Wiem Selmi

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.

045: Is there a protective effect of statins in contrast-induced nephropathy after coronary angiography?

Background Contrast-induced nephropathy (CIN) is a frequent complication after coronary angiography. In the exclusion of saline hydration, the effectiveness of other means of prevention remains unclear, and almost poor. Because of its pleotropic effects, statins have been used in CIN prevention, but data remains controversial. Objective To evaluate the benefit of statins in the prevention of CIN after coronary angiography. Methods We used the database of a randomized controlled trial conducted in our department during the period March to November 2010 to study the effectiveness of ascorbic acid in the prevention of CIN. Patients undergoing coronary angiography were randomly assigned to a saline hydration prevention protocol or a saline hydration associated to ascorbic acid protocol. The primary endpoint was the occurrence of CIN defined as a creatinin arise of more than 25% the baseline level during the following 48 to 72 hours. The relationship between statin intake at baseline and CIN incidence was retrospectively evaluated using a Chi-square test. Results Among the 202 patients included, 126 (62.3%) were treated with statins. There was no significant difference between the two groups concerning the baseline characteristics, particularly in ascorbic acid treatment (p=0.94). CIN incidence dropped from 20.8% in the patients not taking statins to 11.7% in those treated with statins. This resulted in a tendency (p=0.08) but difference wasn’t statistically significant, probably due to the small sample of the population. Conclusion In our study, treatment with statins led to a trend to reduce CIN incidence. The small sample of the population couldn’t allow stronger conclusion. Statins seem to be promising but larger trials are needed.

086: Acute heart failure: Characteristics and predictors of six months mortality

Aim Heart failure is known to be a major cause of morbidity and mortality in developed countries. The number of Tunisians suffering from acute heart failure (AHF) is increasing, but only little is known about the prognosis and possible risk factors for a fatal outcome in our population. The aim of our study is to describe patients with AHF with regard to clinical presentation and mortality at 6 months. Method and results We conducted a retrospective study including 234 patients from a Tunisian center hospitalized with AHF. Our study populations average age was 65±13.8, 56% were male. Hypertension was noted in 60.3% of the cases, diabetes in 51.7% and 69.7% of the patients had new-onset heart failure. Ischemic etiology was noted in 48.7% of cases followed by hypertensive, dilated cardiomyopathy and valvular cardiopathy observed respectively in 21.4%, 14.5%, and 11.1% of cases. Left ventricular ejection fraction (LVEF) was reported in 97% of our population. 46.6% of these had preserved systolic function (LVEF > 45%) and 17.2% had a LVEF At six months 25 patients (11.2%) died. We identified several clinical and biochemical prognostic risk factors in univariate analysis. Independent predictors of 6 months mortality were QRS width ≥130 ms (adjusted HR, 6.15; 95% CI, 1.25-30.15;p=0.025), hyperglycemia at admission (adjusted HR, 1.32; 95% CI, 1.12-1.56;p=0.001), high serum level of glycated hemoglobin (adjusted HR, 0.49; 95% CI, 0.39-0.67; p Conclusion We present the characteristics and prognosis of our population of AHF patients. Six months mortality is relatively high, and independent clinical risk factors include wide QRS, hyperglycemia at admission, poorly controlled diabetes, worsening of renal function during hospitalization and the non-use beta-blockers at discharge.

042: Real life dual antiplatelet therapy after NSTE-ACS in a Tunisian population: is there a need for 12 months of treatment?

Aim Even if the recommended duration for dual antiplatelet therapy (DAT) after non ST elevation acute coronary syndromes (NSTE-ACS) is 12 months, evidence concerning the benefit of clopidogrel adjunction especially beyond 3 months remains poor. The aim of the study was to assess the effective clopidogrel intake and the incidence of a composite endpoint including all causes death and non fatal myocardial infarction in a Tunisian population after NSTE-ACS. Methods We included patients admitted for NSTE-ACS in our department between January 2010 and August 2011 for whom long term evaluation was possible. In-hospital deaths were excluded (including post operative deaths). By telephone follow up, we evaluated the effective DAT duration and the occurrence of all causes death and non-fatal myocardial infarction. Results One hundred thirty patients were included. Mean (SD) follow up was 261 (99) days. DAT was effectively observed during 94(103 days (extremes ranging from 0 to 360 days). Angioplasty was performed in 51.5%, coronary artery bypass graft in 8.4% and medical therapy was considered in 40.1%. In 35 (26.9%) patients, aspirin was the only antiplatelet therapy taken after discharge although DAT was prescribed; 46.9% of the patients took the DAT for more than 3 months, and 23.1% for more than 6 months. The composite endpoint occurred in 6 (4.6%) patients: 2 deaths (both of cardiac causes) and 4 myocardial infarctions. Three of them were under DAT, and the 3 others remained event free during 7, 240 and 270 days after clopidogrel withdrawal. These findings suggest that DAT does not protect against death or myocardial infarction. The rebound phenomenon after clopidogrel withdrawal isn’t patent in our population. Conclusion In the Tunisian context, DAT observance is poor after NSTE-ACS. Death and non fatal myocardial infarction don’t seem to be reduced by DAT and the rebound phenomenon after clopidogrel withdrawal isn’t patent. This may be in part attributed to the small sample of population and the predominantly low risk (as assessed by TIMI risk score), but larger studies are needed to strengthen the evidence for DAT after NSTE-ACS.

047 What are the predictors of not receiving a reperfusion therapy in STEMI patients

The proportion of pts receiving a reperfusion therapy was fluctuating but relatively stable during the last 16 years ranging from 45.2% in 1995 to 58.2% in 2010 with a peak of 74.2% in 2001. From 1995 to 2000, reperfusion was almost exclusively performed by thrombolysis whereas a dramatic increase of the use of PAMI was observed between 2000 and 2005 followed by a decrease in favor of the use of thrombolysis during the following 5 years probably due to an increase of the use of prehospital thrombolysis that ranged from14.3% in 2001 to 84% in 2009 among the thrombolysed pts.