior location is prevalent. The patients with AMI and angiographically normal coronary arteries have a better prognosis than those with coronary artery stenosis. Indeed, their left ventricular function is unaltered [mean ejection fraction 48.7%]. Hypokinesis is the most frequent abnormality of wall motion noticed. The patients' post infarction course is bengin when the coronary arteries are angiographically normal. The incidence of hemodynamic complications and ischemic recurrences are lower than in AMI with coronary stenosis. The choice treatment remains fibrinolysis

Place of definitive cardiac stimulation in cardiomyopathies and atrial arythmia

Definitive cardiac stimulation ralatually used for brady cardia are going to be in the third millennium the specific therapy of arythmia and cardiomyopathy. In the last 10 years, may progress occur in the use of cardiac stmulation as hemodynamic therapy of obstructures hypertrophic and dialted cardiomyobathies resistant to conventional medical treatment. Moreover auricular stimulation present antiarythmic effects in somme atrial arythmias as auricular fibrillations auricular diseases and atypical flutters. It confirmed by prospective multicentric randomized trials cardiac stimulation may represent in the future a good physiopathologic and efficient treatment free from the sidee effects of drugs that remain partially active. These perspectives needs to be modulated by the known and acceptable resks of a definitive cardiac stimulation

Enterococcal infections endocardites associated to laubry and pezzi syndrome

Laubry and Pezzi syndrome is a rare but serious complication of ventricular septal defect that increase the infectious endocardits risk. Authors report a case of an 18 years old young girl prescruling an enteracoccus infectious endocarditis associated to Laubry and Pazzi syndrome. Initial course is not favourable requiring a surgical treatment in the acute stage. Bacterial endocarditis combined with Laubry and Pezzi syndrome have a poor prognosis needing observation and strict preventive precautions when a favoriging factor is present