[Risk factors for hospital mortality during pulmonary embolism]. / Facteurs de risque de mortalité hospitalière au cours de l'embolie pulmonaire en milieu de pneumologie.

OBJECTIVES: The objective of our work is to identify the risk factors for hospital mortality during pulmonary embolism in a pneumology department. MATERIAL AND METHOD: All patients admitted to the pneumology department of Habib-Bourguiba hospital between 2014 and 2019, with a final diagnosis of PE are analyzed. RESULTS: One hundred patients were included, 62% of whom were female, with an average age of 63±16 years. Pulmonary fibrosis was noted in eight patients. On admission, the mean Simplified Pulmonary Embolism Severity Index score was 1.46±1.05. The mean duration of hospitalization was 10.6±7 days. The hospital mortality rate was 12%. The independent risk factors for intra-hospital mortality were arterial hypotension (OR: 6.13; 95%CI: 2.88-14.35; p=0.001), cancer (OR: 2.66; 95%CI: 1.22-9.54; p=0.026), a VD/LV ratio at echocardiography>0.9 (OR: 1.84; 95%CI: 1.06-7.69; p=0.039) and severe hypoxemia (OR: 4.86; 95%CI: 2.19-11,34; p=0.006). CONCLUSION: Pulmonary embolism mortality remains high despite improvements in diagnostic and therapeutic management. It is important for our country to take these results into consideration for a better management of patients admitted for pulmonary embolism, and to improve survival.

Interest of speckle tracking in the detection of cardiac involvement in pregnant women with hypertensive disorder.

INTRODUCTION: Pre-eclampsia is associated with many cardiovascular disorders present even in asymptomatic women. Several echocardiographic parameters are used to identify them. However, these parameters may be normal until late in the course of the disease process. Which justifies using new and more sensitive techniques. PURPOSE: We sought to test the hypothesis of subclinical cardiac involvement in such patients, based on speckle tracking, and to check its sensitivity compared to the usual methods. METHODS: We conducted a comparative case-control study, which included thirty pregnant women with hypertensive disorder and thirty healthy ones. The filling pressure of the left ventricle (LV) and strain peaks are measured for all women. RESULTS: Usual parameters were in favour of diastolic dysfunction in patients. Eighteen patients with high LV filling pressure were recorded, eight of them had at least one complication, which corresponded to a specificity of 77% and a sensitivity of 47%. However, global longitudinal strain (GLS) was severely altered in patients (p < .001). Moreover, there was a strong correlation of GLS with the usual parameters. Thus, for a threshold value of -18%, GLS had the best sensitivity of 87% and a specificity of 42% to predict complications. There was no significant difference for the radial and circumferential strain. CONCLUSION: GLS is more sensitive than other usual echocardiographic parameters in the detection of subclinical cardiac dysfunction in pregnant women with hypertensive disorder. It is strongly correlated with complications. Future larger studies could validate the integration of 2D-strain in the management of such patients.

[Contribution of intracoronary imaging in acute coronary syndrome]. / Apport de l'imagerie endocoronaire dans le syndrome coronarien aigu.

Acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in the world, although it has considerably decreased through technical and pharmacological advances. The physiopathological approach of the ACS has progressed considerably in recent years thanks to the anatomopathological work and the data of the endocoronary imaging, in particular of the endovascular ultrasound (IVUS). Plaque rupture is the most common cause of ACS, however OCT (optical coherence tomography) studies have shown that surface plaque erosion was more common than thought. The use of OCT in the ACS may prove to be a valuable diagnostic aid: study of the culpable lesion, spontaneous coronary dissection or intramural spontaneous hematoma, stent thrombosis; from a therapeutic point of view: reduction of the risk of stent malapposition, additional technique, delayed stenting, implantation of a bioresorbable stent, medical treatment of ACS without stenting. Endocoronary imaging, especially OCT, will of course never be systematic as treatment of ACS, but providing excellent value for both diagnosis and treatment, it must be an integral part of the therapeutic arsenal available in cathlab.

[Exercise-induced coronary thrombosis]. / Thrombose coronaire à l'effort.

Heavy exertion as a trigger of cardiac events has been known since antiquity as it was already described in 492 BC in the famous Athens Marathon. Myocardial infarction occurring after physical exertion accounts for about 4% of myocardial infarctions. It is more common in men and younger patients. It usually occurs during intense efforts and especially in inactive people with multiple risk factors. It would be more severe with more frequent Q waves of necrosis on the victims' electrocardiograms, with greater troponin release and a more raised GRACE score. Atherosclerotic plaque rupture is at the center of its pathophysiology, this event is responsible of a thrombus formation occluding the coronary artery. The hemodynamic stress imposed on the often-atheromatous coronary arteries during exercise, favor the plaque rupture and the occurrence of myocardial infarctions. To these hemodynamic constraints, are added biochemical and rheological modifications, which favor the formation of an intra-coronary thrombus. The occurrence of acute coronary events during heavy exertion in patients who are often untrained must not make us forget about the benefit of regular exercise on both the life quality and morbimortality levels.

[Radial approach in women]. / La voie d'abord radiale chez la femme.

Since the first series of coronary angiographies through the radial approach reported by Campeau in 1989, the radial route has become a major approach, used in up to 95 % of PCIs in some centers. As documented by this clinical case, and although registries show that the radial approach is underused in women compared to men, women benefit from the radial approach mainly by reducing the bleeding risk. Indeed, despite more frequent difficulties encountered by using this approach in women, the radial approach has to be preferred because it reduces haemorrhagic complications and death in comparison to the femoral route.

[Optical coherence tomography applied to vessels: a bright future]. / L'OCT appliquée aux vaisseaux : un avenir prometteur.

Optical Coherence Tomography (OCT) is a new imaging technique recently applied to coronary and is based on the diffusion and reflection of an infrared spectrum. With a resolution 10 times higher than that of IVUS, it allows an analysis of the atherosclerotic plaque and its components, indicating its possible vulnerable character, and can identify the culprit lesion and the presence of thrombus in the course of acute events. It allows quality control of good apposition of stents to the wall and essentially tracks the downstream dissection. In the longer term, it evaluates the endothelisation and in-stent restenosis. Its scope thus extends to basic research and the pharmaceutical industry where it plays a new reference tool in the monitoring of atherosclerotic plaques and stents with drug treatment. This invasive imaging technique is limited by its cost and artifacts but new generation OCT can better overcome them. The OCT appears as a promising intravascular imaging technique whose feasibility and clinical applications, however, require confirmation by randomized clinical trials to better define its place in the cardiac catheterization lab.