Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Activity of a catheterization laboratory in Tunisia: A comparative study before and during confinement (COVID-19)

Introduction

The COVID-19 pandemic has significantly impacted the Tunisian healthcare system. To reduce the risk of contracting or transmitting COVID-19, the Centers for Disease Control and Prevention recommended deferral of elective cardiac procedures, including coronary angiography (CA) and percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD).

Purpose

However anecdotal reports suggest also a decline in the number of patients consulting for an unstable CAD and therefore in the activity of the catheterization laboratory.

Methods

To confirm this finding, we conducted a study comparing the number of patients who consulted for an unstable CAD and who benefited from a CA associated or not with a PCI during the confinement period (CP) (from March 15, 2020 to April 30, 2020) and just 6 weeks before (from February 1, 2020 to March 15, 2020) in Mongi Slim La Marsa University Hospital Center.

Results

Our analysis showed that out of 183 patients with unstable CAD, 127 (69,4%) and 56 (30.6%) consulted and were urgently treated in our catheterization laboratory respectively before and during the confinement period thus an estimated 40% reduction in our daily activity (Fig. 1).

Conclusion

Potential etiologies for the decrease in unstable patients with CAD may be related to the avoidance of medical care due to social distancing or concerns of contracting COVID-19 in the hospital and ST-Segment elevation myocardial infarction misdiagnosis. As long as the pandemic continues, we highly recommend to follow this signal and investigate its causes.

Superdeformed and Triaxial States in ^{42}Ca

Shape parameters of a weakly deformed ground-state band and highly deformed slightly triaxial sideband in ^{42}Ca were determined from E2 matrix elements measured in the first low-energy Coulomb excitation experiment performed with AGATA. The picture of two coexisting structures is well reproduced by new state-of-the-art large-scale shell model and beyond-mean-field calculations. Experimental evidence for superdeformation of the band built on 0_{2}^{+} has been obtained and the role of triaxiality in the A∼40 mass region is discussed. Furthermore, the potential of Coulomb excitation as a tool to study superdeformation has been demonstrated for the first time.

Prolate-spherical shape coexistence at N=28 in 44S

The structure of 44S has been studied by using delayed γ and electron spectroscopy. The decay rates of the 02+ isomeric state to the 2(1)+ and 0(1)+ states, measured for the first time, lead to a reduced transition probability B(E2: 2(1)+→0(2)+)=8.4(26) e(2) fm4 and a monopole strength ρ2(E0: 0(2)+→0(1)+)=8.7(7)×10(-3). Comparisons to shell model calculations point towards prolate-spherical shape coexistence, and a two-level mixing model is used to extract a weak mixing between the two configurations.

Collapse of the N=28 shell closure in (42)Si

The energies of the excited states in very neutron-rich (42)Si and (41,43)P have been measured using in-beam gamma-ray spectroscopy from the fragmentation of secondary beams of (42,44)S at 39A MeV. The low 2(+) energy of (42)Si, 770(19) keV, together with the level schemes of (41,43)P, provides evidence for the disappearance of the Z=14 and N=28 spherical shell closures, which is ascribed mainly to the action of proton-neutron tensor forces. New shell model calculations indicate that (42)Si is best described as a well-deformed oblate rotor.

Enhanced core polarization in (70)Ni and (74)Zn

The reduced transition probabilities B(E2;0(+) --> 2(+)(1)) of the neutron-rich (74)Zn and (70)Ni nuclei have been measured by Coulomb excitation in a (208)Pb target at intermediate energy. These nuclei have been produced at Grand Accélérateur National d'Ions Lourds via interactions of a 60A MeV (76)Ge beam with a Be target. The B(E2) value for (70)Ni(42) is unexpectedly large, which indicates that neutrons added above N=40 strongly polarize the Z=28 proton core. In the Zn isotopic chain, the steep rise of B(E2) values beyond N=40 continues up to (74)Zn(44). The enhanced proton core polarization in (70)Ni is attributed to the monopole interaction between the neutron in the g(9/2) and protons in the f(7/2) and f(5/2) spin-orbit partner orbitals. This interaction could result in a weakening of magicity in (78)Ni(50).

Excitation energies of superdeformed States in 196Pb: towards a systematic study of the second well in Pb isotopes

The excitation energy of the lowest-energy superdeformed band in 196Pb is established using the techniques of time-correlated gamma-ray spectroscopy. Together with previous measurements on 192Pb and 194Pb, this result allows superdeformed excitation energies, binding energies, and two-proton and two-neutron separation energies to be studied systematically, providing stringent tests for current nuclear models. The results are examined for evidence of a "superdeformed shell gap."

(68)(28)Ni(40): Magicity versus superfluidity

The neutron-rich (66,68)Ni have been produced at GANIL via interactions of a 65.9A MeV 70Zn beam with a 58Ni target. Their reduced transition probability B(E2;0(+)(1)-->2+) has been measured for the first time by Coulomb excitation in a (208)Pb target at intermediate energy. The B(E2) value for (68)Ni(40) is unexpectedly small. An analysis in terms of large scale shell model calculations stresses the importance of proton core excitations to reproduce the B(E2) values and indicates the erosion of the N = 40 harmonic-oscillator subshell by neutron-pair scattering.

Isomer spectroscopy in (216)(90)Th(126) and the magicity of (218)(92)U(126)

Excited states in (216)Th were investigated via prompt and delayed gamma decays and the recoil-decay tagging method. The decay schemes of the I(pi) = (8+), t(1/2) = 128(8) micros, the I(pi) = (11-), t(1/2) = 615(55) ns, and the I(pi) = (14+), t(1/2) > or = 130 ns isomers were established. The configuration pi h(9/2)f(7/2) is assigned to the I(pi) = (8+) isomer, which implies that the h(9/2) and f(7/2) states are nearly degenerate. This is ascribed to increased binding of the f(7/2) orbital by its coupling to a low-lying I(pi) = (3-) state at E(x) = 1687 keV. The role of octupole and pairing correlations for a Z = 92 shell closure prediction is discussed on the basis of shell model calculations.