Abstract Background Cardiovascular toxicity related to cancer therapies has become a major concern in breast cancer management, particularly in low- and middle-income countries where access to structured cardio-oncology services remains limited. Data from North African populations are scarce despite potential regional specificities in cardiovascular risk profiles, cancer characteristics, and treatment patterns. This study aimed to describe the cardio-oncological profile of breast cancer patients followed in a North African tertiary center. Methods We conducted a prospective descriptive study including breast cancer patients referred to a dedicated cardio-oncology clinic between January 1, 2023 and June 30, 2025. Clinical, oncological, and cardiovascular data were collected from medical records. Variables included demographic characteristics, cardiovascular risk factors, cancer stage, oncological treatments, baseline and follow-up cardiac function, and treatment-related cardiotoxicity. Cancer therapy–related cardiac dysfunction (CTRCD) was defined according to current international guidelines. Results A total of 150 patients were included, with a mean age of 58 ± 12.6 years; all patients were female. At baseline, the most prevalent cardiovascular risk factors were hypertension (47.3%), dyslipidemia (29.3%), and diabetes (26.7%). Regarding cancer characteristics, 26.7% of patients had locally advanced or metastatic disease. The main oncological treatments received were trastuzumab (58.6%), anthracyclines (44.6%), radiotherapy (43.3%), taxanes (17.3%), pertuzumab (14.6%), and alkylating agents (13.3%). Only two patients received immunotherapy and nine received hormone therapy. At baseline, mean left ventricular ejection fraction (LVEF) was 60.1% ± 7.8% and mean global longitudinal strain (GLS) was –19.2% ± 3.1%. During follow-up, CTRCD occurred in 33.3% of patients. Echocardiographic reassessment demonstrated a significant decline in systolic function, with mean LVEF decreasing to 52.9% ± 9.1% (p < 0.001) and mean GLS worsening to –17.3% ± 3.1% (p = 0.001). Cardio-protective therapy was prescribed in all cases of cardiotoxicity. Conclusion This study provides one of the first comprehensive descriptions of cardio-oncological profiles in breast cancer patients from North Africa. The high prevalence of cardiovascular risk factors and treatment-related cardiac dysfunction underscores the need for structured cardio-oncology programs in the region. Larger studies with longer follow-up are required to better characterize long-term cardiovascular outcomes and optimize preventive strategies.

Introduction Heart failure with reduced ejection fraction (HFrEF) is a major cause of morbidity and mortality, often linked to abnormal cardiac repolarization and an increased risk of arrhythmias. Dapagliflozin, an SGLT2 inhibitor, has demonstrated potential benefits in managing heart failure, but its effects on repolarization markers in HFrEF patients remain unclear. This study aims to evaluate the impact of dapagliflozin on QT interval and other repolarization markers, and to explore their association with reverse remodeling. Objective The aim of the study is to evaluate the effect of dapagliflozin on ventricular repolarization markers in patients with HFrEF, and to assess whether these changes are associated with reverse remodeling. Method This retrospective study included patients referred to our cardiology department between February 2022 and June 2023 for the evaluation of HFrEF. Electrocardiograms (ECGs) were performed before the initiation of dapagliflozin and 6 months later to assess ventricular repolarization parameters, including the QT interval, QTc (corrected using the Bazett formula), QT dispersion (QTd), QTc dispersion (QTc-d), Tpeak to Tend (Tp-e) interval, as well as Tp-e/QT and Tp-e/QTc ratios. Results A total of 50 patients in sinus rhythm were included. The mean age was 60.88±11.36 years old, and 11 (22%) were female patients. The mean ejection fraction was 30.86±7.2%. After introduction of Dapagliflozin we noticed a significant decrease in QTc intervals (430.74±33.81ms vs 408.74±32.45ms; P<0.001), QT-d (54±19.24ms vs 36.2±11.8ms; P<0.001), and Tp-e interval (95.8±24.83ms vs 74.8±22.87ms; P<0.001). There was no significant difference in the variation of repolarization markers between patients who had reverse remodeling (17 patients) and those who did not (33 patients). Specifically, ΔQTc (P=0.728), ΔQTd (P=0.849), ΔQTc-d (P=0.377), ΔTpTe (P=0.103), ΔTpTe/QT (P=0.07), and Δf(QRS-T) (P=0.51) showed no significant difference between the two groups. Conclusion The introduction of dapagliflozin in patients with HFrEF resulted in significant improvements in repolarization markers. However, the variation in these markers did not significantly differ between patients with and without reverse remodeling, These findings suggest that dapagliflozin may influence cardiac electrophysiology, but its effects on repolarization markers appear to be independent of reverse remodeling in this cohort.

Abstract Background Heart failure with reduced ejection fraction remains associated with high mortality and rehospitalisation rates. Myocardial work has emerged as a novel echocardiographic parameter providing a comprehensive assessment of myocardial performance and may offer incremental prognostic value beyond conventional measures. Purpose This study aimed to evaluate the prognostic value of myocardial work for adverse cardiac outcomes in patients with heart failure and reduced ejection fraction. Methods In this prospective study, we enrolled 78 patients with heart failure and reduced ejection fraction between January 2025 and October 2025. Standard echocardiographic parameters and myocardial work indices were measured. Patients were followed for a composite outcome of all-cause mortality and unplanned heart failure hospitalisations. Results The mean age was 62±12 years with a sex-ratio of 4. Ischemic cardiomyopathy was the most common heart failure etiology (66%). Mean left ventrile ejection fraction (LVEF) was 29±8%. Mean global work index (GWI) was 718±359mmHg% and mean global work efficiency (GWE) was 79±7%. Twenty-six (33%) patients reached the composite outcome with a mean time to event of 7 months (range 2-11 months). On univariate analysis, GWI was significantly associated with the composite outcome (Hazard ratio [HR] 0.998, 95% confidence interval [CI] 0.997–0.999, p=0.04) while LVEF (HR 0.98, 95% CI 0.93–1.03, p=0.38) and GWE (HR 0.98, 95% CI 0.94–1.02, p=0.16) were not. On multivariate analysis, GWI remained independently associated with the composite outcome (p=0.03) after adjustment for LVEF. Conclusion Global work index is significantly associated with adverse cardiac outcomes in heart failure with reduced ejection fraction and may serve as a tool for risk stratification warranting validation in further studies.

Introduction Recent studies indicate that dapagliflozin may improve repolarization markers in individuals with chronic heart failure and reduced ejection fraction (HFrEF), potentially reducing the risk of ventricular arrhythmias and sudden cardiac death. However, the extent to which this effect is similar between male and female patients is still uncertain and requires further exploration. Objective The objective of this study is to explore potential gender differences in the effects of dapagliflozin on repolarization markers in patients with chronic HFrEF. Method This retrospective study included patients referred to our cardiology department between February 2022 and June 2023 for the evaluation of HFrEF. Electrocardiograms (ECGs) were performed prior to the initiation of dapagliflozin and after 6 months. Various repolarization parameters were measured, including the QT interval, corrected QT interval (QTc, using the Bazett formula), QT dispersion (QTd), QTc dispersion (QTc-d), Tpeak to Tend (Tp-e) interval, Tp-e/QT ratio, Tp-e/QTc ratio and f(QRS-T) angle. Results A total of 50 patients in sinus rhythm were included, with a mean age of 60.88±11.36 years, and 11 (22%) were female. We compared the variation in repolarization parameters (VRM) between male and female patients following the introduction of dapagliflozin. Significant gender differences were observed in the changes of several parameters: ΔQTc was greater in females (23.79±35.76ms vs. 15.64±21.72ms, P=0.021); ΔTp-e was greater in females (30.91±13.75ms vs. 18.21±20.37ms, P=0.05); ΔTp-e/QT was higher in females (0.08±0.03 vs. 0.05±0.05, P=0.016); ΔTp-e/QTc was more pronounced in females (0.07±0.03 vs. 0.03±0.04, P=0.004); and Δf(QRS-T) was higher in females (8.2±3.48° vs. 5.5±2.56°, P=0.02). No significant gender differences were observed in ΔQTd or ΔQTc-d. Conclusion Our study reveals significant sex-specific differences in the variation of repolarization parameters following dapagliflozin treatment in patients with HFrEF including the QTc interval, Tp-e interval, and Tp-e/QTc ratio, compared to male patients. These findings suggest that gender may influence the response to dapagliflozin, emphasizing the need for further research to explore the underlying mechanisms and potential clinical implications of these sex-specific changes in repolarization.

Introduction Dapagliflozin has emerged as an effective treatment for chronic heart failure with reduced ejection fraction (HFrEF), with established benefits on heart failure symptoms and clinical outcomes. However, its effects on cardiac repolarization, particularly the QRS-T angle, remain under investigation. The QRS-T angle is a recognized marker of arrhythmic risk, and understanding how dapagliflozin influences this parameter could provide valuable insights into its broader cardiovascular effects. Objective The aim of this study is to investigate the effect of dapagliflozin on the QRS-T angle in patients with chronic HFrEF to better understand its influence on cardiac repolarization. Method This retrospective study included patients referred to our cardiology department between February 2022 and June 2023 for the assessment of hHFrEF. All patients were receiving a stable regimen of beta-blockers, angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists. Electrocardiograms (ECGs) were performed before and six months after the initiation of dapagliflozin. The QRS-T angle in the frontal plane was measured prior to and following dapagliflozin treatment to evaluate any changes. Results A total of 50 patients in sinus rhythm were included in this study, with a mean age of 60.88±11.36 years. Among them, 11 (22%) were female, and the mean ejection fraction was 30.86±7.2%. The cohort had common comorbidities, with 48% of patients reporting diabetes, 30% having hypertension, and 20% diagnosed with chronic kidney disease. We compared the QRS-T angle before and after the introduction of dapagliflozin. Our analysis revealed a significant decrease in the QRS-T angle, from 71.50±24.50° prior to dapagliflozin treatment to 64.25±32.60° after 6 months (P=0.03). This change suggests that dapagliflozin may influence cardiac repolarization, which could have implications for arrhythmic risk. Conclusion In conclusion, our study indicates that dapagliflozin treatment in patients with chronic HFrEF leads to a significant decrease in the QRS-T angle. This reduction in the QRS-T angle may reflect favourable changes in cardiac repolarization. These results suggest that dapagliflozin could have potential benefits in improving electrical stability in the heart.

Abstract Background Heart failure (HF) continues to be a prevalent condition with high morbidity and mortality. To address this, we established a Heart Failure Therapeutic Unit (HFTU) focused on promptly optimizing medical treatment. Purpose The primary objective was to evaluate the impact of the HFTU on reducing cardiovascular mortality and HF rehospitalizations at 1 year. Secondary objectives included assessing the impact of the HFTU on treatment dose optimization. Methods We conducted a prospective, longitudinal, and single-center study with a 1 year follow-up period. The HFTU group received frequent follow-ups and rapid medication optimization, while the control group received standard care. Results We included 299 patients with chronic HF, 234 in the HFTU group and 65 in the control group. The mean age was 63,4±11,6 years, with a predominance of males (76,3%) and a high prevalence of ischemic cardiomyopathy (55.9%). At inclusion, the mean left ventricular ejection fraction (LVEF) was 32.5±10.3%. The HFTU group demonstrated a significant reduction in cardiovascular mortality and HF rehospitalizations (11.1% vs 41.5%, p<0.001), as well as a significant decrease in HF rehospitalizations (6.4% vs 36.9%, p<0.001), compared to controls, irrespective of age, gender, comorbidities and LVEF. Optimal medical treatment was more common in the HFTU group (p<0.001), alongside improvements in dyspnea (p<0.001), LVEF (from ≤ 40% to > 40%) (p=0.003) and heart rate control (HR<70bpm) (p=0.007). Conclusion The HFTU significantly reduced the combined endpoint of cardiovascular mortality and HF rehospitalizations, as well as HF rehospitalizations alone, while improving medication optimization, symptoms, LVEF, and heart rate control, demonstrating its efficacy in managing HF.

Introduction Non-ST-segment elevation myocardial infarction (NSTEMI) in patients with type 2 diabetes mellitus (T2DM) is frequently associated with increased inflammation and myocardial injury. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) show cardiovascular benefits in chronic care, but their role in acute ischemia remains uncertain. Objective To assess whether chronic use of SGLT2-I in T2DM patients admitted for NSTEMI is associated with reduced systemic inflammation, infarct size, and improved left ventricular function. Method This retrospective, monocentric study included 60 T2DM patients hospitalized for NSTEMI at Abderrahmen Mami Hospital between December 2024 and April 2025. Patients were divided into two groups: 21 on chronic SGLT2-I (Dapagliflozin, ≥3 months use) and 39 without prior SGLT2-I therapy, initiation of SGLT2-I was planned upon discharge. Inflammatory markers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR)), infarct size (peak troponin, affected myocardial segments), and left ventricular ejection fraction (LVEF) were assessed. HbA1c and renal function (eGFR) were also evaluated. Results SGLT2-I users had significantly lower CRP (17.8±20.1 vs 35.7±32.8mg/L, P=0.011), NLR (2.9±1.1 vs 3.9±1.6, P=0.02), and PLR (102.5±35.2 vs 132.1±48.7, P=0.03) (Fig. 1). Peak troponin was markedly reduced (1273.6±1473, median: 500ng/L vs 6100.2±10824ng/L, median: 1200ng/L, P=0.009). LVEF, assessed by the Simpson biplane method, was significantly higher in the SGLT2-I group: 53.0±9.4% (median: 52.7%), with 71.4% of patients having LVEF>50%, compared to 48.0±10.1% (median: 47.7%) and 38.5% with LVEF>50% in the non-SGLT2-I group (P=0.002), with fewer affected myocardial segments (1.6 vs 2.4). HbA1C was lower (7.7±1.5% vs 8.5±1.2%, P=0.16), though not significant. Renal function was assessed using the MDRD formula. Two patients (3.3%) had an estimated glomerular filtration rate below 30mL/min/1.73m2, both from the non-SGLT2-I group. Overall, 96.7% of patients had an eGFR above 30mL/min/1.73m2. Conclusion Chronic SGLT2-I use in T2DM with NSTEMI may be associated with reduced inflammation, smaller infarcts, and better cardiac function.

Background Cancer therapy-related cardiac dysfunction (CTRCD) is a significant adverse effect of cancer treatments, particularly in breast cancer patients receiving chemotherapy and/or radiation. Objectives This study describes the trajectory of CTRCD in this population. Methods A retrospective study was conducted on 77 breast cancer patients who completed chemotherapy. Demographic, clinical, and echocardiographic data were extracted from medical records. The severity of cardiotoxicity was classified as mild, moderate, or severe. Treatment patterns and recovery rates were assessed. Results Among the 77 patients (mean age 49.1 years), 94.9% received chemotherapy, with 57.7% receiving both anti-HER2 and anthracyclines, 29.5% anthracyclines alone, and 7.7% anti-HER2 alone. Hypertension (19.2%) was the most prevalent cardiovascular risk factor, followed by diabetes (14.1%). Risk stratification (HFA-ICOS) classified 79.5% as low risk, 11.5% as moderate, and 5.1% as high/very high risk. CTRCD occurred in 42.3% of patients, predominantly during chemotherapy (87.9%), with a mean onset of 9.6 months post-treatment. Cardiotoxicity was mild in 75.8%, moderate in 9.1%, and severe in 9.1% of cases, with symptoms in 21.2%. Baseline LVEF declined from 65.7% to 53.1%, and GLS from −21.48 to −16.31 post-toxicity. Regarding management, 60.6% of affected patients received treatment, leading to complete recovery in 51.5% and partial recovery in 9.1%, with a mean recovery time of 6.2 months. Conclusion CTRCD is common in breast cancer patients, mostly occurring during chemotherapy. Despite declines in LVEF and GLS, treatment led to significant recovery. These findings emphasize the importance of early detection, regular monitoring, and timely intervention to mitigate cardiotoxicity risks.

Thrombotic events are present at higher rates among COVID-19 patients. Prophylactic use of parenteral anticoagulants during hospitalisation is recommended to reduce the risk of complications. In this context, the Tunisian Anticoagulation Survey in COVID-19 patient General Practice experience (TASC-GP) was conducted. The evaluation of the incidence of venous thromboembolic events (VTE) and bleedings in COVID-19 patients treated in ambulatory. The TASC-GP is an observational, multicenter study included 3,383 patients from July to October 2021. The following up of patients was done 35 days after inclusion date with investigation of VTE and bleeding events. The four main enrolment criteria were: 1) age ≥ 18 years; 2) confirmed COVID-19 infection; 3) treated as an outpatient; 4) initiation of Rivaroxaban 10 mg/d. Patients were excluded if any of the following criteria applied: 1) the use of anticoagulant or thrombolytic drugs other than Rivaroxaban on admission or within days of admission; 2) the use of any dosage other than that specified in the study protocol. The mean age of the population was 51.6 ± 15.5 years with a sex ratio of 0.67, 30.7% of the population had hypertension, 23.4% were diabetic and 34.9% were obese. At least one cardiovascular comorbidity was observed in 40% of cases and 9.5% had chronic respiratory disease. The mean IMPROVE and IMPROVE DDimer scores were 0.65 ± 0.9 and 1.4 ± 1.4, respectively. The mean Improve bleeding score was 1.4 ± 1.5. A VTE was reported during follow-up in 39 patients (1.15%). Diabetes and chronic respiratory disease were independent factors for the occurrence of VTE with an odd ratio of 2.2 [95% CI 1.1–4.2] (P = 0.017) and 3.2 [95% CI 1.5–6.4] (P = 0.002) respectively. IMPROVE and IMPROVE DDimer scores were comparable in patients with and without VTE. There was no statistically significant increase in the rate of major bleeding (0.001%). The IMPROVE Bleeding score was comparable in the bleeding and non-bleeding groups at follow-up. There were no predictive factors for bleeding. Our study is in agreement with the literature concerning a decrease in the rate of thrombembolic complications when using prophylactic anticoagulation versus placebo. Other VTE estimation scores including chronic respiratory disease and diabetes can be proposed. The use of Rivaroxaban in this population was not associated with increased bleeding.

IntroductionSeveral studies suggest that preexisting of cardiovascular comorbidities are associated with an increased risk of mortality following COVID-19 infection. However, it remains unclear how COVID-19 prognosis differs between different types of cardiovascular comorbidities. In this way the Tunisian Anticoagulations Survey in COVID-19 patients General Practice experience (TASC-GP) was conducted.ObjectiveAnalysis of cardiovascular comorbidities in patients included in the TASC-GP study and their impact on the prognosis.MethodThe TASC-GP is an observational, multicenter study done between July 2021 and October 2021 included 3383 COVID-19 patients treated in ambulatory. Baseline characteristics and mortality rates were compared between patients with cardiovascular comorbidities and those without cardiovascular comorbidities. Statistical analysis was performed with SPSS (IBM, Chicago, IL).ResultsThe mean age was 51.6±15.5years with a sex ratio of 0.67. Forty percent of patients had at least one cardiovascular comorbidity. The distribution of cardiovascular comorbidities in the population was as follows: arterial hypertension in 1042 patients (30.7%), ischemic heart disease in 158 patients (4.6%) and heart failure in 121 patients (3.6%). Patients with at least one cardiovascular comorbidity had significantly more severe forms of COVID-19 compared to patients without comorbidities (10.8% vs. 5.6% P<0.001). Deaths occurred mostly in patients with cardiovascular comorbidities (2.9% vs. 0.3%, P<0.001).ConclusionCardiovascular comorbidities are common in ambulatory patients with COVID-19 dominated by hypertension and ischemic heart disease. Cardiovascular comrobidities have a pejorative impact on the prognosis of patients hospitalized for COVID-19.

IntroductionAmong patients with Coronavirus disease 2019 (COVID-19), coronary artery disease (CAD) has been identified as a high-risk condition. The TASC GP study (Tunisian Anticoagulation Survey in COVID-19 patient General Practice experience) is an observational, multicenter survey in ambulatory patients with COVID-19.ObjectiveThe aim of this sub study was to assess the clinical characteristics and outcomes among patients with COVID-19 and a history of CAD.MethodWe examined between July 2021 and October 2021 ambulatory patients with COVID-19. Baseline characteristics and mortality rates were compared between those with history of CAD and those without history of CAD. CAD was defined as a history of prior percutaneous coronary intervention, prior coronary artery bypass grafting or CAD that was being medically treated.ResultsThe study population included 3412 ambulatory patients with COVID-19. History of CAD was reported in 158 patients (4.6%). Patients with CAD were older 66.6±11.2years vs. 51±15.4years (P<0.001), had more hypertension 84% vs. 28% (P<0.001), diabetes 63% vs. 21% (P<0.001) and heart failure (40% vs. 1.8% P<0.001) and they had more severe forms of COVID-19 (19% vs. 7.1%; P<0.001) and lower saturation of oxygen (93.7±4% vs. 95.6±2.9% P<0.001) with a higher prevalence of use of oxygen therapy (48.9% vs. 20%). They had higher inflammatory markers (white blood counts 19,434 elts/mm3 vs. 12,096 elts/mm3; CRP 74.1±64.3mg/L vs. 50.8±93.1mg/L). Mortality rate was higher among patients with history of CAD (7.2% vs. 1.1%; P<0.001).ConclusionPatients with COVID-19 and a history of CAD have a higher risk of mortality, which can be attributable to the age and comorbidities.

Several comorbidities have been associated with an increased risk of severity and mortality in coronavirus disease 2019 (COVID-19). The TASC GP study (Tunisian Anticoagulation Survey in COVID-19 patient General Practice experience) is an observational, multicenter survey in ambulatory patients with COVID-19. The purpose of this sub study analysis was to evaluate clinical characteristics and outcomes in ambulatory patients with COVID-19 infection and a history of heart failure (HF) We examined between July 2021 and October 2021 ambulatory patients with COVID-19. Baseline characteristics and mortality rates were compared between those with history of HF and those without history of HF. The study population included 3,406 patients. History of HF was reported in 121 patients (3.5%). Compared to patients without history of HF, patients with HF were older 71.1 ± 14.3 years vs. 51 ± 15.2 years (P < 0.001), had more hypertension 88.4% vs. 28.5% (P < 0.001), diabetes 63% vs. 21.8% (P < 0.001), ischemic heart disease (52.1% vs. 2.8% P < 0.001) and had higher heart rates (92.5 ± 18.6 bpm vs. 88.4 ± 14.6 bpm P < 0.003). They had more severe forms of COVID-19 (26.7% vs. 6.9%; P < 0.0013) and lower saturation of Oxygen (92.7 ± 3.5% vs. 95.6 ± 2.9% P < 0.0010). They had higher inflammatory markers (white blood counts 26040.6 ± 44896.9 elts/mm3 vs. 11872.3 ± 23368 elts/mm3 P < 0.001; CRP 87.5 ± 66.8 mg/L vs. 50.6 ± 92.4 mg/L P = 0.003). Hospitalization and mortality rates were higher among patients with history of HF (18.3% vs. 3.3% P < 0.001; 7.9% vs. 1.2% P < 0.001). Patients with heart failure are at increased risk for hospitalization, poor outcome, and death from COVID-19. Patients with HF hospitalized with COVID-19 are at high risk for complications, with higher rates of mortality. This may be in large part due to age and comorbid conditions.

Introduction: many healthcare resources have been and continue to be allocated to the management of patients with COVID-19 This pandemic influenced our healthcare system aiming at a minimum of contact between patients and professionals We tried to study the impact of this disease, on cardiac patients under anticoagulation with vitamin K antagonists (VKA) and to propose an algorithm to facilitate their monitoring Materials and method: This is a retrospective, descriptive study including patients on VKA hospitalized at the Ariana cardiology department or arriving at the outpatient clinic or contacted by telephone during the month of August 2020 Results: A total of 100 patients were collected The average age was 61 59 years old 58% of the patients did not know their target international normalized ratio (INR) During lockdown period, only 49% of patients monitored their INR 71 7% of blood samples were taken in a private laboratory and 27 3% in another nearby public structure To adjust their treatment, 20% of patients called their treating physicians, 31% saw another physician while 49% adjusted the doses on their own After reopening, 54% of patients did not visit the hospital for one month At the time of the first medical contact, 57% of the INRs were in the therapeutic zone There is a significant relationship between therapeutic education and the regularity of the INR control in lockdown (p = 0 01) and between the regularity of the INR monitoring and an INR after lockdown in a therapeutic zone (p = 0 000) In the light of our results, we proposed an algorithm for the management of anticoagulant therapy in uninfected patients Conclusion: The need to observe social distancing or lockdown rules should not affect the quality and safety of anticoagulant therapy Therefore, we strongly urge clinicians to ensure patients receiving VKA therapy are appropriately managed despite the COVID-19 crisis

The survival rate of breast cancer patients has been improved thanks to the progress accomplished in chemotherapy therapeutics and targeted therapies. However, cardiovascular side effects have increased. Cancer therapeutics-related cardiac dysfunction (CTRCD) is a serious side effect of anti-cancer treatment. The aim of our study was to determinate the role of echocardiography in the detection of CTRCD. This was a longitudinal, prospective and monocentric study. Eighty female patients diagnosed with breast cancer and addressed to the echocardiography lab of Ariana hospital, were enrolled between 2017 and 2019. An echocardiographic monitoring were realised according to the chemotherapy protocol. CTRCD is defined as a drop of left ventricular ejection fraction (LVEF) by > 10 percentage points from baseline to a value < 50%. A new entity named subclinical systolic dysfunction, is defined by drop of global longitudinal strain (GLS) by > 15% from baseline, however, LVEF remains > 50%. The average age of our patients was 49.9 ± 10.8 years. The mean LVEF was at 64 ± 4.4%. The incidence of CTRCD was 6% (5 patients). It was reversible in 3 cases after the initiation of a cardioprotective treatment. The incidence of subclinical cardiac dysfunction was 25%. Cardioprotective treatment was administered in this case and none of them evolved to CTRCD. At univariate analysis, baseline LVEF between 50 and 55% (P < 0.001), GLS decrease (P < 0.001) and adriamycin administration (P = 0.01) were predictive factors of cardiotoxicity. At multivariate analysis, only borderline baseline LVEF between 50% and 50% was a predictive factor of CTRCD (P = 0.002). Echocardiographic monitoring of breast cancer patients revealed a CTRCD in 5 cases (6%). GLS allowed the diagnosis of a subclinical cardiac dysfunction in 25% of cases. In breast cancer patients, both Simpson biplane LVEF and GLS should be assessed.