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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.

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.

Hypertension is the first cause of atrial fibrillation. Its onset is explained by intricate mechanisms such as atrial conduction impairment.To evaluate atrial conduction by tissue Doppler imaging in hypertensive patients compared to a control group.This is a comparative prospective study performed in the cardiology department of the FSI hospital enrolling 55 patients with hypertension and 55 controls. All of them underwent a complete echocardiocardiography exam with Doppler tissue imaging. We measured intraatrial and interatrial electromechanical delay by Pulsed Tissue Doppler. Statical analysis was conducted using SPSS version 22.0. Comparison of means was made with t student test.Left ventricular mass and septal thikness were more important in the hypertensive group. Mitral A wave was greater in hypertensive group compared to controls (7,1cm/s vs 5,6cm/s; p0,0001; respectively). Left atrial volume was of 32,7±6,8mL/m² in hypertensives vs 29,5±4,3 mL/m² in controls (p=0,006). Doppler Tissue study showed homogeneous statistically significant elongation of atrial conduction times in hypertensive patients compared to controls: interatrial time (16.8±7.8ms vs 12.4±4,2ms, p0.0003) and left intraatrial (27.6±8.6ms vs 19.0±4.3ms, p0.0001) and right intraatrial time (10.8±6.0ms vs 6.6±2.9ms, p0.0001; respectively for hypertensive and control subjects. There was a significant correlation between measured intraatrial and interatrial electromechanical delays and duration of hypertension, indexed left atrial volume ans indexed left ventricular mass (r 0.27-0.41, p0.001).Atrial conduction time is significantly longer in hypertensive patients. Impairment of atrial conduction may be predictive of atrial fibrillation and should prompt closer surveillance to detect this arrhythmia in these patients.

Acute myocarditis is an inflammation of the heart muscle. Its unpredictable evolution justifies the importance of its early recognition. The clinical polymorphism associated with the lack of sensitivity of conventional diagnostic means make diagnosis a challenge for the clinician. However, the magnetic resonance imaging has been of great interest for the differential diagnosis as well as for the evolutionary follow-up of this pathology.Determine the clinical profile of acute myocarditis and the contribution of multimodal imaging in its diagnosis.This was a descriptive, retrospective study, including 31 patients hospitalized for acute myocarditis at the cardiology department of the Internal Security Forces Hospital-La Marsa between 2011 and 2017.The mean age of our patients was 36.5 ± 13.3 years [17-63] with a clear male predominance (sex ratio = 6.75). Smoking was the most common cardiovascular risk factor (60%). Fifty percent of the population had only two cardiovascular risk factors. The most common clinical picture was acute chest pain (84%) preceded by influenza-like illness (53%). The electrocardiogram was pathological in 97% of cases. Hyperleukocytosis was objectified in 33% of cases. Elevation of C-reactive protein was present in 80% of cases. As for troponins, they were high in 94% of cases. Overall myocardial contractility was conserved in 84% of cases with segmental kinetic disorders in 45%. Cardiac magnetic resonance imaging showed pericardial effusion (10%), spontaneous myocardial hypersignal in triple-reversal-T2 recovery (42%) and which corresponded to the zones of late enhancement. Late contrast enhancement was predominant at the lateral wall (39%), with epicardial involvement occurring in 100% of cases.28 patients had a favorable outcome after a follow-up of 24 months. However, there was only one case of death at 3 months and two cases that progressed to dilated cardiomyopathy.Acute myocarditis is mainly a disease of the young male subject. Cardiac magnetic resonance imaging is of crucial interest for positive diagnosis.

The left atrium (LA) have an important role in the normal functioning of the heart thanks to its three functions: reservoir, conduct and pump. Several pathologies lead directly or indirectly to morphological and functional modifications of the LA. Investigate the effect of arterial hypertension on LA size and function. Prospective study including 50 hypertensive patients compared to 50 healthy controls. LA Volumes were measured using transthoracic echocardiography by biplane Simpson method at different times of cardiac cycle: at the end of systole (maximum LA volume (Vmax)), at mitral valve closure (minimum LA volume (Vmin)) and immediately before LA contraction (Vp)). LA reservoir function (total emptying volume and expansion index), conduct function (passive emptying volume and passive emptying fraction) and pumping function (active emptying volume and active emptying fraction) have been calculated. Hypertension was associated with an increase of all LA volumes: Vmax (p0.001), Vmin (p=0.001) and Vp (p0.001). LA reservoir function evaluated by LA total emptying volume was higher in hypertensives than in control group (p=0.032). LA conduct function was impaired in hypertensive patients with a significantly lower passive emptying fraction in hypertensive group compared to control group (22 ± 12% versus 32 ± 11%, p0.001, respectively). This decrease was greater in the presence of left ventricular hypertrophy (p = 0.02). LA pumping function was significantly higher in hypertensive patients than in controls with an increase of LA active emptying fraction (35±12% versus 30±12%respectively; p=0.037). The increase of LA pumping function was found to be higher in hypertensive patients with impaired diastolic function (p=0.029). Hypertension was associated with an increase of pumping and reservoir functions and a decrease in left atrial passive emptying function. These changes appear to be related to left ventricular hypertrophy and the degree of left ventricular diastolic dysfunction.

Introduction: COPD and CAD are common chronic diseases with shared risk factors. COPD continues to be largely underdiagnosed and undertreated. We aimed to describe the prevalence of COPD in Tunisian smokers with CAD Methods: In a cross-sectional study, patients over 35 years of age who underwent coronary angiography for suspected CAD and reported ≥10 pack-year of cigarette smoking were recruited. Spirometry was undertaken for all participants, and COPD was defined according to GOLD criteria. The finding of ≥50% coronary luminal narrowing confirmed the presence of CAD Results: Spirometry was undertaken for 122 men with mean age of 59.3 years and mean pack-year of 52.3. Mean CAD follow-up duration was 3.9 years. Diabetes, hypertension and dyslipidemia were the most common comorbidities. One or more threatening coronary lesions were found in 50% of patients. Echocardiography was normal in 45.9% of patients. The prevalence of COPD was 19.7%. Of the 24 patients with COPD,17 patients were newly diagnosed. Six patients had mild COPD,15 had moderate COPD,2 had severe COPD and 1 had very severe COPD. The mean FEV1 in COPD patients was 68.7%. COPD-related symptoms were:chronic cough(56%), dyspnea(76%) and wheezes(28%). Pulmonary arterial hypertension was observed in 36% of COPD patients. The comparison of patients with COPD with those without COPD showed that respiratory symptoms, chest-X-ray abnormality and pulmonary arterial hypertension were significantly more frequent in COPD patients Conclusion: There was a high prevalence of COPD among patients with CAD and most were underdiagnosed despite being symptomatic. Smokers with CAD and respi­ratory symptoms should be evaluated for airflow limitation

BACKGROUND The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). OBJECTIVE The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. METHODS A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. RESULTS At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. CONCLUSIONS The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. CLINICALTRIAL ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/12262

Background The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). Objective The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. Methods A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. Results At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. Conclusions The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial Registration ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID) DERR1-10.2196/12262

Carcinoid tumors are rare, mainly located in the gastrointestinal tract particularly in the small intestine. Cardiac involvement, fairly frequent and usually affecting right sided heart valves, had a poor prognosis that is improved by an earlier detection and valve surgery. We report the case of a 50-years old woman with neuroendocrine tumor and liver metastases, in whom carcinoid involvement of the right heart was diagnosed following exertional dyspnea. She had dilated right cavities, severe tricuspid regurgitation, mild tricuspid stenosis and a moderate pulmonary stenosis. She underwent a double valve replacement by bioprosthesis with improvement of symptoms and recovery of normal right cavities size.

Background Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited. Objective The aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial. Methods A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points. Results Results will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients. Conclusions This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region. Trial registration ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX). Registered report identifier RR1-10.2196/8523.

BACKGROUND Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiologic pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiologic profile and management of atrial fibrillation (AF) patients in Tunisia are limited. OBJECTIVE The aim of this study was to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial. METHODS A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective to describe the epidemiologic pattern of AF. Patients will be officially enrolled in the NATURE-AF only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points. RESULTS Results w be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients. CONCLUSIONS This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region. CLINICALTRIAL ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX)

Right ventricular (RV) involvement in obstructive sleep apnea syndrome (OAS) is controversial. The aim of this study was to determine a correlation between echocardiographic parameters of RV function and severity of OSA assessed by the apnea- hypopnea index (AHI).Sixty patients with suspected OSA were enrolled. All patients had overnight polygraphy and an echocardiographic assessment of RV structure and function. Patients were divided into three groups: a control group (n=20) with an AHI5/h, a group of mild to moderate OSA (n=18) with an AHI=5-30/h and a group of severe OSA (n=22) with AHI≥30/h.There were no differences of age, body mass index and sex among the three groups. There was no difference in systolic pulmonary pressure. RV free wall thickness, end-diastolic surface and right atrium surface were statistically higher in OSA patients compared with controls. The peak systolic myocardial velocity at tricuspid lateral annulus S' were significantly lower in patients compared with controls (14.5±3 vs 12.2±2 cm / s, p0.001; respectively). This decrease was greater in patients with severe OSA compared with mild to moderate OSA (11.4±3 vs 13.0±1 cm/s, p=0.05, respectively). Right ventricular myocardial performance index (MPI) was significantly higher in OSA compared with controls (0.55±0.12 vs 0.46±0.14, p=0.024, respectively) but it was not correlated with the severity of IAH.In OSA patients, there was a significant RV dysfunction independently of pulmonary pressure, although the correlation with the severity of IAH was moderate.

"2-chlorobenzylidene malononitrile" also named CS gas is the most used riot-control agent in the world. Its reputation as the least toxic tear gas explains its large use by different authorities. Early exposure to CS spray commonly induces visual irritation, skin reactions, with increased mucous secretion in order to temporarily incapacitate targeted people. However, there is a large agreement that safety data of this product is limited and further studies need to be performed since serious problems could occur after heavy exposure such as loss of consciousness, laryngospasm, pulmonary edema and hemorrhage... Herein, we report a case of a young man who had acute myocardial infarction with serious cardiac sequelae after exposure to tear gas. To our knowledge, this is the second case since forty years in the literature that directly links documented acute heart infarction to CS gas exposure.

Background: Pleural effusions (PE) occur commonly after cardiac surgery (CS). However little is known about risk factors for their developing. Objective: the aim of our study was to investigate the prevalence, the clinical course and risk factors of PE after CS. Methods: It was a retrospective study from January 2011 to December 2016. We enumerate patients who developed pleural effusion after a CS and studied epidemiological clinical, biological and radiological data. Results: Among 75 patients included in the study, 31 patients(41%) developed a PE. The mean age was 57 years (28 males and 3 females). Seventeen patients were smokers. The Most common comorbidities were hypertension (55%), diabetes (55%).The most of these effusions occurred 15 days post surgery (early onset). The mean time of occurrence was by the seventh post operative day. PE were on the left side (51%), and bilateral (22%). The etiology of most of PE remains unclear. Eight of the effusions were a pneumonitis reaction, 3 were attributed to congestive heart failure and 1 was an empyema. Pleural fluid was hemorrhagic and fluid analysis showed an exudate in most cases. The volume of effusion was under 120 ml in 80% of patients. Coronary artery bypass grafting (CAPG) (71%) and valvular replacement (VR) (22%) were the most common indications for CS. The PE occurred in 40% of cases after a CAPG and in 14% of cases after a VR. The mean duration of CBP in patients who developed PE was 99,11min.The treatment was based on the etiology and pleural physiotherapy. The evolution was favorable in most cases. Conclusion: PE is common complication of CS. The cause of many of PE remains unclear. CAPG is associated with greater proportion of them.

Evaluation of left ventricular systolic function, usually based on the assessment of the ejection fraction, is increasingly supplemented by other more sophisticated techniques such as 3D echocardiography and speckle tracking. However these methods require a high technicity and a good echogenicity. As heart failure leads to lengthening of aortic pre-ejectional time (PET) and shortening of left ventricular ejection time (ET), systolic time intervals (STI) were proposed for the evaluation of systolic myocardial performance.to establish a correlation between left ventricular ejection fraction (LVEF) and STI and determine a cut-off value of PET/ET ratio to diagnose a LVEF inferior to 35%.109 consecutive patients referred to two echocardiographic laboratories had measurements of STI and LVEF estimated by Simpson biplane method. Patients included were in sinus rhythm with a heart rate100 beats per minute. Patients with atrial fibrillation, pacemaker or prosthetic valves were excluded.Feasibility of STI measurements was 100%. A significant negative correlation between PET and LVEF was found (r=-0.49, p0.0001). LVEF was also significantly correlated to ET (r=0.44, p0.0001). PET/ET ratio was significantly correlated to LVEF (r=-0.63, p0.0001). Receiver operating curve analyses revealed a cut-off value of PET/ET ratio of 0.33 to diagnose a LVEF35% with a sensitivity of 85% and a specificity of 78%.STI, easy to obtain and useful in case of poor quality echographic window, are an interesting alternative to evaluate systolic left ventricular function and may be used to detect alteration of LVEF.

PREREQUIS: Amyloidosis is a rare infiltrative disease characterized by multiple clinical features. Various organs are involved and the cardiovascular system is a common target of amyloidosis. Cardiac involvement may occur with or without clinical manifestations and is considered as a major prognostic factor.To analyze the clinical features of cardiac involvement, to review actual knowledgement concerning echocardiographic diagnostic and to evaluate recent advances in treatment of the disease.An electronic search of the relevant literature was carried out using Medline and Pubmed. Keys words used for the final search were amyloidosis, cardiopathy and echocardiography. We considered for analysis reviews, studies and articles between 1990 and 2007.Amyloidosis represents 5 to 10% of non ischemic cardiomyoparhies. Cardiac involvement is the first cause of restrictive cardiomyopathy witch must be evoked in front of every inexplained cardiopathy after the age of forty. The amyloid nature of cardiopathy is suggered if some manifestations were associated as a peripheric neuropathy, a carpal tunnel sydrome and proteinuria3g/day. Echocardiography shows dilated atria, a granular sparkling appearance of myocardium, diastolic dysfunction and thickened left ventricle contrasting with a low electric voltage. The proof of amyloidosis is brought by an extra-cardiac biopsy, the indications of endomyocardial biopsy are very limited. The identification of the amyloid nature of cardiopathy has an direct therapeutic implication: it indicates the use of digitalis, calcium channel blockers and beta-blockers. Today the treatment of amyloidosis remains very unsatisfactory especially in the cardiac involvement. An early diagnosis before the cardiac damage may facilitate therapy and improve prognosis.

IntroductionThe prevalence of chronic heart failure (CHF) is increasing in the world. Coronary artery disease is its most common cause in Europe. In Tunisia, valvular abnormalities were the leading aetiology of CHF in the eighties. We sought to determine its epidemiologic profile nowadays.Methods99 patients were hospitalized between 2004 and 2008 for chronic heart failure in our center. We analysed their demographic features, clinical caracteristics and their evolution.ResultsThe mean age was 59,1± 15 years (24 women). 42 patients were hypertensive and 42 had diabetes mellitus. 21% had atrial fibrillation. The mean ejection fraction (EF) at the time of diagnosis was 31,9±8%, 33% of patients had EF< 30%. Coronary artery disease was the cause in 54% of CHF. Hypertension was responsible in 16% of cases. A valvulopathy was the aetiology in only 3 cases. At discharge, the ACE were prescribed in 85% of patients, and betablockers in 41%. The mean follow up was 24±12 months, 12% were in class NYHA III or IV. 50% were hospitalized for worsening HF. 53% of hospitalizations occured during the first 12 months. During the follow up, 17 patients died, all of cardiac cause (i.e= 11.5%). LVEF was the only independent predictive factor of morbid-motality.ConclusionThe epidemiologic profile of CHF in Tunisia had underwent a profound change during the late decade. The regression of rhumatic fever is unfortunately opposed by the high prevalence of diabetes mellitus and systemic hypertension in our population which explain this new profile tracing the european one.

IntroductionThe relationship between right ventricular function and severe tricuspid regurgitation is intricate: severe TR can lead to right ventricle dysfunction and changes in right ventricle morphology can aggravate a tricuspid regurgitation.AimEstablish a correlation between regional and global right ventricular (RV) function parameters and TR severity.MethodsForty consecutive patients with TR and left ventricle valve disease were enrolled prospectively (mean age: 54±16 years; 23 males), TR was evaluated according to EACVI recommendations by PISA method. Regional right systolic function assessed by tricuspid annular plane systolic excursion (TAPSE) and systolic tissue Doppler velocity measured at the lateral tricuspid annulus (S’) and global RV function assessed by fractional area change (FAC) were measured for all patients. Patients were divided into two groups according to the severity of TR.ResultsTen patients (25%) had severe TR (G1) and 30 patients (75%) had mild or moderate TR (G2). FAC was lower in G1 compared to G2 (24.7±7.4% vs 40.4±10.1%, p

Objective To determine the impact of obstructive sleep apnea (OSA) on left ventricle (LV) structure and function and to search for a relationship between systolic LV function and severity of OSA. Methods 40 subjects without any cardiac or pulmonary disease, referred for evaluation of OSA had overnight polysomnography and complete echocardiographic assessment with estimation of left ventricular myocardial performance index (MPI) by tissue Doppler method. According to apnea hypopnea index (AHI), subjects were divided into two groups: patients with moderate OSA (AHI=15-30/h, n=18), and patients with severe OSA (AHI ≥30/h, n=22). Results were compared using ANOVA. The correlation between OSA severity and these variables was determined with Pearson's correlation coefficient. Results There was no significant difference between the 2 groups in clinical data. Ventricular septal and posterior wall thicknesses, LV mass index and LV end-diastolic and end-systolic volume index were similar between the groups. Patients with severe OSA had shorter aortic ejection times (288±32 ms vs 267±23 ms; p=0.02, for severe and no severe OSA respectively) and a higher MPI (0.61±0.14 vs 0.50±0.17; p=0.036, respectively). A correlation was found between OSA severity and left MPI (r=0.36, p=0.019), and aortic ejection times (r=–0.28; p=0.046). Conclusions MPI of left ventricle and aortic ejection time are altered in severe OSA and are correlated to AHI severity.