N. Larbi

Design and Rationale of the National Tunisian Registry of Atrial Fibrillation: Protocol for a Prospective, Multicenter Trial

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

Two-dimensional speckle-tracking echocardiography and QRS fragmentation inpatients with extracardiac sarcoidosis with preserved left ventricle ejection fraction

Purpose We investigated the prevalence of LV strain impairment as estimated by 2D speckle-tracking imaging, Late potentials on signal averaged ECG (SAECG) and QRS fragmentation inpatients with diagnosed sarcoidosis without cardiac involvement according to the current guidelines. Methods and results Thirty-three patients with biopsy-proven extracardiac sarcoidosis were analyzed. We performed a prospective case–control longitudinal study including 33 patients with diagnosed extracardiac sarcoidosis and normal cardiac function as assessed by standard transthoracic echocardiography and 33 healthy age- and gender-matched controls. All patients underwent a twelve lead ECG and comprehensive echocardiographic study. Mean age of patients was 45.9xa0±xa013.4 years old (32 women). Compared with controls, global LV longitudinal strain (LV GLS) was reduced in sarcoidosis patients: (−18.2xa0±xa02.5 vs −22.4xa0±xa01.7%, Pxa0 Conclusion Speckle-tracking echocardiography revealed decreased longitudinal LV strain in extracardiac sarcoidosis patients. QRS fragmentation was also frequently identified in this population. QRS fragmentation and LV GLS may represent an early marker of myocardial involvement in extracardiac sarcoidosis patients and should be integrated in a more sensitive and simple diagnostic algorithm criterion.

0511: Intraventricular delay and cardiac dysfunction in patients with myocardial infarction

In the acute phase of myocardial infarction (AMI), ischemic phenomena may affect the strength and timing of myocardial contraction. Purpose To correlate intraventricular delays to systolic, diastolic and performance parameters of the left ventricle (LV) and to heart failure occurrence in AMI patients. Methods A total of 372 consecutive patients (mean age: 61.6±12.4 years) who presented with an AMI were prospectively enrolled. Echocardiographic evaluation was carried out within 24-36 hours. Six basal LV segments were explored by pulsed tissue Doppler imaging (TDI) for electromechanical delays. Intraventricular mechanical delay (IMD) was then calculated from the difference between the earliest and most delayed sites. Correlations were assessed by the nonparametric Spearman rho test, and means were compared using Kruskall-Wallis and Mann-Whitney tests were used for correlations and Results The IMD (30.3ms±13.72ms) was not correlated to the location and extent of the AMI. The IMD was correlated to the cardiac output (Rho=-0.27, p=0.003) and to the mitral annular systolic velocity (lateral: Rho=0.18, p=0.027 and septal: Rho=-0.37, p 42.5ms had a higher rate of in-hospital heart failure (35.0% versus 4.7%, p Conclusion acute dyssynchrony in patients with AMI could be a marker or a factor of cardiac dysfunction.

121: Left ventricular diastolic function evaluation by left atrial volume and myocardial performance index in patients with acute myocardial infarction

Background Both left atrial volume index (LAVI) and myocardial performance index (MPI) were proved to be reliable parameters of left ventricular (LV) diastolic function. Aim We aimed to assess their usefulness in the setting of acute myocardial infarction (AMI) in comparison with conventional diastolic parameters Methods A cohort of three hundred and sixty patients with AMI (72% with ST segment elevation) with a mean age of 61.6 ±12.4 years (79% males; 39% diabetics) was enrolled. Patients with atrial fibrillation or conduction abnormalities were excluded from the study. All patients had a conventional and Doppler echocardiography assessment 24 to 36 hours after admission coupled with a measurement of LAVI and MPI index by conventional Doppler method (MPI1), tissue Doppler method at the lateral side of the mitral annulus (MPI2) and at its medial side (MPI3). Correlation between parameters was evaluated by Pearson coefficient (r). Results The three MPI indexes were significantly correlated to these parameters of LV diastolic function: The early diastolic tissue velocities at the lateral side of the mitral annulus (Ea l) (r1=−0.31, r2=−0.36, r3=−0.46, p LVAI was not correlated to MPI (r1=0.14, r2=0.11, r3=0.11, p>0.05) and it was only correlated with the early diastolic tissue velocity at the medial side of the mitral annulus (Ea s) (r=−0.18, p Conclusion While myocardial performance conventional and tissue indexes are strongly correlated with diastolic LV function in the acute phase of myocardial infarction, left atrial volume index seems be not sensitive to acute but only chronic alterations of this function.