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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 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.

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.

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.

International audience; Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05-0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53-192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej, and ser (sedjr; adjusted OR 0.07; 95% CI 0.004-0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr-encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr. This mecA-sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.

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.

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.

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.

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.

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.

Atrial fibrillation, the most commonly encountered arrhythmia in clinical practice, is associated with substantial morbidity and mortality. Its incidence and prevalence are increasing, and it represents a growing clinical and economic burden. Recent research has highlighted new approaches to both pharmacological and non-pharmacological management. Pooled data from trials comparing antithrombotic treatment with placebo show that warfarin reduces the risk of stroke by 62% and that aspirin alone reduces the risk by 22%. Overall, in high-risk patients, warfarin was better than aspirin in preventing strokes, with a relative risk reduction of 36%, but the risk of major hemorrhage with warfarin was twice that with aspirin. Anticoagulation treatment needs to be tailored individually for patients on the basis of age, comorbidities, and contraindications. However, warfarin remains under-prescribed in clinical practice, for reasons related to patients (comorbidities) and physicians. The limitations of warfarin treatment have prompted the development of new anticoagulants with predictable pharmacokinetics that do not require as frequent monitoring. Ximelagatran, an oral direct thrombin inhibitor, was compared with warfarin in the SPORTIF program, which found both agents to be broadly effective in the prevention of embolic events, but observed abnormal liver function tests in 6% of patients on ximelagatran. Liver function monitoring during treatment is thus needed. Idraparinux, a factor Xa inhibitor administered by once weekly subcutaneous injections, is being evaluated in patients with atrial fibrillation. The ACTIVE trial is currently assessing the role of aspirin plus clopidogrel, compared with adjusted dose warfarin, in the prevention of vascular events in high-risk patients with atrial fibrillation. Angiotensin-converting enzyme inhibitors and angiotensin II receptor-blocking drugs interfere with atrial remodeling and show promise in atrial fibrillation, as suggested in the LIFE trial. Preliminary studies suggest that statins may reduce the risk of recurrence after electrical cardioversion. Finally, percutaneous methods for occlusion of the left atrial appendage are currently under investigation in patients at high risk of thromboembolism but with contraindications for chronic warfarin.

Purpose The aim of our work is to study early repolarization (ER) in athletes and comparing between the end QRS slurring and notching. Materials and methods Our study population consists of 621 competitive athletes of both sexes aged 12 to 48 with an average age of 17.4 years. The statistical study used the chi-square test for the comparison of the proportions and the analysis of the variance analysis (ANOVA) for the comparison of the averages. The significance level was set at 5%. Results The prevalence of ER according to the new diagnostic criteria is 26.1%. With a clear masculine predominance. This prevalence increases with age, reaching its maximum in the third decade, and then decreases. The prevalence of ER is higher in athletes with bradycardia and with a Sokolow-Lyon index greater than 35 mm. No relationship was found for the Cornell index. The prevalence of ER is significantly lower in athletes with an incomplete right bundle branch block. The ER are located in the inferior leads in 40.7%, lateral in 34.6% and both in 24.7%. This distribution of topographies of ER is not influenced by age and gender. The notching is the predominant pattern whatever the topography of ER (notching, 57.4%; slurring, 18.5%; both, 24.1%). The notching predominate on lateral leads (52.3%) while the slurring on inferior leads (68.1%). Only the notching was significantly associated with the male gender (23.8% vs. 5.7%, P Conclusion We found a prevalence of ER of 26.1%. The inferior topography is the most frequent and the notching is the predominant aspect.

The objective of this study is to evaluate the impact of the organic extracts of Bunium incrassatum roots, belonging to the Apiaceae family, on some hematological parameter and histomorphological changes of the genital tract. This plant, called ‘Talghouda‘, is widely distributed in the east parts of Algeria. Phytochemical analyzes of the roots of this plant reveal the presence of two coumarins, scopoletin, scoparone Beta-sitosterol, sucrose and oleic acid. The study was achieved on mature rabbits of the local breed ( Oryctolagus cuniculus ) for 15 days. The animals were divided into five groups, which have daily administered 0, 25, 50, 100 and 200 mg/kg/day respectively doses of organic extract of Bunium incrassatum. The group with dose 0 was taken as a control. After treatment, the rabbits were sacrificed, the blood was collected in heparin tubes and their ovaries and uterus were removed and fixed in 10% formalin and then stained with hematoxylin-eosin. We found that treatment with the organic Bunium Incrassatum extract induces a significant decrease in the level of Triglyceride, Cholesterol in treated rabbits. The results of the histological study revealed a significant increase in the number of primary and secondary follicles in rabbits treated with 50 and 100 mg/kg/day doses and a decrease accompanied by an increase in atretic follicles in rabbits treated with a dose of 200 mg/kg/day, compared to the control group. The study shows that the organic extract of Bunium Incrassatum had estrogenic effects at doses of 50 and 100 mg/kg/day.

Background Discrepancies between the usual medications of patients and the medications prescribed when patients are admitted to hospital could be associated with severe complications. Implementation of medication reconciliation at admission has been reported as a way to improve quality of care. Purpose The aim of the study was to evaluate the feasibility and additional contribution of a retroactive medication reconciliation process at admission in an acute cardiology unit. Material and methods Before any intervention, we included prospectively, in the first part of the study, 67 patients (mean age 64 years; 66% men). From the patient and/or family, retail pharmacist, doctor interviews, a senior and a pre-graduated pharmacist carefully collected the usual medications taken by the patient. These medications were compared with the actual medications prescribed during the hospital stay. The discrepancies were classified as justified or unjustified. In the second part of the study, the physicians in the unit were educated on the medication reconciliation process. In addition, a pre-graduated pharmacist was in charge during this period to check and discuss with the physician any medication discrepancies. The clinical impact of this intervention was evaluated prospectively on another population of 141 patients (mean age 68 years; 64% men). Results Medication reconciliation was feasible in all patients included in the study. The rate of medication discrepancies decreased dramatically from 33% in the first phase of the study to 14% after the educational intervention (p = 0.003). In addition, during the second phase of the study, the pharmacist informed the physician of any medication discrepancies. Among the 20 patients with a medication discrepancy, thanks to the pharmacist the prescription was appropriately corrected in 16 (80%) patients. Conclusion This study showed the feasibility of the medication reconciliation process in an acute cardiology unit. The rate of prescription errors was dramatically decreased after implementation of the process. Implementation of a medication reconciliation process could enhance quality of care. References and/or Acknowledgements World Health Organization. MEDREC Assuring medication accuracy at transitions in care: medication reconciliation. High 5s: action on patient safety getting started kit. 2010 No conflict of interest.