K. Ben Hamda

Lipids and lipoprotein(a) concentrations in Tunisian type 2 diabetic patients: Relationship to glycemic control and coronary heart disease

The aim of this study was to evaluate plasma lipoprotein(a) [Lp(a)] concentrations in Tunisian patients with type 2 diabetes mellitus (DM), to correlate the values with other lipid parameters, and to examine the relationship to glycemic control and coronary heart disease (CHD). Diabetic patients with and without CHD (n=200) had significantly higher levels of Lp(a) (327.94+/-239.93 mg/l) and a greater proportion of elevated (>300 mg/l) Lp(a) concentrations (46%) compared with 100 healthy nondiabetic controls (269.83+/-225.6 mg/l, P<.01, and 26%, P<.01), while there were no statistically significant difference between diabetics without CHD (n=100) and controls. No significant association of Lp(a) with glycemic control (HbAlc or fasting blood glucose) was noted in diabetic patients. Positive correlations were observed between Lp(a) levels and total cholesterol and LDL-C in all diabetic patients and particularly in diabetic men. Male patients with CHD showed significantly higher plasma Lp(a) levels than those without CHD (P=.023), and 57.3% of patients with CHD showed increase (>300 mg/l) Lp(a) compared with 33.3% of patients without CHD. Elevated levels of Lp (a) and abnormal lipid profile in diabetic men suggest their involvement in atherogenesis and subsequent development of CHD.

Wide QRS in a 2-month infant associated with recurrent ventricular tachycardia: A case of Brugada-like syndrome

We report the case of a 2-month old infant who experienced recurrent sustained ventricular tachycardia (VT) in a structurally normal heart. Resting electrocardiogram (ECG) showed wide QRS with a complete right bundle branch bloc (RBBB) morphology. There was no family history of syncope or sudden death, but the ECGs of the father and the brother showed incomplete RBBB with negative T waves on V1 lead. This case seems to fit well with the newly defined entity of Brugada-like syndrome with a highly suspected genetic underlying disposition.

P-193: Impact of renal failure on in-hospital prognosis in patients with hypertension presenting with acute myocardial infarction: insights from a tunisian registry

BACKGOUND Patients with hypertension (HTN) presenting with acute myocardial infarction (AMI) are at high risk of major cardiac events in the hospital course. On the other hand, renal failure on admission (RF) is common in this population. We aimed to study the impact of renal failure on admission on in-hospital mortality in patients with HTN presenting with AMI. METHODS We reviewed data from a retrospective registry including 1498 patients presenting to our center for AMI from January 1998 to November 2014. Patients were managed either by primary percutaneous coronary intervention (pPCI), prehospital thrombolysis or conservative medical treatment. In-hospital prognosis was studied according to hypertensive status of patients and the impact of RF on mortality. RESULTS Out of the overall study population, 451 (30.1%) have hypertension and 288 (19.2%) have RF (plasma creatinin rate on admission more than 120μmol/L). Patients with HTN were older (65.9 vs. 58.1 years, p<0.001), and more likely to be female (50.2% vs. 24.4%, p<0.001) when compared with patients without HTN. Patients with HTN were also more likely to have diabetes mellitus (DM) (43.8% vs. 22.5%, p<0.001), hyperlipidemia (45.2% vs. 28.3%, p<0.001), prior history of coronary artery disease (35.8% vs. 30.3%, p=0.003) but less likely to be cigarette smokers (20.6% vs. 49.2%, p<0.001). In hypertensive patients, 101 (27.4%) were managed by pPCI and 150 (29.4%) were managed by prehospital thrombolysis. Plasma creatinin rate on admission was significantly higher in hypertensive patients (120±73μmol/ L vs. 99±37μmol/L in non-hypertensives, p<0.001) with more frequently RF (46.9% vs. 25.8% in non-HTN patients, p<0.001). In-hospital mortality rate was significantly higher in hypertensive patients (42.6% vs. 28.9%, p=0.001). In univariate analysis, factors associated with in-hospital death in HTN patients were age (70.3 vs. 65.2 years in non-HTN patients, p<0.001), female gender (p=0.04), history of DM (p=0.06), acute heart failure on admission (AHF) (p<0.0001) and RF (p<0.001). CONCLUSIONS In our study, in HTN patients presenting with AMI, renal failure on admission was common and associated with higher mortality rate.