Early screening of cardiotoxicity of chemotherapy by echocardiography and myocardial biomarkers.

INTRODUCTION: cardiotoxicity remains the most serious complication of anticancer chemotherapy, especially if it manifests by heart failure. Early detection of myocardial involvement, before alteration of LVEF, would involve the necessary measures to be taken to prevent progression to heart failure. AIM: Early detection of the cadiotoxicity of anti-cancer chemotherapy, through clinical, echocardiographic and biological parameters. METHODS: Prospective comparative study in a cohort of 100 patients treated with anti-cancer cardiotoxic chemotherapy for any type of cancer. Each patient received before his first course of chemotherapy, as well as three weeks after, a clinical evaluation, electrocardiography, echocardiography and an assay of biological markers. RESULTS: for the LV study (LVEF (Tei): before CT: 67.75 ± 5.53, after CT 64.7 ± 5.6%, p = 0.002; LVEF (SBP): before CT: 64.5 ± 3.83, after CT 61.85 ± 1.9%, p <0.001; SLGVG: before CT: -21.85 ± 1.9, after CT: -20.08 ± 1.63%, p <0.001) and for the study of the DV (TAPSE: before CT: 22.9 ± 3.02, after CT: 21 ± 2.86, p = 0.014; SLGVD: before CT: -23.42 ± 2.69, after CT: -21.67 ± 2.6%, p = 0.004). Variations in troponin levels and BNP was not significant. CONCLUSION: anticancer chemotherapy has harmful cardiovascular effects which can be detected and controlled p by echocardiographic monitoring and  biological markers and prevented by the use of protective agents.

Epidemiology of thromboembolic and hemorrhagic events in patients with atrial fibrillation under anti-vitamin K.

BACKGROUND: Atrial fibrillation is the most common heart rhythm disorder in the general population. It is associated with increased cardiovascular morbidity and mortality. Given this risk, anticoagulant therapy is vital. AIM: To estimate the incidence of thromboembolic and hemorrhagic events in patients with Atrial fibrillation and treated by oral anticoagulant in a cardiology department. METHODS: We carried out an observational longitudinal study over a period of three years (January 2013 - December 2015) in the external consultation of cardiology of Farhat Hached hospital of Sousse. Pre-established individual records were used as a source and tool for data collection. RESULTS: Overall, 200 patients were eligible. Forty-nine percent had valvular atrial fibrillation. After an average follow-up of 2.6 years, 15 thromboembolic events were noted affecting 13 patients (6.5%), with an incidence of 2.8%. We found a significant association between TTR <50% and the occurrence of stroke and transient ischemic events. Half of the patients had minor bleeding and 9.5% had major bleeding, with an incidence of 3.6%. No significant correlation between these accidents and the TTR was found. In addition, 9.5% of patients were hospitalized for international normalized ratio equilibration. They were mainly patients with valvular atrial fibrillation (72%) (p = 0.002). CONCLUSION: Anticoagulant therapy with anti-vitamin-K remains the most adequate treatment. Thus, a well-conducted treatment ensures a reduction in thromboembolic risk and minimizes the occurrence of hemorrhages inherent to this therapy. Therefore, an assessment of the quality of anticoagulation is essential.

[Study of unexpectedly detected repolarization in a group of black athletes]. / Etude de la repolarisation chez les sportifs de race noire.

INTRODUCTION: Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. METHODS: We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. RESULTS: Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. CONCLUSION: Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.

[Incidence of adverse events associated with the peripheral venous catheter in a Tunisian university hospital]. / Incidence des événements indésirables associés au cathéter veineux périphérique dans un service de cardiologie, Tunisie.

OBJECTIVE: To determine the incidence of peripheral venous catheters-related adverse events (PVCAEs). METHODS: We conducted a prospective observational study in the cardiology department over a period of 3 months. All inserted PVCs were monitored (every 12 hours) from insertion to up to 48 hours after removal. RESULTS: Data were analyzed for 148 patients with a mean age of 63.37±12.26 years and male predominance (n=76, 51.4%). The most common medical history was high blood pressure (56.1%) followed by obesity (39.2%). Intake of antibiotics was noted in 16.2% of cases where amoxicillin-clavulanic acid was the most prescribed molecule (4.1%). A total of 210 PVCs was studied (794 PVC-days). The mean maintenance time was 5.36±3.95 days. 38 PVCs resulted in 70 AEs with an incidence of 33.33 % (8.81 per 1000 PVC-days). The most common complication was pain (n=35, 50%), followed by mechanical PVCAEs (n=22, 31.42%). CONCLUSION: The incidence of PVCAEs remains high. The analysis of the main risk factors for these AEs would make better the identification of the preventive actions that should be undertaken.

Clinical features and prognosis of infective endocarditis in children: Insights from a Tunisian multicentre registry.

BACKGROUND: Infective endocarditis (IE) is a rare condition in the paediatric setting. No data on the epidemiology and prognosis of IE in children are available from North African countries. AIM: To investigate the epidemiological profile and prognosis of IE in children in Tunisia. METHODS: All patients aged≤18 years presenting with IE in three Tunisian tertiary care centres between January 1997 and September 2013 were included. Clinical features and 30-day and 6-month mortality rates were studied. Factors predictive of death at 6-month follow-up were determined. RESULTS: A total of 73 patients were included in the present study. The mean age was 12±4.8 years; 35 (50.7%) patients were male. Rheumatic heart disease (RHD) was the underlying heart disease in 17 (23.3%) cases and IE occurred in a structurally normal heart in 36 (49.3%) cases. Staphylococcus species were isolated in 17 (23.3%) cases. Regarding IE localization, the mitral valve was involved in 28 (38.4%) cases and the aortic valve in 14 (19.2%) cases. Recourse to surgery was reported in 37 (50.7%) cases. Thirty-day and 6-month mortality rates were 13.6% and 19.2%, respectively. Heart failure on admission or during the hospital course, acute renal failure and neurological complications were significantly associated with death at 6-month follow-up in the univariate analysis and after adjustment for age and sex. CONCLUSIONS: In the Tunisian context, IE in children is still characterized by the high prevalence of RHD as an underlying heart disease. Short- and long-term mortality rates remain high. Heart failure, acute renal failure and neurological complications are significantly associated with death at 6-month follow-up.

Low erythrocyte catalase enzyme activity is correlated with high serum total homocysteine levels in Tunisian patients with acute myocardial infarction.

BACKGROUND: An imbalance between pro-oxidants and antioxidant systems has been suggested to be implicated in the physiopathology of acute myocardial infarction (AMI). We aimed to evaluate the antioxidant capacity in Tunisian patients and to assess the possible relationship between erythrocyte catalase enzyme activity and hyperhomocysteinaemia. METHODS: 108 patients with AMI and 81 healthy subjects were enrolled in this study. Catalase erythrocyte enzyme activity was determined spectrophotometrically whereas "total antioxidant status" (TAS) concentration was measured by a commercially available method. Serum total homocysteine (tHcy) level was determined by a fluorescence polarization immunoassay (FPIA). Lipid peroxidation was measured with a fluorimetric method as "thiobarbituric acid reactive substances" (TBARS). RESULTS: Compared with healthy subjects, patients with AMI had significantly lower catalase activity (P<0.001), TAS concentrations (P<0.001), and significantly higher serum tHcy (P<0.001) and TBARS levels (P<0.001). Erythrocyte catalase enzyme activity was negatively correlated with serum tHcy and TBARS while serum tHcy and TBARS were in positive correlation. Furthermore, the unbalance between pro-oxidants and antioxidants seems to be more aggravated in patients with Q wave AMI compared to patients with non-Q wave AMI. CONCLUSION: Our results suggest the involvement of hyperhomocysteinaemia in the drop of erythrocyte catalase activity related to myocardial ischemia reperfusion. Hyperhomocysteinaemia may increase the myocardial wall dysfunction under ischemia reperfusion by excessive production of reactive oxygen species which is made evident by increased lipid peroxidation. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1623509866881834.

[Peripartum dilated cardiomyopathy]. / Cardiomyopathies dilatées du péripartum.

AIM: To analyze the clinical characteristics and to evaluate the different factors that influences the prognosis of the peripartum cardiomyopathy (PPCM). METHODS: A retrospective review was undertaken on records of women who were diagnosed with peripartum cardiomyopathy at Farhat Hached Hospital (Sousse) between January 1992 and December 2004. RESULTS: Clinically, PPCM shows pulmonary symptoms such as dyspnea and tachypnea. The diagnosis is established by echocardiography that showed decreased systolic function of the left ventricular. Both gynecologist and cardiologist must check the patients regularly. No patient died. Three preterm pregnancies occured with 9 health newborns (2 sets of twins). One miscarriage took place. PPCM is often undetected or misdiagnosed because of the low incidence and the unspecific symptoms. The treatment is also unspecific and similar to dilated cardiomyopathy or acute cardiac failure. CONCLUSION: Early diagnosis of the peripartum cardiomyopathy is extremely important. Pregnancy in patients with dilated cardiomyopathy is associated with maternal and fetal morbidity. Left ventricular function is a prognostic factor and must be the most parameter when conseling patients with peripartum cardiomyopathy about a new pregnancy.

Epidemiology of infective endocarditis in Tunisia: a 10-year multicenter retrospective study.

BACKGROUND: Since the first description of infective endocarditis, the profile of the disease has evolved continuously with stable incidence. However, epidemiological features are different in developing countries compared with western countries. OBJECTIVE: To describe epidemiological, microbiological and outcome characteristics of infective endocarditis in Tunisia. PATIENTS AND METHODS: This was a descriptive multicenter retrospective study of inpatients treated for infective endocarditis from 1991 to 2000. Charts of patients with possible or definite infective endocarditis according to the Duke criteria were included in the study. RESULTS: Four hundred and forty episodes of infective endocarditis among 435 patients (242 males, 193 females; mean (SD) age=32.4 (16.8) years, range 1-78 years) were reviewed. The most common predisposing heart disease was rheumatic valvular disease (45.2%). Infective endocarditis occurred on prosthetic valves in 17.3% of cases. Causative microorganisms were identified in 50.2% of cases: streptococci (17.3%), enterococci (3.9%), staphylococci (17.9%), and other pathogens (11.1%). Blood cultures were negative in 53.6% and no microorganism was identified in 49.8%. Early valve surgery was performed in 51.2% of patients. The in-hospital mortality was 20.6%. CONCLUSION: Infective endocarditis is still frequently associated with rheumatic disease among young adults in Tunisia, with a high frequency of negative blood cultures and high in-hospital mortality, given that the population affected is relatively young.

Echinococcosis of the heart: clinical and echocardiographic features in 12 patients.

UNLABELLED: We describe the clinical and echocardiographic features in 12 patients with hydatid cyst of the heart who were screened between 1985 and 2001. Presenting symptoms have a wide variability but the main symptom was precordial pain. The electrocardiogram was always abnormal and showed T wave inversion in 8 cases, ST depression in 5 cases, incomplete right bundle-branch block in one case and atrial fibrillation in one case. Transthoracic echocardiography and transoesophageal echocardiography constitute the imaging procedure of choice for the diagnosis of cardiac hydatid cyst with a high sensibility, specificity. Computed tomography (CT) was performed in all patients and confirmed the echocardiographic data. MRI was performed in one patient with right atrium hydatid cyst location and confirmed the echocardiographic data. CONCLUSION: In the presence of atypical symptomatology in a patient coming from an endemic area of hydatid cyst, the diagnosis of cardiac echinococcosis is possible.TTE and TEE are the imaging procedure of choice and sufficient for the diagnosis of cardiac hydatid cyst. CT and/or MRI provide more information about the extension of echinococcus disease in other intra- or extrathoracic locations.

[Surgically treated chronic aortic insufficiency: prognostic value of preoperative echocardiography]. / Insuffisance aortique chronique opérée: valeur pronostique des données échocardiographiques préopératoires.

Between March 1979 and December 1998, 38 patients with isolated chronic aortic insufficiency underwent aortic valve replacement. The aim of this study is to determine whether preoperative echocardiography parameters are useful in predicting operative results in patients with aortic valve replacement for chronic aortic insufficiency. The global survival is 92% in one year and 89% in ten years. We conclude that on end systolic left ventricle diameter < 55 mm has good prognosis (p = 0.019) and there is a strong correlation between preoperative end systolic and post operative end systolic diameter an end diastolic left ventricular diameter > 70 mm and a left ventricular fractional shortening < 25% weren't predictive of a poor prognosis.