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Background Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure ( Objective To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring. Methods Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model. Results A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2). Conclusion Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated. Funding Acknowledgement Type of funding sources: None.

Introduction Mitral Valve Prolapse (MVP) is associated with complex ventricular arrythmia (VA) and sudden cardiac death but risk stratification remains unclear. Exercise induces an hyperadrenergic state and could trigger VA, however, data on exercise-induced VA (EIVA) in MVP patients are scarce. Objective To describe EIVA prevalence, origin, characteristics and associated features in MVP patients. Methods In this observational prospective study, 64 MVP asymptomatic patients (58±14 years, 41 men) with mild to severe mitral regurgitation (MR) and without left ventricular (LV) dysfunction, underwent echocardiography and symptom-limited exercise testing. Continuous 12-lead ECG monitoring was performed throughout testing. Severe EIVA was defined as ventricular triplets, sustained or non-sustained ventricular tachycardia (NSVT) or ventricular fibrillation. Results All patients exercised at maximal intensity until exhaustion. EIVA was observed in 54 (84%) subjects including 12 (19%) patients with severe EIVA (7 triplets, 5 NSVT). Severe EIVA originated mainly from the mitral apparatus (all but one) and occurred at high exercise intensity (median 90% of predicted workload) or during early recovery phase. Compared to the rest of the cohort the patients with severe EIVA had similar resting ECG characteristics, similar LV dimension and function, similar degree of MR and mitral apparatus morphology. Finally, severe EIVA was not associated with an alteration of exercise tolerance. Conclusion Exercise frequently unmasks ventricular arrythmia in patients with MVP. EIVA appears not linked to MVP features nor to exercise tolerance and seems to provide additional phenotyping information that could be linked to prognosis. Funding Acknowledgement Type of funding sources: None.

Background Little is known about the prognosis of colorectal cancer associated with inflammatory bowel disease (CRC-IBD) in a real-world cohort in France. Methods We conducted a retrospective observational study including all patients presenting CRC-IBD in a tertiary French center between 1990 and 2021. Clinical and molecular data were collected. We analyzed overall survival (OS), progression free survival (PFS) and factors associated with prognosis. Outcome probabilities were analyzed using the Kaplan-Meier method. Results Among 6510 patients, the incidence rate of CRC was 0.8% (N =49) with a median delay of 19.5 years after IBD diagnosis. The median age was 46 years, the main IBD was ulcerative colitis (59%), the primary tumor was rectal in 49% and localized at diagnosis in 69%. There was a previous exposure to immunosuppressants (IS) in 57% and anti-TNF in 29% of the cases. The most frequent mutation was TP53 (56%). A RAS mutation was observed in 37% of the whole population and 13% of metastatic patients. OS of the whole cohort was 45 months OS and PFS of synchronous metastatic patients was 20.4 months and 8.5 months respectively. Among the patients with localized tumor those previously exposed to IS had a better progression-free survival (39 months vs 23 months; p =0.05) and a better OS (74 vs 44 months; p =0.03). Only 2 patients (4%) experienced IBD relapse during follow-up despite IS and biologics discontinuation in all exposed patients. Chemotherapy exposure was 53% and 93% in the adjuvant and metastatic setting respectively. No unexpected side-effect was observed, the only reason for discontinuation was oxaliplatin-sensitive neuropathy. Conclusion Incidence of CRC is elevated in IBD patients with a poor OS in metastatic patients although IBD is not associated with under-exposure or increased toxicity to chemotherapy. Previous IS exposure may be associated with a better prognosis.

Background Infliximab (IFX) is a humanized monoclonal anti-TNF antibody widely used for the treatment of Inflammatory Bowel Diseases (IBD). Hypersensitivity reactions (HSR) to the administration of the drug are not rare. Their occurrence usually leads to permanent drug discontinuation. We report data on safety and effectiveness of desensitization to IFX in patients with previous HSR. Methods We conducted a retrospective monocentric observational study. Patients for whom a desensitization protocol to IFX was realized after a previous HSR were included. Clinical data on IBD were collected. Anti-drug antibodies (ADA) and IFX trough levels at both inclusion and six months after were collected. Clinical outcome and recurrence of HSR were evaluated. Results From 2005, 27 patients (Female: 18 (66%), Median age at IBD diagnosis: 18.1 (15.6-28.2)) were included. Among these 27 patients, 26 (96%) had Crohn’s Disease, 17 (62%) a history of surgery, 14 (52%) an ileal disease location and 7 (26%) were smokers. It was an immediate HSR in most patients, classified as severe (n=13) or moderate (n=12), and a delayed HSR in only 2 patients. Eleven (41%) patients were treated with immunosuppressants as combination therapy at time of HSR. In most cases (n=18, 66%), HSR occurred at IFX reintroduction after a drug interruption, and in most of these cases after one or two infusions. For 9 (33%) patients, HSR occurred during a maintenance treatment with IFX after a median time of 38 months with 5 moderate and 4 severe reactions. Desensitization was performed after a median time of 10.4 months (2.9-33.1). Nineteen (70%) patients received immunosuppressants as combination therapy. IFX was well tolerated, without recurrence of HSR in 19 (70%) patients, and 12 had a clinical response at 6 months. Eight were still treated with IFX (30%) at 1 year. Eight (30%) patients presented a HSR at first (n=2), second (n=4) or third (n=2) IFX perfusion. Five were moderate with only cutaneous manifestations and 3 were severe. None led to intensive care unit transfer or death. All led to definitive drug discontinuation. Female gender and young age at desensitization were significantly associated with long term continuation of IFX (p=0.05 and p=0.03 respectively). ADA and IFX trough levels were available for 14 patients at time of desensitization. All except 2 had ADA. Among patients who were treated with IFX for a long-term period, 7 had drug levels available at desensitization and 6 months later. All had ADA at baseline. At 6 months, four reduced their level of ADA, 2 had no ADA and a significant trough level of IFX. Conclusion IFX desensitization in patients with IBD is a safe therapeutic alternative and represents a potential option for patients refractory to multiple biologics.

Background Early assessment of response to neoadjuvant chemoradiotherapy (CRT) is crucial in determining the most suitable treatment strategy in locally advanced oesophageal cancer (LAEC). Aims We evaluated the impact of early metabolic response during CRT on overall survival (OS) and histological response. Methods Patients with biopsy-proven oesophageal carcinoma underwent FDG PET/CT with evaluation of the standardized uptake value (SUV) before any treatment and during CRT after 20 Gy. Results 116 patients (Male: 66.4%, Median age: 63; squamous cell carcinomas (SCC): 70%) met inclusion criteria. Median OS was 21.7 months. There was a significant positive correlation between interim metabolic response and OS. In multivariate analysis, only metabolic response using the 50% cut-off value remained significantly associated with OS (IC95% = 0.28–0.73; p = 0.001). In this statistical analysis, surgery (p = 0.007) and T stage (p = 0.023) were also correlated with OS. There was a significant correlation between early metabolic response and local recurrence (Chi-squared test p = 0.0001). Conclusions Early metabolic response using FDG PET/CT is associated with better OS, disease-free survival, local control and pathological response in patients treated by CRT for LAEC.

Background Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory conditions that affect the gastrointestinal tract. Biological therapy with monoclonal antibodies has provided significant benefit for patients with IBD, resulting in clinical and endoscopic remission. Gut microbiome alterations were shown to serve as a marker of response to treatment in IBD. The aim of the study is to characterize gut microbiome and metabolome in patients with CD and UC after initiation of biological therapy. Methods We studied a prospective cohort of 41 CD and 39 UC patients initiating biological therapy. Biological therapy included anti-TNF (Adalimumab, Infliximab and Golimumab), anti-α4β7 integrin (Vedolizumab) or anti-IL-12/23 p40 antibody (Ustekinumab). One-year follow up showed that up to 60% of the patients achieved clinical and endoscopic remission. Fecal samples and mucosal biopsies were collected both at baseline and 14 or 52 weeks after initiation of therapy. Microbiota and metabolite changes were analyzed using 16S rRNA gene sequencing and targeted/untargeted metabolomics. Results Longitudinal profiling of luminal and mucosal bacteria reflected the individual patient-related variations over the study duration. CD and UC patients showed distinct luminal and mucosal bacterial communities. Bacterial dysbiosis was significantly higher in patients with CD than with UC, as shown by community richness and diversity. While fecal microbiota of patients with CD was enriched in Escherichia coli and Bacteroides, both Faecalibacterium and Bifidobacterium were enriched in UC. In contrast to fecal bacterial communities, mucosal bacteria from patients with ileal and colonic CD showed a clear separation of microbial profiles based on disease location. Members belonging to Haemophiles, Fusobacterium, and Escherichia coli were significantly more abundant in IBD patients with active disease. Machine-learning based analysis showed that fecal and biopsy profiles equally classified patients based on their disease subtype, with an area under the curve (AUC)=0.86. Metabolite profiling revealed enrichment of platelet-activating factor and the glycosphingolipid lactosylceramide in inflamed phenotypes. Conversely, enrichment of bile acids, such as deoxy cholic acid, chenodeoxycholic acid and Lithocholic acid was observed in responders or patients during remission. Conclusion Gut microbial and metabolomic profiling revealed associations between gut microbial taxonomic or functional profiles and IBD subtypes. The association between enrichment of fatty acids and bile acids and disease activity suggests an important role of these pathways in the development or the resolution of intestinal inflammation.

Background The modified Rutgeerts’ score (mRS) differentiates i2a – lesions confined to the anastomosis – and i2b – neoterminal ileum lesions – categories. Its relevance for therapeutic management of Crohn’s disease (CD) patients after ileocolonic resection is still debated. Our objective was to compare the postoperative recurrence (POR) risk in patients with a mRS i2a or i2b score using an individual patient data meta-analysis. Methods We conducted a systematic literature search of Medline, Embase and abstracts from international conferences (until July 2020) to identify all relevant studies reporting the risk of clinical and/or surgical POR and the i2a/i2b status in the year following ileocolonic resection. Initial datasets were obtained from the corresponding authors. Time from endoscopy to clinical and surgical POR was estimated using Kaplan-Meier method. The association between time to event and mRS was evaluated using a mixed Cox with centre as the random effect. Results From the 17 studies identified, 7 published between 2008 and 2019 (cohort studies, n=4; clinical trials, n=2) corresponding to a total of 400 patients (median (InterQuartileRange) age at surgery 34 (26,47) years; 52% female) were included. In the year following ileocolonic resection, 189 (47%) patients displayed an i2a mRS and 211 (53%) an i2b. In the i2b group, we observed more male patients (56% versus 41%, p=0.01), more patients with previous ileocolonic resection (31% versus 21%, p=0.03) and temporary ileostomy (14% versus 6%, p=0.03) and an immunosuppressant or antiTNF therapy was more frequently initiated after endoscopy (42% versus 26%, p Conclusion In this individual patient data meta-analysis, no difference is observed between i2a and i2b mRS subcategories in terms of clinical, surgical or endoscopic POR. Limits of the mRS may explain this lack of predictive value.

Background T resident memory (Trm) cells in the intestinal mucosa and in particular subpopulations expressing phenotypic markers such as alphaE-beta7 or NKG2D have been associated with chronic inflammatory bowel disease (IBD) activity. We hypothesize that these populations may have a direct deleterious impact on the intestinal epithelium in IBD. Methods The phenotypic study of mucosal lymphocytes was performed in two prospective cohorts: ELYP including patients with active IBD before initiation of biotherapy and REMIND including patients with ileal Crohn’s disease (CD) requiring ileocaecal resection. These analyses were performed before initiation of treatment and one year after continuous therapy in the ELYP cohort and on the resection specimen in the REMIND cohort. An innovative ex vivo autologous organoid-mucosal T cell coculture model was developed using the REMIND cohort specimens for patients and healthy ileum from individuals without IBD for controls (Figure 1). T cell infiltration within the organoid and epithelial cell death were assessed by confocal microscopy. A panel of 30 cytokines was quantified in the supernatants of cocultures. Figure 1 Results In the ELYP cohort, before the start of treatment, IBD patients had lower expression of alphaE-beta7 and NKG2D on mucosal CD8 T cells. While alphaE-beta7 and NKG2D expression on mucosal CD8 T cells had returned to normal in endoscopic responders, it remained decreased in non-responders. Similarly, the inflammatory mucosa of the REMIND surgical specimens had lower levels of CD4 and CD8 T cells expressing alphaE-beta7 and NKG2D compared with controls and non-inflamed regions. We developed a coculture model between mucosal lymphocytes and organoids generated under autologous conditions. We showed an increase in apoptotic cell death in epithelial cells from CD patients which was not found in control cocultures. There was a significant correlation between the degree of epithelial cell death and T cell infiltration (Figure 2). Various proinflammatory cytokines such as IFNgamma, TNFalpha, IL-6 and IL- 17a were also increased in the supernatants. The use of antibodies blocking the alphaE-beta7 and NKG2D pathways of interest inhibited this effect by different mechanisms (Figure 3) While anti-beta7 and anti-NKG2D had comparable effects in terms of cell death inhibition, only anti-beta7 reduced T cell infiltration. Anti-NKG2D had no effect on cell infiltration but a reduction of perforin was observed in the supernatants. Figure 2 Figure 3 CC= Coculture Conclusion These data demonstrate for the first time the direct cytotoxic deleterious effect of mucosal T cells on the epithelium of CD patients using a novel coculture model. AlphaE-beta7 and NKG2D pathways appear to be relevant in this process.

Background We used the postoperative recurrence model to better understand the role of AIEC bacteria in Crohn’s disease (CD), taking advantage of a well-characterized postoperative cohort. Methods From the REMIND prospective, multicenter cohort of operated CD patients (ileocolonic resection), AIEC identification was performed within the surgical specimen (M0) (N=181 patients) and the neo-terminal ileum (n=119 patients/181) during colonoscopy performed 6 months after surgery (M6). Endoscopic postoperative recurrence was graded using Rutgeerts’ index, which was interpreted, either from a clinical point of view (postoperative endoscopic recurrence ≥ i2b or severe ≥ i3), or from a pathophysiological point of view (reappearance of the first ileal lesions = i1 and more advanced postoperative ileal recurrence = i2b + i3). The mucosa-associated microbiota was analyzed by 16S sequencing at M0 and M6. Relative risks (RR) or odds ratios (OR) were adjusted on potential confounders ((gender, smoking, CD duration, CD phenotype, prior bowel resection, indication for surgery, granuloma, preventive treatment, antibiotics). Results Among the 228 patients included at the time of the analyzes, the search for AIEC was carried out in 181 patients at M0, and 119 patients at M6. Among these 181 patients included in our study, 46.3% did not receive any preventive treatment for endoscopic postoperative endoscopic recurrence while 24.3% have been treated with anti-TNF to prevent postoperative recurrence. AIEC prevalence was two-fold higher within the neo-terminal ileum at M6 (30.3%) than within the surgical specimen (14.9%) (p Conclusion Based on the postoperative recurrence model, our data support the role of AIEC in the early steps of ileal CD.

Background It is unclear whether HIV infection affects the long‐term prognosis after an acute coronary syndrome (ACS). The objective of the current study was to compare rates of major adverse cardiac and cerebrovascular events after a first ACS between people living with HIV (PLHIV) and HIV‐uninfected (HIV−) patients, and to identify determinants of cardiovascular prognosis. Methods and Results Consecutive PLHIV and matched HIV− patients with a first episode of ACS were enrolled in 23 coronary intensive care units in France. Patients were matched for age, sex, and ACS type. The primary end point was major adverse cardiac and cerebrovascular events (cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke) at 36‐month follow‐up. A total of 103 PLHIV and 195 HIV− patients (mean age, 49 years [SD, 9 years]; 94.0% men) were included. After a mean of 36.6 months (SD, 6.1 months) of follow‐up, the risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− patients (17.8% and 15.1%, P =0.22; multivariable hazard ratio [HR], 1.60; 95% CI, 0.67–3.82 [ P =0.29]). Recurrence of ACS was more frequent among PLHIV (multivariable HR, 6.31; 95% CI, 1.32–30.21 [ P =0.02]). Stratified multivariable Cox models showed that HIV infection was the only independent predictor for ACS recurrence. PLHIV were less likely to stop smoking (47% versus 75%; P =0.01) and had smaller total cholesterol decreases (–22.3 versus –35.0 mg/dL; P =0.04). Conclusions Although the overall risk of major adverse cardiac and cerebrovascular events was not statistically significant between PLHIV and HIV− individuals, PLHIV had a higher rate of recurrent ACS. Registration URL: https://www.clini​caltr​ials.gov ; Unique identifier: NCT00139958.

Background Crohn’s disease (CD)-like inflammation in TNFdeltaARE mice (ARE) mice is triggered by dysbiotic gut microbial communities. Similar to the therapeutic effect of exclusive enteral nutrition in CD, dietary intervention using semi-synthetic experimental diet prevents disease development in ARE mice. The aim of this study is to identify the causal microbial cues responsible for CD-like inflammation and to dissect the protective role of diet in ARE mice. Methods Bacterial communities in ARE and wildtype (WT) mice were profiled by 16S rRNA gene sequencing, FISH and qPCR. Germfree WT and ARE mice were colonized with segmented filamentous bacteria (SFB) from dysbiotic ARE mice. Disease activity, cytokine expression, mucosal immune cell infiltrates as well as Paneth and goblet cells phenotypes were assessed in murine ileal and colonic tissue. To assess the influence of diet on disease development, ARE mice were fed either chow, purified semi-synthetic experimental diet (SED) or fiber-rich diet. Impact of SFB on ileo-colonic inflammation was tested in additional mouse models (XIAP-/- and IL10 -/-). Mucosal biopsies from adult and pediatric IBD patients (N=407) were screened for the presence of human SFB using SFB-specific PCR primers. Results Under specific pathogen-free (SPF) conditions, ARE mice developed CD-like ileal inflammation which correlated strongly with increasing abundance of SFB. Mono-colonization of germfree ARE mice with SFB resulted in severe enterocolitis. Parallel to high tissue levels of TNF and IL-17, SPF-mediated inflammation was associated with neutrophil infiltration and the expansion of IFNγ expressing Th1 cells in the mucosa. Loss of Paneth and goblet cell function allowed SFB to penetrate mucus layers towards the epithelium. SED eradicated SFB and completely abolished inflammation in ARE mice. In contrast, fiber-rich diet partially restored SFB colonization and led to increased levels of inflammatory cytokines. SFB mono-colonization of GF XIAP-/- and IL10 -/- failed to induce inflammation, emphasizing host specificity to the mucosa-adherent SFB. Presence of SFB was confirmed in 12 ileal and 11 colonic mucosal biopsies from IBD patients with active or inactive disease. Conclusion We identified a novel pathogenic role of SFB in driving severe CD-like ileo-colonic inflammation characterized by loss of Paneth and goblet cell functions in ARE mice. Detection of SFB in mucosal biopsies of patients with IBD opens new perspectives about therapeutic strategies targeting SFB-mediated processes. Purified diet antagonized SFB colonization and prevented disease development in ARE mice in contrast to fiber-rich diet, clearly demonstrating the important role of diet in modulating a novel IBD-relevant pathobiont.

Resume Un aspect de repolarisation precoce en inferolateral a l’ECG a ete associe a un risque accru de FV idiopathiques. Ces etudes ont ete pour l’essentiel realisees dans des populations occidentales. La prevalence et les caracteristiques de la repolarisation precoce dans la population maghrebine reste en revanche meconnue. Le but de notre etude a ete de determiner la prevalence et les facteurs de risque de repolarisation precoce au sein de cette population. Methodes Les ECG de 441 patients originaires d’Algerie ont ete analyses par trois cardiologues independants. Un aspect de repolarisation precoce etait defini par une elevation du point J de 0,1 mV dans au moins 2 derivations en apicolateral, inferieur ou les deux. Resultats Un aspect de repolarisation precoce (RP) en inferolateral etait retrouve chez 55 patients (12,4 %). Cinq sujets (9 % des RP) avaient une repolarisation precoce maligne, 40 % des RP etaient en inferieur et lateral. Un aspect de repolarisation precoce etait plus souvent associe au sexe masculin, au jeune âge, a la bradycardie et a plus d’ondes T positives en V1. Conclusion Un aspect de repolarisation precoce a l’ECG est une anomalie frequente chez le jeune maghrebin. Il est probable que ces chiffres eleves soient plus en rapport avec l’âge jeune de la population que leur origine raciale. Les criteres de gravite de RP semblent plus frequents que dans les autres etudes. On retrouve par ailleurs une tendance a plus d’ondes T positives en V1, pouvant soit etre une particularite ethnique chez l’africain, soit rentrer dans le cadre d’une origine phenotypique commune avec le syndrome de Brugada.

Resume L’insuffisance cardiaque (IC) est la principale maladie chronique en cardiologie. Si son pronostic reste extremement grave, les progres dans sa prise en charge font que les patients vivent de plus en plus longtemps avec cette affection, dont l’evolution va etre emaillee de decompensations necessitant des hospitalisations. Les recommandations regulierement mises a jour permettent d’integrer les resultats des etudes qu’ils soient positifs ou negatifs dans la pratique de soins et d’indiquer le niveau de recommandation et son niveau de preuve. Il est important de resumer ces recommandations pour les rendre accessibles au plus grand nombre de praticiens et favoriser leur application. Parmi les points importants a retenir des dernieres recommandations, il y a la proposition d’une nouvelle classification avec l’individualisation de l’IC a fraction ventriculaire gauche (FEVG) moderement diminuee (FEVG 40–50 %), de nouveaux algorithmes pour le diagnostic et le traitement, incluant le diagnostic de l’IC a FEVG preservee, la place et les moyens des traitements preventifs, la prise en charge des comorbidites, en particulier de la carence martiale, une simplification des indications de resynchronisation, et enfin une place croissante accordee aux parcours des patients et a la gestion de la sortie d’hospitalisation. Il est important que le medecin fasse le choix de la bonne prescription mais il est tout aussi fondamental que le patient ait bien compris les enjeux de sa maladie afin d’etre un acteur important dans cette prise en charge, et cela passe par l’education therapeutique dont le developpement reste insuffisant en France.

Present in many experiments, wire and drift chambers have been used in a large variety of shapes and configurations during the last decades. Nevertheless, their readout elements has not evolved much: tungsten, sometimes gold-plated or aluminum, wires. By taking advantage of the developments in the manufacture of conducting carbon fiber, we could obtain interesting improvements for wire detectors. In this article, we present recent tests and simulations using carbon fibers to readout signal in place of traditional tungsten wires. Unlike metallic wires, their low weight guaranties a reduced quantity of material in the active area.

Introduction Surgical treatment is required in approximately half of the patients with infective endocarditis (IE) because of severe complications. To date there is no recommendation favoring a specific valve substitute for IE treatment and accordingly there is a wide variation in routine surgical management of these patients. The purpose of this study is to describe surgical practices in our center and to investigate the impact on clinical outcomes. Method All patients with native valve left-sided IE, who underwent valve replacement surgery with a mechanical or biological prosthesis in our institution between 1 January 2006 and 31 December 2018 were enrolled in this retrospective study. Results A total of 303 patients were included (mean age = 58 years, 80% men). Patients in whom a biological valve was chosen (64%, n = 194) were older and had more comorbid conditions compared to patients who received a mechanical valve (36%, n = 109). In hospital mortality was respectively 19% (n = 36) in the bioprosthesis group avec 3% (n = 3) in the mechanical valve group (P Conclusion For surgical management of IE, a biological valve is the most used valve substitute in our institution. Mechanical valves seem to be implanted in a very selected and low-risk patient subgroup. The valve substitute does not appear to be related to in hospital nor to midterm mortality rates.

Objectives There are limited data on the management of hypertension (HT) in Algeria. The aim of this study was to assess in current medical practice the use and benefits of ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of HT. Methods A prospective, observational, multicenter study was performed in 2017. Patients aged ≥ 18 years with suspected or treated HT were included. A 24-hour ABPM was performed at baseline in all patients. Therapeutic decision was taken according to ABPM results and patients were then followed up to 6 weeks. Results The analysis included 1027 patients (mean age, 51.0 years; women, 61.6%) with treated HT (37.3%) or suspected HT (62.7%). Major cardiovascular risk factors were diabetes (15.7%) and lipid disorders (7.2%). Daytime ABPM was pathological in 55.1% of patients on antihypertensive treatment and in 60.8% of patients with suspected HT. A therapeutic adjustment or a treatment switch was performed after ABPM in 65.4% of patients already on antihypertensive treatment and an antihypertensive therapy was initiated in 88.9% of patients with initially suspected HT. Therapeutic strategy was mainly based on monotherapy regimen in 35.8% of patients with treated HT and in 69.3% of patients with initial suspicion of HT. Most frequent treatments were angiotensin receptor antagonists (55.3% and 50.0%, respectively). Comparable findings were observed 6 weeks later. Conclusions Our results confirm that ABPM is a highly valuable method in diagnosing and confirming HT, as well as in guiding and assessing antihypertensive therapy.

Introduction Myocardial infarction in young women is rare. it has a poorer prognosis with more complications and an excess mortality in the acute phase compared to MI in young men. Purpose to study the prognostic features of MI in young women. Method We carried out a prospective study including young women whose age is ≤ 55 years and young men whose age is ≤ 45 years hospitalized for MI in the cardiology department of the CHU Constantine (Algeria) from January 2013 to March 2016. We compared the complications occurring in the acute phase and one year of the event between the 2 groups. Results Out of 200 MI hospitalized patients, 30.5% were women, with an average age of 48 years. They had more clinical atypia in 34.4% of cases P = NS, more NSTEMI P = NS, had an average of 3 risk factors compared to 2 in men and had more significant coronary lesions. The reperfusion treatment was prescribed with no significant difference in the 2 groups but with a significantly longer mean delay in women. The initial complications were more frequent in women but without significant difference, heart failure 3.3% vs. 1.4%, conductive disorders 11.5% vs. 8.6%, excitability disorders 3.3% vs. 1.4% and embolic complications 4.9% vs. 0%. Hospital complications were significantly frequent in women 32.8% against 20.1%; P = 0.04. With more heart failure 11.5% vs. 6.5%, more excitability disorders 3.3% vs. 1.4%, more conductive disorders 8.2% vs. 2.1%, more thromboembolic complications 3.3% vs. 0% and more LV dysfunction24.6% vs. 18%. Hospital mortality was 4 times more frequent in women 9.8% than men 2.2%; P = 0.02. One year from the initial event, the number of events decreased and tended to be the same for both sexes 7.1% for women versus 8.7% for men. The death rate decreased also 2.4% versus 1.8%. Conclusion MI in young women has a worse prognosis in the acute phase with excess mortality probably related to more clinical atypia, delayed consultation and severe coronary lesions.

Background Differences between long-term outcomes among women and men treated by percutaneous intervention (PCI) are unknown. Purpose To compare characteristics mortality and impact of gender on poor outcomes after PCI. Methods Consecutive men and women admitted for PCI between 2008 and 2011 were prospectively included and followed-up until January 2019. Major adverse cardiovascular and cerebrovascular events (MACCE) and causes of death were collected through consultations, calls and death certificates. The primary endpoint was all-cause mortality according to gender. Secondary endpoints were cardiovascular death, non-cardiovascular death and MACCEs. Results A total of 3524 patients including 2720 men (77.1%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2) with a follow rate of 97.6%. At baseline, women were older (70 ± 13.1 vs. 64.6 ± 12 years old) and smoked less (18.9% vs. 30.4%), had more frequently hypertension (67.9% vs. 58.1%) and chronic kidney disease (42.6% vs. 22.7%), whereas diabetes rate was similar around 29%. PCI for myocardial infarction at admission represented 23% with no difference according to gender. Prognosis was severe as all-cause death occurred for 30.3% and MACCE for 40.9% of all patients. In unadjusted analyses, women had a higher risk of all-cause mortality (35% vs. 29%, HR = 1.25, 95%CI [1.09–1.43], P = 0.0015) and cardiovascular mortality (61% vs. 57%, HR = 1.31, 95%CI [1.10–1.56]) but there was no difference on occurrence of MACCE (HR = 1.079, 95%CI [0.9271–1.221]). After adjustment for baseline cardiovascular risk factors, presentation and severity of coronary disease, there was no difference between men and women for mortality ( Fig. 1 ). Conclusions In this long-term follow-up, women had a higher risk of all-cause and cardiovascular mortality after PCI in unadjusted analyses. However, gender was not independently associated with mortality after adjustment for cardiovascular risk factors.

Purpose: No consensus exists for the diagnosis of heart failure with preserved ejection fraction (HFPEF). Current studies recommend stress echocardiography protocols, but single standard peak or timing measurements are limited towards the complexity of the disease. We show the contribution of a combined analysis of multiple myocardial velocity patterns and investigate their relative relevance for the characterization of HFPEF. Methods: Velocity traces from 55 subjects were examined (69±6 years, 22 healthy, 19 HFPEF and 14 breathless subjects). Data came from tissue Doppler acquisitions at rest and exercise at the basal septum and lateral wall, and were temporally aligned to a common reference for comparison. Each phase of the cycle at each stage of the protocol was identified for analysis (figure). Unsupervised machine learning (multiple kernel learning) was used to characterize this population and automatically determine the relevance of each velocity pattern. Results: The learning found a discrimination algorithm that performed well in agreement with diagnosis based on current guidelines (sens=78.9%, spec=86.3%, K=0.65). The importance given to early diastole at exercise was substantially higher, while the isovolumic contraction was the lowest contributor. The breathless subjects were associated to their closest subgroup. Conclusion: The characterization of HFPEF is improved by a combined analysis of multiple velocity traces from stress echo studies using machine learning. The method additionally suggests features of interest to be used in clinical diagnosis.

An early repolarization variant (ERV) in inferolateral leads has recently been associated with vulnerability to ventricular fibrillation. These studies have been conducted in the occidental countries. The prevalence of ERV in the population of the Maghreb is unknown. The aim of this study was to evaluate the prevalence and risk factors of ERV in a young population from Algeria.We assessed the prevalence of ERV within a population of 441 healthy subjects (mean age 25 years) using 12-lead electrocardiography. ERV was stratified by three independent cardiologists according to the J-point elevation (≥0.1mV) in the inferior, apicolateral or both leads with QRS slurring or notching.The inferolateral ERV pattern was present in 55 subjects (12.4%). A malign ERV (2mm) was present in 5 subjects (9% of ER) and ER in inferior and lateral leads in 40% of ER. An ERV pattern was more frequently associated with young age, male, bradycardia and T wave in V1 lead.An ERV is a common finding in a healthy Algerian young population. This prevalence seems to be more important than other studies due to young age and not to a racial difference. Our population were more at risk that other studies, and we found more T waves in V1 lead in this people, due to an ethnic particularities or a phenotypic association with the Brugada syndrome.

Summary The management of sickle cell nephropathy (SCN) at an early stage is an important issue to prevent renal and cardiovascular morbidity and mortality. This study aimed to evaluate in this population, whether angiotensin converting enzyme inhibitors (ACEIs) treatment could exert a cardio-renal protection in a SCN cohort. Forty-two SCN patients (urine albumin:creatinine ratio (ACR) > 10 mg/mmol) were treated with ACEIs for 6 months, then evaluated for ACR, measured glomerular filtration rate (mGFR) together with haematological and cardiovascular parameters. A 1-month washout was also performed in order to differentiate short- and long-term ACEIs effects. A decrease in ACR baseline value (>30%) was detected in 62% of cases (mean ACR: 46·4 ± 7·6 and 26·4 ± 3·9 mg/mmol at baseline and 6 months respectively; P = 0·002), whereas mGFR values were unchanged. ACR decrease was detected at 1 month following ACEI initiation (32·9 ± 6·9, P = 0·02) with a persistent trend after withdrawal (P = 0·08). ACEIs also decreased diastolic blood pressure (P = 0·007), pulse wave velocity (P = 0·01), tricuspid regurgitation velocity (TRV; P = 0·04), asymmetric dimethyl arginine (ADMA: P = 0·001) and haemoglobin (P = 0·01) while conventional haemolytic biomarkers were unchanged. Our data suggest that ACEIs are safe and effective at decreasing albuminuria in sickle cell patients with a beneficial effect on specific mortality risk factors, such as TRV and asymmetric dimethyl arginine.

Introduction Wellens syndrome was first described in the early 1980s by Zwann, Wellens, and colleagues, who identified a subset of patients with unstable angina who had specific precordial T-wave changes and subsequently developed a large anterior wall myocardial infarction (MI). Wellens syndrome is also referred to as left anterior descending (LAD) coronary T-wave syndrome. Purpose Highlight the importance of recognizing wellens syndrome in the care of patients. Methods We present a prospective study of 40 patients with Wellens syndome treated between june 2017 and december 2018 at The CNMS Hospital (Algiers). The following parameters were considered in this analysis: Age, gender, cardiovascular risk factors, characteristic of chest pain, Electrocardiographic aspects, Enzymatic profile, location of the coronary lesion, The delay between hospitalization and revascularization. Results There was a clear predominance of men with a sex ratio of 3 men for a woman, and we noticed that the prevalence increased after the age of 60, the main risk factors found in our patients were smoking, high blood pressure and diabetes mellitus, 3/4 of patients complained of typical anginal pain, the most common electrical aspect was Wellens syndrome type 1, the most frequent sites were the proximal and medium left anterior descending coronary artery (LAD), 50 per cent of the patients underwent revascularization within the first 24 hours of hospitalization with active stent placement, while 80 per cent had, within the first 48 hours. Conclusion Wellens syndrome represents a critical LAD disease. Recognition of this ECG abnormality is very important because this syndrome represents a preinfarction stage of coronary artery disease (CAD) that often progresses to an extensive infarction.

Purpose to study electrocardiographic abnormalities in Algerian competitive athletes in the Setif region, and compare with other international studies. Material and methods 621 competitive athletes aged 12 and over (86% male, mean age 17.38 years) were included in our observational and cross-sectional epidemiological study. Results Our study confirms the rarity of rhythmic incidents in athletes (regular sinus rhythm 81.3%, sinus arrhythmia 17.7%, rhythm disorders 1%). The prevalence of bradycardia is 20.6%. It is proportional to age and more pronounced among male athletes, the influence of training on heart rate is not significant since 8 hours of training per week. The prevalence of fragmented QRS is 12.6%. The index of Sokolow-Lyon > 35 mm is found in 31.9% of athletes, with a male predominance. The pathology index is found in 8.2% of athletes without significant difference between the two sexes, these criteria of the HVG are not influenced by training, but rather by the type of sport activity and the intensity of dynamic activity. The prevalence of BAV 1 (1.3% in our study) is independent of the importance of bradycardia. The prevalence of early repolarization (RP) is 26.1%, with male predominance. We investigated the influence of age, gender, sport, training, electrical LVH and heart rate on RP. The lower topography of RP is the most common (65.4%) and hooking is the predominant aspect (57.4%). The latter is influenced by gender, age, type of sport, training, heart rate and QRS range. While the impasto is influenced only by the amplitude of the QRS. PR is associated with concave and ascending ST segment elevation in 30.7% of cases. The prevalence of non-specific branch blocks is 1.3% ( Table 1 ). Conclusion The ECG was normal in 29.3% of athletes with a female predominance and presents adaptive abnormalities to regular exercise in 66.3% with male predominance. 4.3% of athletes (with a female predominance) have abnormal aspects, not related to sports training.

Background Data concerning long-term mortality after percutaneous coronary intervention (PCI) and factors of poor outcomes are scarce. Objective To describe short-term, intermediate-term, and long-term mortality and their correlates after PCI. Methods In this prospective cohort study, we included and followed-up consecutive patients admitted for PCI from 2008 to 2011. Independent adjudicators reviewed the ischemic outcomes and causes of death until January 2019. A survival analysis was performed to compare the occurrence of cardiovascular and non-cardiovascular death at 30 days, one year and up to 8 years. Results Of the 3524, patients treated with PCI from 2008 to 2011, 2720 (77.2%) were men and 804 (22.8%) were women with a mean age of 65.8 years old. The median follow-up was 7.0 years (IQ1: 5.4; IQ3: 7.2) and complete for 97.6% of the patients. One third of the patients died (30.3%; n = 1070) in a median time of 2.5 years after PCI, with a rate of 5.3 deaths per 100 patient-years. Overall, mortality was mostly related to cardiovascular causes than non-cardiovascular causes (17.7% versus 12.6%, log-rank Fig. 1 ). Cardiovascular death was more frequent within 30 days (4.7% vs. 0.3%, P Conclusions Cardiovascular death was more frequent than non-cardiovascular death in patients treated with PCI in the short and intermediate-term but not beyond one year. Cancer accounted for one fifth of the overall mortality.

Aims Latent heart failure at rest can be observed in a number of patients upon exercise. Considering left atrial (LA) remodelling as the reflection of the cumulative effects of the LV filling pressure (FP) over time, our aim was to investigate whether the LA volume would predict abnormal exercise LVFP. Methods and results Ninety patients (58.6 ± 10.8 years, 74 men) underwent exercise echocardiography. The LA maximal volume was measured by the Simpson method and indexed to body surface area. LVFP was assessed by the ratio between early peak diastolic velocities of mitral inflow and the septal annular mitral plane (E/e′). Exercise E/e′ >13 was used as a threshold to define abnormal LVFP. Indexed LA volume was correlated with E/e′ at rest (r = 0.37, P = 0.003), but the correlation was better with exercise E/e′ (r = 0.54, P 13; compared with the rest of the population, these patients were older and achieved a milder effort. LA volume index >33 mL/m2 predicted an abnormal exercise LVFP with a 91% sensitivity and a 78% specificity. None of the patients with an LA volume index 13. Conclusion Exercise LVFP is a determinant of LA size. LA volume index seems to be helpful for predicting abnormal exercise LVFP. The potential use of LA remodelling to identify the patients benefitting most from exercise echocardiography should be investigated in larger studies.

Summary Background Management of increased referrals for transthoracic echocardiography (TTE) examinations is a challenge. Patients with normal TTE examinations take less time to explore than those with heart abnormalities. A reliable method for assessing pretest probability of a normal TTE may optimize management of requests. Aim To establish and validate, based on requests for examinations, a simple algorithm for defining pretest probability of a normal TTE. Methods In a retrospective phase, factors associated with normality were investigated and an algorithm was designed. In a prospective phase, patients were classified in accordance with the algorithm as being at high or low probability of having a normal TTE. Results In the retrospective phase, 42% of 618 examinations were normal. In multivariable analysis, age and absence of cardiac history were associated to normality. Low pretest probability of normal TTE was defined by known cardiac history or, in case of doubt about cardiac history, by age > 70 years. In the prospective phase, the prevalences of normality were 72% and 25% in high (n = 167) and low (n = 241) pretest probability of normality groups, respectively. The mean duration of normal examinations was significantly shorter than abnormal examinations (13.8 ± 9.2 min vs 17.6 ± 11.1 min; P = 0.0003). Conclusion A simple algorithm can classify patients referred for TTE as being at high or low pretest probability of having a normal examination. This algorithm might help to optimize management of requests in routine practice.

Introduction Grâce a une prise en charge precoce, l’esperance de vie des patients drepanocytaires homozygotes augmente expliquant l’incidence des complications chroniques liees a cette maladie. La prevalence de la maladie renale chronique (MRC) serait de 85 % chez les patients de plus de 65 ans drepanocytaires. L’objectif de notre etude est de determiner les facteurs de risque d’apparition d’une MRC stade 2. Methodes Etude prospective observationnelle monocentrique d’une cohorte de 688 patients suivis entre 2007 et 2018 dans un centre de drepanocytose. Un total de 660 patients ayant un eDFG > 90 ml/min/1.73 m2 (CKD EPI) ont ete inclus. L’evenement etudie etait l’apparition d’une MRC stade 2 (DFG Resultats obtenus ou attendus Le delai median de suivi etait de 3,7 ans (IQR 0,76–7,36). L’âge median a l’inclusion etait de 22 ans (IQR 19–29), avec 377 (57,12 %) femmes. Une hyperfiltration glomerulaire (DFG > 130 ml/min/1,73m2) etait presente chez 380 patients (57,58 %), une microalbuminurie et une macroalbuminurie chez 218 (33,70 %) et 83 (12,83 %) patients respectivement. Les pressions arterielles systoliques et diastoliques moyennes (± deviation standard) etaient basses ; respectivement 114,8 mmHg (± 13,6) et 66,0 (± 9,7) mmHg. Les facteurs associes a l’apparition d’une MRC stade 2 etaient (analyse multivariee) : la proteinurie (pour 100 mg/mmol creatinine) HR : 1,24 [1,07–1,45] p = 0,005, la pression arterielle diastolique (PAD) (pour 10 mmHg) HR : 1,35 [1,03–1,76] p = 0,029 et les LDH HR : 1,22 [1,04–1,43] p = 0,015, le DFG initial HR : 0,92 [0,90–0,95] p Conclusion Notre etude montre une augmentation significative du risque de degradation de la fonction renale dans les cas de macroalbuminurie, d’augmentation de la PAD et d’hemolyse chronique intense. Ces resultats suggerent l’importance d’un controle tensionnel dans cette population avec des valeurs cibles particulierement basses.

Introduction Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM). Exercise echocardiography is necessary to unmask latent obstruction in patients with HCM. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery. We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM. Method We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position. Results In total, 121 patients with HCM were included (age 49 ± 16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66 ± 7%, max LV wall thickness 19 ± 5 mm, 69% receiving betablockers). Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17 ± 18, 39 ± 43 and 55 ± 60 mmHg, P Conclusion The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.

Resume Objectif Les auteurs ont tente d’evaluer la nuisance sonore et sa relation sur le developpement de l’hypertension arterielle chez le personnel exercant a l’aeroport civil d’Alger. Cette population etant soumise de facon continue aux bruits des avions. Le bruit par le stress qu’il engendre agit sur le systeme nerveux central et sur le systeme nerveux autonome et est susceptible de generer une hypertension arterielle par l’augmentation des resistances peripheriques, du cholesterol total, des acides gras, de l’adrenaline, du cortisol et de la glycemie. Plusieurs etudes ont montre qu’a partir de 65 decibels, le bruit provoque une HTA chez les sujets âges de plus de 40 ans apres cinq ans d’exposition. Methodes Une etude analytique a ete realisee en 2000, elle a compare deux groupes d’agents masculins exercant a la compagnie Air Algerie. Il s’agissait de 91 agents appartenant au personnel navigant sur les 547 de l’effectif total de l’epoque et dont l’âge moyen etait de 49 ans, compares aux 111 agents exercant au sol sur le nombre total de 1200 et dont l’âge moyen etait de 56 ans. Tous ces agents ont beneficie d’une consultation de medecine du travail. Les patients suspects d’hypertension arterielle ont ete systematiquement orientes vers le cardiologue. De meme, tous ont eu un bilan biologique, une consultation d’ophtalmologie et une autre en ORL. Resultats L’hypertension arterielle a ete retrouvee dans 9,25 % chez le personnel au sol et 16,63 % chez le personnel navigant ( p Conclusion A la lueur de ces resultats, le bruit semble reellement interferer sur le developpement de l’HTA en milieu aeroportuaire. Il serait interessant de repertorier le nombre d’accidents vasculaires cerebraux et surtout les syndromes coronaires aigus qui sont loin d’etre rares dans cette population soumise a cette nuisance sonore. Les mesures de prevention sont bien sur tres importantes a appliquer.

Introduction While ultrasound lung comets (ULC) at rest provide prognosis information inpatients presenting with heart failure with reduced ejection fraction (HF-rEF), cardiopulmonary exercise testing (CPET) remains reference. This study aims to compare dynamic ULC with CPET measurements and stress echocardiography on HF-rEF patients. Methods Forty patients with HF-rEF (left ventricle ejection fraction below 40%) and 10 control patients matched on age and gender were included. Evaluation was performed by CPET (with oxygen uptake, VO2; carbon dioxide output, VCO2; ventilation, VE), stress echocardiography (with E and Ea wave velocities) and pulmonary echography (with baseline and postexercise ULC). ULC were assessed using a semi-quantitative method (LUS score). Cox regression analysis and areas under receiver-operator-curve (AUROC) analysis were performed on HF-rEF patients with all-cause mortality as main endpoint. Results One-year mortality was 12.5% among HF-rEF patients. Baseline and postexercise ULC were associated with mortality (respective adjusted hazard-ratio HR = 1.25 (CI 95 = 1.05–1.49, P = 0.01) and HR = 1.38 (CI 95 = 1.11–1.71, P = 0.003), independently from peak VO2). Postexercise ULC tended to be more discriminative than baseline ULC, with respective AUROC = 0.89 (P = 0.006) and AUROC = 0.79 (P = 0.038). Discrimination of VE/VCO2 slope was similar (AUROC = 0.92, P = 0.003), peak E/Ea ratio's tended to be lower (AUROC = 0.78, P = 0.045) and peak VO2 was not discriminative of mortality. Postexercise ULC were correlated with peak VO2 (r = −0.31, P = 0.03), VE/VCO2 slope (r = 0.58, P Table 1 , Fig. 1 ). Conclusion Dynamic assessment of ULC improves risk stratification of ambulatory HF-rEF patients in addition to CPET measurements such as peak VO2.

Background Few data are available on the management of acute myocardial infarction (MI) and risk assessment after MI in Algeria. Methods The STAMI registry is a prospective, multicenter, non-interventional study conducted in fourteen public and private hospitals in the central, eastern, western but also in the Sahara containing a cardiac intensive care unit (with and without PCI facilities). Enrollment started in November 2016 for a 2-month period. The primary Outcome Measures major adverse cardiac and cerebrovascular events during hospitalization. Additional outcomes include the delay between onset of symptoms and hospitalization, the types of reperfusion management and MACCE at 1 month and 1 year after discharge from hospital. A total of 327 patients were enrolled. The majority were male 260 (79.5%) and was younger (Men 59.4 ± 11.8 years) women 63.9 ± 13.1 years). Smoking (45,5%, n = 150), hypertension (39,9%, n = 130), and diabetes (35.2%, n = 116) were the main risk factors; a history of coronary dieses was reported in less 5% of the patients. Reperfusion therapy was performed in 285 (86.5%) patients (56.9%, n = 188 thrombolytic therapy and 29.4%, n = 97 primary PCI). The median time since symptom onset to hospitalization is 349mn. A total of 67.8% (n = 224) of the patients were issued from another healthcare facility. Major adverse cardiovascular events occurred in 5.5% (n = 18) and the in-hospital mortality was 2.1%. Conclusion Those first in hospital results on Algerian STEMI patients revealed that a large percentage of patients benefit from a strategy of reperfusion, the thrombolysis remains the most used, but the delays of management and reperfusion of patients are long, more than 5 h. The rate of intra-hospital complications is relatively low and may have several explanations, the most important seems to be of which is the low risk of patients enrolled. This is probably related to the current management of STEMI in Algeria, the most severe patients do not arrive at cardiac centers.

Objectif La fraction d’ejection ventriculaire gauche (FEVG) et les valeurs absolues du strain longitudinal global (GLS) sont plus basses chez les hommes que chez les femmes. Nous rapportons ici l’influence du statut hormonal sur la fonction du VG systolique chez les sujets sains et les patients atteints d’hyperplasie surrenale congenitale (HCS). Patients et methodes Quatre-vingt-quatre patients ayant une forme classique ou non classique diagnostiquee dans l’enfance d’HCS (58 femmes) et 84 sujets sains apparies-apparies pour sexe et âge ont ete inclus prospectivement, et ont eu une evaluation hormonale et une echographie cardiaque avec une evaluation de la LVEF et du strain longitudinal, radial et circonferentiel (CARDIOHCS NCT01807364 ). Resultats Les LVEF et GLS etaient plus eleves chez les femmes controles que chez les hommes controles (63,9 ± 4,2 % contre 60,9 ± 5,1 %, p Conclusion Nos donnees confirment l’existence d’une influence hormonale complexe sur la fonction systolique cardiaque.

Objectif Le but de ce travail etait d’evaluer a travers une enquete des pratiques les modalites de diagnostic et de prise en charge de la carence martiale (CM) et de l’anemie ferriprive (AF) en pratiques courantes en Algerie. Methode Les medecins ont ete identifies a partir d’un annuaire professionnel. A defaut d’une carte sanitaire a jour, les medecins ont ete selectionnes sur l’importance et la situation geographique des centres representatifs en termes d’offre de soins. Ils ont rapporte, sur un questionnaire ferme, la frequence estimee de la CM et de l’AF chez leurs patients, ainsi que les modalites de diagnostic et de traitement. Ils ont egalement rapporte les conditions d’utilisation du fer oral et/ou du fer intraveineux (IV) et des agents stimulant l’erythropoiese (ASE). L’analyse a porte sur 362/400 questionnaires completes par des medecins de differentes specialites (anesthesie-reanimation-chirurgie, n = 43 ; gynecologie-obstetrique, n = 111 ; oncologie-hematologie, n = 71 ; hepato-gastro-enterologie, n = 64 ; cardiologie, n = 36 ; medecine interne, n = 28 ; autres n = 9). Resultats Les medecins interroges ont rapporte une frequence importante de CM : 90 % (315/349) d’entre eux declarent suivre des patients avec CM. Parmi eux, 21 % (74/349) evaluent la frequence de cette CM chez plus de la moitie de leurs patients. Les medecins sont 93 % (324/349) a rapporter une AF. Pour 72 % (252/349) d’entre eux, la frequence de l’AF etait retrouvee chez plus de 30 % des patients. Les praticiens sont 25 % (89/349) a rechercher systematiquement une CM (56 % en gynecologie-obstetrique) et 69 % (241/349) a la rechercher seulement en presence d’anemie. Le coefficient de saturation de la transferrine est tres peu utilise dans le diagnostic de la CM (37 % (128/349)). Ils sont 93 % (324/349) a prescrire principalement du fer oral comme traitement de premiere intention pour la CM et 37 % (128/349) a utiliser du fer IV si le taux d’hemoglobine (Hb) etait ≤ 8 g/dL (mediane). Les medecins interroges sont 48 % (168/349) a avoir recours a la transfusion pour une AF severe, principalement dans le post-partum. Quant aux ASE, leur utilisation a ete rapportee par 38 % (91/238) des medecins essentiellement en oncologie et en hematologie (75 % (53/71)). Conclusion Cette enquete fournit des resultats preliminaires sur la frequence de la CM et de l’AF en Algerie en 2016. Elle est basee sur les pratiques medicales courantes d’un echantillon pluridisciplinaire de medecins algeriens, issus de centres representatifs en termes d’offres de soins. Il convient de noter que la CM n’est consideree que dans un contexte d’AF, appuyant ainsi la necessite d’un diagnostic precoce sur la base d’une meilleure utilisation des marqueurs du statut martial afin d’optimiser le traitement et de reduire le recours aux transfusions sanguines.

Introduction Causes of brain abscesses are multiple and often unclear. We present the case of a pregnant woman who developed a temporal brain abscess revealed by an epileptic seizure. Observation Perfusion lung scan was performed because she had a mild hypoxemia: absence of contrast into the pulmonary arteries was suggestive of a massive intracardiac shunt or an anomalous drainage of the superior vena cava. Contrast-enhanced echography showed an abnormal drainage of the superior vena cava into the left atrium. Conclusion Although rare, this anomaly can exist in adults. This report emphazes the necessity of effective cardiologic investigations in case of unexplained brain abscess.

Background Two-dimensional left atrial (LA) size is an independent echocardiographic predictor of atrial fibrillation (AF) occurrence and recurrence. Purpose Our study aimed to evaluate LA and right atrial (RA) three-dimensional (3D) volumes at admission (M0) in patients with AF to define atrial remodeling according to rhythm outcome at 6 month follow-up (M6). Methods 3D RA and LA parameters were assessed at M0 in patients admitted for AF: body surface area-indexed maximum 3D volume (Max 3D RA Voli, Max 3D LA Voli) and indexed minimum volume (Min 3D RA Voli, Min 3D LA Voli); atrial emptying fraction (3D RAEF, 3D LAEF) and atrial expansion index (3D RAEI, 3D LAEI). Results Forty-eight consecutive patients hospitalized for AF were prospectively included. Two groups were individualized according to rhythm outcome: successful cardio version (SuccCV) in 35(72.9%) patients including either spontaneous (n = 10) or electrical cardioversion (n = 25) (AF at M0 and sinus rhythm (SR) at M6); failure or contra indication to cardioversion (FailCV) in 13(27.1%) patients (AF at M0 and AF at M6). 3D echocardiographic evaluation from 41 patients at M0 found: – significantly upper Min 3D RA Voli, Min 3D LA Voli in group FailCV in comparison with SuccCV; – significantly lower 3D RAEF, 3D RAEI, 3D LAEF, 3D LAEI in group FailCV in comparison with SuccCV; – no significant differences regarding Max 3D RA Voli, Max 3D LA Voli between groups FailCV and SuccCV ( Table 1 ). Conclusion 3D atrial echocardiographic parameters could be useful to predict initial atrial remodelling in patients admitted for AF.

In the framework of the R&D program on the TTF III main RF coupler, IPN Orsay developed in close collaboration with LAL institute, a dedicated facility for the electrical characterization of different materials at low temperature. This apparatus was used for measuring the electrical resistivity versus temperature (4.2 K–300 K) of various samples produced in the industry. These tests were performed in order to compare the RRR of the samples, qualify and find the optimum parameters for the coating process. Seven flat samples were tested in a saturated liquid helium bath under ∼1013 mbar pressure: measurements were performed on bare 316L samples, nickel coated 316L samples, and copper coated 316L samples with a nickel under layer. We investigated, in particular, the effect of vacuum annealing at 400 °C on the RRR of the copper coating. Our experimental data are compared to previous measurements reported by other groups, and theoretical results (e.g., Gruneisen–Bloch equation) and a good agreement was found. Finally, the tested samples fulfil the TTF III coupler design parameters requirements in terms of heat loads to the refrigerator at 2 K, 4 K and 70 K.