[Predictive factors of medication adherence in patients with chronic heart failure: Morocco's experience]

L’adhésion médicamenteuse chez les patients ayant une insuffisance cardiaque chronique est reconnue comme l’un des problèmes majeurs dans la gestion de cette pathologie. L’état démographique et socioéconomique des pays africains peut avoir un impact sur l’adhésion au traitement de l’insuffisance cardiaque chronique. Nous avons réalisé une étude transversale de Septembre 2014 à Janvier 2015 portant sur les patients en insuffisance cardiaque chronique suivis au centre d’insuffisance cardiaque du département de cardiologie du centre hospitalier universitaire IBN ROCHD à Casablanca au Maroc. La mesure de l’adhésion médicamenteuse était basée sur un questionnaire: questionnaire CARDIA. Les informations relatifs aux facteurs prédictifs d’adhésion médicamenteuse était dérivés du model d’adhésion multidimensionnel. Nous avons inclus dans cette étude 147 patients insuffisants cardiaques chroniques. Le pourcentage de l’adhésion médicamenteuse était de 83.6% selon CARDIA-Questionary. Les facteurs prédictifs qui influencent significativement l’adhésion médicamenteuse était: La dépression (p=0.034), le niveau de support social (p=0.03) et la prise de médicaments par le patient lui-même (p=0.0001). Comme dans plusieurs régions au monde, l’adhésion médicamenteuse chez les patients ayant une insuffisance cardiaque chronique reste un problème de santé au Maroc. Les différentes stratégies qui agissent sur les facteurs prédictifs pourraient améliorer l’adhésion médicamenteuse.

[Epidemiology of the relationship between atrial fibrillation and heart failure]

La fibrillation atriale et l’insuffisance cardiaque sont des maladies cardiovasculaires souvent associées, leur coexistence aggrave le pronostic et constitue un problème de santé public majeur. L’objectif de cette étude est d’évaluer la prévalence de la fibrillation atriale chez les patients en insuffisance cardiaque chronique et déterminer le profil clinique de ce groupe de patients. Nous avons conduit une étude rétrospective descriptive basée sur le registre d'insuffisance cardiaque du département de cardiologie du centre hospitalier universitaire de juin 2006 à Mars 2015.Nous avons inclus les patients âgés de plus de 18 ans ayant une insuffisance cardiaque chronique avec une fibrillation atriale. Durant cette période 3048 patients ayant une insuffisance cardiaque chronique avec fibrillation atriale(FA) ont été inclus. La prévalence de la fibrillation atriale était de 10,6%. La fréquence des facteurs de risque cardiovasculaires associée à (FA) était de: (54%) pour l'hypertension artérielle, (39%) pour le diabète, (8%) pour la dyslipidémie, (26%) pour le tabac, (30%) pour la sédentarité et (17%) pour la ménopause. La (FA) était présente chez (67,4%) des hommes versus (32,6%) des femmes. Les étiologies de l'insuffisance cardiaque chronique associées à la fibrillation atriale étaient: les valvulopathies (44,1%); les coronaropathies (32%); Hypertensives (11%), primitive (10%), toxiques (2%) et alcoolisme chronique (1%). La fibrillation atriale reste fréquente dans la population des patients insuffisants cardiaques au Maroc et la moyenne d’âge est inférieure à celle retrouvée dans la littérature.

Congenital heart disease and Down syndrome: various aspects of a confirmed association

BACKGROUND

Congenital heart disease (CHD) is frequently described in patients with Down syndrome (DS) and is the main cause of death in this population during the first two years of life. The spectrum of CHD patterns in DS varies widely worldwide; this variation could be due to sociodemographic, genetic and geographic factors.

METHODS

A six-year retrospective, descriptive study was carried out from December 2008 to October 2014, based on the Paediatric Unit CHD registry of Ibn Rochd University Hospital. Clinical, echocardiographic and outcomes data were collected and sorted according to confirmation of the syndrome.

RESULTS

Among 2 156 patients with CHD, 128 were identified with Down syndrome. The genders were equally represented (gender ratio 1) and the median age at diagnosis was 9.5 months (2 days to 16 years). The median age of mothers at delivery was 39 years (16-47). Of the 186 CHD lesions reported, the most common was atrioventricular septal defect (AVSD, 29%), followed by ventricular septal defect (VSD, 21.5%) and atrial septal defect (ASD, 19.9%). The most common associations of CHD were AVSD + ASD (10%) and VSD + ASD (7.8%). Surgery was the most common modality of treatment (54.3%). The overall mortality rate was 14.1%.

CONCLUSION

Our study confirmed that the profile and type of CHD in DS in the Moroccan setting exhibited slight differences in the distribution of these CHDs compared with European neighbours and other Western countries. Further studies are needed to determine which variables have an impact on these differences.

Spectrum of cardiac lesions associated with Isolated Cleft Mitral Valve and their impact on therapeutic choices

Background

Isolated cleft mitral valve (ICMV) may occur alone or in association with other congenital heart lesions. The aim of this study was to describe the profile of cardiac lesions associated with ICMV and their potential impact on therapeutic management.

Methods

We conducted a descriptive study with data retrieved from the Congenital Heart Disease (CHD) single-center registry of our institution, including patients with ICMV registered between December 2008 and November 2014.

Results

Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had Down syndrome. Seventeen patients (77.3%) had associated lesions, including 11 (64.7%) with accessory chordae in the left ventricular outflow tract (LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD), three had secundum atrial septal defect, and four had patent ductus arteriosus. Thirteen patients (59.1%) required surgical repair. The decision to proceed with surgery was mainly based on the severity of the associated lesion in eight patients (61.5%) and on the severity of the mitral regurgitation in four patients (30.8%). In one patient, surgery was decided based on the severity of both the associated lesion and mitral regurgitation.

Conclusion

Our study shows that ICMV is rare and strongly associated with Down syndrome. The most common associated cardiac abnormalities were VSD and accessory chordae in the LVOT. We conclude that cardiac lesions associated with ICMV are of major interest, since in this study patients with cardiac lesions were diagnosed earlier. The decision to operate on these patients must take into account the severity of both mitral regurgitation and associated cardiac lesions.

Correlation between the plasma fibrinogen concentration and coronary heart disease severity in Moroccan patients with type 2 diabetes. Prospective study

AIM

The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients.

METHODS

Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 non diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4).

RESULTS

The average age was 59.58±7.88 years; female gender predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; with a significant difference between the four groups (P=0.001). The plasma fibrinogen concentration increased in parallel with the cardiovascular risk (P=0.0001); there was also a significant correlation between the plasma fibrinogen concentration and the clinical and para-clinical coronary disease severity (respectively P=0.005 and P=0.0001). A positive correlation between the plasma fibrinogen concentration and hyperglycemia (P=0.035) was found in G4. But no correlation with the lipids parameters, except for the low density-lipoproteins in G3 (P=0.035).

CONCLUSION

In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.

Cardiac consequence of misdiagnosed vascular complication of spinal lumbar surgery: 6 years of diagnosis delay

Ilio-caval fistula is a rare complication of lumbar disk surgery that may pose a real diagnostic challenge. We report a case of a 50-year-old woman with overlooked massive right ilio-caval fistula complicating lumbar surgery 6 years previously, and who presented with refractory right heart failure misdiagnosed as chronic pericarditis. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. <Learning objective: Ilio-caval fistula is a rare vascular complication of low lumbar disk surgery often overlooked, which explains the frequency of late discovery cases due to the semiological polymorphism of the presentation. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. The treatment could be based on surgery or endovascular intervention; the prognosis remains good in treated patients.>.