Background:Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the Middle East and Africa (MEA), with a rising incidence particularly among women. Regional factors such as limited health care access, cultural barriers, and sex-specific risk factors exacerbate this burden. Despite this, women remain significantly underrepresented in cardiovascular research, and no large-scale, multicenter prospective trials have been conducted to provide national data. To address this gap, we established the Middle East African Registry Women Cardiovascular Disease (MEA-WCVD) to create a comprehensive database on the epidemiological profile and management of heart failure (HF), atrial fibrillation (AF), ischemic heart disease (IHD), and valvular heart disease (VHD) in women. Objective:The primary aim of this study is to compare the management of CVDs in women and men across MEA countries in accordance with current clinical practice guidelines. The study also seeks to identify gender-based disparities in health care insurance, income, and access to cardiovascular services. Methods:The MEA-WCVD is a prospective, multicenter, observational study enrolling consecutive patients aged ≥18 years with diagnosed HF, AF, IHD, or VHD across 25 tertiary care centers. Participants provide informed consent during a single visit, and trained investigators collect sociodemographic, clinical, and treatment data via electronic case report forms. The electronic case report form captures general characteristics (age, gender, and comorbidities) and diagnosis-specific details (imaging, guideline-based therapies, and complications). Data are stored in a centralized, contract research organization-managed database (Eshmoun-Clinical Research, Tunisia). An initial 75-day enrollment phase (May 2023-July 2023) is followed by a planned 1-year follow-up for outcome analysis. Data will be analyzed using SPSS (version 25) to compare gender disparities in management and outcomes using multivariable regression and survival analyses. Results:The MEA-WCVD study was funded in April 2023, and data collection began in May 2023. As of July 2023, a total of 15,366 participants have been enrolled across 25 centers. A 1-year follow-up is expected to be completed by July 2024. Data analysis is planned to commence in July 2024, with primary results anticipated for publication in March 2025. The study aims to establish the largest registry in the MEA region for HF, AF, IHD, and VHD, providing valuable insights into demographic trends, clinical management, and adherence to current guidelines. Conclusions:The MEA-WCVD registry will provide essential real-world data on the management and outcomes of the most prevalent CVDs (HF, AF, IHD, and VHD) in the MEA region. By directly comparing standard care management between men and women, this study will highlight gender disparities and inform future strategies for equitable cardiovascular care. The registry is expected to contribute to the largest contemporary cohort of patients with CVD in the region, advancing knowledge in cardiovascular epidemiology and clinical practice.

Introduction Reduced coronary blood causes metabolic changes, followed by diastolic then systolic dysfunction, electrical abnormalities and finally chest pain, “the ischemic cascade”. Echocardiography allows early detection of functional alterations with different parameters: wall motion abnormalities, strain alteration, and post-systolic shortening (PSS). PSS is myocardial shortening after end-systole, seen in regions with contractile dysfunction. Objective Investigate the association between post-systolic shortening and coronary artery disease. Method We conducted a prospective monocentric study at the Cardiology Department of the Interior Security Forces Hospital. Eligible patients had stable angina, unstable angina, or non-ST-elevation myocardial infarction (NSTEMI) and were scheduled for coronary angiography as part of their clinical management. An echocardiogram was performed before coronary angiography. Patients were divided into two groups: 37 with CAD (G1), 24 without CAD (G2). Results We included 61 patients with a mean age of 57±10 years, with 68% male. Acute coronary syndrome was the main indication for angiography.Significant stenosis affected the left anterior descending artery in 52%, 23% the circumflex artery in 23%, the right artery in 21%. Among CAD patients, 18 presented PSS. PSS showed 95% sensitivity and 54% specificity (P<0.001). The median post-systolic index (PSI) was 2.47 (1.04–4.05) and was significantly associated with CAD (AUC=0.765, P=0.001). The number of walls exhibiting pathological PSS was also a significant predictor, yielding an AUC of 0.754 (P=0.001). PSS has not shown localizing value in ischemic myocardial segments. Optimal threshold were >2.17 for mean PSI, providing a sensitivity of 81.8% and specificity of 70.8% (P<0.0001), and ≥0.5 for the number of walls with pathological PSS, yielding a sensitivity of 54.1% and specificity of 95.8% (P=0.001, Youden index=0.541).In multivariate analysis, the number of walls with pathological PSS was the only independent predictor (OR=12.87, 95% CI: 1.89–91.59, P=0.011). Conclusion PSS showed high sensitivity but limited specificity, quantitative assessment, particularly the number of left ventricular walls with pathological PSS, proved to be the strongest and only independent predictor of CAD.

INTRODUCTION:Cardiac amyloidosis is an underdiagnosed cause of heart failure characterized by extracellular deposition of misfolded proteins, most commonly transthyretin (ATTR) or immunoglobulin light chains (AL). Despite recent advances in disease-modifying therapies, prognosis remains poor. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardiovascular and renal benefits. However, evidence regarding their safety and efficacy in cardiac amyloidosis remains limited. AIM:This systematic review aimed to synthesize current evidence on the clinical outcomes and safety of SGLT2 inhibitors in patients with cardiac amyloidosis. METHODS:A comprehensive literature search was conducted in PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library through June 2025, in accordance with PRISMA guidelines. Studies evaluating the use of SGLT2i in cardiac amyloidosis were included. Outcomes assessed were all-cause mortality, stroke, hospitalization for heart failure, and kidney failure. Data extraction and quality assessment were performed independently by two reviewers. Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled when appropriate. RESULTS:Five studies comprising 17,416 patients met inclusion criteria. The mean age was 76.8 years, and 78% were male. Use of SGLT2 inhibitors was associated with a significant reduction in all-cause mortality (HR 0.64; 95% CI 0.57-0.71) and stroke risk (HR 0.64; 95% CI 0.54-0.77). For hospitalization due to heart failure, there was a trend toward benefit (HR 0.88; 95% CI 0.76-1.02), though this did not reach statistical significance. The risk of kidney failure was modestly reduced (HR 0.91; 95% CI 0.71-1.08). Overall study quality was moderate. CONCLUSIONS:SGLT2 inhibitors appear to be a promising therapeutic option in cardiac amyloidosis, potentially improving survival and reducing cerebrovascular events while maintaining a favorable safety profile. However, current evidence is limited by observational study designs and heterogeneity. High-quality randomized controlled trials are needed to confirm these findings and guide clinical practice.

Introduction: L’inertie thérapeutique est une cause majeure de l’hypertension artérielle (HTA) non contrôlée. Objectif: Décrire les connaissances, attitudes et pratiques des médecins de première ligne dans la prise en charge de l’HTA et décrire les facteurs de l'inertie thérapeutique. Méthodes: Il s'agissait d'une étude descriptive auprès des médecins de première ligne réalisée à travers un questionnaire en ligne créé à l'aide de Google Forms durant la période allant du 15 Mars au 15 Mai 2022. Résultats: Notre population incluait 232 médecins, âgés en moyenne de 39 ans, principalement actifs dans le secteur public (83%). Seuls 24% connaissaient les seuils diagnostics de l’HTA toutes méthodes confondues et 50% connaissaient les objectifs thérapeutiques. L’initiation par monothérapie était choisie par 49% des médecins avec une préférence notable pour les inhibiteurs de l’enzyme de conversion (79.3%) et les inhibiteurs calciques (60.8%). Les principales causes de l’inertie thérapeutique étaient le coût (78,4%), les pénuries de médicaments (72,8%), la non-adhésion thérapeutique (61,2%), le suivi par un autre spécialiste (46,5%), la crainte des effets secondaires (48,7%), l’âge du patient (40,5%), le manque d’organisation du suivi (36,6%) et les comorbidités (35%) principalement l’insuffisance rénale (78,4%). Conclusion: Notre étude révèle un manque de connaissance et d’application des nouvelles recommandations de l’HTA. Pour y remédier, il faut renforcer la formation médicale continue, promouvoir l’éducation des patients, réformer le système de santé et encourager l’utilisation de thérapies combinées.

Introduction Acute heart failure (AHF) is a life-threatening condition that requires swift diagnosis and tailored management to enhance patient outcomes. In the pursuit of more precise prognostic indicators, Tricuspid Annular Plane Systolic Excursion (TAPSE) and Pulmonary Arterial Systolic Pressure (PASP) have emerged as potential significant advancements. The TAPSE/PASP ratio, a novel parameter, has recently gained attention as a promising predictor of outcomes in acute heart failure. AIM:This study delves into the significance of TAPSE/PASP as a predictive tool, shedding light on its potential to revolutionize the landscape of AHF management. METHODS:We included 152 patients with AHF. Echocardiographic evaluation for left ventricle systolic and diastolic function was performed at the time of admission. RV functions were evaluated by calculating the following (TAPSE, PASP, TAPSE/PASP ratio). Data were analyzed to find the predictors of mortality and/or rehospitalization. RESULTS:The TAPSE/PASP ratio emerged as a significant independent predictor of clinical outcomes in AHF patients (HR=2.6; 95%CI: 1.04-6.47; p=0.04). Furthermore, it was the sole predictor of rehospitalization for AHF (HR=3.97; 95%CI: 1.38-11.40; p=0.01). It also independently predicted all-cause mortality in AHF, with an HR of 2.73 (95% CI: 1.25-9.12; p=0.03). When evaluating its predictive accuracy, the TAPSE/PASP ratio with a cutoff value <0.35 mm/mmHg demonstrated a sensitivity of 65%, specificity of 70%, and an area under the receiver operating characteristic curve of 0.70 for forecasting adverse outcomes. CONCLUSION:The non-invasive TAPSE/PASP ratio is an independent predictor of mortality and /or rehospitalization in patients with acute heart failure.

The escalating incidence of cardiovascular disease (CVD) in the general population, particularly among women, has resulted in increased morbidity and mortality in the Middle East and African (MEA) Regions. Despite this concerning tendency, women remain significantly underrepresented in cardiovascular research, with no large-scale prospective multicenter trials reflecting national data published to date. To address this gap, we initiated the "Women CardioVascular Disease Middle East African Registry (MEA-WCVD)" to establish a comprehensive database on the contemporary epidemiological profile and management of Heart Failure (HF), Atrial fibrillation (AF), ischemic heart disease (IHD) and Valvular Heart disease (VHD) in women. This study aims to compare the management of cardiovascular diseases in women and men in a MEA countries sample, according to the current practice guidelines and encompass the identification of gender-based disparities, specifically examining healthcare insurance, income, and access to healthcare services. This prospective observational study involves a one-shot visit where patients diagnosed with HF, AF, IHD, or VHD provide informed consent, and their data are collected in a centralized certified database. The registry spans 75 days, with plans for an extended protocol to assess 1-year clinical outcomes. The study's findings, expected at the conclusion, will include a comprehensive evaluation of the demographic profile and care management practices for the most prevalent cardiovascular diseases in women worldwide, aligned with current guidelines. The MEA-WCVD registry is anticipated to become the largest database for Middle East African patients monitored for HF, AF, IHD, and VHD. The MEA-WCVD registry will provide unique and necessary data on the management and outcomes of the most common CV diseases (AF, HF, IHD and VHD) while comparing standard care management in women to men in MEA regions. This study will yield the largest contemporary cohort of patients with cardiovascular diseases in MEA countries and would provide valuable answers about real-world cardio-vascular clinical epidemiology and management.

INTRODUCTION:Advanced heart failure (AHF) is associated with high morbidity and mortality. Inotropic agents such as dobutamine, levosimendan, and milrinone are commonly used to improve cardiac output, but their impact on mortality remains controversial due to limited head-to-head comparisons. AIM:To compare the effectiveness of inotropes (dobutamine, levosimendan, milrinone) versus placebo or each other in reducing mortality in patients with AHF. METHODS:This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO (CRD42024584389). We searched Scopus, CENTRAL, Google Scholar, PubMed, and clinical trial registries up to December 2024 for randomized controlled trials (RCTs) published from 2000 onward. Eligible studies included adults (≥18 years) with AHF and cardiorenal syndrome. Risk differences (RD) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the Cochrane Q-test, Tau², and I². Subgroup analyses and meta-regression were performed. Publication bias was evaluated using funnel plots and Duval and Tweedie's trim-and-fill method. RESULTS:Twenty-four RCTs involving 2,862 participants were included. The pooled RD for mortality was -0.023 (95% CI: -0.046 to 0.000; p=0.055), indicating no significant difference. Subgroup analysis by control (inotropes vs. placebo) showed similar non-significant results. Meta-regression for moderators (age, LVEF, systolic blood pressure) did not explain heterogeneity. The funnel plot suggested asymmetry, indicating potential publication bias. CONCLUSIONS:Inotropic agents showed a non-significant trend toward reduced mortality in AHF patients. Heterogeneity limits firm conclusions. Larger RCTs are needed to identify subgroups that may benefit.

INTRODUCTION:Basic life support is important for increasing patient survival after a cardiac arrest. However, it was demonstrated that healthcare professionals lacked certain knowledge and skills in basic life support. This study aimed to evaluate the effectiveness of a low-fidelity simulation training session in improving paramedical personnel knowledge and performance in Basic life support. METHODS:A cross-sectional quasi-experimental single-group pre-post intervention study was conducted at the Internal Security Forces Hospital in Tunisia in January 2024. All paramedical personnel providing direct patient care were included. The training program involved a theoretical course and a simulation training session. Participants filled out pre-tests and post-tests before and after the theoretical course. A practical simulation test with a skill assessment sheet occurred after the basic life support simulation training session. RESULTS:Fifty-five paramedical personnel participated in the study. Participants' mean age was 39.7±10.3 years and 72.7% of the participants were women. Most participants were nurses (50.9%). Comparing the pre-test (M=1.73, SD= 0.7) with the post-test scores (M=2.77, SD=1.02,) showed a significant improvement in basic life support knowledge after the theoretical course (p< 10-6). After the basic life support simulation training session, a significant improvement in the practical test score (M=4.04, SD= 0.7) compared to the post-test score was observed (p< 10-6). CONCLUSIONS:Simulation training has a positive effect on improving paramedical personnel's knowledge and performance. To enhance their knowledge and practice in cardiopulmonary resuscitation, a basic life support training program is recommended for all paramedical personnel.

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

Cardiovascular disease (CVD) is a major health burden worldwide, yet gender-specific data from the Middle East and North Africa (MENA) region remain scarce. The Middle East African Registry of Women with Cardiovascular Disease enrolled adult patients with coronary heart disease (CHD), heart failure (HF), atrial fibrillation (AF), or valvular heart disease (VHD) across Tunisia between May and July 2023. Of 15,366 patients, 37.6% were women. Compared with men, women were older, had lower socioeconomic status, and presented with more obesity, hypertension, diabetes, dyslipidemia, and sedentary lifestyle but smoked less. CHD was less frequent in women, while AF and VHD were more prevalent. Women underwent fewer coronary angiographies and percutaneous interventions, experienced longer delays, and received fewer guideline-based therapies, including dual antiplatelet agents and high-intensity statins. Among HF patients, women more often had preserved ejection fraction and higher hospitalization rates. These results highlight persistent gender inequities in CVD care in Tunisia.

BACKGROUND:Sodium-glucose transport protein 2 inhibitors (SGLT2i) have revolutionized the management of heart failure and renal dysfunction. Cardiac amyloidosis, an underdiagnosed cause of heart failure, primarily results from light-chain (AL) or transthyretin (ATTR) deposition. Emerging evidence suggests that SGLT2i may improve cardiac and renal outcomes in these patients. However, data on their efficacy and safety in cardiac amyloidosis remain limited. This study aimed to conduct a systematic review to evaluate the efficacy and safety of SGLT2i in cardiac amyloidosis. METHODS:This systematic review and meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42024584183). A comprehensive search was performed across PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library databases, including studies involving adult patients with AL or ATTR cardiac amyloidosis. Outcomes analyzed included cardiovascular mortality, heart failure hospitalizations, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), NT-proBNP, renal parameters, and adverse events. Data were synthesized using a random-effects model to account for heterogeneity, with effect measures expressed as risk ratios (RR) or mean differences (MD) and 95% confidence intervals (CIs). RESULTS:Preliminary findings indicate that SGLT2i use in cardiac amyloidosis is associated with significant improvements in LVEF, NT-pro BNP levels, and renal parameters such as eGFR and albuminuria progression. A reduction in heart failure hospitalizations and stabilization of NYHA functional class were also observed. Adverse events, including genitourinary infections and orthostatic hypotension, were reported but were consistent with known SGLT2i safety profiles. However, heterogeneity in study designs and small sample sizes limit definitive conclusions. CONCLUSION:This systemic review highlights the potential of SGLT2i to improve functional and cardiovascular outcomes in cardiac amyloidosis while maintaining an acceptable safety profile. Despite these promising results, further randomized controlled trials are necessary to confirm the findings and define the role of SGLT2i in managing cardiac amyloidosis. Until then, clinicians should cautiously integrate SGLT2i into treatment strategies based on individual patient characteristics and clinical context.

BACKGROUND:Therapeutic inertia is a major cause of uncontrolled hypertension. The aim of our work study is to describe the knowledge, attitudes, and practices of primary care physicians in the management of hypertension and to describe the factors of therapeutic inertia. METHODS:This was a descriptive study among primary care physicians conducted through an online questionnaire created using Google Forms during the period from March 15 to May 15, 2022. RESULTS:Our population included 232 physicians with an average age of 39 years. They mainly worked in the public sector (83%). Only 24% of the physicians knew the diagnostic thresholds for hypertension using all methods. Fifty percent knew the therapeutic objectives. Initiation with monotherapy was chosen by 49% of physicians. Angiotensin converting enzyme inhibitors and calcium channel blockers were chosen by 79.3% and 60.8% of physicians, respectively. The main reasons for therapeutic inertia were cost (78.4%), drug shortage (72.8%), non-adherence to therapy (61.2%), follow-up by another specialist (46.5%), fear of side effects of antihypertensive drugs (48.7%), patient's age (40.5%), lack of organization of patient follow-up (36.6%), and the presence of other comorbidities (35%). Renal failure was the main comorbidity involved (78.4%). CONCLUSIONS:Our study concludes that there was a lack of knowledge and application of the new recommendations for hypertension. It would be necessary to promote continuous training of primary care physicians, to insist on therapeutic education of patients, to reform the public health system in Tunisia to cover the provisions of hypertensive patients, and to introduce combination therapy.

Introduction: Diagnosing heart failure with preserved ejection fraction (HFpEF) remains challenging. Several diagnostic criteria have been proposed, and current guidelines recommend using the HFA-PEFF score in the diagnostic algorithm for HFpEF. We sought to evaluate the clinical utility of left atrial strain (LAS) in the diagnosis of HFpEF as assessed by the HFA-PEFF score. Methods: This was a prospective, mono-centric, cross-sectional study conducted from October 2021 to June 2022 in the Cardiology Department of the Internal Security Forces Hospital of Marsa, Tunisia. Patients were classified into two groups (A and B) based on the HFpEF diagnosis assessed by the HFA-PEFF scoring system: Group A with a score of ≥5 and Group B with a score of <5. Results: A total of 110 patients were eligible for the study. The mean age was 61 ± 11 years. A female predominance was noted, with 57% of the patients being female. Hypertension and diabetes were the most common cardiovascular risk factors, found in 81.8% (n=90) and 54.5% (n=60) of patients, respectively. The median HFA-PEFF score was 4 [2-6]. Forty-six patients (41.6%) were given a clinical diagnosis of HFpEF. LAS analysis showed that PALS (p<0.001) and PACS (p<0.001) were significantly lower in Group A compared with Group B. PALS was strongly correlated with the HFA-PEFF score (r=-0.693, p<0.001). PALS (AUC=0.889; p<0.001) was significantly the best predictor of HFpEF diagnosis. After multivariate analysis, PALS (HR=0.782; 95% CI: 0.629-0.973; p=0.027) was an independent predictor of HFpEF diagnosis, with a cut-off value of 24% (sensitivity of 86% and specificity of 89.5%). Conclusion: PALS is a simple and sensitive ultrasound parameter that can be used for the diagnosis of HFpEF.

Acute heart failure (AHF) is a critical condition with significant morbidity and mortality, necessitating timely and accurate diagnosis for effective management. The Venous Excess Ultrasound (VExUS) score has emerged as a non-invasive diagnostic tool, aimed at evaluating venous congestion through ultrasound. This scoring system integrates assessments of the inferior vena cava, hepatic veins, portal veins, and renal venous flow to quantify congestion severity. By providing a real-time assessment of venous pressure, the VExUS score has shown potential in optimizing early diagnosis of AHF and predicting outcomes and overall prognosis. Recent studies suggest that incorporating the VExUS score into clinical practice can enhance patient stratification and guide tailored therapeutic interventions, reducing the need for invasive procedures like right heart catheterization. However, further large-scale studies are required to fully validate its role in predicting long-term outcomes and establishing its place in standard heart failure protocols. We aimed to review the current evidence on the utility of the VExUS score in improving AHF diagnosis and its potential as a prognostic marker, highlighting its technical aspects, clinical implications and future research directions.

Introduction La présence d’un déficit ventilatoire (DV) chez les patients tabagiques suivis pour cardiopathie ischémique (CI) aggrave l’état respiratoire et altère la qualité de vie de ces patients vulnérables sur le plan cardiaque. Ainsi, le dépistage des DV est nécessaire afin améliorer le pronostic de la CI. La fréquence de ces DV a été peu étudiée dans la littérature. L’objectif de notre travail était de déterminer la fréquence des DV chez les coronariens tabagiques. Méthodes Il s’agit d’une étude transversale descriptive incluant 129 patients tabagiques suivis à la consultation externe du service de cardiologie de l’hôpital des FSI de la Marsa en Tunisie, pour CI stable entre janvier et août 2024. Chaque patient a eu une spirométrie simple complétée au besoin par une pléthysmographie. Résultats L’âge moyen était de 59,7±9,5 ans avec une nette prédominance masculine. La consommation tabagique moyenne était à 51,9±29,4 PA et 53,4 % des patients avaient un tabagisme actif. Le diabète (56,5 %), l’hypertension artérielle (47,2 %) et la dyslipidémie (47,2 %) étaient les comorbidités les plus fréquentes. La dyspnée d’effort était le symptôme respiratoire le plus fréquent (47,2 %). Aucun symptôme respiratoire n’a été retrouvé chez 48 % des patients. La spirométrie était normale dans 65,1 % des cas. Un DV obstructif, une atteinte isolée des petites voies aériennes et un DV restrictif ont été diagnostiqués dans respectivement 18,6, 7,7 et 7,7 % des cas. La fréquence de la BPCO était de 17,8 %, dont 66,6 % des patients étaient diagnostiqués au moment de l’étude. La comparaison des patients ayant une spirométrie normale avec ceux ayant un DV a montré que les patients ayant un DV étaient significativement plus âgés (p=0,007), avaient une consommation tabagique plus importante (p=0,01) et une dyspnée d’effort plus fréquente (p < 10−6). L’hypertension artérielle pulmonaire (p=0,01) et la dysfonction du ventricule droit (p=0,03) étaient significativement plus fréquentes chez ces patients. Conclusion Les résultats de notre travail suggèrent une fréquence élevée des DV chez les coronariens tabagiques particulièrement le DV obstructif. Ces patients présentent plus de symptômes respiratoires avec une fonction ventriculaire droite plus altérée d’où l’importance d’un dépistage précoce de ces DV dans ce groupe de patients.

RESEARCH PROBLEM:Hypertension is a multifactorial disease that affects approximately one third of the Tunisian adult population. It is a major risk factor for stroke and cardiovascular disease. Environmental and psychosocial factors play an important role in hypertension onset and control. The prevalence of depression among hypertensive patients is 26, 8% and its presence is associated with increased risk of cardiovascular related morbi-mortality. Our study aims to evaluate the role of depression in blood pressure control among ambulatory hypertensive patients. Investigative process: This study is a cross-sectional, multicentric and descriptive study. We intend to include three hundred and two patients. A 24-hour ambulatory blood pressure monitor will be used to evaluate blood pressure control. Depression will be assessed by the 9-item Patient Health Questionnaire (PHQ-9) in Tunisian dialect. Clinical, socio-environmental, psychosocial and therapeutic and prognosis data will be collected from medical records. Patients will be classified into two groups: Controlled versus non-controlled hypertension. PHQ-9 scores will be then compared between the two cohorts. RESEARCH PLAN:Ethical considerations will be undertaken and respected. All patients should express an informed oral consent before enrollment. This trial will run for three months from the 15th August 2022. TRIAL REGISTRATION:NCT05516173.

INTRODUCTION:The occurrence of death from acute pulmonary embolism (PE) is often linked to right ventricular (RV) failure, arising from an imbalance between RV systolic function and heightened RV afterload. In our study, we posited that an echocardiographic ratio derived from this disparity [RV systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) divided by pulmonary arterial systolic pressure (PASP)] could offer superior predictive value for adverse outcomes compared to individual measurements of TAPSE and PASP alone. METHODS:We conducted a retrospective analysis using data from a University Hospital Centre spanning from 2017 to 2023. All individuals with confirmed PE and a formal transthoracic echocardiogram within 7 days of diagnosis were included. The primary endpoint was a composite outcome of death, hemodynamic deterioration needing introduction of inotropes or thrombolysis within 30 days. Secondary endpoints included 6 months all-cause mortality and onset of right-sided heart failure. RESULTS:Thirty-eight patients were included. Mean age was 58 ±15 years old. A male predominance was noted: 23 male patients (60.5%) and 15 female patients (39.5%). Eight patients met the primary composite endpoint while nine patients met the secondary composite endpoint. In multivariate analysis, the TAPSE/PASP ratio was independently associated with the primary outcome (OR=2.77, 95% CI 1.101-10.23, P=0.042). A TAPSE/PASP ratio <0.3 was independently associated with the secondary outcome (OR=3.07, 95% CI 1.185-10.18, P=0.034). CONCLUSION:This study suggests that a combined echocardiographic ratio of RV function to afterload is effective in predicting adverse outcomes in acute PE.