Ayoub El Hammiri

Correlation between the plasma fibrinogen concentration and coronary heart disease severity in Moroccan patients with type 2 diabetes. Prospective study.

AIM The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients. METHODS Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 non diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4). RESULTS The average age was 59.58±7.88 years; female gender predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; with a significant difference between the four groups (P=0.001). The plasma fibrinogen concentration increased in parallel with the cardiovascular risk (P=0.0001); there was also a significant correlation between the plasma fibrinogen concentration and the clinical and para-clinical coronary disease severity (respectively P=0.005 and P=0.0001). A positive correlation between the plasma fibrinogen concentration and hyperglycemia (P=0.035) was found in G4. But no correlation with the lipids parameters, except for the low density-lipoproteins in G3 (P=0.035). CONCLUSION In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.

APPROPRIATENESS OF CORONARY ARTERY BYPASS GRAFTING BASED ON FRACTIONAL FLOW RESERVE LESIONS ASSESSMENT

Background: Fractional Flow Reserve (FFR) is currently validated as an important tool in the hemodynamic evaluation of coronary stenosis. Some studies reported that Coronary Artery Bypass Graft (CABG) on lesions with normal FFR arteries might result in early graft patency compromise. However, the

Cardiac consequence of misdiagnosed vascular complication of spinal lumbar surgery: 6 years of diagnosis delay

Ilio-caval fistula is a rare complication of lumbar disk surgery that may pose a real diagnostic challenge. We report a case of a 50-year-old woman with overlooked massive right ilio-caval fistula complicating lumbar surgery 6 years previously, and who presented with refractory right heart failure misdiagnosed as chronic pericarditis. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. <Learning objective: Ilio-caval fistula is a rare vascular complication of low lumbar disk surgery often overlooked, which explains the frequency of late discovery cases due to the semiological polymorphism of the presentation. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. The treatment could be based on surgery or endovascular intervention; the prognosis remains good in treated patients.>.

Congenital heart disease and Down syndrome : various aspects of a confirmed association

Summary Background Congenital heart disease (CHD) is frequently described in patients with Down syndrome (DS) and is the main cause of death in this population during the first two years of life. The spectrum of CHD patterns in DS varies widely worldwide; this variation could be due to sociodemographic, genetic and geographic factors. Methods A six-year retrospective, descriptive study was carried out from December 2008 to October 2014, based on the Paediatric Unit CHD registry of Ibn Rochd University Hospital. Clinical, echocardiographic and outcomes data were collected and sorted according to confirmation of the syndrome. Results Among 2 156 patients with CHD, 128 were identified with Down syndrome. The genders were equally represented (gender ratio 1) and the median age at diagnosis was 9.5 months (2 days to 16 years). The median age of mothers at delivery was 39 years (16–47). Of the 186 CHD lesions reported, the most common was atrioventricular septal defect (AVSD, 29%), followed by ventricular septal defect (VSD,21.5%) and atrial septal defect (ASD, 19.9%). The most common associations of CHD were AVSD + ASD (10%) and VSD + ASD (7.8%). Surgery was the most common modality of treatment (54.3%). The overall mortality rate was 14.1%. Conclusion Our study confirmed that the profile and type of CHD in DS in the Moroccan setting exhibited slight differences in the distribution of these CHDs compared with European neighbours and other Western countries. Further studies are needed to determine which variables have an impact on these differences.BACKGROUND Congenital heart disease (CHD) is frequently described in patients with Down syndrome (DS) and is the main cause of death in this population during the first two years of life. The spectrum of CHD patterns in DS varies widely worldwide; this variation could be due to sociodemographic, genetic and geographic factors. METHODS A six-year retrospective, descriptive study was carried out from December 2008 to October 2014, based on the Paediatric Unit CHD registry of Ibn Rochd University Hospital. Clinical, echocardiographic and outcomes data were collected and sorted according to confirmation of the syndrome. RESULTS Among 2 156 patients with CHD, 128 were identified with Down syndrome. The genders were equally represented (gender ratio 1) and the median age at diagnosis was 9.5 months (2 days to 16 years). The median age of mothers at delivery was 39 years (16-47). Of the 186 CHD lesions reported, the most common was atrioventricular septal defect (AVSD, 29%), followed by ventricular septal defect (VSD, 21.5%) and atrial septal defect (ASD, 19.9%). The most common associations of CHD were AVSD + ASD (10%) and VSD + ASD (7.8%). Surgery was the most common modality of treatment (54.3%). The overall mortality rate was 14.1%. CONCLUSION Our study confirmed that the profile and type of CHD in DS in the Moroccan setting exhibited slight differences in the distribution of these CHDs compared with European neighbours and other Western countries. Further studies are needed to determine which variables have an impact on these differences.

Facteurs prédictifs de l’adhésion médicamenteuse chez les patients en insuffisance cardiaque chronique: expérience marocaine

Medication adherence in patients with chronic heart failure is recognized as one of the major issues in the management of this pathology. Demographic status and socioeconomic conditions in African countries may have an impact on chronic heart failure treatment adherence. We conducted a cross-sectional study of patients with heart failure treated in the center of heart failure in the Department of Cardiology at the IBN ROCHD University Hospital (Morocco) from September 2014 to January 2015. The extent of medication adherence was based on a questionary: CARDIA-Questionary. The informations related to predictive factors of medication adherence were derived from the multidimensional adherence model. 147 patients with chronic heart failure were included in the study. Medication adherence rate was 83.6%, according to CARDIA-Questionary. Predictive factors that significantly influenced medication adherence were: depression (p=0.034), level of social support (p=0.03) and patient self administration of the drugs (p=0.0001). Medication adherence in patients with chronic heart failure is a health problem in Morocco as well as in several world regions. Strategies affecting predictive factors might improve medication adherence.

Epidémiologie de l’association fibrillation atriale et insuffisance cardiaque

Atrial fibrillation and heart failure are diseases which often coexist aggravating prognosis and constituting a major public health problem. The aim of this study was to assess the prevalence of atrial fibrillation in patients with chronic heart failure and to determine the clinical profile of this group of patients. We conducted a retrospective descriptive study based on the registry of heart failure of the Department of Cardiology at the University Hospital Centre from June 2006 to March 2015. All patients over 18 years of age with chronic heart failure associated with atrial fibrillation were included in the study. During the study period 3048 patients with chronic heart failure associated with atrial fibrillation (AF) were enrolled. The prevalence of heart failure was 10.6%. The frequency of cardiovascular risk factors associated with (AF) was: (54%) hypertension, (39%) diabetes, (8%) dyslipidemia, (26%) tobacco, (30%) sedentary lifestyle and (17%) menopause. FA affected 67.4% of men and 32.6% of women. The causes of chronic heart failure associated with atrial fibrillation were: heart valve diseases (44;1%); coronary artery diseases (32%); hypertensive (11%), primary (10%), toxic (2%) and chronic alcoholism (1%). Atrial fibrillation frequently appears in patients with heart failure in Morocco and it occurs at an average age lower than that found in the literature.

Valve-in-Valve Implantation of a Sapien 3 Transcatheter Heart Valve for Reduction of Paravalvular Regurgitation Despite Optimal Placement of the First Transcatheter Heart Valve

Valve-in-valve implantation is generally successful in reducing paravalvular regurgitation (PVR) in cases in which the first transcatheter heart valve is deployed in a suboptimal location. We describe a case of severe PVR 2 months after implantation of a 26-mm Sapien XT valve (Edwards Lifesciences Inc, Irvine, CA) in the optimal location. Valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences Inc), and enough left ventricular outflow tract tissue at the inflow edge the Sapien XT to appose the sealing cuff of the Sapien 3 combined for successful PVR treatment. To our knowledge, this is the first case of PVR reduction with valve-in-valve despite the original valve being appropriately sized and placed.

TCT-619 Periprocedural Intracardiac Echocardiography from the Left Atrium for Left Atrial Appendage Occlusion with the Amplatzer Cardiac PlugTM

RESULTS Over a lifetime, LAAC provided an additional 0.35 life years (LY) and 0.52 QALYs relative to warfarin and an additional 0.17 LYs and 0.23 QALYs relative to NOACs. LAAC was dominant (more effective and less costly) relative to warfarin and NOACs. NOACs were cost effective but not cost saving relative to warfarin. In sensitivity analyses, LAAC was cost effective in 97% and 90% of simulations relative to warfarin and NOACs, respectively.

TCT-689 Tailored Therapy in TAVI: Outcomes of a Device Selection Algorithm based on the Presence of Risk Factors for Paravalvular Regurgitation

Paravalvular regurgitation (PVR) negatively impacts prognosis after TAVI. Risk factors associated with PVR include eccentric shape of annulus, non-symmetric distribution of calcification and lack of oversizing. New generation transcatheter heart valves (THV) designed for PVR reduction has

Spectrum of cardiac lesions associated with Isolated Cleft Mitral Valve and their impact on therapeutic choices.

Background Isolated cleft mitral valve (ICMV) may occur alone or in association with other congenital heart lesions. The aim of this study was to describe the profile of cardiac lesions associated with ICMV and their potential impact on therapeutic management. Methods We conducted a descriptive study with data retrieved from the Congenital Heart Disease (CHD) single-center registry of our institution, including patients with ICMV registered between December 2008 and November 2014. Results Among 2177 patients retrieved from the CHD registry, 22 (1%) had ICMV. Median age at diagnosis was 5 years (6 days to 36 years). Nine patients (40.9%) had Down syndrome. Seventeen patients (77.3%) had associated lesions, including 11 (64.7%) with accessory chordae in the left ventricular outflow tract (LVOT) with no obstruction, 15 (88.2%) had ventricular septal defect (VSD), three had secundum atrial septal defect, and four had patent ductus arteriosus. Thirteen patients (59.1%) required surgical repair. The decision to proceed with surgery was mainly based on the severity of the associated lesion in eight patients (61.5%) and on the severity of the mitral regurgitation in four patients (30.8%). In one patient, surgery was decided based on the severity of both the associated lesion and mitral regurgitation. Conclusion Our study shows that ICMV is rare and strongly associated with Down syndrome. The most common associated cardiac abnormalities were VSD and accessory chordae in the LVOT. We conclude that cardiac lesions associated with ICMV are of major interest, since in this study patients with cardiac lesions were diagnosed earlier. The decision to operate on these patients must take into account the severity of both mitral regurgitation and associated cardiac lesions.