Antonio Creta

Unexpectedly high rates of obesity and dysglycemia among villagers in Cameroon.

Our survey in Cameroon recorded obesity and dysglycemia in inhabitants, which are similar to those reported elsewhere in the region. Typically these metabolic disturbances are attributed to the adoption of a new urban lifestyle including diminished physical activity and an altered (‘Western’) diet. Unexpectedly we found that, like urban populations, our rural population had high rates of metabolic disturbances, despite living in villages and being physically active and consuming traditional diet that is high in plant sources of food and low in meat. From our preliminary study, we raise the possibility that the environmental elements that are driving the pandemic of obesity and diabetes in sub‐Saharan Africa are far more complex than heretofore appreciated. Copyright

Percutaneous Treatment of Recurrent In-Stent Restenosis of Carotid Artery Stenting: A Case Report and State-of-the-Art Review

Patient: Male, 76 Final Diagnosis: Carotid in-stent restenosis Symptoms: None Medication: — Clinical Procedure: Carotid Doppler ultrasound • carotid percutaneous angioplasty Specialty: Cardiology Objective: Unusual clinical course Background: Restenosis after carotid artery stenting (CAS) is a poorly described phenomenon. Studies have reported a variable incidence ranging from 4% to 19.7% at 1 year of follow-up. Doppler Ultrasound (DUS) is now routinely used in the follow-up after CAS and endarterectomy with optimal accuracy in detecting significant restenosis, compared to digital subtraction angiography (DSA). Case Report: We reported the case of a 76-year-old patient with evidence of recurrent severe in-stent restenosis (ISR) of the left internal carotid artery (ICA). In April 2007, due to evidence at DUS of severe left ICA disease, the patient underwent CAS. In January 2009, due to DUS evidence of severe ISR, the patient underwent balloon angioplasty. In September 2011, DUS showed a severe ISR with a peak systolic velocity (PSV) of 436 cm/s; in June 2012 angiography showed a sub-expanded stent in the middle medial side with severe ISR (70%). Multiple inflations were performed and a slight residual sub-expansion of the lateral side of the stent was observed. Post-procedural DUS showed a reduction of PSV to 283 cm/s and 266 cm/s at 1-month follow-up. An increasing value (322 cm/s) was noticed at 3-month follow-up DUS, while at 6-month follow-up DUS showed an important increase to 483 cm/s. Strict follow-up was adopted because of the patient’s refusal of further treatment. Conclusions: Criteria for diagnosis of restenosis are not well established. The optimal treatment is still debated and no indications have been established, due to the lack of sufficient data. Approaches to ISR include percutaneous transluminal angioplasty, cutting-balloon angioplasty (CB-PTA), stenting, and drug-eluting balloon (DEB) angioplasty. Several studies indicate that endovascular treatment, including balloon angioplasty and (CB-PTA) alone or in conjunction with stenting, is the preferred strategy.

Impact of the high-frequency cutoff of bandpass filtering on ECG quality and clinical interpretation: A comparison between 40 Hz and 150 Hz cutoff in a surgical preoperative adult outpatient population

BACKGROUND In 1990 the American Heart Association (AHA) established a standard 0.05 to 150Hz bandwidth for the routine recording of 12-lead electrocardiograms (ECGs). However, subsequent studies have indicated a very high prevalence of deviations from the recommended cutoffs. OBJECTIVE This prospective observational study investigates the impact of 40Hz compared to 150Hz high-frequency cutoffs on ECG quality and clinical interpretation in a single-center surgical outpatient population. METHODS 1582 consecutive adult patients underwent two standard 12-lead ECG tracings using different high-frequency cutoffs (40Hz and 150Hz). Two blinded cardiologists randomly reviewed and interpreted the recordings according to pre-defined parameters (PR and ST segment, Q and T wave abnormalities). An arbitrary score, ranging from 1 to 3, was established to evaluate the perceived quality of the recordings and the non-interpretable ECGs were noted. The tracings were then matched to compare interpretations between 40 and 150Hz filters. RESULTS A 40Hz high-frequency cutoff resulted in an increased rate of optimal quality ECGs compared to the 150Hz cutoff (93.4% vs 54.6%; p<0.001) and a lower rate of non-interpretable traces (0.25% vs 4.80%; p<0.001). Analyzing the morphologic parameters, no significant differences between the filter settings were found, except for a higher incidence of the J-point elevation in the 40Hz high-frequency cutoff (p=0.007) and a higher incidence of left ventricular hypertrophy in the 150Hz high-frequency cutoff (7.4% vs 5.4%, p<0.001). The latter was noted only in ECGs with borderline QRS amplitudes (between 3.3 and 3.7mV; p<0.001). CONCLUSION Despite current recommendations, the large deviation from standard high-frequency cutoff in clinical practice does not seem to significantly affect ECG clinical interpretation and a 40Hz high-frequency cutoff of the band-pass filtering may be acceptable in a low risk population, allowing for a better quality of tracings.

Congenital Absence of Left Atrial Appendage in a Patient with Intracranial Hemorrhage

Patient: Male, 78 Final Diagnosis: Congenital absence of left atrial appendage Symptoms: None Medication: — Clinical Procedure: Transesophageal echocardiography • Cardiac CT Specialty: Cardiology Objective: Rare disease Background: Intracranial hemorrhage is the most serious complication of anticoagulant therapy and is itself an absolute contraindication to further treatment. Case Report: We present the case of a 78-year-old patient with permanent atrial fibrillation and previous intracranial hemorrhage during oral anticoagulation therapy, who was a candidate for percutaneous closure of the left atrial appendage. Transesophageal echocardiography and computed tomography showed absence of the left atrial appendage. The patient continued with single antiplatelet therapy. Conclusions: Absence of the left atrial appendage is a very rare congenital condition usually found in patients scheduled for cardiovascular procedures and without clinical significance. The risk of thromboembolism is reasonably low but unknown.

ECG is an inefficient screening-tool for left ventricular hypertrophy in normotensive African children population

Background Left ventricular hypertrophy (LVH) is a marker of pediatric hypertension and predicts development of cardiovascular events. Electrocardiography (ECG) screening is used in pediatrics to detect LVH thanks to major accessibility, reproducibility and easy to use compared to transthoracic echocardiography (TTE), that remains the standard technique. Several diseases were previously investigated, but no data exists regarding our study population. The aim of our study was to evaluate the relationship between electrocardiographic and echocardiographic criteria of LVH in normotensive African children. Methods We studied 313 children (mean age 7,8 ± 3 yo), in north-Madagascar. They underwent ECG and TTE. Sokolow-Lyon index was calculated to identify ECG-LVH (>35 mm). Left ventricle mass (LVM) with TTE was calculated and indexed by height2.7 (LVMI2.7) and weight (LVMIw). We report the prevalence of TTE-LVH using three methods: (1) calculating percentiles age- and sex- specific with values >95th percentile identifying LVH; (2) LVMI2.7 >51 g/m2.7; (3) LVMIw >3.4 g/weight. Results 40 (13%) children showed LVMI values >95th percentile, 24 children (8%) an LVMI2.7 >51 g/m2.7 while 19 children (6%) an LVMIw >3.4 g/kg. LVH-ECG by Sokolow-Lyon index was present in five, three and three children respectively, with poor values of sensitivity (ranging from 13 to 16%), positive predictive value (from 11 to 18%) and high values of specificity (up to 92%). The effects of anthropometrics parameters on Sokolow-Lyon were analyzed and showed poor correlation. Conclusion ECG is a poor screening test for detecting LVH in children. In clinical practice, TTE remains the only tool to be used to exclude LVH.

Interrupted versus uninterrupted novel oral anticoagulant peri-implantation of cardiac device: A single-center randomized prospective pilot trial

Many patients requiring cardiac implantable electronic device (CIED) implantation are on long‐term oral anticoagulant therapy. While continuation of warfarin has been shown to be safe and reduce bleeding complications compared to interruption of warfarin therapy and heparin bridging, it is not known which novel oral anticoagulants (NOAC) regimen (interrupted vs uninterrupted) is better in this setting.

Catheter ablation for fascicular ventricular tachycardia: A systematic review

INTRODUCTION Catheter ablation has been evaluated as treatment for fascicular ventricular tachycardia (FVT) in several single-centre cohort studies, with variable results regarding efficacy and outcomes. METHODS A systematic search was performed on PubMed, EMBASE and Cochrane database (from inception to November 2017) that included studies on FVT catheter ablation. RESULTS Thirty-eight observational non-controlled case series comprising 953 patients with FVT undergoing catheter ablation were identified. Three studies were prospective and only 5 were multi-centre. Eight-hundred and eighty-four patients (94.2%) had left posterior FVT, 25 (3.4%) left anterior FVT and 30 (2.4%) other forms. In 331 patients (41%), ablation was performed in sinus rhythm (SR). The mean follow-up period was 41.4 ± 10.7 months. Relapse of FVT occurred in 100 patients (10.7%). Among the 79 patients (8.3%) requiring a further procedure after the index ablation, 19 (2%) had further FVT relapses. Studies in which ablation was performed in FVT had similar success rate after multiple procedures compared to ablation in SR only (95.1%, CI95% 92.2-97%, I2 = 0% versus 94.8%, CI95% 87.6-97.9%, I2 = 0%, respectively). Success rate was numerically lower in paediatric-only series compared to non-paediatric cases (90.0%, CI95% 82.1-94.6%, I2 = 0% versus 94.3%, CI95% 92.2-95.9%, I2 = 0%, respectively). CONCLUSION Data derived from observational non-controlled case series, with low-methodological quality, suggest that catheter ablation is a safe and effective treatment for FVT, with a 93.5% success rate after multiple procedures. Ablation during FVT represents the first-line and most commonly used approach; however, a strategy of mapping and ablation during SR displayed comparable procedural results to actively mapping patients in FVT and should therefore be considered in selected cases where FVT is not inducible.

Prevalence of Rheumatic Heart Disease in North Madagascar: An echocardiographic screening in young and adult populations

Background Rheumatic Heart Disease (RHD) prevalence in Madagascar is poorly known. Echocardiographic screening detects a higher prevalence of RHD than clinical examination. Aims We aimed to describe RHD prevalence in children and adults in North Madagascar using the most updated World Heart Federation (WHF) criteria for RHD echocardiographic diagnosis. Methods Children aged 5–19 years (Group One) and adults aged more than 20 years (Group Two) underwent a four-steps visit: clinical questionnaire, physical examination, laboratory test oropharyngeal swab for Group One and Antistreptolysin O (ASO) titre for Group Two and echocardiogram using a portable machine.. Results Among 859 people (522 in Group One, 337 in Group Two) RHD prevalence was 2.1 per cent. Group Two had a higher risk of having RHD than Group One (OR 4.39, CI 1.39–13.9, p=0.004), while clinical findings were more frequent in Group One (children had a higher risk of heart murmur (O.R. 3.85 C.I. 1.08–13.72; p=0.029)). RHD prevalence was 1.34 per cent in children. Those positive to oropharyngeal swab had a higher risk of RHD (OR 14.5, CI 3.04–69.44, p=0.0024); children with history of fever and sore-throat had a higher risk of positive oropharyngeal swab (OR 15.97, CI 3.14– 81.19, p=0.002). RHD prevalence was 3.3 per cent in adults. None of those had history of fever and throat-pain, positive ASO titre and cardiac murmur simultaneously. Conclusion This is the first study describing prevalence of RHD in Madagascar. Our results, although preliminary, are important to enhance prevention programs in this country.