Introduction Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease whose clinical presentation and outcomes vary according to the presence of associated cardiac malformations. Objective The aim of this study was to compare isolated and associated forms of ccTGA in order to assess the impact of concomitant anomalies on clinical features and prognosis. Method A retrospective study was conducted in the Department of Cardiology at Hédi Chaker University Hospital in Sfax, including patients with ccTGA followed between 2010 and 2024. Clinical, echocardiographic, and outcome data were analyzed and compared between the two groups defined by the presence or absence of associated cardiac malformations. Results Thirty-seven patients were included in the study, of whom 8 presented with isolated ccTGA and 29 with associated forms. Associated ccTGA showed a more pronounced clinical expression, with higher rates of cyanosis (37.9% vs 12.5%), growth impairment (51.7% vs 0%), and cardiac murmur (79.3% vs 25%). Severe systemic atrioventricular valve regurgitation was comparable between the two groups (13.8% vs 12.5%, P=1.00). Systemic right ventricular dysfunction was also observed with similar frequencies (51.7% vs 50%, P=1.00). Complete atrioventricular block occurred more frequently in associated forms (20.7% vs 12.5%), without reaching statistical significance (P=0.58). Deaths occurred exclusively in the associated group (24.1% vs 0%), though without statistical significance (P=0.31). Conclusion Associated ccTGA is characterized by a more severe clinical presentation and more frequent complications, including richer symptomatology and mortality occurring exclusively in this group. However, the severity of systemic valve regurgitation and systemic right ventricular dysfunction did not differ significantly between isolated and associated forms. These findings highlight the importance of close and specialized follow-up in patients with ccTGA and associated anomalies.

Introduction Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease characterized by atrioventricular and ventriculo-arterial discordance, frequently associated with complex structural and functional anomalies. Cardiac position—variable among patients (levocardia, mesocardia, or dextrocardia)—may influence anatomical features and clinical evolution. Objective The aim of this study was to assess the impact of cardiac position on associated anatomical abnormalities, systemic right ventricular function, severity of systemic atrioventricular valve regurgitation, conduction disorders, and overall prognosis. Method This was a retrospective descriptive study conducted in the Department of Cardiology at Hedi Chaker University Hospital in Sfax, including patients with ccTGA followed between 2010 and 2024. Clinical, electrocardiographic, and echocardiographic data were collected and compared according to cardiac position, categorized into two groups: levocardia versus mesocardia/dextrocardia. Results The study included 37 patients, of whom 25 had levocardia, 5 mesocardia, and 7 dextrocardia. Cardiac anatomical anomalies did not show marked variations according to cardiac position: ventricular septal defect was present in 12/25 in levocardia, 3/7 in dextrocardia, and 4/5 in mesocardia; atrial septal defect in 6/25, 3/7, and 2/5; patent ductus arteriosus in 3/25, 0/7, and 1/5; coarctation of the aorta in 3/25 and absent in the other groups; pulmonary stenosis in 7/25, 3/7, and 3/5, respectively. Functional parameters showed that systemic right ventricular dysfunction was observed in 9/25 in levocardia versus 3/12 in mesocardia/dextrocardia, with no significant difference (P=0.630). Severe systemic atrioventricular valve regurgitation was noted in 7/25 and 3/12, respectively (P=0.829). Complete atrioventricular block was present in 5/25 versus 1/12 (P=0.389). Death occurred in 6/25 patients with levocardia and 2/12 with other cardiac positions (P=0.643). None of the observed differences reached statistical significance. Conclusion In this cohort of patients with ccTGA, cardiac position did not appear to influence the presence of associated anatomical anomalies, systemic right ventricular function, severity of systemic atrioventricular valve regurgitation, or mortality.

Endothelial function, a key determinant of prognosis in heart failure with reduced ejection fraction (HFrEF), is still frequently under-assessed in clinical practice. The present study aimed to assess endothelial function in patients with HFrEF and investigate its association with echocardiography and hemodynamics over 3 mo of medical treatment. In addition, this study aimed to investigate the association between changes in endothelial function and the incidence of cardiovascular rehospitalizations or deaths. This prospective longitudinal study included 120 patients with HFrEF. Hemodynamic parameters were assessed using impedance cardiography. Endothelial function was evaluated using digital thermal monitoring to calculate the endothelial quality index (EQI) at baseline and after 3 mo. Patients were followed for 12 mo. The mean age was 61.9 ± 10.2 yr, with a sex ratio of 5:1. A total of 42.5% of patients tend to experience endothelial dysfunction at baseline. After 3 mo of optimal medical therapy (i.e., renin-angiotensin-aldosterone system inhibitors, β-blockers, the aldosterone antagonist spironolactone, and sodium-glucose cotransporter 2 inhibitors), EQI improved significantly (P < 0.001), correlating with improved echocardiographic and hemodynamic parameters. Over 12 mo, there were 5 deaths (4.16%) and 44 heart failure rehospitalizations (36.6%), predominantly among those with severe endothelial dysfunction (P = 0.008). Improved EQI was associated with reduced mortality [area under the curve (AUC) = 0.82] and rehospitalization risk (AUC = 0.837). A ΔEQI ≥ 0.2 predicted a better prognosis, with a reduced risk of 1-year rehospitalization for acute heart failure.NEW & NOTEWORTHY Endothelial dysfunction is highly prevalent in patients with heart failure, with significant improvements observed after medical optimization. Importantly, changes in endothelial function strongly correlated with echocardiographic and hemodynamic improvements and independently predicted mortality and rehospitalization risk. Notably, an improvement in endothelial function emerged as a valuable prognostic marker.

Systemic sclerosis is an autoimmune disorder that affects both the skin and internal organs. Pericardial abnormalities in SSc may manifest as fibrous pericarditis, pericardial adhesions, or pericardial effusion, and rarely as pericardial tamponade or constrictive pericarditis. The present literature review reports the only eight cases of constrictive pericarditis that have been reported in the literature, highlighting the rarity of this severe complication. The present report also describes another case of constrictive pericarditis complicating systemic sclerosis in a 57-year-old woman. The onset of this complication happened during the patient's follow-up, leading to heart failure.

[This corrects the article DOI: 10.1371/journal.pone.0251658.].

Introduction:Patients receiving anticoagulation for atrial fibrillation (AF) are required to consult their doctor before starting Ramadan fasting to get their authorization for fasting and adapt their treatment. More often, a once-daily regimen is proposed to facilitate their intake schedule. Apixaban, a direct oral anticoagulant, prescribed twice daily with an optimal benefit/risk ratio in numerous situations, has very limited data regarding its use during Ramadan. Aim:The aim of this study was to evaluate the safety and the efficacy of apixaban for stroke prevention in AF patients during the month of Ramadan. Methods:An observational, multicentric study was performed in Tunisia during two consecutive years during the specific month of Ramadan. The API-RAM study included AF patients who were on apixaban and fasted at least 10 days. Efficacy was defined by the absence of ischemic events, and safety was established by classifying bleeding events using the BARC (Bleeding Academic Research Consortium) classification during the study period. Results:A total of 257 patients were included in our study. No ischemic events were reported during the study period. Minor bleeding events were reported in only 12 patients (4.7%), with no major bleeding event. Based on multivariate analysis, independent predictors for the bleeding risk of our population were as follows: smoking, history of hypertension, and creatinine clearance. Conclusion:Apixaban seems to be safe and effective for the prevention of the thromboembolic episode in AF patients during Ramadan fasting. Larger studies such as randomized clinical trials are necessary to confirm these results.

Heart failure with reduced ejection fraction (HFrEF) is still associated to a high rate of mortality and re-hospitalization. New HF therapy such as SGLT2 inhibitors (SGLT2i) and sacubitril valsaratan (ARNI) had proven to be effective in reducing morbidity and mortality. But the effect of these therapies on echographic and haemodynamic parameters measured by impedance cardiography (ICG) data is still controversial. To evaluate the impact of HF treatment guided by ICG haemodynamic study at 6-months rehospitalization and mortality. A prospective monocentric study (with a case control group) conducted between June 2021 and November 2022. Patients included had left ventricle ejection fraction (LVEF ≤ 40%), a creatinine clearance > 30 mL/min and no other severe pathology that could alter the prognosis. All patients had echocardiographic and hemodynamic study with a follow-up at 6 months. A total of 127 patients with HFrEF were included. The mean LVEF of our patients increased from 26% to 29% and LV filling pressures were elevated in 22.7% at inclusion and 13.2% at 6-months follow up. The 6-month rehospitalization and death rates were 22.8% and 18.1% respectively. The ARNI/SGLT2i group had significantly lower rates of rehospitalization and death from cardiovascular causes with P = 0.001 and P = 0.015 respectively. In the multivariate study, tachycardia, renal failure and elevated resistance measured by ICG were independent factors associated with mortality (OR = 6.56, P = 0.05; OR = 13.457, P = 0.03 and OR = 10.354, P = 0.03 respectively) while reduced intra thoracic fluid and optimal medical therapy were protective factors (OR = 0.866, P = 0.002 and OR = 0.035, P = 0.03 respectively). A controlled volemia collected by ICG and gliflozin treatment were independent protective factors of re-hospitalization in multivariate study (OR = 0.257, P = 0.02 and OR = 0,239, P = 0.02 respectively). The HFrEF is still a disease with a poor prognosis. Hemodynamic parameters measured by impedance cardiography could improve the disease profiling and patients' management in the era of new therapies.

Introduction La fièvre Q est une zoonose ubiquitaire liée à l’infection par Coxiella burnetii. Elle se caractérise par son polymorphisme clinique et des perturbations immunologiques possibles mimant les maladies de système. On distingue la forme aiguë se présentant comme une pneumopathie atypique, une hépatite granulomateuse ou une fièvre nue et la forme chronique correspondant à une endocardite infectieuse à hémocultures négatives particulièrement dans un contexte de valvulopathie préexistante. Nous rapportons le cas d’une femme présentant une fièvre Q chronique révélée par fièvre prolongée avec une anémie hémolytique auto-immune. Observation Femme de 27 ans aux antécédents d’endocardite infectieuse à l’âge de 13 ans, antécédents de bicuspidie aortique opérée à l’âge de 15 ans avec mise en place de tube HONCKOCK VDAP, admise en médecine interne pour pancytopénie avec AAN positifs. Son histoire remonte depuis une année marquée par la survenue de fièvre nocturne avec amaigrissement non chiffré et asthénie. Devant la découverte d’une pancytopénie à la numération avec des AAN positifs à1/160, elle a été adressée en médecine interne. À l’admission elle était fébrile à 39°, tachycarde à 98bpm. L’auscultation trouvait un souffle systolique au foyer aortique. À la biologie, il n’y avait pas de syndrome inflammatoire biologique (VS=12, CRP=5mg/L), l’objectivait une pancytopénie. (GB=3410Ets/mm3/Hb=11g/dL/VGM78fl/plaquettes=76 000). L’anémie était de type hémolytique auto-immune (haptoglobine effondrée, LDH élevés, test de Coombs direct positif). La biopsie ostéomédullaire a permis d’éliminer une hémopathie maligne. Une endocardite infectieuse était suspectée. Une série d’hémocultures était pratiqué revenant négative. L’échocardiographie transthoracique n’a pas trouvé de végétations ou de signes d’endocardite. L’enquête tuberculeuse y compris l’IDR à la tuberculine et la recherche de BK était négative. Les sérologies virales à savoir VHB, VHC, VIH. Les AAN ont été refaits revenant négatifs. La TDM TAP avait montré des adénomégalies sus- et sous-diaphragmatiques avec hépato-splénomégalie homogène. Devant ce tableau, l’hypothèse d’endocardite infectieuse était fortement suspectée devant les antécédents d’endocardite infectieuse et d’homogreffe malgré l’absence de syndrome inflammatoire biologique et la négativité de l’ETT et des hémocultures. L’échographie trans-œsophagienne a découvert une image hautement mobile de 8×7mm sur la valve du tube VDAP. La sérologie de la fièvre Q est revenue positive avec IgG au cours de la phase 1/12 800. Ainsi, le diagnostic d’endocardite infectieuse à Coxiella burnetti était retenu et la patiente était mise sous plaquénil (600mg/j) et doxycycline (200mg/J) avec bonne évolution clinique et échographique (écho cœur de contrôle : image de 4mm). La durée totale prévue de l’antibiothérapie était de 2 ans. Conclusion Nous illustrons l’association rare entre l’infection à Coxiella Burnetti et le dérèglement immunitaire. Cette hypothèse était supportée depuis plusieurs années devant la positivité des anticardiolipides (47–81 %) des antimuscles lisses (20 à 30 %), la positivité du FR et des AAN. L’association fièvre Q chronique et anémie hémolytique auto-immune était décrite dans quelques cas rapportés. La fièvre Q devrait être suspectée devant toute fièvre prolongée de cause indéterminée même en présence de manifestations dysimmunitaires, particulièrement chez les porteurs de cardiopathies congénitales ou de valvulopathie. Il convient alors de compléter par l’échographie trans-œsophagienne et la sérologie de la fièvre Q en cas de négativité de l’enquête initiale.

INTRODUCTION:Ischemic Stroke in young adults is a real public health problem; it's a major cause of disability, alters quality of life and has a great socio-economic impact. AIM:determine risk factors and specify the etiology of arterial ischemic stroke in young Tunisian adults. METHODS:In this 5 years retrospective study (2015-2020), we included all young adults (18-50 years) admitted for arterial ischemic stroke (AIS). Risk factors were registered and analyzed. All patients were investigated using a standard protocol: biological tests, brain imaging, carotid ultrasound and cardiac assessment. Additional investigations were carried out at the discretion of the treating physician. The cause of ischemic stroke was classified according to the TOAST criteria. RESULTS:We collected 200 patients with AIS. The mean age was 41.37 years ± 6.99. Traditional vascular risk factors were observed in more than 1⁄4 patients. A definite cause of stroke was identified in 120 patients. Cardio-embolic causes were the most common among our patients (19%) followed by atherosclerosis of the large arteries (11.5%). Other determined etiologies were found in 27.5% of patients. The etiology remained unclear in 40% of cases: undetermined despite complete investigation in 17.5%, undetermined and incompletely investigated 14.5 % and more than one potential pathomechanisms in 8%. CONCLUSION:Through this study, we demonstrated the diversity of etiology of stroke in young Tunisian adults. Changes of lifestyle are responsible for the occurrence of the traditional risk factors at an early age. Rheumatic heart diseases remain a frequent cause of AIS in our area.

Introduction L’amylose est une maladie infiltrative résultant d’un dépôt de substance protéique fibrillaire au niveau de différents organes. Le pronostic est conditionné par la sévérité des atteintes viscérales en premier lieu cardiaque. L’amylose cardiaque figure dans la classification des cardiopathies restrictives et hypertrophiques. Notre objectif était de déterminer les caractéristiques cliniques des patients ayant des amyloses cardiaques. Patients et méthodes Il s’agissait d’une étude rétrospective descriptive incluant les patients atteints d’amylose cardiaque hospitalisés en médecine interne entre 2000 et 2024. Notre objectif était de déterminer les caractéristiques épidémiologiques et clinicobiologiques des patients ayant des amyloses cardiaques. Résultats Neuf patients avaient une amylose cardiaque parmi 25 cas d’amylose (36 %). Le sex-ratio H/F était de 7/2. L’âge moyen du diagnostic d’amylose cardiaque était de 52,6 ans avec des extrêmes entre 39 et 74 ans. Le diagnostic d’amylose cardiaque était concomitant à la maladie dans 2 cas. Le délai moyen du diagnostic d’amylose était de 6,3 mois. Il s’agissait dans tous les cas d’amylose systémique de type AL. Elle était secondaire à un myélome multiple dans 5 cas, à une gammapathie monoclonale de signification indéterminée (MGUS) dans 2 cas et primitive dans 2 autres cas. L’amylose cardiaque était asymptomatique dans 2 cas. Elle était suspectée devant une dyspnée d’effort dans 7 cas, un syndrome œdémateux dans 3 cas. L’ECG avait objectivé un micro-voltage dans 3 cas et des ondes Q de pseudo de nécrose dans 2 cas. La radiographie thoracique trouvait une cardiomégalie dans 4 cas. L’échographie transthoracique révélait une hypertrophie du VG (3 cas), une hypertrophie biventriculaire (1 cas) un myocarde hyperéchogène (1 cas) ; un épaississement valvulaire (1 cas) et une dilatation bi-atriale (1 cas). La FeVG était altérée dans 1 seul cas. L’IRM cardiaque réalisée dans 2 cas montrait un rehaussement tardif sous-endocardique. Parmi les atteintes extracardiaques associés, on a observé l’atteinte rénale dans 4 cas, l’atteinte digestive dans 3 cas (biopsie iléocolique et gastrique), une macroglossie et une diarrhée chez deux patients. Un TP spontanément bas était observé dans 3 cas. Une atteinte hépatique était notée dans 5 cas. Une neuropathie végétative occasionnant une hypotension orthostatique et une neuropathie périphérique étaient observées dans 1 cas chacun. Une atteinte hypophysaire confirmée à l’IRM hypothalamo-hypophysaire occasionnant un hypogonadisme hypo-gonadotrope était présente chez une femme en âge de procréation. L’étude anatomopathologique avec IHC a permis de confirmer dans tous les cas le diagnostic d’amylose AL. Sur le plan thérapeutique, une chimiothérapie à type de : melphalan dexa était prescrite chez 5 malades et de type COP dans 1 cas. Une autogreffe de la moelle était indiquée dans 2 cas. L’évolution était marquée par l’amélioration de l’atteinte cardiaque (2 cas), la stabilisation (3 cas) et le décès (3 cas). La cause de décès était cardiaque dans 2 cas et digestive dans 1 cas. 1 patient était perdu de vue. Conclusion L’amylose cardiaque est une pathologie grevée d’une forte mortalité qu’il faudrait dépister à un stade précoce. Elle pose une difficulté diagnostique particulièrement quand elle est isolée. Elle est suspectée devant des anomalies électriques. Le diagnostic est orienté par les moyens d’imagerie particulièrement l’échographie cardiaque, l’IRM cardiaque et la scintigraphie osseuse. La certitude reste un diagnostic anatomopathologique. Le traitement dépendra du type du dépôt amyloïde.

Introduction: The prevalence of arterial hypertension (HTA) was continuously increased with a low percentage of pressure control blood pressure among treated patients. Therapeutic education (TE) was one of the inventive methods in the management of high blood pressure (HBP) worldwide. The objective was to assess the impact of TE on the control and management of HBP. Methods: This was a quasi-experimental study consisting of an intervention, a pretest, and a post-test evaluation. This study was conducted in the external consultation service of cardiology CHU HEDI CHAKER of Sfax during over a period of 4 months (November 2021–March 2022). Results: In total, 35 of the patients (50%) were women with a sex ratio of 1. The mean age was 63.33 ± 8.91 years. We noted a statistically significant decrease on both systolic and diastolic blood pressure blood pressure values after TE among educated patients (135.3 ± 9.77 vs. 141.9 ± 10.9; P = 0.010) and (75 [70–80] vs. 80 [75–80]; P = 0.002), respectively. We found a significantly good knowledge about HBP definition (Odds ratio [OR] = 3.4; P = 0.022), HBP symptoms (OR = 9.1; P < 0.001), and HBP complications (OR = 12.3; P < 0.001) among educated patients. A significant association was noted between educated patients and low daily salt consumption after TE (OR = 2.7; P = 0.048). Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation Educated patients had significantly more adequate auto-control devise use (OR = 1.01; P = 0.028). Moreover, the respect of therapeutic compliance was statistically more important among educated patients (OR = 3.7; P = 0.028). Conclusions: Our results showed that the TE training session is an operative intervention to improve HBP management. Thus, integrating TE therapy in daily care should be continuous and should be exhaustive to all cardiovascular and all chronic diseases.

Background:Radial artery occlusion (RAO) remains the most frequent complication of trans-radial access. Once the radial artery is occluded, its future use as an access site for coronary procedures, or as a conduit for coronary bypass grafting or fistula for hemodialysis, will be precluded. Therefore, we aimed to assess the value of the short-term use of Rivaroxaban to prevent RAO after a trans-radial coronary procedure. Methods:This was a prospective, open-label, randomized study. The patients were randomly assigned (1:1) to one of two groups: those who received Rivaroxaban 10 mg for 7 days following the trans-radial coronary procedure (the Rivaroxaban Group) and those who received the standard treatment (the Control Group). The primary outcome was an occurrence of RAO evaluated by Doppler ultrasound at 30 days, and the secondary outcomes were hemorrhagic complications according to BARC classification. Results:We included 521 patients randomized into two Groups: the Control Group (N = 262) and the Rivaroxaban Group (N = 259). The 1-month RAO was significantly reduced in the Rivaroxaban Group as compared to the Control Group [6.9% vs. 13%; p = 0.011, OR = 0.5, (95% CI, 0.27-0.91)]. We noted no cases of severe bleeding events (BARC3-5). The overall incidence of minor bleeding (BARC1) was 2.3%, with no significant difference between the two groups [Rivaroxaban Group = 2.7%, Control Group = 1.9%, p = 0.54, OR= 1.4, (95%CI 0.44-4.5)]. Conclusions:Short-term postoperative anticoagulation with Rivaroxaban 10 mg for seven days reduces the rate of 1-month RAO.

Le risque de maladie cardiovasculaire chez le sujet âgé est nettement plus élevé que chez le sujet jeune ; paradoxalement, certaines molécules qui ont prouvé leur efficacité dans la réduction du risque cardiovasculaire sont souvent sous-prescrites dans cette tranche d’âge. La place des statines en prévention secondaire est indiscutable jusqu’à l’âge de 80ans. En prévention primaire, ces molécules permettent de réduire le risque de survenue d’infarctus de myocarde et d’accident vasculaire cérébral, mais leurs effets sur la mortalité cardiovasculaire ou de toute cause restent non prouvés. Chez le sujet très âgé, nous ne disposons pas d’études randomisées concernant l’impact des statines sur la morbimortalité que ce soit en prévention primaire ou secondaire. Les effets indésirables chez le sujet âgé ne semblent pas être statistiquement différents du sujet jeune, cependant, la prescription chez les patients très âgés doit être individualisée, prenant en considération l’espérance et la qualité de vie, les comorbidités et surtout le risque d’interactions médicamenteuses.

Poor adherence to antihypertensive treatment is one of the major factors of poor blood pressure control, particularly in rural areas. The objectives of our study were to assess treatment adherence and identify factors associated with poor adherence in rural areas. We carried out a cross-sectional descriptive study carried out in a regional hospital in Kasserine during the months of January and February 2021. We measured therapeutic compliance using the Girerd questionnaire and we studied the associations between poor blood pressure medications adherence and demographic, socioeconomic, hygieno-dietetic and therapeutic covariates. One hundred patients were included. The mean age was 66.86 years ± 11.97 with a sex ratio of 2.33. Factors associated with poor adherence were age ≥ 65 years (P = 0.007), hypertension duration more than 1 year (P = 0.008), physical inactivity (P < 0.001), diabetes (P = 0.024), history of stroke and/or heart disease (P < 0.001), treatment with a number ≥ 2 of antihypertensive drugs (P = 0.0035), without a fixed association (P = 0.040), existence of adverse effects (0.034) and treatment with ACE inhibitors (0.015). On the other hand, we did not find a significant effect of sex, educational level, type of medical insurance and adherence to the low-sodium diet on therapeutic adherence, whereas treatment with ARB was significantly associated with better adherence (P = 0.018). Our study found poor adherence in this rural population with a low socioeconomic level, with more significant problems found in elderly, poly-pathological subjects treated with several antihypertensive drugs, a fortiori without a fixed association. To improve drug adherence, it is important to include therapeutic education programs adapted to the socioeconomic level of this population in the therapeutic arsenal.

INTRODUCTION:Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients.METHODS:It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study.RESULTS:A total of 50 patients were included. The mean age was 46.52±10.4 years. The mean systolic blood pressure (BP) at office was 120.8±8.8mmHg and the mean diastolic BP was 75±7.3mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average -18.85±0.9% and the LA GLS was on average 37.35±4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults.CONCLUSION:It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension.

PROBLEMATIC AND OBJECTIVE:Masked arterial hypertension (MHTN) is a recently described entity that is associated with the same cardiovascular risk as permanent hypertension. Its prevalence is more frequent in patients with diabetes. The objective of this study is to assess the value of systematic screening for MHTN by 24-hour blood pressure monitoring in a population of type 2 diabetic patients by estimating its prevalence and looking for predictive factors of MHTN in this population.METHODS:Through a prospective study, we recruited normotensive type 2 diabetics for clinical measurement, in whom we systematically searched for MHTN by performing an ambulatory blood pressure measurement (ABPM). The diagnosis of MHTN is established if: mean daytime BP ≥ 135/85 mmHg and / or, mean nighttime BP ≥ 120/70 mmHg and / or, mean 24 hour BP ≥ 130/80 mmHg. We then compared the two populations of MHTN (G1) and normotensive (G2) on clinical and laboratory parameters and we assessed end-organ damage in order to identify the predictive factors of MHTN.RESULTS:We recruited 53 patients whose mean age was 55.3 ± 8.4 years (range 35-72 years) with a female predominance (53%). The duration of diabetes was on average 8.7 ± 3.9 years with extremes between 2 and 17 years. The average BMI of our patients was 28.2 ± 5.3 Kg/m2. Overweight was found in almost half of our patients (47.2%). Obesity was found in 32.1% of cases. Metabolic syndrome was found in 64.2% of patients. In our study, the prevalence of HTAM in type 2 diabetics was 64%. We also found that MHTN was more often nocturnal (58.5%) and occurred mainly in non-dipper patients. Left ventricular hypertrophy, microalbuminuria and arterial stiffness evidenced by pulse pressure greater than 60mmHg were more common in the MHTN group. For the predictive factors of MHTN, we were able to collect in univariate analysis the following factors: duration of diabetes, fasting blood sugar, weight and microalbuminuria. In multivariate analysis, the predictive factors that emerged in our study are poor glycemic control (HbA1c ≥7%), high BMI and duration of diabetes.CONCLUSION:MHTN should be sought in diabetics because it allows a better assessment of the cardiovascular risk, in particular by identifying end-organ damage.