Mohamed Ali Azaiez

Clinical features and prognosis of infective endocarditis in children: Insights from a Tunisian multicentre registry

BACKGROUND Infective endocarditis (IE) is a rare condition in the paediatric setting. No data on the epidemiology and prognosis of IE in children are available from North African countries. AIM To investigate the epidemiological profile and prognosis of IE in children in Tunisia. METHODS All patients aged≤18 years presenting with IE in three Tunisian tertiary care centres between January 1997 and September 2013 were included. Clinical features and 30-day and 6-month mortality rates were studied. Factors predictive of death at 6-month follow-up were determined. RESULTS A total of 73 patients were included in the present study. The mean age was 12±4.8 years; 35 (50.7%) patients were male. Rheumatic heart disease (RHD) was the underlying heart disease in 17 (23.3%) cases and IE occurred in a structurally normal heart in 36 (49.3%) cases. Staphylococcus species were isolated in 17 (23.3%) cases. Regarding IE localization, the mitral valve was involved in 28 (38.4%) cases and the aortic valve in 14 (19.2%) cases. Recourse to surgery was reported in 37 (50.7%) cases. Thirty-day and 6-month mortality rates were 13.6% and 19.2%, respectively. Heart failure on admission or during the hospital course, acute renal failure and neurological complications were significantly associated with death at 6-month follow-up in the univariate analysis and after adjustment for age and sex. CONCLUSIONS In the Tunisian context, IE in children is still characterized by the high prevalence of RHD as an underlying heart disease. Short- and long-term mortality rates remain high. Heart failure, acute renal failure and neurological complications are significantly associated with death at 6-month follow-up.

Risk profile and in-hospital prognosis in elderly patients presenting for acute ST-elevation myocardial infarction in the Tunisian context

Objectives Little is known about the risk profile and in-hospital prognosis of elderly patients presenting for ST-elevation myocardial infarction (STEMI) in Tunisia. We sought to determine in-hospital prognosis of elderly patients with STEMI in a Tunisian center. Methods The study was carried out on a retrospective registry enrolling 1403 patients presenting with STEMI in a Tunisian center between January 1998 and January 2013. Patients ≥75 years old were considered elderly. Risk factors and in-hospital prognosis were compared between elderly and younger patients, and then predictive factors of in-hospital death were determined in elderly patients. Results Out of the overall population, 211 (15%) were part of the elderly group. Compared to younger patients, elderly patients were more likely to have arterial hypertension but less likely to be smokers and obese. Thrombolysis was significantly less utilized in the elderly group (22.3% vs. 36.6% in the younger group, p < 0.001), whereas the use primary percutaneous coronary intervention was comparable between the two sub-groups (24.2% vs. 28.8%, p = 0.17). The incidence of in-hospital complications was higher in the elderly group, and so was the in-hospital mortality rate (14.2% vs. 8.1%, p = 0.005). Heart failure on-admission, renal failure on-admission, and inotropic agents use were independently associated to in-hospital death in the elderly group. Conclusions In the Tunisian context, elderly patients presenting with STEMI have higher prevalence of risk factors and a worse in-hospital course in comparison to younger patients. Clinical presentation on-admission has a strong impact on in-hospital prognosis.

Prognostic value of hyperglycemia on-admission in diabetic versus non-diabetic patients presenting for ST-elevation myocardial infarction in Tunisia

Background Hyperglycemia on-admission is a powerful predictor of adverse events in patients presenting for ST-elevation myocardial infarction (STEMI). Aim In this study, we sought to determine the prognostic value of hyperglycemia on-admission in Tunisian patients presenting with STEMI according to their diabetic status. Methods Patients presenting to our center between January 1998 and September 2014 were enrolled. Hyperglycemia was defined as a glucose level ≥11 mmol/L. In-hospital prognosis was studied in diabetic and non-diabetic patients. The predictive value for mortality of glycemia level on-admission was assessed by mean of the area under receiver operating characteristic (ROC) curve calculation. Results A total of 1289 patients were included. Mean age was 60.39 ± 12.8 years and 977 (77.3%) patients were male. Prevalence of diabetes mellitus was 70.2% and 15.2% in patients presenting with and without hyperglycemia, respectively (p < 0.001). In univariate analysis, hyperglycemia was associated to in-hospital death in diabetic (OR: 8.85, 95% CI: 2.11–37.12, p < 0.001) and non-diabetic patients (OR: 2.57, 95% CI: 1.39–4.74, p = 0.002). In multivariate analysis, hyperglycemia was independently predictive of in-hospital death in diabetic patients (OR: 9.6, 95% CI: 2.18–42.22, p = 0.003) but not in non-diabetic patients (OR: 1.93, 95% CI: 0.97–3.86, p = 0.06). Area under ROC curve of glycemia as a predictor of in-hospital death was 0.792 in diabetic and 0.676 in non-diabetic patients. Conclusion In patients presenting with STEMI, hyperglycemia was associated to hospital death in diabetic and non-diabetic patients in univariate analysis. In multivariate analysis, hyperglycemia was independently associated to in-hospital death in diabetic but not in non-diabetic patients.

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.

Prevalence and prognostic significance of anemia in patients presenting for ST-elevation myocardial infarction in a Tunisian center

Background Anemia on admission is a powerful predictor of major cardiovascular events in patients presenting for acute coronary syndromes. We sought to determine the prevalence and prognostic impact of anemia in patients presenting for ST-elevation myocardial infarction (STEMI). Methods We analyzed data from a Tunisian retrospective single center STEMI registry. Patients were enrolled between January 1998 and October 2014. Anemic and nonanemic patients were compared for clinical and prognostic features and according to four prespecified hemoglobin level subgroups. In patients with severe anemia, factors associated with in-hospital death were studied. Results A total of 1498 patients were enrolled. Mean age was 60.47 ± 12.7 years and prevalence of anemia was 36.6%. Anemic patients were more likely to be elderly, hypertensive, and diabetic in comparison to nonanemic patients. In-hospital mortality was significantly higher in anemic patients (14.9% vs. 5%, p < 0.001). Lower hemoglobin levels were significantly associated with a higher prevalence of heart failure on admission, cardiogenic shock, and in-hospital mortality (p < 0.001 for all). In univariate analysis, factors associated with in-hospital death in patients with severe anemia were hypertension (p = 0.044), heart failure on admission (p < 0.001), renal failure on admission (p < 0.001), and primary percutaneous coronary intervention (pPCI) use (p = 0.016). The absence of pPCI use was independently associated with in-hospital death in multivariate analysis (odds ratio = 2.22, 95% confidence interval: 1.07–4.76, p = 0.033). Conclusion According to this study, anemic patients presenting for STEMI have a higher in-hospital mortality rate. The absence of pPCI use was independently associated with in-hospital death.

0105: Prognostic value of anemia in patients hospitalized for acute heart failure

Purpose The purpose of our study is to investigate the presence of anemia among patients admitted for acute heart failure and to evaluate its short and medium term prognostic value. Methods This is a retrospective study of 234 patients admitted in the cardiology department of Fattouma Bourguiba Monastir hospital between January 2010 and March 2011. Anemia was defined according to the criteria of the World Health Organization (WHO): Haemoglobin Results The mean hemoglobin (Hb) was 12.1±2.26g / dl. The prevalence of anemia in our population is 55.6% (N=130 cases). A significantly higher frequency of anemia is found among subjects older than 75 years (71.18% vs 50.28%, P=0.005), patients with impaired renal function (72.46% vs 48.48%, p=0.001) and among those who had shown signs of right heart failure (72.18% vs. 48.48%, p=0.001) whereas no statistically significant difference was found among hypertensive diabetics or those with impaired LVEF. 17 of our patients died during hospitalization. 10 Among these patients had anemia. The relative increase in hospital mortality in anemic patients was not significant. Nevertheless, the rate of rehospitalization during follow-up of 6 months and the rate of mortality at 6 months were significantly higher in patients who had anemia; Respectively 14.28% vs 3.68%, p=0.001 and 7.83% vs 3.68% p=0.019. Conclusion Anemia is frequent in patients admitted for acute heart failure and seems to be related to an increase in readmission and mortality at 6 months in our study.

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.