Abstract Background ST elevation myocardial infarction (STEMI) is the leading cause of cardiovascular related mortality. In the context of Inferior STEMI, the culprit artery is whether the right coronary artery (RCA) or left circumflex coronary artery (LCx). An accurate prediction of culprit artery prior to primary percutaneous coronary intervention (PCI) could improve the door-to-balloon time and could prevent contrast-induced-nephropathy. However algorithms established for that purpose were not evaluated within the Tunisian population. We aimed then to assess their performance in our population Methods We conducted a single-center hostorical cohort study from January 2014 to December 2022 on patients admitted at Sahloul university hospital Sousse Tunisia for PCI following an inferior STEMI. We analyzed the ST segment deviations at the J-point and 80 ms after the J-point then evaluated the performance of previous algorithms. Results We collected data from 156 patients, of which 130 (83.3%) hada RCA occlusion, and 26 (16.7%) a LCx occlusion. We evaluated 19 published algorithms. The criterion of zimetbaum et al (ST elevation in III> II and I and/or VL <-1 mm) had the highest AUC 0.77[0.66 - 0.88] YI = 52 accuracy = 0.81. The criterion of Herz et al (ST III > II) had AUC ROC of 0.71 [0.58 - 0.83] YI = 0.41 accuracy = 0.78, the algorithm of Tierala et al: AUC = 0.70[0.58 - 0.83] YI = 0.40 accuracy = 0.78. The algorithm og Fiol et al: AUC = 0.79 [0.58-0.83] YI = 0.59 accuracy = 0.73. Conclusions The Zimetbaum criterion had the highest performance in predicting the culprit artery and Fiol’s algorithm was the most specific to the LCx occlusion in our population. Further study on the impact of these algorithms on patients outcome is necessary. Key messages • The prediction of the culprit artery in inferior STEMI is challenging. • The criterion of Zimetbaum et al had a good performance for that regard.

Heart sarcomas are scarce neoplasms with various clinical features and are known to be great imitators of several clinical representations. This article presents a case of a cardiac metastatic sarcoma complicated by infective endocarditis in a 35-year-old female patient with a history of rheumatic fever, brain surgery, and Covid-19 infection. The diagnosis was based on echocardiography, computed tomography and biopsy results. Despite receiving six weeks of antibiotic treatment, the patient’s prognosis was bleak due to the lack of effective palliative options. The article underlines the challenges in the management of cardiac sarcomas and the need for further research in this field.

Infective endocarditis (IE) is a systemic disease with many potential neurologic complications that occur in about one-fourth of patients increasing thus its morbidity and mortality rates. Our aim was to determine the frequency of neurologic complications, their clinical manifestations, factors associated with their development and their influence on the clinical outcome. This was a retrospective analysis of data of 73 consecutive episodes of left-sided infective endocarditis collected in our department between January 2000 and December 2017. We included 73 patients with left-sided infective endocarditis. The mean age was 39 years. There were 47 (64.4%) males and 26 (35.6%) females. 18 (24.65%) presented neurologic involvement at some time of the disease. 13 (17.8%) patients had ischemic events, 5 (6.85%) had hemorrhages of whom 3 had mucotic aneurysm. The most prevailing lesion was cerebral ischemia (72%). Vegetations larger than 1 cm were associated to neurologic involvement (P = 0.01). Anticoagulant therapy was particularly related to a greater incidence of hemorrhagic events. Hospital mortality was 33%, and neurological complications had a negative impact on outcome (33% of deaths versus 11.1% in patients without these complications; P < 0.01). All patients with hemorrhage died in our context while prognosis was relatively better in patients with ischemic stroke. Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Management of such patients requires an individualized case discussion and the participation of an experienced multidisciplinary team.

Coronary artery birth defect is an uncommon heart disease. Its incidence is 1% among congenital heart diseases, it is largely underestimated because some forms are asymptomatic. The natural evolution of this pathology depends on the type of coronary birth defect, indeed it is favorable in forms of the multiple ostium type or if there is a birth variation in front of the adequate Valsalva sinus, and appalling in the case of birth of the left coronary artery from the pulmonary artery. To describe clinical and epidemiological particularities of birth defects of coronary arteries with multiple ostia. Between 1998 and 2022, 33 cases of multiple ostium coronary artery birth defects were identified in our department. Were analyzed retrospectively: the presence or absence of underlying congenital heart disease, clinical expression with the circumstances of discovery, ECG, chest X-ray, transthoracic echocardiography (TTE) and coronary angiography data. The average age was 57 years (from 33 to 72 years), there was a male predominance (63.63%). None of the patients had underlying congenital heart disease. In our series 28 patients (84.84%) had at least one cardiovascular risk factor. The circumstances of discovery of coronary birth defects were: stable angina in 33.4% of cases, NSTEMI in 45.5%, STEMI in 3% cases and heart failure in 3% cases, isolated exertional dyspnea in 3% of cases. In 12.1% of patients, the discovery was fortuitous. The contribution of chest X-ray was limited, showing cardiomegaly without specificity in 30.3% of patients. The ECG performed in all patients showing repolarization disorders related to the culprit artery affected. The TTE performed in all patients showed left ventricular dilation in 36.36% of cases. The ejection fraction was reduced in 36.36% of patients. On coronary angiography, the multiple ostia were: 2 ostia at the level of the antero-left sinus from which the LAD and the CX are born and an ostium from which the RCA is born, all the patients in our series had atheromatous involvement associated with the presence of at least one artery the seat of a tight stenosis which explains the symptomatology. Multiple ostium coronary birth defects are usually asymptomatic and discovered incidentally. ALCAPA and the birth from the opposite sinus are the most prone to clinical manifestations.

BACKGROUND:Most of congenital ventricular septal defects evolve towards spontaneous closure of different mechanisms depending on their location.AIM:To determine the prevalence and factors associated with spontaneous closure of congenital ventricular septal defects.METHODS:We conducted a retrospective study of 1000 patients diagnosed with congenital ventricular septal defects in our department from January 2000 to December 2017.RESULTS:After an average follow-up of 52.65 months (± 76.93 months), 183 (18.88%) of ventricular septal defects closed spontaneously. The average time for spontaneous closure was 45.78 months (76.34 months). 30.77% of trabecular ventricular septal defects (p<0.05) and 16.93% of perimembranous defects closed spontaneously (p=0.17). 28.5% of perimembranous defects associated with aneurysm formation versus 17.4% of those without associated aneurysm evolved to spontaneous closure (p<0.05). 65.6% of spontaneous closure occured during the first 3 years of life. In multivariate analysis, trabecular site [OR=2.85; CI (2.05-3.97)] and aneurysms of membranous septum [OR=1.9; CI (1.41-2.8)] were independent factors associated with spontaneous closure of defects.CONCLUSION:The highest VSD closure rate was observed during the first three years of life. Trabecular site and aneurysms tissue of membranous septum were found as independent factors associated with spontaneous closure.

Stroke is a major public health problem, the leading cause of acquired disability in adults and the third leading cause of death worldwide. Ischaemic stroke accounts for 80% of all strokes. Approximately 20% of DVAs are associated with atrial fibrillation (AF). However, 25% remain of undetermined origin (ESUS) with a risk of recurrence under anti-platelet therapy greater than 4% per year. In this population, the challenge is the detection of subclinical atrial fibrillation (AF), the incidence of which could reach 25%. The effectiveness of the probabilistic anticoagulation strategy has not been demonstrated in this population, making it necessary to identify ESUS patients at high risk of subclinical AF. The aim of this study is to determine the incidence and the electrocardiographic and echographic predictive factors of silent AF in ESUS stroke. Monocentric descriptive and analytical historical cohort study conducted at the Neurology Department between January 2016 and December 2020. Three hundred Esus patients were included. In our study, 42/300 (14%) patients had at least one episode of AF (> 30 s). In univariate analysis, the variables significantly associated with sluggish AF in ESUS-type stroke were age greater than or equal to 60 years (P = 0.004, OR = 3.76), female gender (P = 0.045, OR = 1.94), P-wave markers (abnormal axis, prolonged duration), P-wave dispersion (P < 10−3), a high number of supraventricular extrasystoles (P < 10−3, OR = 1.007), OG dilatation (P < 10−3, OR = 1.61) and diastolic dysfunction (P < 10−3, OR = 30.25). In multivariate analysis, p-wave dispersion (P < 10−3, OR = 57.77), number of SVSEs > 500/24 h (P < 10−3, OR = 185.83), and left atrial area > 20 cm2 (P < 10−3, OR = 74.7) appeared to be independent predictors of the occurrence of a subclinical AF episode. In this cohort of ESUS patients, several factors appeared to be predictive of subclinical AF. This result is consistent with the finding of several studies that the subgroup of ESUS patients with these factors appeared to benefit from probabilistic anticoagulation in preventing cerebral infarct recurrence.

A quarter of cerebral infarctions remain without etiology (ESUS: embolic stroke of unknown source) with a risk of recurrence under anti-platelet therapy greater than 4% per year. In this population, the challenge is the detection of subclinical atrial fibrillation (AF), the incidence of which could reach 25%. The efficacy of the probabilistic anticoagulation strategy has not been demonstrated in this population making it necessary to identify ESUS patients at high risk of subclinical AF. The aim of this study is to determine clinical and radiological predictive factors of silent AF in ESUS stroke. Monocentric descriptive and analytical historical cohort study conducted at the Neurology Department between January 2016 and December 2020. Three hundred Esus patients were included. In our study 42/300 (14%) patients had at least one episode of AF (> 30 s). In univariate analysis, the variables significantly associated with slower AF in ESUS-type stroke were age greater than or equal to 60 years (P = 0.004, OR = 3.76), female gender (P = 0.045, OR = 1.94), coronary artery disease (P = 0.008, OR = 3.43), previous stroke (P = 0.007, OR = 2.67), stroke of different territory or age (P = 0.031, OR = 2.65), stroke on awakening (P < 10−3, OR = 5.95), higher NIHSS score on admission (P = 0.023, OR = 1.08), lower NIHSS score on discharge (P = 0.031, OR = 0.89), older cerebellar stroke (P < 10−3, OR = 14.16). In multivariate analysis, higher NIHSS score at admission (P = 0.023, OR = 1.08), and lower NIHSS score (P = 0.031, OR = 0.89) at discharge appeared as independent predictors of the occurrence of a subclinical AF episode. In this cohort of ESUS patients, several factors appeared to be predictive of subclinical AF. The subgroup of ESUS patients with these factors appeared to benefit from probabilistic anticoagulation in preventing recurrent cerebral infarction. A therapeutic trial should confirm this hypothesis.

Mechanical cardiac dyssynchrony is an important component of cardiac remodeling during heart failure with reduced ejection fraction. Furthermore, echocardiographic assessment of left ventricle reverse remodelingrepresents the major tool to evaluate cardiac resynchronization therapy (CRT) response. In contrast, according to major randomized trialsmechanical dyssynchrony assessment failed and electrocardiographic proof of dyssynchrony is needed to indicate CRT, therefore; electrical reverse remodeling was suggested by few clinical studies conducted with a small number of patients. Additional information is required on the relationship between electrical (ERR) and structural reverse remodeling (SRR) in patients treated with cardiac resynchronization therapy. We investigated whether ERR defined as narrowing of the native electrocardiographic QRS duration after CRT might predict improvement in echocardiographic outcome. We collected 75 patients who underwent successful CRT device implantation in our department. Clinical, electrocardiographic and echocardiographic parameters were collected before implantation and after a variable duration of follow up in the outpatient clinic. SRR was defined as an improvement of LVEF > 5% and/or a reduction in LVESV > 15%. ERR was defined as a decrease in native QRS duration > 10 milliseconds (was recorded after switching off biventricular pacing). After a mean follow up duration of 69 months from the time of implantation, 51 patients had an echocardiographic response (SRR) and among 45 patients who had demonstrated an electrocardiographic response (ERR), 75% developed SRR (vs. 55% for those without ERR P = 0.07) and only 7.5% of them were ischemic cardiomyopathy. Mean QRS reduction was at 16 milliseconds in patients with SRR versus 8 milliseconds in patients without SRR (P = 0.02). Reversal electric remodeling as assessed by native QRS narrowing was associated with greater improvements in mean LVEF (16% vs. 10%, P = 0.1), mean LVEDV (85 mL vs. 35 mL, P = 0.04) and mean LVESV (77 mL vs. 37 mL, P = 0.1). Native QRS narrowing after initiation of CRT in patients with HFrEF was positively correlated tostructural reverse remodeling parameters assessed by echocardiography and consequently to the echocardiographic outcome.

Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient's sepsis and electrolyte disturbance, she had a favorable outcome.

Journal Article Corrected proof An unusual cause of chest pain after redux aortic valve replacement surgery Get access Mehdi Slim, Mehdi Slim Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de cardiologie, Sahloul 1, 4054 Sousse, Tunisie Corresponding author. E-mail: mehdislim_fms@yahoo.fr https://orcid.org/0000-0002-8984-3738 Search for other works by this author on: Oxford Academic PubMed Google Scholar Sameh Ben Farhat, Sameh Ben Farhat Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de cardiologie, Sahloul 1, 4054 Sousse, Tunisie Search for other works by this author on: Oxford Academic PubMed Google Scholar Rym Gribaa, Rym Gribaa Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de cardiologie, Sahloul 1, 4054 Sousse, Tunisie Search for other works by this author on: Oxford Academic PubMed Google Scholar Taieb Cherif, Taieb Cherif Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de chirurgie cardiovasculaire et thoracique, Sousse, Tunisie Search for other works by this author on: Oxford Academic PubMed Google Scholar Imene Mgarech Imene Mgarech Université de Sousse, Faculté de médecine de Sousse, Hôpital Sahloul de Sousse, Service de chirurgie cardiovasculaire et thoracique, Sousse, Tunisie Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jead179, https://doi.org/10.1093/ehjci/jead179 Published: 22 July 2023 Article history Published: 22 July 2023 Corrected and typeset: 01 August 2023

During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?

Drug eluting coronary stents (DES)have been shown to be effective and cost effective in treating complex lesions such as long lesions in coronary artery disease. Very long DES will reduce the number of stents used and will cover diffuse coronary lesions. This was a retrospective study including 105 patients who had implanted at least one DES (40 mm or more in length)from 2015 to 2020. We included 105 patients. The mean age was 63.6 ± 9.4 years. We noted a male predominance(81 men). The most common CV RF were as follows: Htn: 59%, dyslepidemia: 51.4%, diabetes: 47.7%, tobacco: 44.8%. The most reported antecedents were: 46.7% known coronary artery patients of which 27.6% were stented. Ischemic stroke was present in 6.7% of patients. The most frequent clinical presentation were chronic coronary syndrome (CCS)(41.9%), followed by NSTEMI (28.6%). On admission 4.9% had an acute edema of lungs on admission, 24.6% of patients had a glycemia greater than 9.9 mmol/l. At TTE 8.8% of patients had LVEF < 40%. On coronary angiography, the most coronary status was twin-cell (44.8%). The left coronary trunk was reached in 5.7%. Several coronary arteries were stented by long stents, the most frequent of which were the RCA(46.7%), and the LAD in 39%. Coronary lesions were: thrombotic in 10.5%; in 21.9% they were bifurcation lesions, and CTO in 9.5%. The long stent covered the ostium of the coronary arteries 8.6%. The mean length of stents were 47.26mm(from 40 to49 mm). Balloon predilation was performed in 75.2% and post-dilation was performed in 88.6%. In 18.1% of the cases the long stents overlapped with short stens. All procedures by long stents were performed successfully except in 2 cases where the thrombotic load was significant. The final TIMI flux was 3 in 98% of the cases. Patients of our study had more Htn and dyslepidemia. The most frequent clinical presentation was CCS. Long DES provide complete coverage of diffuse coronary lesions.

Catheter-induced aortocoronary dissection(CIACD) is a rare but potentially devastating complication of percutaneous coronary interventions(PCI). We aimed to assess the incidence, management modalities and in-hospital outcomes of CIACD. This was a retrospective multicentric observational cohort from the national PCI registry. Dissections were defined using the NHLBI classification. The primary endpoint was the occurrence of in-hospital Major Adverse Cardiovascular Events(MACE): a composite clinical criterion including in-hospital cardiac death(CD), heart failure and post-procedural myocardial infarction(MI). Between 2011 and 2020,75556 PCI were performed. We identified 68 patients(0.09%) with CIACD. The mean age was 60 ± 11 yrs and the sex ratio was 1,7. The radial approach was predominant(58,8%). Judkins left and Judkins right catheters caused CIACD in respectively 33,8% and 35,3% of the population. 6 patients had previously normal coronary arteries. CIACD was located at the left main coronary artery in 55,9%. The majority of CIACD was Type C(39,7%). Associated aortic dissection (AAD) was observed in 6 patients (8,8%). Management modalities consisted mainly of immediate stenting of the dissection(75%), however, 16 operators (23,7%) preferred initial medical treatment. Dissections disappeared in 15 patients. 30% of PCI were performed by fellows. 10 patients (14,7%) presented in-hospital MACE. In hospital CD and post-procedural MI occurred in 4,4% and 7,4% of the population. Multivariate analysis showed that left dominance angiogram HR = 12[1,03-142]P= 0,013, AAD HR = 41[1,13-1555]P = 0,047 and procedure complications HR = 13[1,43-130]P = 0,023 were predictive of In-hospital MACE. The management of CIACD is still challenging. Our study was one of the largest series showing that stenting is the main treatment of CIACD; however selective patients who have been treated medically had a good clinical and angiographic evolution.

Persistent ductus arteriosus (PDA) is defined by the persistence of the DA beyond the first 3 months of life. Natural closure normally occurs 24 to 48 hours after birth. Discovery is rare in adulthood. This was a retrospective study of patients with PDA discovered in adulthood and who underwent percutaneous closures (PC) of PDA. Patients were collected over a period from 2009 to 2018. Eleven PC of PDA in adults were performed. The average age of discovery of PDA was 22 years. While the average age for percutaneous treatment was 25 years (18 to 33 years). There was a female predominance (9 women). All the patients were symptomatic. The circumstances of discovery of PDA were as follows: NYHA stage II dyspnea in 9 patients and bronchopulmonary infections in 2 patients. On the chest x-ray, 4 patients had cardiomegaly. On ECG, 10 patients had a left axis. Six patients had electrical LVH. On TTE, the left cavities were dilated in 10 patients. The pulmonary artery (PA) was dilated in 3 patients. LVEF was preserved in 100% of cases. At the TTE the averaged channel diameter was 5.2 mm (from 3 to 8 mm). The maximum average gradient between the aorta and the PA was 78.6 mmHg. The average SPAP was 32.5 mmHg. There were 4 patients who had PAH. No other heart disease was associated. The most common type of PDA was type A (8 patients). The average size of the prosthesis (amplatzer) put in was 8/7 mm. The 11 PDAs were closed successfully, without immediate complications. Angiographic and TTE in the KT room showed minimal residual shunt in 4 patients, and eliminated an aortic and pulmonary obstacle. In the short-term (3 months), all patients were asymptomatic. On TTE LV measurements normalized, SPAP were normal, all prostheses were in place, and there is no residual shunt. The duration of follow-up was 26 months. PDA is a common congenital heart disease. It can remain asymptomatic for a long time and does not appear until adulthood. PC is the treatment of choice.

heart failure in peripheral arterial disease in 4 patients (1.3%) and valvular heart disease in 1 patient. Patients with at least one cardiovascular comorbidity had significantly more severe forms of covid 19 compared to patients without comorbidities (46% vs 16% p <0.05). All deaths occurred in patients with cardiovascular co-morbidities Conclusion: Cardiovascular comorbidities are common in hospitalized patients with COVID 19 dominated by hypertension and ischemic heart disease. Cardiovascular comrobidities have a pejorative impact on the prognosis of... Background: Central blood pressure is superior to office blood pressure measurements in predicting cardiovascular end organ damage. Conclusion: Therapy based on SPC of Valsartan/amlodipine was effective in providing extensive BP control (office and central BP). for a of 36 Independent follow were identified by multivariate logistic regression. Results : A total of 116 patients were included. 41,1% were treated with DES, 23,3% with DEB and 8,6 % with POBA. 12,9% underwent CABG and 13,8% received MT only. During follow-up, 37,9% of patients had at least one MACE. The mean delay to the occurrence of the first MACE is 15 months. [95% CI 1,2 – 6,8]; p=0,008) and the absence of post-dilatation after ISR angioplasty (OR 1,32; [95% CI 1,0 – 1,35]; p=0,04). Conclusion : Determining of these factors is important in order to improve ISR angioplasty outcomes. The a ratio of 1.3. the risk increase in pulse and respectively). in pulse between two types of therapy which are internal electric shock (IES) and anti-tachycardia pacing (ATP)leading to reduction of severe ventricular arrythmia. Despite the implementation of DAI either in primary or secondary prevention, several studies have predefined scores identifying patients who can really benefit from this treatment. Method: Our study is a descriptive and analytical cohort including 80 patients implanted in the cardiology department of the Habib Thameur hospital from January2010to June2019. Data on mortality and its causes were collected from medical records. We looked for predictors of mortality. Results: Males were predominant (92%) in our population. Ischemic During a follow-up of 55 we ischemic of infectious endocarditis, case of electrical In multivariate analysis, the of inappropriate therapies(p=0.008), ischemic heart disease(p=0.066) and Conclusion: In our study we identified three predictor factors of mortality which are ischemic heart disease, inappropriate with SaO2 <= 90%, LVEF <= 50%, and redo surgery. At 06 months follow-up, the functional gain in the overall population was significant (p <0.001) (table). However, the improvement in the functional status of group 1 patients was not significant. Ultrasound data showed a significant decrease in Right atrium area from 28.6 ± 7.4 cm² to 22.1 ± 5.2 cm² (p <0.001), right ventrivular diameter from 41 ± 5 , 8 to 31.4 ± 7.1 mm (p <0.001) and systolic PAP from 46.3 ± 14.1 mmHg to 33.3 ± 7.3 mmHg (p <0.001 ). We also note an improvement in right systolic function in our series. Conclusion: are a strongly in The diagnostic and therapeutic management of these patients requires specialized human skills and a well-equipped technical platform within the framework of specialized functional units. have them during follow up. It was found that only the PACS was significantly lower in the population having had these two complications (7.2 ± 2.9 vs 9.4 ± 4.1, p = 0.049). There was no significant difference between the two compared groups according PALS and left atrium area. The analysis of the ROC curve (PACS vs stroke and / or AF) objected that patients with a PACS value less than 10% have a significantly higher incidence of stroke and AF (89% vs 61%, p = 0.03) with a sensitivity of 50% and a specificity of 74% (AUC= 0.65). In our study, we did not find an independent predictor of the onset of stroke and / or AF in the follow-up of an asymptomatic patient with severe or moderate MS: PACS <10% (p = 0.06; OR = 1.18; 95% CI: [0.9-1.14]) and PALS <25 (p = 0.11; OR = 1.06; 95% CI: [0.9-1.14]). Conclusion: Our study demonstrated that the lower values of left atrial strain can be a predictor of AF and or stroke. re-examination, we identified patients who had shown an improvement of the LVEF to reach a LVEF > 40%. Results : In all, 223 patients were enrolled in the study, based on initial LVEF, 87 (39%) patients were classified as having HFrEF. Among patients with reduced LVEF (mean age: 66.1; gender ratio: 1.55), 13.8% (12 patients) had shown an improvement of LVEF and then considered to have HFiEF and 86.2% (75 patients) had a persistent HFrEF.patients with HFiEF younger (mean age: 58.5 vs 67.7; p= 0.04), more recent onset of heart failure (de Novo HF: 22.9%; p=0.01) (25% vs 56%; 0.04). of HTA and AF were similar (HTA :41.7% vs 52%; 0.5 ; AF: 16.7% vs 28% ; 0.4). All patients with HFiEF were treated with guideline-directed HF medical therapy. some The immediately onset of AVB was the only factor significantly correlated with the patient’s pacemaker dependency (p = 0.041). Conclusion : This study highlights the need for regular and prolonged rhythmic monitoring of cardiac surgery patients because a conductive disorder may occur late. and the cerebral veins in 1 patient. Superficial venous thrombosis was present in 20.8% of cases. Arterial involvement was present in 11.1% of patients. It included pulmonary artery aneurysms in 8 cases and occlusion of the central retinal artery in one patient. Other associated systemic manifestations were: skin and mucous membrane disorders (100%), articular (34.7%), ophthalmological (29.2%), neurological (27.8%) and cardiac involvement in 7 patients. Treatment was based on long term curative anticoagulation (70%), corticosteroid therapy (50%) and immunosuppressants (21%). Embolization was performed in two patients with good results. Conclusion : Our study illustrates the frequency and the polymorphism of vascular involvement in BD. The diagnosis of acute myocarditis the use of multiple diagnostic tests. The aim of this study is to evaluate the correlation between transthoracic echocardiography (TTE) and cardiac MRI (CMR) findings in acute myocarditis. our Left ventricular ejection fraction (LVEF) in 84% of cases. Three patients had a reduced LVEF.Two patients had a mid-range LVEF. Wall motion abnormalities (WMA) were in fourteen patients: segmental hypokinesia in nine patients, akinesia in four patients and only one case of global median follow-up of55months, 233 appropriate shock (87.3%) and 34 inappropriate shock (12.7%) were recorded. The incidence density of IEC was2.06 shocks/patient-year at one year,0.99shock/patient-year at 3 years and 0.50 shock/patient-year at 5 years. For appropriate shock (CEIA) this incidence density was1.72shock/patient-year at one year, 0.98shock/ patient-year at 3 years and0.42 shock/patient-year at 5 years. Spearman’s correlation coefficient is -1, which is in favor of decreasing this incidence density over time. For inappropriate shocks (CEII), this incidence density was0.33shock/ patient-year at one year,0.02shock/patient-year at3 years and0.09shock/patient-year at 5 years Spearman’s correlation coefficient is not significantly nonzero, which is in favor of a tendency towards stability as a function of time. We found that the incidence density of total IEC was decreasing over time. This decrease concerned the CEIA while the incidence density of CEII was stable during follow-up. A total of 174 patients (75 males and 99 females) this with a mean of 36.8 ± - 65]. Of the study population, 12.6 % underweight (male, 2.7%; female, 20.2 %), 30.5 % as normal weight (male, 49.3 %; female, 16.2 %), 31.0% overweight 36 %; female, 27.3 %) and 25.9% as obese (male, female, 36.4%). The mean BMI was 26.3±5.8 Kg/m2 extremes of 14.5 and 41.2 Kg/m2. Conclusion: In our study, hydration with bicarbonate serum has not shown any benefit in preventing Contrast induced nephropathy compared to hydration with physiological saline. A multi-center observational study is needed to confirm our results. Background : The occurrence of death in a young adult remains an event experienced as dramatic for the family as well as society and doctors. Sudden death at any age constitutes a medico-legal barrier to burial. Methods : We performed a retrospective study using autopsy data from the Department of forensic Medicine in Farhat Hached hospital. A review of all autopsies performed for 17 years was done. In each case, clinical information, and circumstances of death were obtained. A complete forensic autopsy and histological, and toxicological investigations were performed. We have included all sudden cardiac death in persons aged between 18 and 35 years. Results : We collected 120 cases of sudden cardiac death during the studied period. The mean age of the studied population was 26.3 years. SCD is significantly more prevalent in young males. General etiologic categories include heritable and acquired cardiomyopathies and arrhythmia syndromes (30%), structural congenital heart diseases (12.4 %), coronary abnormalities (14.6 %) and other abnormalities. Conclusion : The evaluation of the young victims of SCD and their relatives is an effective strategy for the detection of familiar cardiovascular. Introduction : Sudden cardiac death (SCD) is defined as the unexpected natural death of a cardiovascular cause in any circumstance and at any age. Although SCD in the elderly is not exceptional, publications in this area are rare. Our study aimed to highlight the epidemic peculiarities of sudden cardiac death in elderly people in the center of Tunisia. Methods: We conducted a retrospective study over a period of 4 years (2017- 2020) on all cases of sudden cardiac death of the elderly subject (age over 60 years) autopsied in the Department of Forensic Medicine in the Hospital of Kairouan. Results: During the study period, 71 cases were recorded. The age of the decea

INTRODUCTION:Percutaneous closure of congenital ventricular septal defects (VSDs) represents a promising alternative to surgery with lower rate of complications and shorter hospital stay. Its main limitation is the choice of the appropriate device for each type of defect.AIM:To report the experience of the service of cardiology (Sahloul hospital, Sousse, Tunisia) in percutaneous closure of congenital VSDs with Amplatzer Duct Occluder II (ADOII).METHODS:This was a retrospective, monocentric study, conducted from January 2013 to December 2017. The study included patients treated by percutaneous closure of congenital VSDs with the ADOII device.RESULTS:Twelve patients (6 boys; 6 girls) were included. The mean±SD of patients' age and weight were 65±41 months and 23±10 kg, respectively. VSDs were peri-membranous (n=9) and muscular (n=3), and defects were restrictive (n=11) and non-restrictive (n=1). The mean (minimum-maximum) size of VSDs was 4.72 (3-6) mm. Eleven ADOII prostheses were successfully implanted. One failure procedure was noted with migration of the device into the pulmonary artery. A second child with perimembranous defect developed transient atrioventricular block. No deaths occurred.CONCLUSION:The present early experience shows that percutaneous closure with ADOII device of perimembranous and trabecular VSDs is safe and effective.

Résumé Introduction. La fermeture percutanée des communications interventriculaires congénitales (CIV) constitue une alternative prometteuse à la chirurgie avec un taux de complications moindre et une durée de séjour hospitalier plus courte. Sa principale limite réside dans le choix de la prothèse appropriée pour chaque type de communication. But. Rapporter l’expérience de l’équipe de cardiologie de l’hôpital Sahloul (Sousse, Tunisie) dans la fermeture percutanée des CIV congénitales par la prothèse Amplatzer Duct Occluder II (ADOII). Méthodes. Il s’agissait d’une étude rétrospective, mono centrique, menée depuis janvier 2013 jusqu’à décembre 2017, incluant les patients traités par fermeture percutanée de CIV congénitales par la prothèse ADOII. Résultats. Douze patients (6 garçons, 6 filles) étaient inclus dans l’étude. Les moyennes d’âge et de poids étaient, respectivement, de 65±41 mois et 2±10 kg. Les CIV étaient périmembraneuses (n=9) et trabéculées (n=3), restrictives (n=11) et non restrictives (n=1). La taille moyenne (minimum-maximum) des CIV était de 4,72 (3-6) mm. Onze prothèses type ADOII étaient implantées avec succès. Une première procédure était compliquée par la migration de la prothèse dans l’artère pulmonaire. Un deuxième enfant suivi pour une CIV périmembraneuse a développé un bloc auriculo-ventriculaire transitoire. Aucun décès n’a été noté. Conclusion . Cette expérience débutante montre que la fermeture percutanée des CIV périmembraneuses et trabéculées par la prothèse ADOII est une procédure sure et efficace.

Background Coronary artery diseases remain the leading cause of death in the world. The management of this condition has improved remarkably in the recent years owing to the development of new technical tools and multicentric registries. Objective The aim of this study is to investigate the in-hospital and 1-year clinical outcomes of patients treated with percutaneous coronary intervention (PCI) in Tunisia. Methods We will conduct a prospective multicentric observational study with patients older than 18 years who underwent PCI between January 31, 2020 and June 30, 2020. The primary end point is the occurrence of a major adverse cardiovascular event, defined as cardiovascular death, myocardial infarction, cerebrovascular accident, or target vessel revascularization with either repeat PCI or coronary artery bypass grafting (CABG). The secondary end points are procedural success rate, stent thrombosis, and the rate of redo PCI/CABG for in-stent restenosis. Results In this study, the demographic profile and the general risk profile of Tunisian patients who underwent PCI and their end points will be analyzed. The complexity level of the procedures and the left main occlusion, bifurcation occlusion, and chronic total occlusion PCI will be analyzed, and immediate as well as long-term results will be determined. The National Tunisian Registry of PCI (NATURE-PCI) will be the first national multicentric registry of angioplasty in Africa. For this study, the institutional ethical committee approval was obtained (0223/2020). This trial consists of 97 cardiologists and 2498 patients who have undergone PCI with a 1-year follow-up period. Twenty-eight catheterization laboratories from both public (15 laboratories) and private (13 laboratories) sectors will enroll patients after receiving informed consent. Of the 2498 patients, 1897 (75.9%) are managed in the public sector and 601 (24.1%) are managed in the private sector. The COVID-19 pandemic started in Tunisia in March 2020; 719 patients (31.9%) were included before the COVID-19 pandemic and 1779 (60.1%) during the pandemic. The inclusion of patients has been finished, and we expect to publish the results by the end of 2022. Conclusions This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of PCI in this limited-income region. Trial Registration Clinicaltrials.gov NCT04219761; https://clinicaltrials.gov/ct2/show/NCT04219761 International Registered Report Identifier (IRRID) RR1-10.2196/24595