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Chabrak S, Haggui A, Allouche E, Ouali S, Ben Halima A, Kacem S, Krichen S, Marrakchi S, Fehri W, Mourali MS, Jabbari Z, Ben Halima M, Neffati E, Heraiech A, Slim M, Kachboura S, Gamra H, Hassine M, Kraiem S, Kammoun S, Bezdah L, Jridi G, Bouraoui H, Kammoun S, Hammami R, Chettaoui R, Ben Ameur Y, Azaiez F, Tlili R, Battikh K, Ben Slima H, Chrigui R, Fazaa S, Sanaa I, Ellouz Y, Mosrati M, Milouchi S, Jarmouni S, Ayadi W, Akrout M, Razgallah R, Neffati W, Drissa M, Charfeddine S, Abdessalem S, Abid L, Zakhama L. National Tunisian Study of Cardiac Implantable Electronic Devices: Design and Protocol for a Nationwide Multicenter Prospective Observational Study. JMIR Res Protoc 2024; 13:e47525. [PMID: 38588529 PMCID: PMC11036188 DOI: 10.2196/47525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND In Tunisia, the number of cardiac implantable electronic devices (CIEDs) is increasing, owing to the increase in patient life expectancy and expanding indications. Despite their life-saving potential and a significant reduction in population morbidity and mortality, their increased numbers have been associated with the development of multiple early and late complications related to vascular access, pockets, leads, or patient characteristics. OBJECTIVE The study aims to identify the rate, type, and predictors of complications occurring within the first year after CIED implantation. It also aims to describe the demographic and epidemiological characteristics of a nationwide sample of patients with CIED in Tunisia. Additionally, the study will evaluate the extent to which Tunisian electrophysiologists follow international guidelines for cardiac pacing and sudden cardiac death prevention. METHODS The Tunisian National Study of Cardiac Implantable Electronic Devices (NATURE-CIED) is a national, multicenter, prospectively monitored study that includes consecutive patients who underwent primary CIED implantation, generator replacement, and upgrade procedure. Patients were enrolled between January 18, 2021, and February 18, 2022, at all Tunisian public and private CIED implantation centers that agreed to participate in the study. All enrolled patients entered a 1-year follow-up period, with 4 consecutive visits at 1, 3, 6, and 12 months after CIED implantation. The collected data are recorded electronically on the clinical suite platform (DACIMA Clinical Suite). RESULTS The study started on January 18, 2021, and concluded on February 18, 2023. In total, 27 cardiologists actively participated in data collection. Over this period, 1500 patients were enrolled in the study consecutively. The mean age of the patients was 70.1 (SD 15.2) years, with a sex ratio of 1:15. Nine hundred (60%) patients were from the public sector, while 600 (40%) patients were from the private sector. A total of 1298 (86.3%) patients received a conventional pacemaker and 75 (5%) patients received a biventricular pacemaker (CRT-P). Implantable cardioverter defibrillators were implanted in 127 (8.5%) patients. Of these patients, 45 (3%) underwent CRT-D implantation. CONCLUSIONS This study will establish the most extensive contemporary longitudinal cohort of patients undergoing CIED implantation in Tunisia, presenting a significant opportunity for real-world clinical epidemiology. It will address a crucial gap in the management of patients during the perioperative phase and follow-up, enabling the identification of individuals at particularly high risk of complications for optimal care. TRIAL REGISTRATION ClinicalTrials.gov NCT05361759; https://classic.clinicaltrials.gov/ct2/show/NCT05361759. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/47525.
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Affiliation(s)
- Sonia Chabrak
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Abdeddayem Haggui
- Military Hospital, Faculty of Medicine of Tunis, University of Tunis, Tunis, Tunisia
| | - Emna Allouche
- Cardiology Department, Faculty of Medicine of Tunis, Charles Nicole Hospital, University of Tunis, Tunis, Tunisia
| | - Sana Ouali
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Afef Ben Halima
- Abderrahmen Mami Hospital, Faculty of Medicine of Tunis, University of Tunis, Tunis, Tunisia
| | | | | | - Sonia Marrakchi
- Cardiology Department, Versailles Cardiology Center, Paris, France
| | - Wafa Fehri
- Cardiology Department, Faculty of Medicine of Tunis, Military Hospital, University of Tunis, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Zeineb Jabbari
- Cardiology Department, Faculty of Medicine of Tunis, La Rabta Hospital, University of Tunis, Tunis, Tunisia
| | - Manel Ben Halima
- Cardiology Department, Faculty of Medicine of Tunis, Abderrahmen Mami Hospital, University of Tunis, Tunis, Tunisia
| | - Elyes Neffati
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Aymen Heraiech
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Mehdi Slim
- Cardiology Department, Faculty of Medicine of Sousse, Sahloul Hospital, University of Sousse, Sousse, Tunisia
| | - Salem Kachboura
- Cardiology Department, Faculty of Medicine of Tunis, Abderrahmen Mami Hospital, University of Tunis, Tunis, Tunisia
| | - Habib Gamra
- Cardiology A Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Majed Hassine
- Cardiology A Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Sondes Kraiem
- Cardiology Department, Faculty of Medicine of Tunis, Habib Thameur Hospital, University of Tunis, Tunis, Tunisia
| | - Sofien Kammoun
- Cardiology Department, Faculty of Medicine of Tunis, Habib Thameur Hospital, University of Tunis, Tunis, Tunisia
| | - Leila Bezdah
- Cardiology Department, Faculty of Medicine of Tunis, Charles Nicole Hospital, University of Tunis, Tunis, Tunisia
| | - Gouider Jridi
- Cardiology Department, Faculty of Medicine of Sousse, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Hatem Bouraoui
- Cardiology Department, Faculty of Medicine of Sousse, Farhat Hached Hospital, University of Sousse, Sousse, Tunisia
| | - Samir Kammoun
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Rania Hammami
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Rafik Chettaoui
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Youssef Ben Ameur
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Fares Azaiez
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Rami Tlili
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | | | - Hedi Ben Slima
- Cardiology Department, Faculty of Medicine of Tunis, Menzel Bourguiba Hospital, University of Tunis, Bizerte, Tunisia
| | - Rim Chrigui
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Samia Fazaa
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | - Islem Sanaa
- General & Cardiovascular Clinic, Tunis, Tunisia
| | - Yassine Ellouz
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | | | - Sami Milouchi
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
- Cardiology Department, Habib Bourguiba Hospital, University of Sfax, Medenine, Tunisia
| | - Soumaya Jarmouni
- Pasteur Clinic, General and Cardiovascular Clinic of Tunis, Tunis, Tunisia
| | | | | | | | | | - Meriem Drissa
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
- Cardiology Department, Faculty of Medicine of Tunis, Mongi Slim Hospital, University of Tunis, Tunis, Tunisia
| | - Selma Charfeddine
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Salem Abdessalem
- Tunisian Society of Cardiology and Cardiovascular Surgery, Tunis, Tunisia
| | - Leila Abid
- Cardiology Department, Faculty of Medicine of Sfax, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Lilia Zakhama
- Cardiology Department, Hospital of the Interior Force Security, University of Tunis, Tunis, Tunisia
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Guizani I, Zidi W, Zayani Y, Nesrine F, Douik H, Sanhaji H, Mourali MS, Feki M, Allal-Elasmi M. Matrix metalloproteinase 3 and 9 as genetic biomarkers for the occurrence of cardiovascular complications in coronary artery disease: a prospective cohort study. Mol Biol Rep 2022; 49:9171-9179. [PMID: 35960412 DOI: 10.1007/s11033-022-07742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) are widely expressed in atherosclerosis lesions. The disequilibrium of MMPs driving to an overexpression or a lack of its level can be influenced by genetic variations. MMP-3 and MMP-9 may be affected by specific polymorphisms like - 1612 5 A/6A and the - 1562 C/T respectively. We aim in the present study to investigate prospectively the association between the - 1612 5 A/6A MMP-3 and - 1562 C/T MMP-9 polymorphisms and clinical outcomes in patients with coronary artery disease (CAD). This study is elaborated to reveal whether one of these polymorphisms is a probable predictor of cardiovascular complications in this CAD cohort. METHODS AND RESULTS A total of 168 patients with CAD were prospectively followed up over a period of 5 years. Genotypes for the MMP-3 (-1612 5 A/6A) and MMP-9 (-1562 C/T) polymorphisms were performed using PCR-RFLP. Their levels were measured by ELISA in Sandwich test during the follow-up period, 39 cardiovascular outcomes occurred with 21 repeat targets for revascularization, 3 patients with Myocardial infarction, 8 for heart failure, 5 for Stroke and 2 for cardiovascular mortality. The MMP-3 5 A/6A polymorphism was related to the disease on the contrary of the MMP-9 -1562 C/T. Patients carrying the 5 A allele had a higher level of MMP-3 level and those who carried the 6 A allele had lower level (p = 0.04). After applied multivariable Cox-hazard models we revealed that the 6 A allele is independently associated to the disease complication. Kaplan-Meier survival test revealed that individuals having the 6 A allele had a lower survival rate than those with the 5 A allele (p = 0.04). CONCLUSION Our study suggests the disruption of the MMP-3 level may be due to the existence of the polymorphism - 1612 residing in its promoter region. MMP-3 can be considered as a marker of diagnosis and prediction in cardiovascular events.
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Affiliation(s)
- Imen Guizani
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia.,Faculty of Mathematics, Physics and Natural Sciences, University of Tunis El Manar, Tunis, Tunisia
| | - Wiem Zidi
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Yosra Zayani
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fourti Nesrine
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Hayet Douik
- LR99ES10 Human Genetics Laboratory, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Haifa Sanhaji
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | | | - Moncef Feki
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Monia Allal-Elasmi
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia. .,Laboratory of Biochemistry, La Rabta Hospital, 1007, Jebbari, Tunis, Tunisia.
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Ben Halima M, Yaakoubi W, Boudiche S, Rekik B, Zghal Mghaieth F, Ouali S, Mourali MS. New-onset atrial fibrillation after acute coronary syndrome: prevalence and predictive factors. Tunis Med 2022; 100:114-121. [PMID: 35852244 PMCID: PMC9272446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION New-onset AF atrial fibrillation (NOAF) frequently complicates acute coronary syndromes (ACS) leading to adverse outcomes in the short and long term. The prevalence of NOAF in patients hospitalized for ACS is variably reported and ranges between 2 and 37%. Several predictor factors have been implicated in the literature but remain a subject of controversy. AIM To determine the prevalence of NOAF in a population of patients admitted for ACS and to identify its predictive factors. METHODS We carried out a prospective, descriptive and comparative observational study in hospitalized patients with ACS who did not have a previous diagnosis of AF. RESULTS In our study, we included 404 patients hospitalized for ACS. The prevalence of NOAF was 10%. In the multivariate analytical study, we retained as independent predictors of NOAF: age greater than 62 years (p = 0.04; adjusted OR = 4.83; CI95%: 1.07-21.77), chronic renal failure (p = 0.043; adjusted OR = 6.61; CI95%: 1.06-35.80), history of stroke (p = 0.002; adjusted OR = 44.51; CI95%: 3.97- 498.10) and finally uricemia greater than or equal to 62 mg / l (p = 0.04; adjusted OR = 4.4; CI95%: 1.06-18.15). CONCLUSIONS The prevalence of NOAF in patients with ACS was 10%. Its systematic screening in these patients appears to be a relevant approach because of the strong association between these two pathologies.
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Ben Halima A, Aouina H, Hamzaoui A, Gharbi L, Chaouech N, Dhahri B, Ghrairi H, Maazaoui S, Sahnoun I, Ben Mansour A, Louhichi S, Ben Amar J, Lakehal R, Allouche E, Ben Ahmed H, Aissa MS, Fathi M, Boudiche F, Ben Jemaa H, Béji M, Ouechtati W, Bezdah L, Ben Abdessalem MA, Cheikh Sidiya K, Romdhane AF, Ben Ameur Z, Mosrati H, Ammar F, Bouraoui H, Hajri S, Mahdhaoui A, Jeridi G, Nasser K, Elhraiech A, Kacem M, Tekaya MA, Meddeb A, Ben Hamda K, Maatouk F, Wachem O, Antit S, Fekih R, Antit C, Boussabah E, Thameur M, Zakhama L, Ben Youssef S, Ben Doudou M, Kamoun S, Ben Mrad I, Ben Moussa F, Fennira S, Mzoughi K, Zairi I, Kraiem S, Messaoudi Y, Ben Abdallah M, Ghabi O, Ben Halima N, Mleyhi S, Sandi T, Miri R, Besbes T, Ghédira F, Ben Omrane S, Denguir R, Drissa M, Brahim A, Mousli E, Ousji C, Abou Nada H, Bouslimi A, Merdassi A, Taher O, Drissa H, Yaakoubi W, Ben Hlima M, Rekik B, Soula MA, Zouari F, Boudiche S, Mghaieth F, Ouali S, Mourali MS, Taamallah K, Abid M, Hajlaoui N, Haggui A, Fehri W, Ben Abdallah M, Azaiez F, Cherif N, Jaoued F, Tlili R, Ben Ameur Y, Khorchani A, Ben Ali Z, Dali AE, Milouchi S, Boufares A, Ben Krayen I, Mtimet H, Ben Haj Mbarek MG, Bouhamed O, Dardouri S, Gribaa R, Ben Ali I, Slim M, Neffati E, Damak E, Jaber C, Cherif T, Bousnina M, Jemel A, Jerbi S, Marzouki Y, Neji S, Beji M, Chaabene I, Tahri S, Kechida M, Daada S, Hammami S, Ben Abdallah W, Klii R, Khochtali I, Rekik E, Abdelhedi M, Lahbib N, Aouadi D, Abid S, Besbes B, Oumaya Z, BelKahla N, Arbaoui I, Daoued F, Jebali H, Lahmaier E, Chaabouni E, Hajji M, Zouaghi MK, Abdallah M, Mlayah S, Selmi Y, Idriss H, Ahmed J, Brahim O, Turki E, Ghzel R, Ouaghlani K, Hakim K, Boussema A, Ben Arbia H, Said S, Msaad H, Ouarda F, Khalifa R, Hamila G, Triki S, Ataoui S, Keita A, Ben Othman R, Ghardallou H, Karmous R, El Bardi M, Lassoued C, Laadhar L, Khadhar Y, Aouini F, Ben Mrad M, Ben Romdhane N, Hamdi S, Chenik S, Jabloun Y, Talhaoui A, Mahfoudhi H, Ghardallou M, Noamen A, Raddaoui H, Chourabi C, Amorri A, Boukhili H, Khannouch A, Louati M, Alzain H, Hamdani A, Bousnina S, Ajra Z, Gheni R, Ben Hmida R, Ounissi T, Ibn Elhadj Z, Fekih W, Ben Yedder M, Medi W, Elghoul J, Ben Dayekh A, Ben Radhia B, Nasser K, Mtir H, Kortas C, Mgarrech I, Jamli M, Kaddour H, Mekki N, Amamou I, Achour A, Ouannes S, Ben Farhat S, Jaouadi A, Ben Saad S, Letaief R. Abstracts of the Tunisian Society of Cardiology and Cardiovascular Surgery congress, STCCCV 2021. Tunis Med 2022; 100:72-90. [PMID: 35822336 PMCID: PMC9028527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abid L, Kammoun I, Ben Halima M, Charfeddine S, Ben Slima H, Drissa M, Mzoughi K, Mbarek D, Riahi L, Antit S, Ben Halima A, Ouechtati W, Allouche E, Mechri M, Yousfi C, Khorchani A, Abid O, Sammoud K, Ezzaouia K, Gtif I, Ouali S, Triki F, Hamdi S, Boudiche S, Chebbi M, Hentati M, Farah A, Triki H, Ghardallou H, Raddaoui H, Zayed S, Azaiez F, Omri F, Zouari A, Ben Ali Z, Najjar A, Thabet H, Chaker M, Mohamed S, Chouaieb M, Ben Jemaa A, Tangour H, Kammoun Y, Bouhlel M, Azaiez S, Letaief R, Maskhi S, Amri A, Naanaa H, Othmani R, Chahbani I, Zargouni H, Abid S, Ayari M, Ben Ameur I, Gasmi A, Ben Halima N, Haouala H, Boughzela E, Zakhama L, Ben Youssef S, Nasraoui W, Boujnah MR, Barakett N, Kraiem S, Drissa H, Ben Khalfallah A, Gamra H, Kachboura S, Bezdah L, Baccar H, Milouchi S, Sdiri W, Ben Omrane S, Abdesselem S, Kanoun A, Hezbri K, Zannad F, Mebazaa A, Kammoun S, Mourali MS, Addad F. Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study. JMIR Res Protoc 2021; 10:e12262. [PMID: 34704958 PMCID: PMC8581756 DOI: 10.2196/12262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/04/2019] [Accepted: 03/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). OBJECTIVE The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. METHODS A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. RESULTS At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. CONCLUSIONS The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. TRIAL REGISTRATION ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12262.
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Affiliation(s)
- Leila Abid
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia
| | - Ikram Kammoun
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia.,Hôpital Abderrahmen Mami-Ariana, Ariana, Tunisia
| | - Manel Ben Halima
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia.,Hôpital La Rabta 2, Tunis, Tunisia
| | - Salma Charfeddine
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Meriem Drissa
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Khadija Mzoughi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Dorra Mbarek
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Leila Riahi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Saoussen Antit
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Afef Ben Halima
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Wejdene Ouechtati
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Emna Allouche
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Mehdi Mechri
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Chedi Yousfi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Ali Khorchani
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Omar Abid
- Centre Hospitalier de Chambéry, Chambéry, France
| | - Kais Sammoud
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Khaled Ezzaouia
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Imen Gtif
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Sana Ouali
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Feten Triki
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Sonia Hamdi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Selim Boudiche
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Marwa Chebbi
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Mouna Hentati
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Amani Farah
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Habib Triki
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Houda Ghardallou
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | - Haythem Raddaoui
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Seifeddine Azaiez
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Aymen Amri
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Iheb Chahbani
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Syrine Abid
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Ali Gasmi
- Hospital Lariboisière, Paris, France
| | | | | | | | - Lilia Zakhama
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Wided Nasraoui
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | - Sondes Kraiem
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Alifa Kanoun
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | | | | | - Samir Kammoun
- Hôpital Des Forces De Sécurité Intérieure De La Marsa, Tunis, Tunisia
| | | | - Faouzi Addad
- Société Tunisienne De Cardiologie Et De Chirurgie Cardiovasculaire, Tunis, Tunisia
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Gouissem I, Midani F, Soualmia H, Bouchemi M, Ouali S, Kallele A, Romdhane NB, Mourali MS, Feki M. Contribution of the ACE (rs1799752) and CYP11B2 (rs1799998) Gene Polymorphisms to Atrial Fibrillation in the Tunisian Population. Biol Res Nurs 2021; 24:31-39. [PMID: 34227426 DOI: 10.1177/10998004211029376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study investigated the association of angiotensin-converting enzyme (ACE I/D) and aldosterone synthase (CYP11B2-344C/T) gene polymorphisms in the renin-angiotensin-aldosterone system (RAAS) with atrial fibrillation (AF) in the Tunisian population. MATERIALS AND METHODS The study population included 120 patients with AF and 123 age-matched controls. Genotyping of the I/D polymorphism in the ACE gene and the -344C/T polymorphism in the CYP11B2 gene was performed by polymerase chain reaction (PCR) and PCR-RFLP methods, respectively. RESULTS The genotype distribution of the ACE I/D and CYP11B2-344C/T polymorphisms was significantly different between AF patients and control participants (p < 0.01 and p < 0.006 respectively). In addition, ACE I/D increased the risk of AF significantly by 3.41-fold for the DD genotype (OR = 3.41; 95% CI [1.39-8.34]; p < 0.007), and after adjusting for confounding factors (age, diabetes, hypertension, and dyslipidemia), the risk was higher (OR = 5.71; 95% CI [1.48-21.98]; p < 0.01). Likewise, the CYP11B2-344C/T polymorphism increased the incidence of AF for the TT genotype (OR = 3.66; 95% CI [1.62-8.27]; p < 0.002) and the CT genotype (OR = 2.68; 95% CI [1.22-5.86]; p < 0.01). After adjusting for confounding factors (age, diabetes, hypertension and dyslipidemia), the risk remained higher for the TT genotype (OR = 3.58; 95% CI [1.08-11.77]; p < 0.03). Furthermore, the haplotype-based association of the ACE I/D and CYP11B2-344C/T polymorphisms showed that the D-T haplotype increased the risk for AF. CONCLUSION Our study suggests a significant association of the ACE (I/D) and CYP11B2-344C/T polymorphisms with AF in the Tunisian population.
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Affiliation(s)
- Ilhem Gouissem
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Carthage, Faculty of Sciences of Bizerte, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Fatma Midani
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Hayet Soualmia
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Meryem Bouchemi
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia.,University of Tunis El Manar, High Institute of Medical Technologies of Tunis, Jebbari, Tunis, Tunisia
| | - Sana Ouali
- University of Tunis El Manar, Faculty of Medicine of Tunis, Rabta Hospital, Department of Cardiology, Jebbari, Tunis, Tunisia
| | - Ameni Kallele
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia
| | - Neila Ben Romdhane
- University of Tunis El Manar, Faculty of Medicine of Tunis, Rabta Hospital, Department of Hematology, Jebbari, Tunis, Tunisia
| | - Mohamed Sami Mourali
- University of Tunis El Manar, Faculty of Medicine of Tunis, Rabta Hospital, Department of Cardiology, Jebbari, Tunis, Tunisia
| | - Moncef Feki
- University of Tunis El Manar, Faculty of Medicine of Tunis, LR99ES11, Rabta Hospital, Laboratory of Biochemistry, Jebbari, Tunis, Tunisia
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Jebali H, Ghabi H, Mami I, Fatma LB, Smaoui W, Kaab BB, Krid M, Hlima MB, Ayed TB, Guermazi O, Mourali MS, Beji S, Chermiti M, Zied L, Kateb H, Hassan M, Hmida FB, Raies L, Zouaghi MK. Evaluation of electrocardiographic findings before and after hemodialysis session. Saudi J Kidney Dis Transpl 2021; 31:639-646. [PMID: 32655050 DOI: 10.4103/1319-2442.289450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dialysis patients have higher rates of sudden cardiac death. The study of the electrocardiogram could identify patients at risk of developing rhythm disorders. The aim of this study was to evaluate the electrocardiographic findings before and after the hemodialysis (HD) session and to examine associations of clinical and serum electrolytes with electrocardiogram findings. We conducted a multicentric transversal study, including chronic HD patients during January 2018. Standard 12-lead electrocardiogram was recorded, before and after the HD session. A medical history was documented. It included age, gender, initial nephropathy, and comorbidities. Serum potassium and total serum calcium were measured before a routine HD session. Serum potassium was measured after HD session. Corrected QT for heart rate was calculated using Bazett's formula. The study included 66 patients. Nineteen patients (28.8%) had hyperkalemia before the HD session and 44 (66.7%) patients had hypokalemia after the HD session. Seventeen patients had prolonged QTc interval (25.7%). On multiple regression analysis, only the prolonged QTc interval was significantly correlated with the serum potassium (P = 0.046).When comparing the mean values of electrocardiogram parameters before and after the HD session, we noted a significant change of heart rate (P = 0.001), R wave (P = 0.016), T wave (P = 0.001), and T/R (P = 0.001) wave. Delta K+ did not correlate with the change in T wave amplitude (r = 0.23, P = 0.59), R wave amplitude (r = -0.16, P = 0.2), T/R wave (r = 0.055, P = 0.65), or QRS duration (r = 0.023, P = 0.85). Delta QTc was correlated to ΔK+. We conclude that usual electrographic manifestations of hyperkalemia are less pronounced in HD patients. Our results confirmed the unstable status of cardiac electrophysiology during HD session.
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Affiliation(s)
- Hela Jebali
- Department of Nephrology, Rabta Hospital; Faculty of Medicine, Tunis, Tunisia
| | - Hiba Ghabi
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
| | - Ikram Mami
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
| | | | - Wided Smaoui
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
| | - Badr Ben Kaab
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
| | - Madiha Krid
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
| | | | | | - Omar Guermazi
- Department of Cardiology, Rabta Hospital, Tunis, Tunisia
| | | | - Soumaya Beji
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
| | | | - Loumi Zied
- Department of Nephrology, Kef Hospital, Kef, Tunisia
| | - Hanene Kateb
- Department of Nephrology, Manouba Hospital, Manouba, Tunisia
| | - Mohanad Hassan
- Department Laboratory Research of Kidney Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Fethi Ben Hmida
- Department Laboratory Research of Kidney Pathology (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Lamia Raies
- Department of Nephrology, Rabta Hospital, Tunis, Tunisia
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Halima MB, Ezzaouia K, Boudiche S, Rekik B, Mghaieth F, Ouali S, Zidi A, Mourali MS. Silent stroke in patients with atrial fibrillation: Prevalence and predictive factors. Tunis Med 2021; 99:416-422. [PMID: 35244926 PMCID: PMC8734472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Silent strokes are damagesof brain not accompanied by symptoms suggestive of stroke. Currentepidemiological trends suggesttheirindependent association with atrial fibrillation (AF). However, this association is not yetwelldefined. AIM To assess the prevalence of silent stroke in AF and determine itspredictivefactors. METHODS We carried out a cross-sectional study enrolling 37 patients followed for non-valvular AF in the cardiologydepartment. All participants had a clinicalevaluation and brain MRI. RESULTS The mean age was 66 ± 7 yearswith asex ratio (M / F) of 0.76. The mostcommon class of AF was the persistent form (70%). Oral anticoagulant therapywasprescribedin 32 patients (94.1%). Silent strokewerereported in 9 patients (24.3%). Age ≥72 years and CHA2DS2VASc score ≥ 4 weresignificantlyassociatedwith silent strokes in the univariate study withsensitivities of 77.8% and 62.5% respectively and specificities of 78.6% and 92.3% respectively. In the multivariate study, only CHA2DS2VASc score ≥ 4 wasconsidered to be an independentpredictor of silent stroke in AF (p = 0.004; adjusted OR = 20; CI95%: 2.6-152.6). CONCLUSIONS Our resultsregarding the association between silent strokesand AF confirmedpreviousevidence. Screening for theselesions in AF patients at high thromboembolicriskappears to be a relevant approachgiventheirpoorprognosis.
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Affiliation(s)
- Manel Ben Halima
- 1-hôpital la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Khaled Ezzaouia
- 1-hôpital la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Selim Boudiche
- 1-hôpital la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Bassem Rekik
- 1-hôpital la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Fathia Mghaieth
- 1-hôpital la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Sana Ouali
- 1-hôpital la Rabta, Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Asma Zidi
- 2-Service de radiologie. Institut Salah Azaiez, Faculté de Médecine de Tunis, Université Tunis El Manar
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9
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Ouali S, Ben Halima A, Chabrak S, Chettaoui R, Ben Halima M, Haggui A, Krichane S, Noureddine L, Marrakchi S, Charfeddine S, Hassine M, Sayahi K, Abbes Mohamed F, Nasraoui W, Ajmi H, Ben Miled M, Jebbari Z, Meghaieth MA, Allouche E, Mechmeche R, Zakhama L, Sdiri W, Ben Khalfallah A, Gharbi A, Milouchi S, Neji A, Antit S, Battikh K, Drissa M, Kaabachi S, Najar T, Tlili R, Chahbani I, Charfeddine H, Ben MM, Braham S, Maatouk F, Abdesselem S, Ayari M, Garbaa R, Hamrouni N, Mbarek D, Rekik H, Zaghdoudi H, Ayadi W, Baraket F, Ben Brahim K, Ben Romdhane M, Bousadia H, Brahim W, Mezri M, Guesmi A, Ounissi T, Kammoun S, Smati W, Tlili S, Zoughi K, Zemni J, Cheikh Bouhlel M, Islem S, Jemli R, Joulak A, Mzoughi K, Naanea H, Hached L, Hadrich M, Hmem M, Kacem S, Kammoun I, Othmani R, Ouerghi A, Abid S, Ennouri R, Haidar S, Heraiech S, Jammali M, Jarrar M, Riahi L, Trimech B, Azaiez MA, Azzouzi F, Ben Jemaa K, Ben Rejab O, Chrigui R, Wechtati W, Boughzela E, Jridi G, Bezdah L, Kraiem S, Drissa H, Ben Youssef S, Fehri W, Kachboura S, Gamra H, Kammoun S, Mourali MS, Addad F, Abid L. Epidemiological characteristics, management, and outcomes of atrial fibrillation in TUNISIA: Results from the National Tunisian Registry of Atrial Fibrillation (NATURE-AF). Clin Cardiol 2021; 44:501-510. [PMID: 33704830 PMCID: PMC8027580 DOI: 10.1002/clc.23558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Contemporary registries on atrial fibrillation (AF) are scare in North African countries. HYPOTHESIS In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. METHODS NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. RESULTS A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2 DS2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. CONCLUSIONS NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.
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Affiliation(s)
| | - Afef Ben Halima
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | | | | | | | | | | | - Sonia Marrakchi
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | - Majed Hassine
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | | | | | | | | | | | - Lilia Zakhama
- La Marsa Internal Security Forces Hospital, La Marsa, Tunisia
| | | | | | | | | | - Ali Neji
- Ben Guerdane Hospital, Medenine, Tunisia
| | - Saoussen Antit
- La Marsa Internal Security Forces Hospital, La Marsa, Tunisia
| | | | | | | | | | - Rami Tlili
- University Hospital Center Mongi Slim, La Marsa, Tunisia
| | | | | | | | | | - Faouzi Maatouk
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | - Dorra Mbarek
- University Hospital Center Mongi Slim, La Marsa, Tunisia
| | | | | | | | | | | | | | | | | | | | - Ali Guesmi
- Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | - Taha Ounissi
- Mohamed Taher Al Maamouri Hospital, Nabeul, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ikram Kammoun
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wafa Fehri
- Hôpital Militaire Principal d'instruction de Tunis, Tunis, Tunisia
| | - Salem Kachboura
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | - Faouzi Addad
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
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10
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Ben Halima M, Sammoud K, Ben Amar J, Boudiche S, Rekik B, Mghaieth F, Ouali S, Mourali MS. Prevalence and predictors of Sleep Apnea in Atrial Fibrillation patients. Tunis Med 2020; 98:1031-1038. [PMID: 33480008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) is a common but often under diagnosed condition that constitutes a real public health problem. The prevalence of OSAS in atrial fibrillation (AF) patients ranges from 32 to 85% according to recent studies. AIM To determine the prevalence and severity of OSAS in a population followed for non-valvular AF (NVAF), and to identify OSAS's predictive factors in this population. METHODS A cross-sectional study was conducted, including successive patients followed for NVAF. Patients with a known history of OSAS were not included. All patients had a clinical screening for symptoms suggestive of OSAS and underwent an ambulatory sleep study. RESULTS We included 100 patients in this study. OSAS was detected in 90% of NVAF patients. The average apnea-hypopnea index (AHI) was 21.6 ± 13.6 e/h. OSAS was mild in 32%, moderate in 27% and severe in 31% of cases. Clinical characteristics were comparable between patients with and without OSAS. The multivariate analytical study concluded that independent predictive factors of OSAS in AF patients were an age greater than 61 years (p=0.029), AF duration more than 2 years (p=0.04) and snoring (p=0.01). CONCLUSIONS OSAS was diagnosed in 90% of NVAF patients. Thus, a systematic screening for OSAS in AF patients may be a relevant approach given its high prevalence in this population and its therapeutic implications. Snoring, age greater than 61 years, and AF duration more than 2 years were independently associated with OSAS in our study.
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11
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Abdelmalek R, Maghraoui H, Zribi M, Guerfali M, Ammous A, Mourali MS, Abdellatif S. COVID-19 circuit management: la Rabta experience. Tunis Med 2020; 98:600-605. [PMID: 33480013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Covid-19 pandemic was associated to fear among patients, doctors and nurses, it was responsible of a work impairment in health structures organisation. All patients were at home, only Covid patients were at hospital. Our country has a quick reaction, we declared the pandemic as a social disease with free management. All hospital had the order to create their own Covid-19 circuit. We report the experience of our hospital in the crisis management with the creation of the circuit, its organisation, the management of the different financial, technical, human, sanitary, psychological and logistical aspects. The great point of this crisis was the fear, stress of caregivers for themselves and their families. The other point for members of Covid Cell was the race against time, the learning of a new job: a manager or a polyvalent chief. The presence of a Covid-19 circuit is necessary for each hospital at the epidemic time but it must be managed by infectious diseases doctors, lung specialists, intensive care givers and emergency room caregivers in collaboration. An enhancement of the structures is necessary at the level of medical wards and beds of intensive care.
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12
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Ben Halima G, Cherif W, Ben Aoun M, Cherif F, Gueddiche F, Ben Slima H, Mourali MS, Ben Ameur Y, Sdiri W, Cheour M, Damak R. [Incidence and risk factors of depression after a first coronary acute syndrome: A prospective study among 110 patients]. Ann Cardiol Angeiol (Paris) 2020; 69:125-132. [PMID: 32331696 DOI: 10.1016/j.ancard.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
AIM The purpose of this study was to estimate the incidence of post-acute coronary syndrome (ACS) depression and to identify predictive factors for the onset of this disorder. PATIENTS AND METHODS We conducted a prospective, multicentric study across four cardiology departments, during the period from June to December 2018. A depressive symptom screening was performed using the Hospital Anxiety and Depression Scale, in-hospital (T0) and on average 42.1±7.9 days after hospital discharge (T1). RESULTS A total of 110 patients were enrolled with an average age of 57±8.1 years. Sex ratio was 3.78. The incidences of depressive symptomatology at T0 and T1 were respectively 19.1% and 6.2%. Mean and cumulative incidences of depressive symptomatology were respectively 12.7% and 25.5%. According to the univariate analysis, drinking alcohol, overweight and anxiety were associated with the incidence of depressive symptomatology after SCA at T0. In binary logistic regression, drinking alcohol was the independent predictor of the incidence of depression after ACS at T0 with an odds ratio of 4.680 and CI of 95% [1.449; 15,107]; P=0.01. In univariate analysis, drinking alcohol, high risk of hospital mortality, according to the GRACE score, and non performing coronary angiography were statistically associated with the overall incidence of depressive symptomatology. CONCLUSION Depression screening must be a part of the evaluation of the ACS. A repeated evaluation of depression is also recommended.
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Affiliation(s)
- G Ben Halima
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie
| | - W Cherif
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service de psychiatrie Ibn-Oumrane, hôpital Razi, Manouba, Tunisie
| | - M Ben Aoun
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie
| | - F Cherif
- Faculté de médecine de Sfax, Sfax, Tunisie
| | - F Gueddiche
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie
| | - H Ben Slima
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service de cardiologie, hôpital régional de Menzel-Bourguiba, Bizerte, Tunisie
| | - M S Mourali
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service des explorations fonctionnelles et réanimation cardiologique, hôpital la Rabta, Tunis, Tunisie
| | - Y Ben Ameur
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service de cardiologie, hôpital Mongi-Slim de la Marsa, Tunis, Tunisie
| | - W Sdiri
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service de cardiologie, hôpital Habib-Bougatfa, Bizerte, Tunisie
| | - M Cheour
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service de psychiatrie Ibn-Oumrane, hôpital Razi, Manouba, Tunisie
| | - R Damak
- Faculté de médecine de Tunis, université Tunis ElManar, Tunis, Tunisie; Service de psychiatrie Ibn-Oumrane, hôpital Razi, Manouba, Tunisie.
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Mghaieth Zghal F, Boudiche S, Haboubi S, Neji H, Ben Halima M, Rekik B, Mechri M, Ouali S, Hantous S, Mourali MS. Diagnostic accuracy of strain imaging in predicting myocardial viability after an ST-elevation myocardial infarction. Medicine (Baltimore) 2020; 99:e19528. [PMID: 32384424 PMCID: PMC7220414 DOI: 10.1097/md.0000000000019528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
In the acute phase of ST-elevation myocardial infarction (STEMI) viability imaging techniques are not validated and/or not available.This study aimed to evaluate the ability of strain parameters assessed in the acute phase of STEMI, to predict myocardial viability after revascularization.Thirty-one STEMI patients whose culprit coronary artery was recanalized and in whom baseline echocardiogram showed an akinesia in the infarcted area, were prospectively included. Bidimensional left ventricular global longitudinal strain (GLS), and territorial longitudinal strain (TLS) in the territory of the infarct related artery were obtained within 24 hours from admission. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMR) was used as a reference test to assess post-revascularization myocardial viability. DE-CMR was performed 3 months after percutaneous coronary intervention. According to myocardial viability, patients were divided into 2 groups; CMR viable myocardium patients with more than half of infarcted segments having a DE <50% (group V) and CMR nonviable myocardium patients with half or more of the infarcted segments having a DE >50% (group NV).GLS and TLS were lower in group V compared to group NV (respectively: -14.4% ± 2.9% vs -10.9% ± 2.4%, P = .002 and -11.0 ± 4.1 vs -3.2 ± 3.1, P = .001). GLS was correlated with DE-CMR (r = 0.54, P = .002) and a cut off value of -13.9% for GLS predicted viability with 86% sensitivity (Se) and 78% specificity (Sp). TLS showed the strongest correlation with DE-CMR (r = 0.69, P < .001). A cut off value of -9.4% for TLS yielded a Se of 78% and a Sp of 95% to predict myocardial viability.GLS and TLS measured in the acute phase of STEMI predicted myocardial viability assessed by 3 months DE-CMR. They are prognostic indicators and they can be used to guide the priority and usefulness of percutaneous coronary intervention in these patients.
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Affiliation(s)
- Fathia Mghaieth Zghal
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Selim Boudiche
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Sofiane Haboubi
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
| | - Henda Neji
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Service of Medical Imaging, Abderrahmane Mami University Hospital, Ariana, Tunisia
| | - Manel Ben Halima
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Bassem Rekik
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mehdi Mechri
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
| | - Sana Ouali
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Saoussen Hantous
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Service of Medical Imaging, Abderrahmane Mami University Hospital, Ariana, Tunisia
| | - Mohamed Sami Mourali
- Service of Functional Exploration and Cardio Reanimation, Rabta University Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Mghaieth Zghal F, Boudiche S, Ben Halima M, Rekik B, Larbi N, Mourali MS. Left ventricular non compaction and septal defects. Tunis Med 2020; 98:161-163. [PMID: 32395807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We report the case of a 23-year-old woman with a not yet described (to the best of our knowledge) association of left ventricle non-compaction with both atrial and ventricular defects. Family genetic survey concluded to, a probably sporadic, E101K gene mutation.
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Boudiche S, Zelfani S, Ben Hammamia M, Mghaieth Zghal F, Ouaghlani K, Ben Halima M, Manai H, Ziadi J, Rekik B, Rajhi M, Gharsallaoui O, Farhati A, Ouali S, Larbi N, Denguir R, Daghfous M, Mourali MS. Simulation training for continuing professional development of nurses in cardiology and cardiovascular surgery. Tunis Med 2020; 98:116-122. [PMID: 32395800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nurses play a key role in cardiac arrest management, especially those assigned to cardiac intensive care units, where they are often actively involved in cardiopulmonary resuscitation. AIM To evaluate the effect of simulation training in in continuing professional development of nurses in this setting. METHODS A comparative study using paired samples (where the candidate was his own control with repeated measures before and after intervention), was conducted among nurses working in the cardiology and cardiovascular surgery division of our institution. The primary endpoint was the change in skills judged on the basis of competency score of 20 assessed before and after simulation training. RESULTS 32 nurses participated in the training session. Despite a median job seniority of 8.5 years [4.0 - 12.5], only 44% of nurses had already participated in a simulation session. Although most of the candidates (84%) had previously performed chest compressions, only 34% had delivered an electrical defibrillation during their exercise. We showed a significant increase in overall scores from 8.0 [5.0 - 9.8] to 17.5 [17.0 - 19.0] after the simulation training session (p<0.0001). All the criteria judged in the evaluation grid (basic life support, manual electrical defibrillation) were significantly improved and the most positive effect was observed in the manual defibrillation where the prior experience of the participants was limited. CONCLUSIONS Simulation learning had a major positive impact on the development of nurses' skills in terms of cardiopulmonary resuscitation.
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Habacha S, Mghaieth Zghal F, Boudiche S, Fathallah I, Blel Y, Aloui H, Mourali MS, Brahmi N, Kouraichi N. Toxin-induced cardiac arrest: frequency, causative agents, management and hospital outcome. Tunis Med 2020; 98:123-130. [PMID: 32395801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cardiac arrest (CA) is a public health problem, with various etiologies and a fatal issue in 90-95% of cases. Toxin-induced cardiac arrests (TICA) are poorly described. Scarcity of national data prompted us to carry-out this study. AIM To determine TICA frequency in a Tunisian reference center in toxicology and its hospital prognosis, and to describe its clinical and therapeutic aspects Methods : Data were collected retrospectively over an 8-years period. We included patients admitted for post-CA care with highly suspected or confirmed TICA. Clinical and toxicological data were recorded. RESULTS We recorded 21 cases of TICA, which represented 48.8% of CA. A single toxic agent was incriminated in 90% of cases. Main causative agents identified in our series were pesticides and betablockers: chloralosed (n = 6), carbamate inhibitor of cholinesterase (n = 5), acebutolol (n = 4) and organophosphate (n = 2). One case of opiates and cocaine poisoning was reported. Median duration of "no flow" was 0 minutes. Mean duration of "low flow" was 13.74±9.15 minutes. An initial shockable rhythm was noted only in three patients. Mortality rate was 76% (16/21). Four of the five survivors had a Cerebral Performance Category Scale (CPC) 1, only one patient survived with a CPC 3. Factors associated with mortality were : the duration of "low flow" (p=0.02) and APACHE II score (p=0.014). APACHE II≥29 was the only independent factor (OR=2.0, 95%CI [1.07;3.71]). CONCLUSION TICA were most frequently provoked by pesticides, mortality was high and was independently predicted by APACHE II score.
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Mghaieth Zghal F, Houas H, Boudiche S, Ben Halima M, Rekik B, Abdeljelil F, Ouali S, Mourali MS. P857 Diagnostic and prognostic value of 2D Strain in Non ST elevation myocardial infarction patients. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Following an acute coronary syndrome, ischemic myocardial dysfunction has several degrees of severity and different outcomes from a total or partial recovery to an irreversible injury.
In this study led in non-ST elevation myocardial infarction (NSTEMI) patients without otherwise previous non-ischemic cardiomyopathy (NICM), we investigated the correlation between 2D global longitudinal strain (GLS) and angiographic prognostic factors.
The ability of territorial longitudinal strain (TLS), defined as the sum of segmental strain in a coronary territory,to identify culprit artery occlusion was also assessed.
Methods
82 consecutive NSTEMI patients were prospectively screened for inclusion; 70 of them without NICM were enrolled. Severe coronary artery disease (CAD) was defined as three-vessel disease or a left main disease. Group 1 and 2 were defined by the presence or not of severe CAD. Statics ‘analyses was performed with IBM SPSS Statistics (version 22).
Results
mean age of patients was 60, 2 ±10 years. 37 patients had diabetes mellitus (53%), 31 had hypertension (44%), 21 had dyslipidemia (30%) and 5 had renal insufficiency (7%). Severe CAD was present in 24 patients (34%).
The first ultrasound exam showed that mean EF was 49 ± 11, mean WMSI was 1.43 ± 0.4 and mean GLS was -14.9 ± 4.
GLS was higher in group 1 (-12.82 ± 0.95 vs -16.04 ± 0.42; p < 0.001); LVEF and WMSI in group 1 and 2 were (43.3 ± 13.5% Vs 52.7 ± 7.9%; p < 0.001) and (1.64 ± 0.1 Vs 1.32 ± 0.04; p < 0.001) respectively. Correlations were found between LVEF and GLS (p = 0.004), and between WMSI and GLS (p = 0.002) . TLS was able to discriminate between coronary stenosis of LAD, LCX or RCA and to predict the occlusion of the culprit vessel: 7 patients had acute coronary occlusion (10%). TLS was -7.4 ± 5.1 in patients with coronary occlusion and -14.1 ± 6 in the absence of coronary occlusion (p < 0.001). A cut off of -9.5 was able to detect this occlusion with a specificity of 82% and a sensitivity of 85%.
The second ultrasound exam, performed after a median of 10 ± 3.1 months, showed a statistically significant improvement of EF (53 ± 10, p =0.02), WMSI (1.35 ± 0.39, p= 0.01) as well as GLS (-17.1 ± 4.2, p =0.004).
Patients who received only medical treatment (n = 11) had the lowest variation of EF (47% to 48 %; p = 0.7), WMSI (1.62 to 1.59; p = 0.69) and GLS (14.2 to 15.2; p = 0.2) with no statistical correlation between the two exams. While patients who had PCI or bypass revascularization, had the best outcome with improvement of EF (49% to 53%; p = 0.002), WMSI (1.4 to 1.32;p = 0.01) and GLS (15 to 17.4;p = 0.004).
Conclusion
GLS is a strong diagnostic and prognostic ultra sound parameter for NSTEMI patients correlated to CAD severity. Strain is a reliable parameter during follow up.TLS can be used to localize the culprit coronary artery and especially to predict its occlusion during the acute phase of NSTEMI which can lead to a different therapeutic strategy.
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Affiliation(s)
| | - H Houas
- Rabta Hospital, Tunis, Tunisia
| | | | | | - B Rekik
- Rabta Hospital, Tunis, Tunisia
| | | | - S Ouali
- Rabta Hospital, Tunis, Tunisia
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Mghaieth Zghal F, Boudiche S, Houes H, Fathallah I, Ouaghlani K, Bonkano A, Ayari J, Rekik B, Ben Halima M, Ouali S, Mourali MS. Diagnostic and prognostic value of 2D-Strain in Non-ST Elevation Myocardial Infarction. Tunis Med 2020; 98:70-79. [PMID: 32395780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Strain has shown a promising diagnostic and prognostic value in acute coronary syndromes. With, however, less data in non-ST elevation myocardial infarction (NSEMI). AIM to evaluate in NSTEMI patients, the ability of strain to predict the severity of the disease, by assessing correlations to established prognostic parameters, and to predict culprit and occluded coronary arteries (CA). Secondary, to determine factors associated to strain changes during follow-up. METHODS The study was prospective, NSTEMI patients with significant coronary lesion and without significant non-ischaemic disease were included. Angiographic and echocardiographic investigation including global (GLS) and territorial (TLS) longitudinal strain were performed within 24h from admission. Syntax I score was calculated. Severe coronary artery disease (CAD) was defined by left main of three-vessel disease. RESULTS Seventy NSTEMI patients aged 60.2±10.1 years were enrolled; 61% were smokers, 54% diabetics and 46% hypertensive. 34% had a severe CAD, 7% had an acute coronary occlusion (ACO) and 14% a chronic coronary total occlusion (CTO). GLS >-15.3% predicted a left ventricular ejection fraction (LVEF) <50% with 80% Sensitivity (Se) and 78% Specificity (Sp). GLS was associated to CAD complexity and severity. GLS > -14.1% detected severe CAD with 83% Se and 80%Sp. TLS determined the culprit artery in 74% of cases and TLS > -9.2% predicted ACO with 85% Se and 85% Sp. TLS was also associated to CTO. At a 10 months median follow-up [3-12months], GLS significantly improved, baseline LVEF, GLS, wall motion score index and revascularization were the predictors of this improvement. CONCLUSION In NSTEMI patients, GLS detected severe CAD and poor myocardial function. TLS predicted the culprit vessel and its occlusion. GLS improvement at midterm was predicted by baseline systolic LV function parameters and myocardial revascularization.
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Mghaieth Zghal F, Habboubi S, Boudiche S, Ben Halima M, Rekik B, Farhati A, Ouali S, Mourali MS. P773 Can strain imaging predict viability in ST segment elevation myocardial infarction patient. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the acute phase of ST elevation myocardial infarction (STEMI), the main objective is to recanalize the guilty artery, but it is important to know whether myocardium with severely compromised function is permanently injured or reversibly dysfunctional indicating myocardial viability. On the other hand, viability tests such as scintigraphy, magnetic resonance imaging with delayed enhanced (DE-MRI) or dobutamine stress echography are either not validated or unavailable in the acute phase of STEMI. The assessment of myocardial deformation by bidimensional strain (2D) is a technique that has emerged in recent years with good correlation with MRI for viability assessment. An important question remains : Is myocardial viability can be determined by 2D strain parameters at the acute phase of STEMI ?
Aim : To assess myocardial viability in the acute phase of STEMI by 2D strain echocardiographic parameters in comparison with 3 month DE-MRI as a reference method.
Methods
A total of 31 first STEMI patients treated with successful primary or elective percutaneous coronary intervention (PCI) were included with an akinetic area on echocardiography corresponding to the infarct segments. Doppler strain values from left ventricular basal, mid and apical segments (n= 527) were obtained at the acute phase of STEMI and checked up after 3 months. The scar was assessed for viability by DE-MR as reference method, 3 months after the acute phase. Viability was defined by a DE < 50% of wall thickness in the scar zone.
Results
Mean age of the study population was 59,29 ±9,96 years , 27 (87%) being males. Nine patients (29%) showed post-PCI improvement of left ventricule (LV) function. Regional peak systolic strain of the infarct segments and global longitudinal strain (GLS) after 3 months. At the acute phase, wall motion score index (WMSI), regional and global strain values were signficantly better in the viable than in the non viable segments. GLS was -10,92 ± 2,48 in patients with MRI non viable myocardium and -14,45 ±2,91 in patients with MRI viable myocardium . A pre-PCI strain value of -2,9% as a cutt off predicted segmental function recovery after PCI and myocardial viability with a sensitivity 82% of and a specificity 84%.
Conclusion : This monocenter study confirms that 2D strain imaging can be a usueful and accurate method to predict myocardial viability and recovery of segmental and global LV function after PCI in STEMI patients.
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Affiliation(s)
| | | | | | | | - B Rekik
- Rabta Hospital, Tunis, Tunisia
| | | | - S Ouali
- Rabta Hospital, Tunis, Tunisia
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Farhati A, Mghaieth Zghal F, Boudiche S, Rekik B, Ouali S, Mourali MS. First Tunisian case of percutaneous paravalvular leak closure: immediate and 6 months outcome. Tunis Med 2020; 98:93-95. [PMID: 32395784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Zghal FM, Boudiche S, Zongo T, Rekik B, Ouali S, Mourali MS. An unusual cause of stroke and sudden death: Intracavitary left ventricular echinococcosis. Int J Infect Dis 2020; 90:26-27. [DOI: 10.1016/j.ijid.2019.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 11/29/2022] Open
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Boudiche S, Chatti S, Amroussia R, Mghaieth F, Ziadi J, Farhati A, Ben Hammamia M, Tekaya MA, Ouali S, Guedira F, Denguir R, Mourali MS. Atrial septal defect closure in adults: A ten-year experience. Tunis Med 2019; 97:1362-1369. [PMID: 32173806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Atrial septal defects (ASD) constitute the most frequent congenital heart disease in adults and ostium secundum (OS) the most common type. Benefit of its closure in adulthood has long been controversial. AIM To evaluate outcomes of OS-ASD closure in adults. METHODS Retrospective cohort study, over a ten-year period from 2008 to 2018. All adults (≥20 years old) who benefited from OS-ASD closure were included. Study endpoints were closure success rate, functional status evolution and incidence of new arrhythmias at 12 months. RESULTS Fifty patients were recruited. Dyspnea (≥ NYHA II) was noted in 58% and arrhythmia in 18% of patients. Feasibility of a percutaneous closure was 50%. Closure success rate was 100%. Surgery was associated with high postoperative morbidity with longer hospitalization stay (20 vs. 4 days, p <0.001). At 12 months, an improvement in functional status was observed in 79%. Incidence of new arrhythmias was 5%. A significant decrease in right cavities dilation as well as pulmonary arterial pressure has been reported. CONCLUSIONS Immediate results of OS-ASD closure in adults are satisfactory. Percutaneous closure is associated with reduced hospital morbidity. At 12 months, a significant improvement in functional status was observed however the possible occurrence of new arrhythmias imposes a close follow-up.
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Ziadi J, Derbel B, Boudiche S, Mleyhi S, Besbes T, Ben Mabrouk J, Chatti S, Ouarda F, Mourali MS, Denguir R. Acute ischemia of the lower limb on ECMO: risk factors and preventive modalities. Tunis Med 2019; 97:1422-1425. [PMID: 32173815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The acute ischemia of the lower limb on the veno-arterial Extracorporeal Membrane Oxygenation (ECMO) is a frequent and dangerous complication that can put the vital and functional prognosis at risk. Several risk factors have been incriminated and the lack of a sufficient distal perfusion is the most common. We report the case of an 11-year-old girl with veno-arterial ECMO for acute myocarditis complicated by severe acute lower limb ischemia.
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Daoued Z, Ghedira F, Boudiche S, Ziadi J, Mourali MS, Denguir R. Multiple arterial coronary artery bypass grafting : perioperative complications, clinical and angiographic evolution. Tunis Med 2019; 97:1258-1267. [PMID: 32173828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Multiple arterial coronary artery bypass grafting is a controversial surgical procedure that is still uncommon worldwide. The aim of our study was to determine the outcomes and perioperative complications of the multiple arterial myocardial revascularization and their predictive factors, the mid-term and long term clinical and angiographic prognosis of the studied patients. METHODS This was a single center study of the cardiovascular department of The Rabta hospital. Patients included had serial multiple arterial coronary artery bypass grafting between January 2008 and December 2014. A statistical univariate and multivariate analysis had been conducted to identify complications and their predictive factors and a Kaplan-Meier study was done for the clinical and angiographic late outcomes. RESULTS We included 322 patients mean aged 58 years, sex-ratio was 7.7 with a preserved left ventricle ejection fraction (LVEF) in 68.94% of cases. On-pump 1109 bypasses were made, among them 788 arterial grafts were used. Left internal thoracic artery (LIMA) was used in 100% of patients. Patency of the LIMA was 100%, 94.7%, 91.6% and 73.3% at 1, 3, 5 and 8 years respectively. RIMA (right internal thoracic artery) was used in 87.2% of patients, anastomosed to the left coronary system via the Theile sinus, anastomosed to the LIMA to make a Y shape configuration, or anastomosed in situ to the right coronary artery. Its patency was 98.3%, 86.2%, 68% and 57.9%. There was no significance between configuration patencies except the RIMA anastomosed to the lateral braches of the circumflex artery (p=0.003). Early mortality was 5.9 %, its main predictors were post operative intra aortic balloon pump (OR=22.18), re intervention for bleeding (OR=30.57), post operative myocardial infarction (OR=29.49), aortic clamping >= 60 minutes (OR=10.89), post operative high level of catecholamine (OR=9.1) and mediastinitis (OR=7.15). Main early complications were pulmonary infection (20.2%), acute renal failure (5.3%) and mediastinitis (5%). Data of long term following could be collected only in 39.4% of cases. Major Adverse Cardiologic and Cerebral Events (MACCE) occurred in 30.71% controlled patients. Free-MACCE survival was 52.9% at 5. Initially total arterial bypass grafting was superior to other configurations in free-MACCE survival (p=0.036) but we lost significance beyond 5-years following because of selection bias. CONCLUSION Multi arterial coronary artery bypass grafting was secure in early morbidity and mortality. Long term prognosis seemed to be better in case of total arterial revascularization.
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Zghal Mghaieth F, Bonkano A, Boudiche S, Ayari J, Ben Mansour N, Rekik B, Ben Halima M, Ouali S, Mourali MS. Oral anticoagulation therapy using acenocoumarol during the month of ramadan: a comparative study between fasting and non-fasting patients. Tunis Med 2019; 97:1177-1186. [PMID: 31691946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES The effect of Ramadan fasting on anticoagulation by vitamin K antagonists has been previously investigated in small scale studies with controversial results. From this perspective, this study aimed to compare the fluctuations of anticoagulation in fasting and nonfasting patients taking Acenocoumarol and to identify the factors associated with such fluctuations. METHODS The study, conducted between May and August 2018, was a comparative one. Three study periods were defined: before Ramadan (BR), Ramadan and after Ramadan (AR). Enrolment involved ambulatory patients aged over eighteen, without medical contraindications to fasting (for the fasting group) and whom international normalized ratio (INR) was within the therapeutic target range during the last three months BR. Anticoagulation monitoring consisted in five consecutive INR assays; INR0 (during the 14 days BR), INR1 (between the 1st and the 14th day of Ramadan), INR2 (between the 15th and the 28th day of Ramadan), INR3 (28 days after INR2) and INR4 (28 days after INR3). INR stability was assessed by calculating four percentages of time in therapeutic range (TTR); TTR0 (between INR0 and INR1), TTR1 (between INR0 and INR2), TTR2 (between INR2 and INR3) and TTR3 (between INR3 and INR4). The null hypothesis was the occurrence of an anticoagulation imbalance (evaluated by TTR) in fasting patients in comparison with non-fasting ones. RESULTS One hundred and twenty-two patients (84 fasting patients), aged 60 ± 19 years, were included. In fasting patients, the average differences of INR1, 2, 3 and 4 compared with INR0 were statistically non-significant and accounted for +0.46, +0.34, +0.28 and +0.30 respectively. Among the three TTRs, only TTR2 significantly decreased in comparison with TTR0 in fasting group (50.3 ± 37.4 vs. 63.6 ± 39.3%, p=0.004). TTR1, 2 and 3 were comparable between fasting and non-fasting patients. CONCLUSIONS The fluctuations of anticoagulation balance, assessed by TTR, were comparable between fasting and non-fasting patients taking Acenocoumarol.
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Guizani I, Zidi W, Zayani Y, Boudiche S, Hadj-Taieb S, Sanhaji H, Zaroui A, Mechmeche R, Mourali MS, Feki M, Allal-Elasmi M. Matrix metalloproteinase-3 predicts clinical cardiovascular outcomes in patients with coronary artery disease: a 5 years cohort study. Mol Biol Rep 2019; 46:4699-4707. [PMID: 31218540 DOI: 10.1007/s11033-019-04914-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/11/2019] [Indexed: 11/25/2022]
Abstract
Matrix metalloproteinases (MMPs) are implicated in atherosclerosis evolution into a coronary artery disease (CAD). They could be used as biomarkers for a predictive approach when they are studied simultaneously. We aim in our study to demonstrate prospectively in patients with history of CAD that MMPs level is linked to clinical cardiovascular outcomes. Two hundred and eighteen patients diagnosed with CAD were followed prospectively for 5 years in the Cardiology Department of la Rabta Hospital University. Clinical cardiovascular outcomes during the period of the cohort were recorded. Measures were performed for biological and matrix markers at baseline. MMP-3, MMP-8, MMP-9, TIMP-1 and TIMP-2 were measured by ELISA in Sandwich assay. Fifty-nine cardiovascular outcomes occurred during the cohort period. By multivariate analysis, only MMP-3 persisted as a predictor for cardiovascular events even after adjustment. This metalloproteinase have been shown to be an independent predictor for cardiovascular outcomes (HR = 3.01; CI (1.3-6.95). The found cut-off value by receiver operating curve (ROC) was used for Kaplan-Meier analysis and revealed that patients with MMP-3 level higher than 9.3 ng/mL had a lower survival rate (p = 0.03). MMP-3 baseline level in patients with history of CAD is a potential predictor for cardiovascular outcomes.
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Affiliation(s)
- Imen Guizani
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia
- Faculty of Mathematics, Physics and Natural Sciences, University of Tunis El Manar, Tunis, Tunisia
| | - Wiem Zidi
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia
| | - Yosra Zayani
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia
| | - Selim Boudiche
- Cardiology Department, CHU la Rabta, 1007, Jebbari Tunis, Tunisia
| | - Sameh Hadj-Taieb
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia
| | - Haifa Sanhaji
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia
| | - Amira Zaroui
- Cardiology Department, CHU la Rabta, 1007, Jebbari Tunis, Tunisia
| | - Rachid Mechmeche
- Cardiology Department, CHU la Rabta, 1007, Jebbari Tunis, Tunisia
| | | | - Moncef Feki
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia
| | - Monia Allal-Elasmi
- LR99ES11, Department of Biochemistry, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Jebbari Tunis, Tunisia.
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Soussi M, Kallel A, Ben Wafi S, Ben Halima M, Sanhaji H, Mourali MS, Jemaa R, Feki M. Associations of rs1883832 and rs4810485 polymorphisms of CD40 gene with myocardial infarction in the Tunisian population. Biomarkers 2019; 24:530-537. [PMID: 30924686 DOI: 10.1080/1354750x.2019.1602168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Context: Cluster of differentiation 40 (CD40), and its ligand CD40L, are major co-stimulatory molecules whose interactions are important in both cellular and humoral immunity, and has been suggested to play a role in the pathogenesis of acute coronary syndrome. Objective: The aim of this study was to examine the association of CD40 polymorphisms (-1 C>T (rs1883832) and 945G>T (rs4810485)) and myocardial infarction (MI), and to test the association of CD40 gene haplotypes with MI in Tunisians. Materials and methods: Three hundred and fifty MI patients and 301 apparently healthy controls were included in the study. The polymorphisms of CD40 were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: There were significant differences in the genotype and allele frequencies of CD40 gene -1 C>T (rs1883832) polymorphism between cases and controls. Stratifying according to gender, the association between the TT genotype and MI was statistically significant in males, only. Haplotype analysis revealed that the C-T and T-G haplotypes were associated with an increased risk of MI (p = 0.012 and p < 0.001, respectively). Conclusions: Our work showed a significant association between the -1 C>T (rs1883832) polymorphism of the CD40 gene and MI in the Tunisians.
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Affiliation(s)
- Meriem Soussi
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia.,b Faculty of Sciences of Tunis, University of Tunis El Manar , Tunis , Tunisia
| | - Amani Kallel
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia
| | - Safa Ben Wafi
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia.,b Faculty of Sciences of Tunis, University of Tunis El Manar , Tunis , Tunisia
| | - Meriam Ben Halima
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia.,b Faculty of Sciences of Tunis, University of Tunis El Manar , Tunis , Tunisia
| | - Haifa Sanhaji
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia
| | | | - Riadh Jemaa
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia
| | - Moncef Feki
- a Laboratory of Biochemistry, Faculty of Medicine of Tunis, Rabta Hospital, University of Tunis El Manar , Tunis , Tunisia
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Boudiche S, Mechri M, Ben Halima M, Rekik B, Khader N, Larbi N, Farhati A, Mghaeith F, Ouali S, Mourali MS. Feasibility and safety of Same-Day Discharge after transradial percutaneous coronary intervention: a Tunisian monocentric study. Tunis Med 2019; 97:650-658. [PMID: 31729736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The continuing increase in care, needs and costs in cardiology with the advances in percutaneous coronary intervention (PCI) techniques represent the ideal scenario for considering same-day discharge (SDD) PCI program. AIM The primary endpoints were to examine feasibility and safety of SDD-PCI. METHODS We conducted a comparative observational study of a prospective cohort (April 2017 to September 2017) where patients benefited from SDD-PCI with a retrospective cohort (October 2016 to March 2017) where patients were conventionally managed. We established pre-procedural eligibility criteria and per and post-procedural exclusion criteria to estimate feasibility of SDD-PCI. Safety was assessed at 24 hours and 30 days comparatively in both groups. RESULTS In the one-year study period, 709 PCI were performed. The eligibility for SDD-PCI was 17.2% (122 patients) and feasibility was 14.7% (104 patients). Ultimately, 50 out of 370 patients in the prospective cohort (SDD-group) and 54 out of 339 patients in the retrospective cohort (control-group) had or could have benefited from SDD-PCI. The transradial access was the most used (98.1%). 59.7% of treated lesions were B2 or C type, 53.8% interested the left anterior descending artery and 29.8% were bifurcations. In both groups, no complications were observed at 24 hours. At 30 days, one single non-fatal myocardial infarction related to subacute stent thrombosis occurred in the SDD-group and was attributed to antiplatelet therapy interruption. CONCLUSION SDD-PCI is feasible and safe on the condition of strict stratification criteria of patients before judging their discharge the same day after PCI.
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Boudiche S, Guermazi O, Azaiez F, Ben Halima M, Rekik B, Khader N, Aloui H, Farhati A, Larbi N, Mghaieth F, Ouali S, Mourali MS. Unprotected left main percutaneous coronary intervention: prognostic value of SYNTAX score II. Tunis Med 2019; 97:556-563. [PMID: 31729706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Unprotected left main (LM) coronary artery disease (CAD) represents a challenging lesion with a major prognostic impact. AIM Evaluate the clinical outcome and major adverse cardiac events (MACE) predictors of unprotected LM percutaneous coronary intervention (PCI) in an "all-comers" population. METHODS We performed a prospective observational study of patients with unprotected LM stenosis treated by PCI. MACE were defined as the composite endpoint of all-cause death, myocardial infarction and target lesion revascularization. RESULTS From January 2012 to December 2017, 150 consecutive patients who underwent unprotected LM PCI were included. The mean age was 64±12 years and 75.3% were males. Diabetes was noted in 50.7%. Emergent revascularization was performed in 20.7% of cases, including 3.3% patients with cardiogenic shock. Distal LM was involved in 76.7% of cases. A majority of patients (94.0%) had low or intermediate SYNTAX Score I (≤32). The median SYNTAX score II was 31.1. Drug-eluting stents were used in 78.7% and bare metal stents in 21.3% of patients, mainly in emergent setting where the former were unavailable. In distal LM PCI, provisional approach was mostly used (81.7%). The median follow-up was 13.4 months. MACE occurred in 23.3% with an estimate of 37.9% at 5 years. Significant predictors of MACE were cardiogenic shock, bare metal stents use, previous PCI, and SYNTAX score II ≥30. CONCLUSION Unprotected LM PCI presents encouraging short and long term outcomes. SYNTAX score II might represent a predictor for long-term outcome in this particular lesion subset.
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Boudiche S, Guermazi O, El Ayech F, Ben Halima M, Aouinti MA, Ouaghlani K, Rekik B, Khader N, Aloui H, Larbi N, Farhati A, Mghaieth F, Ouali S, Mourali MS. Outcome predictors of cardiogenic shock complicating ST-segment elevation myocardial infarction. Tunis Med 2019; 97:476-483. [PMID: 31729723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cardiogenic shock complicating ST elevation myocardial infarction is burdened by a high mortality. There is only limited evidence for the management except for early revascularization and the relative ineffectiveness of intra-aortic balloon pump. AIM Our objectives were to evaluate outcome and predictors of early all-cause 30-day mortality in the setting of cardiogenic shock complicating ST elevation myocardial infarction. METHODS From January 2009 to August 2018, all patients who presented within the first 48 hours of ST elevation myocardial infarction complicated by cardiogenic shock and receiving invasive management were prospectively included. RESULTS The study cohort comprised 122 consecutive patients. The mean age was 65±12 years and 74.5% of patients were males. Left ventricular failure was the most common etiology of cardiogenic shock (72.1%) and mechanical complications occurred in 8.2% of cases. Percutaneous coronary interventions were proposed for all patients and performed in a primary setting in 72.1%. A high prevalence of no reflow was noted (15.6%). Multivessel coronary artery disease was noted in 64.8% and multivessel percutaneous coronary interventions at the index procedure were performed in 22.1% of cases. Intra-aortic balloon pump was used in 17.2% of patients. The 30-day mortality was 58.2%. The only predictor of early mortality was the immediate multivessel percutaneous coronary intervention (OR=4.1, 95%CI 1.1-14.5; p=0.031). CONCLUSION Despite invasive management strategies, 30-day mortality of cardiogenic shock complicating ST elevation myocardial infarction remained as high as 58.2%. Immediate multivessel percutaneous coronary intervention was the only predictor of early mortality.
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Alami Aroussi A, Fouad A, Omrane A, Razzak A, Aissa A, Akkad A, Amraoui A, Aouam A, Arfaoui A, Belkouchi A, Ben Chaaben A, Ben Cheikh A, Ben Khélifa A, Ben Mabrouk A, Benhima A, Bezza A, Bezzine A, Bourrahouat A, Chaieb A, Chakib A, Chetoui A, Daoudi A, Ech-Chenbouli A, Gaaliche A, Hassani A, Kassimi A, Khachane A, Labidi A, Lalaoui A, Masrar A, McHachi A, Nakhli A, Ouakaa A, Siati A, Toumi A, Zaouali A, Condé AY, Haggui A, Belaguid A, El Hangouche AJ, Gharbi A, Mahfoudh A, Bouzouita A, Aissaoui A, Ben Hamouda A, Hedhli A, Ammous A, Bahlous A, Ben Halima A, Belhadj A, Bezzine A, Blel A, Brahem A, Banasr A, Meherzi A, Saadi A, Sellami A, Turki A, Ben Miled A, Ben Slama A, Daib A, Zommiti A, Chadly A, Jmaa A, Mtiraoui A, Ksentini A, Methnani A, Zehani A, Kessantini A, Farah A, Mankai A, Mellouli A, Zaouali A, Touil A, Hssine A, Ben Safta A, Derouiche A, Jmal A, Ferjani A, Djobbi A, Dridi A, Aridhi A, Bahdoudi A, Ben Amara A, Benzarti A, Ben Slama AY, Oueslati A, Soltani A, Chadli A, Aloui A, Belghuith Sriha A, Bouden A, Laabidi A, Mensi A, Ouakaa A, Sabbek A, Zribi A, Green A, Ben Nasr A, Azaiez A, Yeades A, Belhaj A, Mediouni A, Sammoud A, Slim A, Amine B, Chelly B, Jatik B, Lmimouni B, Daouahi B, Ben Khelifa B, Louzir B, Dorra A, Dhahri B, Ben Nasrallah C, Chefchaouni C, Konzi C, Loussaief C, Makni C, Dziri C, Bouguerra C, Kays C, Zedini C, Dhouha C, Mohamed C, Aichaouia C, Dhieb C, Fofana D, Gargouri D, Chebil D, Issaoui D, Gouiaa D, Brahim D, Essid D, Jarraya D, Trad D, Ben Hmida E, Sboui E, Ben Brahim E, Baati E, Talbi E, Chaari E, Hammami E, Ghazouani E, Ayari F, Ben Hariz F, Bennaoui F, Chebbi F, Chigr F, Guemira F, Harrar F, Benmoula FZ, Ouali FZ, Maoulainine FMR, Bouden F, Fdhila F, Améziani F, Bouhaouala F, Charfi F, Chermiti Ben Abdallah F, Hammemi F, Jarraya F, Khanchel F, Ourda F, Sellami F, Trabelsi F, Yangui F, Fekih Romdhane F, Mellouli F, Nacef Jomli F, Mghaieth F, Draiss G, Elamine G, Kablouti G, Touzani G, Manzeki GB, Garali G, Drissi G, Besbes G, Abaza H, Azzouz H, Said Latiri H, Rejeb H, Ben Ammar H, Ben Brahim H, Ben Jeddi H, Ben Mahjouba H, Besbes H, Dabbebi H, Douik H, El Haoury H, Elannaz H, Elloumi H, Hachim H, Iraqi H, Kalboussi H, Khadhraoui H, Khouni H, Mamad H, Metjaouel H, Naoui H, Zargouni H, Elmalki HO, Feki H, Haouala H, Jaafoura H, Drissa H, Mizouni H, Kamoun H, Ouerda H, Zaibi H, Chiha H, Kamoun H, Saibi H, Skhiri H, Boussaffa H, Majed H, Blibech H, Daami H, Harzallah H, Rkain H, Ben Massoud H, Jaziri H, Ben Said H, Ayed H, Harrabi H, Chaabouni H, Ladida Debbache H, Harbi H, Yacoub H, Abroug H, Ghali H, Kchir H, Msaad H, Ghali H, Manai H, Riahi H, Bousselmi H, Limem H, Aouina H, Jerraya H, Ben Ayed H, Chahed H, Snéne H, Lahlou Amine I, Nouiser I, Ait Sab I, Chelly I, Elboukhani I, Ghanmi I, Kallala I, Kooli I, Bouasker I, Fetni I, Bachouch I, Bouguecha I, Chaabani I, Gazzeh I, Samaali I, Youssef I, Zemni I, Bachouche I, Youssef I, Bouannene I, Kasraoui I, Laouini I, Mahjoubi I, Maoudoud I, Riahi I, Selmi I, Tka I, Hadj Khalifa I, Mejri I, Béjia I, Bellagha J, Boubaker J, Daghfous J, Dammak J, Hleli J, Ben Amar J, Jedidi J, Marrakchi J, Kaoutar K, Arjouni K, Ben Helel K, Benouhoud K, Rjeb K, Imene K, Samoud K, El Jeri K, Abid K, Chaker K, Abid K, Bouzghaîa K, Kamoun K, Zitouna K, Oughlani K, Lassoued K, Letaif K, Hakim K, Cherif Alami L, Benhmidoune L, Boumhil L, Bouzgarrou L, Dhidah L, Ifrine L, Kallel L, Merzougui L, Errguig L, Mouelhi L, Sahli L, Maoua M, Rejeb M, Ben Rejeb M, Bouchrik M, Bouhoula M, Bourrous M, Bouskraoui M, El Belhadji M, El Belhadji M, Essakhi M, Essid M, Gharbaoui M, Haboub M, Iken M, Krifa M, Lagrine M, Leboyer M, Najimi M, Rahoui M, Sabbah M, Sbihi M, Zouine M, Chefchaouni MC, Gharbi MH, El Fakiri MM, Tagajdid MR, Shimi M, Touaibia M, Jguirim M, Barsaoui M, Belghith M, Ben Jmaa M, Koubaa M, Tbini M, Boughdir M, Ben Salah M, Ben Fraj M, Ben Halima M, Ben Khalifa M, Bousleh M, Limam M, Mabrouk M, Mallouli M, Rebeii M, Ayari M, Belhadj M, Ben Hmida M, Boughattas M, Drissa M, El Ghardallou M, Fejjeri M, Hamza M, Jaidane M, Jrad M, Kacem M, Mersni M, Mjid M, Sabbah M, Serghini M, Triki M, Ben Abbes M, Boussaid M, Gharbi M, Hafi M, Slama M, Trigui M, Taoueb M, Chakroun M, Ben Cheikh M, Chebbi M, Hadj Taieb M, Kacem M, Ben Khelil M, Hammami M, Khalfallah M, Ksiaa M, Mechri M, Mrad M, Sboui M, Bani M, Hajri M, Mellouli M, Allouche M, Mesrati MA, Mseddi MA, Amri M, Bejaoui M, Bellali M, Ben Amor M, Ben Dhieb M, Ben Moussa M, Chebil M, Cherif M, Fourati M, Kahloul M, Khaled M, Machghoul M, Mansour M, Abdesslem MM, Ben Chehida MA, Chaouch MA, Essid MA, Meddeb MA, Gharbi MC, Elleuch MH, Loueslati MH, Sboui MM, Mhiri MN, Kilani MO, Ben Slama MR, Charfi MR, Nakhli MS, Mourali MS, El Asli MS, Lamouchi MT, Cherti M, Khadhraoui M, Bibi M, Hamdoun M, Kassis M, Touzi M, Ben Khaled M, Fekih M, Khemiri M, Ouederni M, Hchicha M, Kassis M, Ben Attia M, Yahyaoui M, Ben Azaiez M, Bousnina M, Ben Jemaa M, Ben Yahia M, Daghfous M, Haj Slimen M, Assidi M, Belhadj N, Ben Mustapha N, El Idrissislitine N, Hikki N, Kchir N, Mars N, Meddeb N, Ouni N, Rada N, Rezg N, Trabelsi N, Bouafia N, Haloui N, Benfenatki N, Bergaoui N, Yomn N, Ben Mustapha N, Maamouri N, Mehiri N, Siala N, Beltaief N, Aridhi N, Sidaoui N, Walid N, Mechergui N, Mnif N, Ben Chekaya N, Bellil N, Dhouib N, Achour N, Kaabar N, Mrizak N, Mnif N, Chaouech N, Hasni N, Issaoui N, Ati N, Balloumi N, Haj Salem N, Ladhari N, Akif N, Liani N, Hajji N, Trad N, Elleuch N, Marzouki NEH, Larbi N, M'barek N, Rebai N, Bibani N, Ben Salah N, Belmaachi O, Elmaalel O, Jlassi O, Mihoub O, Ben Zaid O, Bouallègue O, Bousnina O, Bouyahia O, El Maalel O, Fendri O, Azzabi O, Borgi O, Ghdes O, Ben Rejeb O, Rachid R, Abi R, Bahiri R, Boulma R, Elkhayat R, Habbal R, Rachid R, Tamouza R, Jomli R, Ben Abdallah R, Smaoui R, Debbeche R, Fakhfakh R, El Kamel R, Gargouri R, Jouini R, Nouira R, Fessi R, Bannour R, Ben Rabeh R, Kacem R, Khmakhem R, Ben Younes R, Karray R, Cheikh R, Ben Malek R, Ben Slama R, Kouki R, Baati R, Bechraoui R, Fakhfakh R, Fradi R, Lahiani R, Ridha R, Zainine R, Kallel R, Rostom S, Ben Abdallah S, Ben Hammamia S, Benchérifa S, Benkirane S, Chatti S, El Guedri S, El Oussaoui S, Elkochri S, Elmoussaoui S, Enbili S, Gara S, Haouet S, Khammeri S, Khefecha S, Khtrouche S, Macheghoul S, Mallouli S, Rharrit S, Skouri S, Helali S, Boulehmi S, Abid S, Naouar S, Zelfani S, Ben Amar S, Ajmi S, Braiek S, Yahiaoui S, Ghezaiel S, Ben Toumia S, Thabeti S, Daboussi S, Ben Abderahman S, Rhaiem S, Ben Rhouma S, Rekaya S, Haddad S, Kammoun S, Merai S, Mhamdi S, Ben Ali R, Gaaloul S, Ouali S, Taleb S, Zrour S, Hamdi S, Zaghdoudi S, Ammari S, Ben Abderrahim S, Karaa S, Maazaoui S, Saidani S, Stambouli S, Mokadem S, Boudiche S, Zaghbib S, Ayedi S, Jardek S, Bouselmi S, Chtourou S, Manoubi S, Bahri S, Halioui S, Jrad S, Mazigh S, Ouerghi S, Toujani S, Fenniche S, Aboudrar S, Meriem Amari S, Karouia S, Bourgou S, Halayem S, Rammeh S, Yaïch S, Ben Nasrallah S, Chouchane S, Ftini S, Makni S, Manoubi S, Miri S, Saadi S, Manoubi SA, Khalfallah T, Mechergui T, Dakka T, Barhoumi T, M'rad TEB, Ajmi T, Dorra T, Ouali U, Hannachi W, Ferjaoui W, Aissi W, Dahmani W, Dhouib W, Koubaa W, Zhir W, Gheriani W, Arfa W, Dougaz W, Sahnoun W, Naija W, Sami Y, Bouteraa Y, Elhamdaoui Y, Hama Y, Ouahchi Y, Guebsi Y, Nouira Y, Daly Y, Mahjoubi Y, Mejdoub Y, Mosbahi Y, Said Y, Zaimi Y, Zgueb Y, Dridi Y, Mesbahi Y, Gharbi Y, Hellal Y, Hechmi Z, Zid Z, Elmouatassim Z, Ghorbel Z, Habbadi Z, Marrakchi Z, Hidouri Z, Abbes Z, Ouhachi Z, Khessairi Z, Khlayfia Z, Mahjoubi Z, Moatemri Z. 46th Medical Maghrebian Congress. November 9-10, 2018. Tunis. Tunis Med 2019; 97:177-258. [PMID: 31535714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Ouali S, Mechri M, Ben Ali Z, Boudiche S, Ben Halima M, Rejaibi S, Mourali MS, Larbi N, Meghaieth F. Factors associated to adequate time in therapeutic range with oral vitamin K antagonists in Tunisia. Tunis Med 2019; 97:113-121. [PMID: 31535702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The quality of chronic anticoagulation and predictor factors of poor anticoagulant control in patients under acenocoumarol were unknown in North Africa. METHODS It is an observational study, carried out between November 2015 and November 30, 2016. The international normalized ratio (INR) values were prospectively obtained, and TTR was calculated using the Rosendaal method. RESULTS Overall, 215 patients were included in this study, with a mean age of 63±0,8 years. The prevalence of poor anticoagulation control was 78.1%; 95% CI [72.2-83.2] (168 patients with TTR less than 65%). The median TTR with the Rosendaal method was 44.4%. After multivariate adjustment, variables significantly associated with adequate anticoagulation level were: history of ischemic stroke (Adjusted OR equal to 4.3, 95% CI: 1.4-12.9), associated prescription of antiplatelet therapy (Adjusted OR equal to 3.5, 95% CI: 1.1-11.2), daily prescribed dose of coumarins less than 6 mg (Adjusted OR equal to 6.4, 95% CI: 1.1- 36) and lower risk of bleeding assessed as HAS-BLED score (Adjusted OR: 0.5, 95% CI: 0.3-0.8). CONCLUSION The quality of anticoagulation management with VKA among outpatients who received acenocoumarol was suboptimal. Strategies should be undertaken by clinicians and patients to improve the quality of anticoagulation, to address challenges to adverse cardiovascular outcomes in individuals treated with chronic anticoagulation.
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Ben Halima A, Ouali S, Mourali MS, Chabrak S, Chettaoui R, Ben Halima M, Haggui A, Larbi N, Krichène S, Marrakchi S, Kacem S, Chrigui R, Abbes MF, Baccar H, Baraket N, Ben Halima N, Ben Khalfallah A, Ben Mbarek M, Ben Youssef S, Boughzala E, Boujnah MR, Drissa H, Gamra H, Gasmi A, Haouala H, Harrath Y, Issa I, Jeridi G, Kachboura S, Kammoun S, Kraiem S, Maatouk F, Milouchi S, Nasraoui W, Neji A, Sayahi K, Sdiri W, Smati W, Tlili S, Abid L, Abdesselem S, Zakhama L, Mahdhaoui A, Kammoun H, Ben Omrane S, Addad F. Design and Rationale of the National Tunisian Registry of Atrial Fibrillation: Protocol for a Prospective, Multicenter Trial. JMIR Res Protoc 2018; 7:e181. [PMID: 30322836 PMCID: PMC6231898 DOI: 10.2196/resprot.8523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited. Objective The aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial. Methods A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points. Results Results will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients. Conclusions This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region. Trial Registration ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX) Registered Report Identifier RR1-10.2196/8523
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Affiliation(s)
- Afef Ben Halima
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Sana Ouali
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Sonia Chabrak
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Rafik Chettaoui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Manel Ben Halima
- La Rabta Hospital, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Abdeddayem Haggui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Principal Military Hospital, Tunis, Tunisia
| | - Noureddine Larbi
- La Rabta Hospital, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Salma Krichène
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Sonia Marrakchi
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Abderrahman Mami Hospital, Ariana, Tunisia
| | - Slim Kacem
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Rim Chrigui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Habib Gamra
- Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ali Gasmi
- Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Ali Neji
- Ben Guerdane Hospital, Ben Guerdane, Tunisia
| | | | | | | | | | - Leila Abid
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Hédi Chaker Hospital, Sfax, Tunisia
| | - Salem Abdesselem
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Lilia Zakhama
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Hospital of the Internal Security Forces, La Marsa, Tunisia
| | - Abdallah Mahdhaoui
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Farhat Hached Hospital, Sousse, Tunisia
| | - Helmi Kammoun
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Skander Ben Omrane
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Faouzi Addad
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Abderrahman Mami Hospital, Ariana, Tunisia
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Mghaieth Zghal F, Samoud K, Ben Halima M, Ben Ammar J, Boudiche S, Khadher N, Farhati A, Larbi N, Ouali S, Mourali MS. P5353Assessment of biventricular function in atrial fibrillation patients with obstructive sleep apnea: a speckle tracking imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - J Ben Ammar
- Charles Nicolle Hospital, Pneumology, Tunis, Tunisia
| | | | | | | | - N Larbi
- Rabta Hospital, Tunis, Tunisia
| | - S Ouali
- Rabta Hospital, Tunis, Tunisia
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Ouali S, Boudiche S, Ben Halima M, Jebbari Z, Kacem S, Mourali MS. Atrial flutter ablation by femoral approach in a woman with azygos continuation of an interrupted inferior vena cava and dual chamber pacemaker. Tunis Med 2018; 96:448-450. [PMID: 30430491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This report describes a case of isthmus-dependent atrial flutter ablation by the femoral approach in a 54-year-old woman with a previously unknown absence of the inferior vena cava (IVC) and dual chamber pacemaker. Despite looping of the catheters, ablation and termination of atrial flutter were performed successfully without function alteration of the pacemaker leads. This is the first report of an inferior-to-superior approach for ablation of atrial flutter in the absence of the perihepatic IVC with the presence of chronic indwelling leads in the area targeted for radiofrequency.
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Ben Halima M, Sammoud K, Boudiche S, Ben Amar J, Aouina H, Ouali S, Mourali MS. P371Epworth sleepness scale and Berlin questionnaire: A comparison in a Tunisian population with non valvular atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - K Sammoud
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - S Boudiche
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - J Ben Amar
- Charles Nicolle Hospital, pneumology, Tunis, Tunisia
| | - H Aouina
- Charles Nicolle Hospital, pneumology, Tunis, Tunisia
| | - S Ouali
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - M S Mourali
- La Rabta Hospital, cardiology , Tunis, Tunisia
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Ben Halima M, Sammoud K, Boudiche S, Khedher N, Ben Amar J, Aouina H, Ouali S, Mourali MS. P372Hypertension and atrial fibrillation: an association that increases the risk of developing obstructive sleep apnea in a Tunisian population. Europace 2018. [DOI: 10.1093/europace/euy015.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - K Sammoud
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - S Boudiche
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - N Khedher
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - J Ben Amar
- Charles Nicolle Hospital, pneumology, Tunis, Tunisia
| | - H Aouina
- Charles Nicolle Hospital, pneumology, Tunis, Tunisia
| | - S Ouali
- La Rabta Hospital, cardiology , Tunis, Tunisia
| | - M S Mourali
- La Rabta Hospital, cardiology , Tunis, Tunisia
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Ouali S, Ben Halima M, Boudiche S, Gharbi A, Nadim K, Hakim K, Ouarda F, Mourali MS. Cardiomyopathy induced by incessant ventricular tachycardia originating in the vicinity of the His bundle. Indian Pacing Electrophysiol J 2017; 18:76-79. [PMID: 29113751 PMCID: PMC5998207 DOI: 10.1016/j.ipej.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/06/2017] [Accepted: 10/25/2017] [Indexed: 10/31/2022] Open
Abstract
A 04-year-old boy was referred to our institution with severe, progressive heart failure of 4-months duration associated with a persistent wide QRS tachycardia with left bundle branch block and severe left ventricular dysfunction. Because of incessant wide QRS tachycardia refractory to antiarrhythmic drugs, he was referred for electrophysiological study. The ECG was suggestive of VT arising from the right ventricle near the His area. Electrophysiological study revealed that origin of tachycardia was septum of the right ventricle, near His bundle, however the procedure was not successful and an inadvertent complete atrioventricular conduction block occurred. The same ventricular tachycardia recurred. A second procedure was performed with a retrograd aortic approach to map the left side of the interventricular septum. The earliest endocardial site for ablation was localized in the anterobasal region of left ventricle near His bundle. In this location, one radiofrequency pulse interrupted VT and rendered it not inducible. The echocardiographic evaluation showed partial reversal of left ventricular function in the first 3 months. The diagnosis was idiopathic parahisian left ventricular tachycardia leading to a tachycardia mediated cardiomyopathy, an extremely rare clinical picture in children.
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Affiliation(s)
- Sana Ouali
- Cardiology Department, La Rabta Hospital, Tunisia.
| | | | | | - Anissa Gharbi
- Cardiology Department, Farhat Hached Hospital, Tunisia
| | | | - Kaouthar Hakim
- Congenital Heart Disease Department, La Rabta Hospital, Tunisia
| | - Fatma Ouarda
- Congenital Heart Disease Department, La Rabta Hospital, Tunisia
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Abdallah M, Abdelaziz A, Abdelaziz O, Abdelhedi N, Abdelkbir A, Abdelkefi M, Abdelmoula L, Abdennacir S, Abdennadher M, Abidi H, Abir Hakiri A, Abou El Makarim S, Abouda M, Achour W, Aichaouia C, Aissa A, Aissa Y, Aissi W, Ajroudi M, Allouche E, Aloui H, Aloui D, Amdouni F, Ammar Y, Ammara Y, Ammari S, Ammous A, Amous A, Amri A, Amri M, Amri R, Annabi H, Antit S, Aouadi S, Arfaoui A, Assadi A, Attia L, Attia M, Attia L, Ayadi I, Ayadi Dahmane I, Ayari A, Azzabi S, Azzouz H, B Mefteh N, B Salah C, Baccar H, Bachali A, Bahlouli M, Bahri G, Baïli H, Bani M, Bani W, Bani MA, Bassalah E, Bawandi R, Bayar M, Bchir N, Bechraoui R, Béji M, Beji R, Bel Haj Yahia D, Belakhel S, Belfkih H, Belgacem O, Belgacem N, Belhadj A, Beltaief N, Beltaief N, Ben Abbes M, Ben Abdelaziz A, Ben Ahmed I, Ben Aissia N, Ben Ali M, Ben Ammar H, Ben Ammou B, Ben Amor A, Ben Amor M, Benatta M, Ben Ayed N, Ben Ayoub W, Ben Charrada N, Ben Cheikh M, Ben Dahmen F, Ben Dhia M, Ben Fadhel S, Ben Farhat L, Ben Fredj Ismail F, Ben Hamida E, Ben Hamida Nouaili E, Ben Hammamia M, Ben Hamouda A, Ben Hassine L, Ben Hassouna A, Ben Hasssen A, Ben Hlima M, Ben Kaab B, Ben Mami N, Ben Mbarka F, Ben Mefteh N, Ben Kahla N, Ben Mrad M, Ben Mustapha N, Ben Nacer M, Ben Neticha K, Ben Othmen E, Ben Rhouma S, Ben Rhouma M, Ben Saadi S, Ben Safta A, Ben Safta Z, Ben Salah C, Ben Salah N, Ben Sassi S, Ben Sassi J, Ben Tekaya S, Ben Temime R, Ben Tkhayat A, Ben Tmim R, Ben Yahmed Y, Ben Youssef S, Ben Ali M, Ben Atta M, Ben Safta Z, Ben Salah M, Berrahal I, Besbes G, Bezdah L, Bezzine A, Bezzine A, Bokal Z, Borsali R, Bouasker I, Boubaker J, Bouchekoua M, Bouden F, Boudiche S, Boukhris I, Bouomrani S, Bouraoui S, Bouraoui S, Bourgou S, Boussabeh E, Bouzaidi K, Chaker K, Chaker L, Chaker A, Chaker F, Chaouech N, Charfi M, Charfi MR, Charfi F, Chatti L, Chebbi F, Chebbi W, Cheikh R, Cheikhrouhou S, Chekir J, Chelbi E, Chelly I, Chelly B, Chemakh M, Chenik S, Cheour M, Cheour M, Cherif E, Cherif Y, Cherif W, Cherni R, Chetoui A, Chihaoui M, Chiraz Aichaouia C, Dabousii S, Daghfous A, Daib A, Daib N, Damak R, Daoud N, Daoud Z, Daoued N, Debbabi H, Demni W, Denguir R, Derbel S, Derbel B, Dghaies S, Dhaouadi S, Dhilel I, Dimassi K, Dougaz A, Dougaz W, Douik H, Douik El Gharbi L, Dziri C, El Aoud S, El Hechmi Z, El Heni A, ELaoud S, Elfeleh E, Ellini S, Ellouz F, Elmoez Ben O, Ennaifer R, Ennaifer S, Essid M, Fadhloun N, Farhat M, Fekih M, Fourati M, Fteriche F, G Hali O, Galai S, Gara S, Garali G, Garbouge W, Garbouj W, Ghali O, Ghali F, Gharbi E, Gharbi R, Ghariani W, Gharsalli H, Ghaya Jmii G, Ghédira F, Ghédira A, Ghédira H, Ghériani A, Gouta EL, Guemira F, Guermazi E, Guesmi A, Hachem J, Haddad A, Hakim K, Hakiri A, Hamdi S, Hamed W, Hamrouni S, Hamza M, Haouet S, Hariz A, Hendaoui L, Hfaidh M, Hriz H, Hsairi M, Ichaoui H, Issaoui D, Jaafoura H, Jazi R, Jazia R, Jelassi H, Jerraya H, Jlassi H, Jmii G, Jouini M, Kâaniche M, Kacem M, Kadhraoui M, Kalai M, Kallel K, Kammoun O, Karoui M, Karouia S, Karrou M, Kchaou A, Kchaw R, Kchir N, Kchir H, Kechaou I, Kerrou M, Khaled S, Khalfallah N, Khalfallah M, Khalfallah R, Khamassi K, Kharrat M, Khelifa E, Khelil M, Khelil A, Khessairi N, Khezami MA, Khouni H, Kooli C, Korbsi B, Koubaa MA, Ksantini R, Ksentini A, Ksibi I, Ksibi J, Kwas H, Laabidi A, Labidi A, Ladhari N, Lafrem R, Lahiani R, Lajmi M, Lakhal J, Laribi M, Lassoued N, Lassoued K, Letaif F, Limaïem F, Maalej S, Maamouri N, Maaoui R, Maâtallah H, Maazaoui S, Maghrebi H, Mahfoudhi S, Mahjoubi Y, Mahjoubi S, Mahmoud I, Makhlouf T, Makni A, Mamou S, Mannoubi S, Maoui A, Marghli A, Marrakchi Z, Marrakchi J, Marzougui S, Marzouk I, Mathlouthi N, Mbarek K, Mbarek M, Meddeb S, Mediouni A, Mechergui N, Mejri I, Menjour MB, Messaoudi Y, Mestiri T, Methnani A, Mezghani I, Meziou O, Mezlini A, Mhamdi S, Mighri M, Miled S, Miri I, Mlayeh D, Moatemri Z, Mokaddem W, Mokni M, Mouhli N, Mourali MS, Mrabet A, Mrad F, Mrouki M, Msaad H, Msakni A, Msolli S, Mtimet S, Mzabi S, Mzoughi Z, Naffeti E, Najjar S, Nakhli A, Nechi S, Neffati E, Neji H, Nouira Y, Nouira R, Omar S, Ouali S, Ouannes Y, Ouarda F, Ouechtati W, Ouertani J, Ouertani J, Ouertani H, Oueslati A, Oueslati J, Oueslati I, Oueslati A, Rabai B, Rahali H, Rbia E, Rebai W, Regaïeg N, Rejeb O, Rhaiem W, Rhimi H, Riahi I, Ridha R, Robbena L, Rouached L, Rouis S, Safer M, Saffar K, Sahli H, Sahraoui G, Saidane O, Sakka D, Salah H, Sallami S, Salouage I, Samet A, Sammoud K, Sassi Mahfoudh A, Sayadi C, Sayhi A, Sebri T, Sedki Y, Sellami A, Serghini M, Sghaier I, Skouri W, Skouri W, Slama I, Slimane H, Slimani O, Souhail O, Souhir S, Souissi A, Souissi R, Taboubi A, Talbi G, Tbini M, Tborbi A, Tekaya R, Temessek H, Thameur M, Touati A, Touinsi H, Tounsi A, Tounsia H, Trabelsi S, Trabelsi S, Triki A, Triki M, Turki J, Turki K, Twinsi H, Walha Y, Wali J, Yacoub H, Yangui F, Yazidi M, Youssef I, Zaier A, Zainine R, Zakhama L, Zalila H, Zargouni H, Zehani A, Zeineb Z, Zemni I, Zghal M, Ziadi J, Zid Z, Znagui I, Zoghlami C, Zouaoui C, Zouari B, Zouiten L, Zribi H. Abstracts of the 40th National Congress of Medicine Tunis, 19-20 October 2017. Tunis Med 2017; 95:1002-1070. [PMID: 29877564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kallel A, Sbaï MH, Sédiri Y, Feki M, Mourali MS, Mechmeche R, Jemaa R, Kaabachi N. Association Between the G20210A Polymorphism of Prothrombin Gene and Myocardial Infarction in Tunisian Population. Biochem Genet 2016; 54:653-64. [PMID: 27306359 DOI: 10.1007/s10528-016-9744-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/27/2016] [Indexed: 01/20/2023]
Abstract
The prothrombin is the precursor of the serine protease thrombin, a key enzyme in homeostasis. Prothrombin G20210A polymorphism (rs1799963) was described as a moderate risk factor for venous thrombosis because this mutation is associated with prothrombin elevated levels which may lead to an imbalance between the procoagulant, anticoagulant, and fibrinolytic system. 20210A carriers have an increased risk of thrombosis. In this study, we proposed to determine the prevalence of 20210A prothrombin variant among Tunisian population, and to evaluate the potential relevance of this variant with myocardial infarction. This study included 1290 unrelated Tunisians (1007 male and 283 female) divided in two groups: Four hundred and eighty-seven MI patients (mean age: 52.64 ± 8.98 years) and 803 apparently healthy controls (mean age: 51 ± 8.99). The prothrombin G20210A polymorphism was carried out by polymerase chain reaction/restriction fragment length polymorphism (PCR-RFLP) analysis. The distribution of genotypes was in accordance with Hardy-Weinberg equilibrium (p > 0.05). A significant difference in genotype distribution and allele frequency was observed between patients and controls. Male patients with MI had a frequency of 97 % for GG genotype and 3 % for GA+AA genotypes. The control group had a frequency of 99 % for the GG genotype and 1 % for the GA+AA genotypes which is significantly lower than the frequency found in patients (p = 0.01). The same genotype frequencies were found in women (p = 0.032). The MI patient group showed a significantly higher frequency of 20210A allele compared to controls 0.02 versus 0.01 [OR = 3.60 (95 % CI = 1.29-10.53), p = 0.005] in men and 0.015 versus 0.068 [OR = 4.68 (95 % CI = 1.60-14.26), p = 0.001] in women. Our work showed a significant but not independent association between the G20210A polymorphism of the prothrombin gene and MI in the Tunisian population.
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Affiliation(s)
- Amani Kallel
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Mohamed Hedi Sbaï
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Yousra Sédiri
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Moncef Feki
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Hôpital la Rabta, Service des Explorations Fonctionnelles et de Reanimations en Cardiologie, Université de Tunis El Manar, Tunis, Tunisia
| | - Rachid Mechmeche
- Hôpital la Rabta, Service des Explorations Fonctionnelles et de Reanimations en Cardiologie, Université de Tunis El Manar, Tunis, Tunisia
| | - Riadh Jemaa
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia.
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia.
| | - Naziha Kaabachi
- Faculté de Medicine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Hôpital la Rabta, Service de Biochimie, Université de Tunis El Manar, LR99ES11, 1007, Tunis, Tunisia
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Ben Said R, Zaroui A, Khedher N, Ben Halima M, Sami Mourali M. 0238 : Echocardiographic analysis of myocardial deformation in hypertrophic myocardiopathy. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zaroui A, Zarouk S, Benhalima M, Boudiche S, Wali S, Mechmeche R, Mourali MS. 0261: Inflammatory response phenomena mediate by cytokines in the myocardial remodeling post myocardial infarct. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zaroui A, Asmi M, Fourty N, Said RB, Benhalima M, Mourali MS, Kaabachi N, Mechmeche R. 0139: Detection of myocardial fibrosis in patients with hypertrophic cardiomyopathy evaluated by biological markers. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zidi W, Allal-Elasmi M, Zayani Y, Zaroui A, Guizani I, Feki M, Mourali MS, Mechmeche R, Kaabachi N. Metabolic Syndrome, Independent Predictor for Coronary Artery Disease. Clin Lab 2015; 61:1545-52. [PMID: 26642718 DOI: 10.7754/clin.lab.2015.150219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) was reported to be associated with coronary artery disease (CAD). The aim of the present study was to assess the association between MS and CAD angiographic severity and to search the predictive value of MS and its individual components for CAD. METHODS 428 patients who underwent elective coronary angiography at the Cardiology Department were included in the study. MS was defined according to National Cholesterol Education Program (NCEP) Adult Treatment Panel III criteria. CAD severity was determined by Gensini scors. RESULTS The proportion of CAD (+) who had MS was significantly higher compared to CAD (-) (63.6% vs. 48.6%, p = 0.020). Gensini score and number of MS components were positively correlated (r = 0.144, p = 0.019). The adjusted predictive abilities for angiographic CAD of MS and its individual components showed that high FBG and high TG are predictive factors for CAD in binary logistic regression analysis (OR = 2.238, 95% CI 1.111 - 4.508, p = 0.024 vs. OR = 2.200, 95% CI 1.078 - 4.492, p = 0.030). The OR for CAD risk of different phenotypes in high FBG and/or HTG shows that this combination increased the OR significantly to 2.307. Among the quartets, the cluster with high BP and low HDL-C was the highest risk (OR = 4.879). However, the combination including all components of MS was a significant contributor to CAD risk. CONCLUSIONS The MS score correlates with the angiographic severity of CAD. The predictive ability for CAD was stronger with high FBG and high TG and associated low HDL-C and high BP, which seem to act synergistically as risk factors for CAD. Therefore, to prevent or decrease this risk of CAD, clinicians should screen for individual abnormalities of MS, mainly elevated blood glucose level and TG.
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Aloui S, Elasmi M, Zaroui A, Zidi W, Mna MB, Zayani Y, Feki M, Mourali MS, Mechmeche R, Kaabachi N. 0281: Mitral stenosis: implication of metalloproteinase remodeling and calcification. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71624-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zaroui A, Ben Said R, Chalbia T, Khedher N, Smaali S, Mechmeche R, Sami Mourali M. 0260: Relation of presence and severity of metabolic syndrome with left atrial mechanics in patients, a deformation imaging study. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zaroui A, Said RB, Chalbia T, Benhalima M, Smaali S, Mechmeche R, Mourali MS. 0255: Left ventricular dyssynchrony and radial strain on hypertrophic cardiomyopathy. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zaroui A, Smaali S, Rekik B, Khedher N, Benhalima M, Boudiche S, Mechmeche R, Sami Mourali M. 0258: Prognostic value of new diastolic parameter derived from a two-dimensional speckle-tracking study in acute myocardial infarction. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71585-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kallel A, Sbaï MH, Sediri Y, Abdessalem S, Mourali MS, Feki M, Mechmeche R, Jemaa R, Kaabachi N. Polymorphisms of the NOS3 gene and risk of myocardial infarction in the Tunisian population. Cytokine 2013; 64:646-51. [PMID: 24095258 DOI: 10.1016/j.cyto.2013.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/29/2013] [Accepted: 09/04/2013] [Indexed: 11/27/2022]
Abstract
Controversial results regarding the association of eNOS gene (NOS3) polymorphisms with myocardial infarction (MI) have been reported. This study investigated the relationship of the -786T>C (rs2070744), 894G>T (rs1799983) and 4a4b polymorphisms of the NOS3 gene with the presence of MI in the Tunisian population. In addition, we also examined the association of NOS3 gene haplotypes with MI in Tunisian subjects. A total of 303 patients with MI and 225 controls were included in the study. The 894G>T and -786T>C single nucleotide polymorphisms were analyzed by PCR-RFLP, and 4a4b polymorphism just for PCR. There was significant linkage disequilibrium between the three NOS3 polymorphisms (p<0.0001). The genotype distribution and allele frequency of NOS3 4a4b, but not -786T>C and 894G>T, polymorphism was significantly different between MI patients and controls. The univariate logistic regression analysis showed a significant association of the 4a4b polymorphism and MI according to co-dominant, dominant and recessive models (co-dominant model OR: 4.38, 95%CI: 1.24-15.41; p=0.021, dominant model OR: 1.66, 95%CI: 1.14-2.42); p=0.007, and recessive model OR: 3.85, 95%CI: 1.10-13.47; p=0.035). The multivariate analysis, adjusted for traditional cardiovascular risk factors, revealed that the NOS3 4a4a genotype was an independent predisposing factor to MI, according to the models considered. In addition, a haplotype 7 (C-T-4a), (OR=12.05, p=0.010) was a risk factor of MI after controlling for classical risk factors. These finding suggest that the 4a4b polymorphism of the NOS3 gene was associated with MI in Tunisian patients.
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Affiliation(s)
- Amani Kallel
- Université de Tunis El Manar, Hôpital la Rabta, Service de Biochimie, LR99ES11, 1007 Tunis, Tunisie
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