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Resume Introduction L’obesite est un fleau social. L’hypertension arterielle masquee (HTAM) est une entite de description relativement recente qui pose un probleme de diagnostic. Le but de cette etude etait de determiner les caracteristiques cliniques et paracliniques de ces patients, et identifier les facteurs predictifs de l’HTAM. Methodes Il s’agit d’une etude prospective incluant des patients obeses normo-tendus en mesure clinique. Tous ces patients ont beneficie d’une mesure ambulatoire de la pression arterielle (MAPA) pour depister une HTAM, une exploration biologique et une etude echocardiographique avec etude des deformations myocardiques. Resultats Nous avons recrute 50 patients dont l’âge moyen etait de 46,52 ± 10,4 ans. Le recueil des chiffres tensionnels en consultation avait montre une pression arterielle systolique (PAS) moyenne de 120, 8 ± 8,8 mmHg et une PA diastolique (PAD) moyenne de 75 ± 7,3 mmHg. La prevalence d’HTAM chez les adultes obeses etait de 36 % avec un profil majoritairement non dippers (38 %). L’etude des parametres echocardiographiques a retrouve que l’oreillette gauche (OG) etait dilatee chez 16 patients (32 %). Le ventricule gauche (VG) etait hypertrophie chez 32 patients (64 %). Le strain longitudinal global (SLG) du VG etait en moyenne de −18,85 ± 0,9 % et le SLG de l’OG etait en moyenne de 37,35 ± 4,5 %. Dans notre etude, le syndrome metabolique, des taux de HDL cholesterol bas, une glycemie a jeun elevee, une hyperuricemie, une dilatation de l’OG, une hypertrophie ventriculaire gauche, une dysfonction diastolique du VG et une alteration des deformations myocardiques etaient des facteurs associes a une HTAM chez les adultes obeses. Conclusion Il parait primordial de realiser un depistage de l’HTA par une mesure ambulatoire chez les patients obeses a risque qui presenteraient des facteurs associes a l’HTAM. La morbi-mortalite induite et le risque cardiovasculaire seraient non negligeables et le justifie pleinement.

Background The coronary artery with an interarterial course CAIAC is the most threatening coronary anomaly, especially if it concerns the left coronary. Percutaneous coronary intervention PCI is scarcely described given its low prevalence and lack of long-term outcome data. Therefore, we assessed through this case series the feasibility and safety of PCI in this population. Methods This is an observational multicentric study including patients with CAIAC arising from the opposite sinus of Valsalva. The primary endpoints were immediate angiographic success and target lesion revascularization. Results During the period of the study, we performed 27235 PCI in six Cath labs, 26 procedures concerning abnormal coronaries including 12 with CAIAC. The median age was 57 years extremes: 43–78 with male predominance 1:11. Anomalous coronary artery was Right coronary artery RCA in eight patients, Left main LM in three patients, and left anterior descending LAD in one patient. The stenosis was located in all cases in proximal segments beyond the inter-arterial course proximal LAD, the superior genius of the RCA, or the proximal segment of mid-RCA. Five patients showed slit-like ostium and all have an angle take-off

Resume Introduction Malgre les progres therapeutiques, moins de la moitie des patients hypertendus sont equilibres. L’objectif de cette etude etait d’etudier les liens entre le controle tensionnel et les facteurs socioeconomiques (SE). Materiel et methodes Pour repondre a notre objectif, nous avons utilise les donnees, recueillies dans le service de cardiologie de l’hopital universitaire de Sfax, dans le cadre du registre national tunisien d’hypertension arterielle. Nous avons etudie les associations entre les variables SE (niveau scolaire, profession, couverture medicale) et un controle optimal de la pression arterielle (PAS Resultats L’âge moyen de notre population etait de 65 ans et le sexe-ratio de 0,95. Nous avons trouve, comme prevu, les facteurs cliniques et comportementaux associes a un bon equilibre tensionnel a savoir : le sexe feminin, le regime hyposode, l’observance therapeutique, et la pratique d’une activite physique reguliere. En revanche, l’obesite et le traitement par un nombre augmente d’anti-hypertenseurs ont ete associes a un mauvais controle tensionnel. L’etude de l’effet des variables socioeconomiques sur l’equilibre tensionnel trouve un gradient significatif en defaveur des categories sociales les plus defavorisees pour nos trois variables sociales dans l’analyse univariee. L’inclusion des facteurs cliniques et comportementaux dans l’analyse multivariee a attenue ces associations mais ne les a pas entierement expliquees. Conclusion Notre etude montre qu’il existe des inegalites sociales du controle de la pression arterielle. La justice sociale et l’amelioration des conditions de vie representent probablement les vraies solutions au probleme de ces inegalites sociales de sante.

Background Covid-19 vaccine was associated with several complications such as thromboembolic complications. The exact mechanism is not well established. Since covid 19 virus caused severe endothelial dysfunction, we suspect that the vaccine with a similar immunological response may cause this dysfunction. Aim To study the effect of covid-19 vaccine on endothelial function. Methods We conducted a prospective study. The endothelial function was clinically assessed using a post-occlusive reactive hyperemia protocol with finger thermal monitoring device. Endothelial quality index (EQI) was assessed at inclusion before the first dose of coronavirus vaccine and 30 days later. Results 20 patients were included in our study. Their mean age was 41 years old [23–65]. The sex ratio was 3/2. They were all healthy individuals. The Majority, 75% of our patients, have impaired their endothelial function 30 days after the first dose of covid-19 vaccine. Conclusion The Covid-19 vaccine effect on endothelial function may be responsible for its complications. Key words: Covid-19 vaccine, endothelial dysfunction

Resume Le recepteur HER2 (Human Epidermal Growth Receptor 2) est un recepteur transmembranaire a activite tyrosine kinase qui est surexprime dans 25 a 30 % des carcinomes mammaires. Son activation est associee a une exageration de la proliferation cellulaire avec une augmentation de la capacite de reparation entrainant une radioresistance accrue. Sur les tissus sains, essentiellement cardiaques, l’activation des recepteurs joue un role cardioprotecteur. Le Trastuzumab, premier anti-HER2 utilise pour traiter les patientes atteintes de cancers du sein avec surexpression des recepteurs HER2, inhibe la cascade de reaction aboutissant a la proliferation des cellules tumorales permettant ainsi de restaurer la radiosensibilite cellulaire. Cependant, l’association du Trastuzumab a la radiotherapie supprime l’effet cardioprotecteur des recepteurs HER2 sur les cellules myocardiques ce qui majore le risque de cardiotoxicite. C’est ainsi que l’association concomitante de ces deux modalites therapeutiques a longtemps ete un sujet de controverse. Les progres realises aussi bien sur le plan technique de radiotherapie que pour les moyens de detection precoce des lesions cardiaques, pourraient limiter la cardiotoxicite de cette association. Nous proposons a travers cette mise au point, une revue de la litterature sur les bases biologiques et le benefice-risque de l’association concomitante de radiotherapie et Trastuzumab dans le traitement adjuvant des cancers du sein non metastatique HER2 surexprime et nous discutons les modalites de son optimisation.

Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

Very long coronary lesions account for 20% of coronary stenoses in the real world. There are few data on the effectiveness of angioplasty of these lesions with very long active stents (DES) in the literature. We conducted this study to assess the long-term outcomes of angioplasty with DES length ≥ 40 mm in a population with multiple cardiovascular risk factors.This is a retrospective, multicenter, descriptive, and prognostic study, conducted between January 2015 and January 2020, in four Tunisian centers, including all patients who underwent angioplasty with a DES of length ≥ 40 mm with a follow-up of at least one year. The primary outcome was a combined criteria (major cardiovascular and Cerebral events: MACCE) (stroke, acute coronary syndrome, revascularization of the target lesion: TLR, cardiovascular death: CVD).We included 480 procedures. More than half of the patients had at least three risk factors. The prevalence of high blood pressure, diabetes and smoking were 61.1%, 56.6% and 60.4%, respectively. The treated lesions were complex: 23.54% calcified lesions, 8.75% chronic occlusions, 25% bifurcation lesions and 12.08% ostial lesions. The average length of the stents was 47.72 mm. We noted 17 cases of per-procedural complications (3.55%). The median follow-up was 35 months (extremes 1-60 months). The rate of stent thrombosis was 0.83%. The incidence of MACCE, TLR and CVD were respectively 16.25%, 8.12% and 5.2%. In multivariate analysis, diabetes (HR = 1.7, 95% CI [1.01-2.9]), dyslipidemia (HR = 2.08, 95% CI [1.3-3.3]), familial coronary artery disease (HR = 1.9, 95% CI [1.01-3.6]), left ventricle dysfunction (HR = 2.07, 95% CI [1.1-3.6]) and bifurcation lesions (HR = 1.9, 95% CI [1.2-3.14]) were the independent predictors of MACCE, while statin intake (HR = 0.38, 95% CI [0.19-0.78]) was a protective factor.Angioplasty with very long DES is associated with low levels of MACCE, TLR, stent thrombosis and CVD in our population. Therefore, it could be an interesting alternative to cardiac surgery. Randomized comparative studies of the two treatment options are needed.

The transplant renal artery stenosis occurred up to 23% after kidney transplantation. Endovascular treatment has become the treatment of choice of this complication, but could be challenging in immediate postoperative anastomotic narrowing. We report the case of a adolescent with early renal graft artery stenosis located in the anastomosis and diagnosed 3 days after renal transplantation, with necessity of haemodialysis. This complication was treated by angioplasty on the 25th day, using a polymer free drug eluting stent with a good result. We discussed the precautions and technical features of this procedure.

Le rétrécissement aortique sous-valvulaire reste difficile à prendre en charge, du fait du caractère évolutif imprévisible de la sténose et du taux de récidive élevé après le traitement chirurgical. Les objectifs de notre travail étaient de décrire le profil des patients opérés pour un rétrécissement aortique sous valvulaire et d´analyser les facteurs associés à la récidive post-opératoire de l´obstacle sous aortique. Étude observationnelle portant sur tous les cas de rétrécissement aortique sous-valvulaire opérés et colligés dans le service de cardiologie de l'hôpital universitaire de Sfax entre janvier 2010 et décembre 2020. Notre série comporte 28 patients avec une prédominance masculine (64,29%, n=18). Au moment du diagnostic, l´âge moyen était 6,82 (±4,84) ans et les symptômes étaient présents chez 19 patients (67,85%). A l´échocardiographie, un gradient maximal sous-aortique ≥ 50 mmHg était présent chez 23 patients (82,14 %). Les malformations cardiovasculaires associées à la sténose sous valvulaire étaient observées chez 16 patients (57,14%). L´âge moyen au moment de la chirurgie était 10,43 (±7,08) ans. La résection de la membrane sous-aortique était la technique la plus fréquemment utilisée (46,4%, n=13). Elle a été associée à une myomectomie septale chez 8 patients (28,6%). La mortalité opératoire était nulle. En post-opératoire, la présence d´un gradient résiduel ≥ 30 mmHg était notée chez 8 patients (28,6%). La récidive était observée chez 7 patients (25%) parmi lesquels 6 ont bénéficié d´une réintervention. Dans l´analyse multivariée, seule la présence d´un gradient résiduel post opératoire était significativement associée à la récidive (p=0,030, OR=33,785, IC 95%: 1,398-816,754). Malgré l´âge tardif des patients au moment du diagnostic et de la chirurgie, nos résultats étaient favorables à court terme mais la récidive était fréquente à long terme. Ceci souligne l´intérét d´assurer un suivi régulier, clinique et échographique pré et postopératoire de ces patients.

The coronary artery disease (CAD) is a chronic inflammatory disease involving genetic as well as environmental factors. Recent evidence suggests that the oral microbiome has a significant role in triggering atherosclerosis. The present study assessed the oral microbiome composition variation between coronary patients and healthy subjects in order to identify a potential pathogenic signature associated with CAD. We performed metagenomic profiling of salivary microbiomes by 16S ribosomal RNA (rRNA) next-generation sequencing. Oral microbiota profiling was performed for 30 individuals including 20 patients with CAD and ten healthy individuals without carotid plaques or previous stroke or myocardial infarction. We found that oral microbial communities in patients and healthy controls are represented by similar global core oral microbiome. The predominant taxa belonged to Firmicutes (genus Streptococcus, Veillonella, Granulicatella, Selenomonas), Proteobacteria (genus Neisseria, Haemophilus), Actinobacteria (genus Rothia), Bacteroidetes (genus Prevotella, Porphyromonas), and Fusobacteria (genus Fusobacterium, Leptotrichia). More than 60% relative abundance of each sample for both CAD patients and controls is represented by three major genera including Streptococcus (24.97 and 26.33%), Veillonella (21.43 and 19.91%), and Neisseria (14.23 and 15.33%). Using penalized regression analysis, the bacterial genus Eikenella was involved as the major discriminant genus for both status and Syntax score of CAD. We also reported a significant negative correlation between Syntax score and Eikenella abundance in coronary patients’ group (Spearman rho = −0.68, P=0.00094). In conclusion, the abundance of Eikenella in oral coronary patient samples compared with controls could be a prominent pathological indicator for the development of CAD.

BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.

Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

Introduction:hypertension (HTN) is the main risk factor for most morbidities of elderly subjects. The objective of this study was to identify the epidemiological and clinical characteristics of hypertension in octogenarians and to identify the factors associated with uncontrolled hypertension in this population. Methods:we used data collected in the outpatient cardiology department of the University Hospital of Sfax between 15thApril 2019 and 15thMay 2019 as part of the National Tunisian Registry of Hypertension. We included in our study patients aged 80 years or more with hypertension. We described the epidemiological and clinical profile of this population, and we studied the associations between uncontrolled hypertension and socio-demographic, lifestyle, clinical and therapeutic factors using logistic regression models. Results:we included 346 subjects (45.1% (n=156) male and 54.9% (n=190) female), with a mean age of 84.36 (SD 4.01) years. More than half of them had uncontrolled hypertension. Dyslipidemia was the most common cardiovascular risk factor found in 43.6 % (n=151) of patients followed by diabetes (35.5%, n=122). One-third of patients had a history of coronary artery disease and/or stroke. Renal failure and kalemia disorders were observed, respectively, in 12.1% (n=42) and 25.2% (n=40) of patients. In multivariate analysis, factors associated with uncontrolled HTN were male sex (adjusted odds ratio (aOR):1.663, 95% confidence interval (CI): 1.045-2.647; p=0.032), diabetes (aOR: 1.66, 95%CI: 1.031-2.688; p=0.037,) and poor adherence to blood pressure (BP) medications (aOR: 1.960, 95%CI: 1.195-3.214; p=0.008). Conclusion:our results showed that more than half of octogenarian hypertensive patients did not reach the BP target and that poor adherence to BP medications was the main factor of uncontrolled HTN. In this population, the presence of other comorbidities and poor adherence to BP medications are very common. Systematic research for behaviors suggesting poor medication adherence should be a priority for physicians caring for these patients.

Introduction There are no clear data about the incidence and the prophylactic strategies of arterial and venous thromboembolic events (TE) in COVID-19 ambulatory patients. Thus, we conducted this study to analyze thromboembolic complications in this setting and to assess thromboprophylaxis management and outcomes in the real life. Patients and methods This is an observational study including Covid-19 ambulatory patients. We assessed incidence of venous and arterial TE events as well as thromboprophylaxis outcomes and hemorrhagic complications. We defined high risk thrombo-embolic factor according to the Belgian guidelines which are the only guidelines that described thromboprophylaxis in COVID-19 ambulatory patients. Results We included 2089 patients with a mean age of 43±16 years. The incidence of 30 days venous and arterial TE complications in our cohort was 1%. Venous thromboembolic complications occurred in 0.8% and arterial thromboembolic complications occurred in 0.3%.We noted at least one high-risk TE factor in 18.5% of patients but thromboprophylaxis was prescribed in 22.5% of the cases, LMWH in 18.1%, and Rivaroxaban in 3.7%. Hemorrhagic events occurred in eight patients (0.3%): five patients showed minor hemorrhagic events and three patients showed major ones (0.14%). Conclusions Our study showed that the incidence of thromboembolic complications is very low in COVID-19 ambulatory patients. Paradoxically, there is an over prescription of thrombo-prophylaxis in this population.

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

Background Cardiotoxicity following breast cancer radiotherapy (RT) represents one of the most redoubtable toxicities. The Global longitudinal strain measurement (GLS) based on 2D speckle tracking imaging (STI) allows detection of left ventricular (LV) dysfunction at a subclinical stage. The aim of this prospective study was to detect patients at risk of cardiotoxicity using echocardiographic parameters and to determine the association between segmental RT doses and early cardiac toxicity. Material and methods The STI was performed prior to RT and at 3, 6 and 12 months after. The association between subclinical LV dysfunction, defined as a reduction of GLS more than 10% from the initial value, radiation doses to different LV segments and non-radiation factors were performed based on multivariate analyses. Results From June 2017 to August 2018, a total of 103 female patients were included. Sixty patients had left sided RT. Seven patients (7.8%) developed a GSL impairment. The segmental alterations predominated in the anteroseptal and apical LV segments. The mean Dmean in altered segments was significantly higher than in non-altered segments (6.7 ± 8.8Gy-7.8 ± 8.9Gy vs 4.9 ± 7.9–5.4 ± 8.2Gy; p 55 years and obesity were important confounding factors that should be considered during radiotherapy planning. Conclusion The results of our study show that radiation dose is correlated with the subclinical LV segments' alteration. Global heart delineation seems to be insufficient during the breast radiotherapy planning. Segmental delineation of the LV may be an interesting alternative to limit segmental doses and to reduce the risk of subclinical alterations. A mean dose of 5Gy could be proposed in exposed heart segment.

Summary Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.

Background: The severe valve disease especially stenosis is a contraindication to conception according to World Health Organization. This situation is still encountered in countries with a high rheumatic fever prevalence. The objective of this study is to determine the predictors of maternal cardiac, obstetric and neonatal complications.Methods: This is an observational study of all pregnant women with severe valvulopathy, delivered between 2010 and 2017.Results: We included 60 pregnancies in 54 women. Cardiac complications occurred in 37 patients (61%). In multivariate analysis, the predictors of these complications were parity (OR = 2.41, p = 0.023), revelation of valvulopathy by pregnancy (OR = 6.34, p = 0.025), severe mitral stenosis (OR= 6.84, p= 0.035) and systolic pulmonary arterial pressure (OR = 1.08, p= 0.01). Obstetrical complications were noted in 19 women (31.8%). The predictors of these complications were primiparity (OR = 5.22, p = 0.032), multiple valve disease (OR = 5.26, p = 0.028), systolic pulmonary arterial pressure (OR = 1.04, p = 0.04) and treatment with vitamin K antagonist (OR = 8.71, p = 0.04). Neonatal complications were noted in 39% of new-borns. The predictors of these complications were the occurrence of obstetric complications (OR = 15.48, p = 0.001) and the revelation of valvulopathy by pregnancy (OR = 6.95, p = 0.017).Conclusions: The revelation of valve disease by pregnancy is a predictor not only of cardiac complication but also of neonatal complications, thus valve disease screening during pre-conceptional counselling is so crucial.

Introduction:our aim was to investigate the value of conventional echocardiography, pulsed Doppler and speckle tracking imaging (STI) analysis in the assessment of the left ventricular (LV) myocardial function in hemodialysis (HD) patients with preserved LV ejection fraction and to evaluate the effect of a single HD session on the LV systolic and diastolic functions. Methods:the study population consisted of 30 chronic HD patients. Echocardiography and Doppler studies were performed before and after HD. The LV global longitudinal, circumferential and radial strains were measured with two and three-dimensional STI. Results:after HD, LV dimensions, left atrium (LA) area, systolic pulmonary arterial pressure and inferior vena cava diameter decreased significantly. The peak mitral E velocity, the E/A ratio of the mitral inflow and the lateral E/E´ ratio decreased also significantly. The LV and LA volumes index and LV mass index (LVMi) decreased remarkably after HD. The 3D- LV and LA ejection fractions were unchanged after HD. Although, 3D-estimated LVEF seemed to be preserved in the HD patients, the 2D and 3D- strain rates were decreased in all directions. The global strain values improved in all directions after a single HD session. Inverse correlations were found between the LVMi, serum BNP and LV global longitudinal strain. Conclusion:in HD patients with preserved LV ejection fraction, the STI analysis may add important information concerning the subclinical LV dysfunction.

We review the literature on the safety of fasting in cardiac patients. We examined the changes of blood pressure among hypertensive patients and the incidence of cardiac events during Ramadan in patients with coronary disease and heart failure. We also assess the modifications of INR levels in cardiac patients who take oral anticoagulant. We found that Ramadan fasting is safe in stable cardiac patients, even under several drugs. Fasting does not affect blood pressure. There is no difference in regards to cardiac event incidence between Ramadan and the non-fasting-months. The level of INR is slightly higher when fasting, it is thus recommended to monitor patients with high bleeding risk during Ramadan.

Introduction:l´hypertension artérielle (HTA), la fibrillation auriculaire (FA) et l´accident vasculaire cérébral (AVC) sont trois problèmes de santé publique. A travers cette étude nous avons cherché à déterminer la prévalence de la FA et de l´AVC ischémique chez les patients hypertendus et déterminer les facteurs associés à la survenue de la FA non valvulaire chez ces patients. Méthodes:nous avons utilisé les données recueillies dans le service de cardiologie de l´hôpital universitaire de Sfax dans le cadre du registre national tunisien d´HTA. Nous avons étudié les associations entre les différentes variables sociodémographiques, cliniques, paracliniques et thérapeutiques et la FA chez les hypertendus en utilisant des modèles de régression logistique. Résultats:notre échantillon comprenait 2887 patients avec un sexe ratio à 0,95. L´âge moyen était de 65 ans (±11). La FA était notée chez 230 patients (8%), alors que l´AVC ischémique chez 152 patients (5,3%). Au décours de l´analyse multivariée, les facteurs indépendants associés à une augmentation de la prévalence de la FA étaient: l´âge avancé (p=0,001, Odds Ratio(OR) = 1,647, Intervalle de confiance (IC) à 95%: 1,1227-2,213), la présence d´une hypertrophie ventriculaire gauche (HVG) à l´échographie cardiaque(p = 0,004, OR = 2,140, IC95%: 1,281-3,576), et la fraction d´éjection du ventricule gauche (FEVG) < 50% (p < 0,001, OR = 4,677, IC95%: 2,715-8,057). Conclusion:nous avons confirmé qu´il existe une relation directe et indépendante entre l´HTA, l´âge avancé, l´HVG et la FA. L´installation d´une FA au cours de l´HTA constitue un tournant évolutif de la maladie par majoration du risque d´AVC ischémique. Un contrôle optimal de la pression artérielle tensionnelle être hautement prioritaire chez les hypertendus, en particulier âgés, afin de prévenir le risque de la FA et de l´AVC.

The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p

Background Hypertension is a major concern of public health policy in Tunisia. However hypertension is both highly prevalent (almost 35% of the Tunisian population) and insufficiently treated and controlled, which is partly due to unawareness. Historically, barbershops previously have been used for blood pressure screening and to improve hypertension controlled rate Objective This study aimed to screen hypertension in barbershops. Study design SALOON-HTN is a cross-sectional, descriptive, non-interventional, multicenter survey aiming to screen hypertension by measuring blood pressure in barbershops, located in Metline Township (limited contact with the healthcare system). Twenty-seven barbershops hairdressers were trained by a medical staff to measure the blood pressure by an ambulatory device. All subjects willing to participate in the survey were asked to measure their blood pressure after at least 5 minutes rest. Three measures were performed by the Hairdressers, with an interval of 1 minute between each measure. The mean of the last two measures was considered. If the mean blood pressure level exceeded 135 and/or 85 mmHg the subject was referred to physician. Patients Adults aged more than 18 years were included. Results A total of 1 536 patients were included in the study. The mean age was 40.7±15 years; 57% were men. Among them, 54.2% had never measured their blood pressure; 439 (28.5%) participants had hypertension, only 136 (8.9%) of those with hypertension were aware of their condition, 95 participants (69.9% of those who were aware of their condition) were receiving treatment, and hypertension was controlled in 43.2% participants of those being treated. Overall control was worst in our study (8.9%). Conclusion Saloon-htn confirmed the poor control and unawareness of hypertension. There is an obvious need for programs to increase access to primary care physicians. Funding Acknowledgement Type of funding source: None

Background: The severe valve disease especially stenosis is a contraindication to conception according to WHO. This situation is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine the predictors of maternal cardiac, obstetric and neonatal complications. Methods: This is an observationnal study of all pregnant women with severe valvulopathy, delivered between 2010 and 2017. Results: We included 60 pregnancies in 54 women. Cardiac complications occurred in 37 patients (61%). In multivariate analysis, the predictors for these complications were parity (OR = 2.41, p = 0.023), revelation of valvulopathy by pregnancy (OR = 6.34, p = 0.025), severe mitral stenosis (OR = 6.84, p = 0.035) and systolic pulmonary arterial pressure (OR = 1.08, p = 0.01). Obstetrical complications were noted in 19 women (31.8%). The predictive factors for these complications were primiparity (OR = 5.22, p = 0.032), multiple valve disease (OR = 5.26, p = 0.028), systolic pulmonary arterial pressure (OR = 1.04, p = 0.04) and treatment with vitamin K antagonist (OR = 8.71, p = 0.04). Neonatal complications were noted in 39% of new-borns. The predictive factors for these complications were the occurrence of obstetric complications (OR = 15.48, p = 0.001) and the revelation of valvulopathy by pregnancy (OR = 6.95, p = 0.017). Conclusions: The revelation of valve disease by pregnancy is predictor of not only cardiac complication but also neonatal complications, thus valve disease screening during pre-conceptional counselling is crucial.

BACKGROUND Coronary diseases remain the first cause of death in the world; the management of this condition has improved, thanks to new technical tools and multicentric registries. Recently in Tunisia, the number of intervention procedures has markedly increased, giving the explosion of cardiovascular risk factors among Tunisian people. OBJECTIVE The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI) in Tunisia. METHODS We will conduct a prospective, multicentric, observational study including patients > 18 year-old who underwent a PCI between 31January and 30 June 2020. The primary end point are the occurrence of a major adverse cardiovascular event , defined as cardiovascular death, myocardial infarction, cerebrovascular accident, and target vessel revascularization with either repeat PCI or coronary artery bypass surgery (CABG). Secondary end-points consist in procedural success rate, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. RESULTS Results will be available at the end of the study as well as the demographic profile and general risk profile of Tunisian patients undergoing PCI. The complexity level of procedures, as left main, bifurcation, chronic occlusion PCI will be analyzed and immediate as well as long term results will be determined. NATURE-PCI will be the first national multicentric registry of angioplasty in Africa. CONCLUSIONS This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of contemporary coronary artery disease in this developing region. CLINICALTRIAL clinicaltrials.gov

Introduction reduced exercise capacity, coronary artery abnormalities and reversible myocardial ischemia have been demonstrated after arterial switch operation (ASO) and coronary reimplantation. Despite this, indices of systolic function, assessed by standard and Doppler echocardiography, are within the normal range. The aim of this study was to highlight the long-term changes in myocardial function following coronary reimplantation using Doppler and speckle-tracking imaging (STI) echocardiography. Methods this observational case control study included 36 patients and 20 gender and age-matched healthy controls. A group study was performed using patients who were followed for at least 6 months after the operation and who visited the pediatric cardiology outpatient between October 2015 and May 2016. Systolic and diastolic parameters, left ventricle (LV) and right ventricle (RV) myocardial performance were assessed in each group. Results the LV global peak strain parameters revealed a significant decrease in the longitudinal and circumferential strain components. The LV global longitudinal strain (GLS) values were lower in both groups of operated patients than controls (-19.9 ± 2.2% (group 1) versus -20.9 ± 1.6% (group 2) versus -22.9 ± 2.3% (group 3), p

The HER2 receptor (Human Epidermal Growth Receptor 2) is a transmembrane receptor with tyrosine kinase activity that is over-expressed in 25-30 % of breast carcinomas. Its activation is associated with an exaggeration of cell proliferation with an increase in repair capacity resulting in increased radioresistance. On cardiac tissues, HER2 receptor activation plays a cardio-protective role. Trastuzumab, the first anti-HER2 drug used to treat patients with breast cancer overexpressing HER2 receptor , inhibits the cascade of reactions resulting in the proliferation of tumor cells, thus restoring cellular radiosensitivity. However, the combination of Trastuzumab with radiation therapy also removes HER2 receptor cardio-protective role on myocardial cells which increases the risk of cardiotoxicity. Thus, the concomitant association of these two modalities has long been a subject of controversy. Recent advances in radiation therapy technology and early detection of cardiac injury may limit the cardiotoxicity of this combination. Through this review, we developed the biological basis and the benefit-risk of concomitant combination of radiotherapy and Trastuzumab in adjuvant treatment of breast cancers overexpressing HER2 and we discuss the modalities of its optimization.

BACKGROUND The present study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. It will allow us to have an overview of the Tunisian hypertensive patient in order to optimize treatment and to know the degree of adherence of practitioners to international recommendations in the care of the hypertension in Tunisia. OBJECTIVE he present study was designed to evaluate the care of hypertensive patients in daily clinical practice in public and private centers in all Tunisian regions. METHODS National, observational, cross-sectional, and multicenter study that will include patients older than 18 years with hypertension for duration of 4 weeks, following up in public and private centers and after signing a consent form. The study will exclude patients undergoing dialysis. The parameters that will be evaluated include demographic and anthropometric data, lifestyle habits, BP levels, lipid profile, treatment and adherence to treatment. The data are collected via the DACIMA Clinical Suite® web interface. RESULTS At the end of the study, we will find the demographic and anthropometric characteristics of the patients, their past medical history, clinical features and their paraclinical exploratory characteristics (biology, EKG and / or holter blood pressure, transthoracic echocardiography (TTE),). We will provide a description of the therapeutic environment and of adverse events occurring during medical treatment and recommendations. CONCLUSIONS We will provide a description of the therapeutic environment and of adverse events occurring during medical treatment and recommendations. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT04013503.

Introduction: The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease. Methods: We analyzed 238 consecutive patients admitted for NSTE-ACS and undergoing a coronary angiogram during hospitalization. The severity of CAD was assessed using the SYNTAX score. Obstructive CAD was defined as ≥50% stenosis in the left main or ≥70% stenosis in other vessels. Severe CAD was defined as a SYNTAX score >32. The Pearson test was used to assess the correlation between scores. Results: The SYNTAX score was higher in patients at high risk (GRACE score: p32. O teste Pearson foi usado para avaliar a correlação entre os scores. Resultados: O valor do score Syntax foi superior nos doentes de alto risco (escore GRACE: p

The present study aimed to examine the putative preventive effect of the ethanolic extract Date Palm Pollen (DPP, Phoenix dactylifera L., family Arecaceae) on isoproterenol-induced myocardial infarction (MI) in rats. Twenty four rats were randomly divided into four groups including control. They were treated with DPP extract (400mg/kg) and clopidogrel (0.2mg/kg) for 7days followed by myocardial injury induction using subcutaneous isoproterenol (100mg/kg) with an interval of 24h for two days (6th and 7th day). Administration of isoproterenol exhibited indicative changes in the ECG pattern evidenced by significant elevation of ST-segment and cardiac injury markers viz.; troponin-T, creatine phosphokinase (CPK), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) by 315%, 71%, 64% and 170%, respectively as compared to control. Additionally, the angiotensin-converting enzyme (ACE) activity in plasma was increased by 33% associated to histological myocardial necrosis. However, pre-co-treatment with DPP extract improved the cardiac biomarkers injury, normalized cardiac function indices and prevented the ventricular remodeling process through inhibition of ACE activity by 34% and the inhibition of the generation of radical oxygen species. Extensive characterization of this DPP extract using LC-HRMS revealed numerous flavonoids and phenols compounds which could be endowed with cardiopreventive actions. Overall, these results proved that DPP extract has preventive effects on cardiac remodeling process.

Summary Background Valvular heart diseases occur frequently in Tunisia, but no precise statistics are available. Aim To analyse the characteristics of patients with abnormal valvular structure and function, and to identify the aetiological spectrum, treatment and outcomes of valvular heart disease in a single cardiovascular centre in Tunisia. Methods This retrospective study included patients with abnormal valvular structure and function, who were screened by transthoracic echocardiography at a single cardiology department between January 2010 and December 2013. Data on baseline characteristics, potential aetiology, treatment strategies and discharge outcomes were collected from medical records. Results There were 959 patients with a significant valvular heart disease (mean age 53 ± 17 years; female/male ratio 0.57). Valvular heart disease was native in 77% of patients. Mitral stenosis was the most frequent lesion (44.1%), followed by multiple valve disease (22.3%). Rheumatic origin (66.6%) was the most frequent aetiology, followed by degenerative (17.2%) or ischaemic (8.1%) causes, endocarditis (1.4%) and congenital (0.9%) causes. Native valve disease was severe in 589 patients (61.4%). Percutaneous mitral balloon valvuloplasty was performed in 36.9% of patients with mitral stenosis. Among patients with severe valvular heart disease, surgical treatment was indicated for 446 (75.7%) patients. Only 161 (36.1%) patients were finally operated. Postoperative mortality was 13.6% for all valvular heart diseases. Conclusion This retrospective study has shown that the main cause of valvular heart disease in Tunisia is rheumatic fever. Mitral stenosis and multiple valve disease are the most frequent valvular heart diseases in Tunisia. Percutaneous mitral balloon valvuloplasty and prosthetic valve replacement are the preferred treatment methods for valvular heart disease.

Introduction L’obesite est un fleau social. L’hypertension arterielle masquee (HTAM) est une entite de description relativement recente qui pose un probleme de diagnostic. Elle confere au patient qui en souffre un risque augmente d’evenements cardiovasculaires. Le but de ce travail est de determiner la prevalence de l’HTAM dans une population de patients obeses, etudier les caracteristiques cliniques et paracliniques chez ces patients, et identifier les facteurs associes cliniques et paracliniques a l’HTAM dans cette population. Patients et methodes Notre etude est prospective incluant des patients obeses normotendus en mesure clinique suivis au service d’endocrinologie pour exploration d’obesite. Tous ces patients ont beneficie d’une mesure ambulatoire de la pression arterielle (MAPA) pour depister une HTAM. La population a ete divisee en 2 groupes : groupe d’HTAM (G1) et groupe des normotendus (G2). Resultats Nous avons recrute 50 patients dont l’âge moyen etait de 46,52 ± 10,4 ans avec des extremes allant de 22 a 64 ans. Une nette predominance feminine etait objectivee avec un sex-ratio (H/F) egal a 0,19. L’IMC moyen etait de 36,03 ± 5,2 kg/m2. Une repartition androide des graisses etait objectivee chez tous nos patients. Le diabete et la dyslipidemie etaient les facteurs les plus fortement retrouves (38 % et 40 % respectivement). Seulement 18 % des patients avaient un syndrome d’apnees du sommeil (SAS). Cinq de nos patients etaient tabagiques actifs. Le recueil des chiffres tensionnels en consultation avait montre une PAS moyenne de 120, 8 ± 8,8 mmHg et une PAD moyenne de 75 ± 7,3 mmHg. L’etude des parametres echocardiographiques a retrouve que l’oreillette gauche (OG) etait dilatee chez 16 patients (32 %). Le ventricule gauche (VG) etait hypertrophie chez 32 patients (64 %). L’etude des parametres biologiques chez les patients diabetiques avait montre une glycemie a jeun moyenne a l’admission de 7,59 ± 3,6 mmol/L avec une HBA1C moyenne de 9,03 ± 1,3 %. Pour les patients non diabetiques, une hyperglycemie moderee a jeun a ete retrouvee. Un diabete de primo-decouverte a ete diagnostique chez 2 patients. Un syndrome metabolique etait retrouve chez 62 % des patients. Dans notre etude, la prevalence d’HTAM chez les adultes obeses etait de 36 % survenait chez des sujets majoritairement non dippers (38 %). La PA normale haute etait plus frequente dans le groupe d’HTAM. Dans notre etude, le diabete, le SAS, le tabagisme, le syndrome metabolique, une pression arterielle normale haute, les perturbations du bilan lipidique, une glycemie a jeun elevee, une hyperuricemie, une dilatation de l’OG, une masse VG elevee et une alteration des deformations myocardiques de l’OG et du VG etaient des facteurs associes a une HTAM chez les adultes obeses. Conclusion Il parait primordial de realiser un depistage ambulatoire chez les patients obeses a risque qui presenteraient des facteurs associes a l’HTAM. La morbi-mortalite induite et le risque cardiovasculaire seraient non negligeables et le justifie pleinement.

Introduction Le Lupus erythemateux systemique (LES) est affection non specifique d’organe. L’atteinte cardiaque est grevee d’une lourde mortalite. Elle survient a n’importe quel moment de l’evolution de la maladie et peut etre asymptomatique. L’echocardiographie est un examen non invasif, disponible, reproductible et incontournable dans la prise en charge des patients presentant un LES. C’est une excellente technique pour detecter l’atteinte cardiaque, stratifier le pronostic, orienter et evaluer les differentes strategies therapeutiques. L’objectif de notre travail etait de determiner la frequence et de decrire les differentes anomalies echocardiographiques chez une population lupique. Patients et methodes Nous avons realise une etude transversale descriptive portant sur des patients ayant un LES vus a la consultation ou hospitalises au service de Medecine interne CHU Hedi Chaker Sfax (Tunisie) sur une periode de 1 mois. Les patients ont beneficie d’une echocardiographie transthoracique avec une etude de la fonction systolique et diastolique ventriculaire gauche, la fonction systolique ventriculaire droite, les pressions pulmonaires, les valves cardiaques et les deformations myocardiques en utilisant les moyens echocardiographiques conventionnels et les nouvelles techniques (speckle tracking). Resultats Vingt patients ont ete inclus dans l’etude avec une predominance feminine (90 %). L’âge moyen etait de 36 ans (extremes : 24–57 ans). Les manifestations echocardiographiques etaient frequentes, touchant 75 % des patients mais variables. Tous les patients avaient une fraction d’ejection normale par la methode de Teichlotz. Elle etait alteree chez 5 patients (25 %) par la methode de Simpson. Le strain longitudinal global etait altere chez plus que la moitie des patients (55 %). Une dysfonction diastolique de type 1 d’Appleton a ete observee chez 20 % des patients, et une oreillette gauche dilatee chez 10 %. Quatre patients (20 %) avaient une valvulopathie significative dont 3 avec indication operatoire. L’epanchement pericardique etait retrouve chez 15 % des malades et etait de faible abondance dans tous les cas. Une hypertension arterielle pulmonaire etait retrouvee chez 15 % des patients. Discussion Notre etude s’est focalisee sur les atteintes echocardiographiques du lupus, mais d’autres manifestations cardiovasculaires peuvent passer inapercues a l’echographie a savoir les troubles du rythme, les troubles de conduction ou une insuffisance coronaire. Ce travail a montre l’utilite de l’echocardiographie dans la detection des anomalies cardiaques infracliniques au cours du LES ainsi que l’interet des nouvelles techniques de deformations myocardiques (speckle tracking) par rapport aux moyens conventionnels. Conclusion Les anomalies echocardiographiques observees chez les patients lupiques doivent inciter a inclure cet examen de maniere systematique dans le bilan des patients lupiques et a renouveler dans la surveillance.

Cardiovascular diseases (CVD) are a major cause of morbidity and mortality, driven by the epidemiological transition world-wide.We aimed to describe the epidemiological profile of CVD hospitalizations, to assess their chronological trends and to estimate their future projected trends.We retrospectively collected data from the regional morbidity registry of the University Hospital of Sfax, Tunisia, between 2003 and 2016. We included patients with ischemic heart disease (IHD), heart failure (HF) and rhythm and conduction disorder (RCD).The mean age-standardized hospital incidence rate (ASHIR) was 94.8, 20.6 and 14/100000 inhabitants/year for IHD, HF and RCD, respectively. Trends analysis of CVD showed a significant increase in the ASHIR of IHD from 54.3/100000 inhabitants in 2003 to 123/100000 inhabitants in 2016, with an Annual Percentage Change (APC) of 3.59% (95%CI:0.4-6.7%;p0.001). An upward trend was observed for HF, with ASHIR rising from 8.6/100000 inhabitants in 2003 to 22.6/100000 inhabitants in 2016, with an APC of 8.29% (95%CI:4.1-12;p0.001). For RCD, no significant change in ASHIR was found. Projections showed that the estimated ASHIR would attend 131 and 36.5/100000 inhabitants for IHD and HF, respectively, while RCD would decline to 19.6/100000 inhabitant in 2026.IHD and HF were rising at an alarming rate and were expected to continue up to the next 10 years. Therefore, there is an urgent need to emphasize on primordial, primary, and secondary prevention in order to reduce the massive burden of CVD.

Correction: Volume: 292 Pages: 160-162 DOI: 10.1016/j.atherosclerosis.2019.11.020 Published: JAN 2020