[Echocardiographic risk score after acute coronary syndrome]

AIMS

Identify the predective echocardiographic parameters of major cardiovascular events (death, ischemic recurrence, heart failure and rehospitalization) in-hospital and after six months of follow-up and to establish an echocardiographic prognostic score and to evaluate its prognostic value alone or in association with clinical risk scores.

METHODS

We recruited 302 patients in intensive care unit of cardiology for ACS consecutively on admission, patients were assessed by clinical risk scores (GRACE, TIMI, CRUSADE) and resting doppler echocardiography, a follow-up of six months.

RESULTS

The echocardiographic risk score has four variables: LV-EF (RR=0.931; 95%CI=0.885-0.979, P<0.01), RV-AF (RR=0.951; 95%CI=0.903-0.999, P<0.05), iMAE-M-strain (RR=1.226; 95%CI=1.081-1.390, P<0.01) and ULCs (RR=1.151; 95%CI=1.081-1.224, P<0.01). Its discrimination capacity (AUC=0.85), greater than that of the clinical risk scores, (GRACE: AUC=0.72, TIMI: AUC=0.71 and CRUSADE: AUC=0.76).

DISCUSSION

The risk stratification can be achieved using echocardiographic score easy to acquire and interpret in the clinical setting, with a stratification power higher than the clinical risk scores. The iconoclinical model makes it possible to select a group of heterogeneous patients by their clinical presentations and iconographic data at high risk but with an echoscore or clinical score weak or intermediate.

CONCLUSION

The developed echocardiographic model could prove very useful in the decision-making process and optimization of the therapeutic strategy in some high-risk patients with acute coronary syndromes following an invasive strategy. It is appropriate for expert interpretation, yet relatively simple because it contains only four simple echocardiographic variables as predictors.

Exceptional association of Budd-Chiari syndrome with pheochromocytoma

We are reporting a case revealed by an abdomino-thoracic painful syndrome associated with multi-organ failure. A 61-year-old hypertensive woman was hospitalized for the management of hypertensive emergency associating acute coronary syndrome and abdominal pain. A thoraco-abdomino-pelvic CT-scan showed a right adrenal mass associated with hepatic vein thrombosis. After medical preparation, an adrenalectomy was performed by way of open surgery; the study of the surgical specimen found a pheochromocytoma score PASS 4. The follow-up was marked by the normalization of blood pressure and biological abnormalities.

Ductus diverticulum associated with Takayasu disease and incidental finding of Wolff Parkinson White syndrome

Ductus diverticulum is either a remnant of the ductus arteriosus or the right dorsal aortic root. The most common diagnosis is the differentiation of an aortic isthmus pseudoaneurysm from a type III ductal diverticulum. Both aortic entities occur at roughly the same anatomical location often leading to diagnostic confusion. Aortic dissection should be considered if it is Takayasu's disease. We are reporting the case of a 31-year-old woman with chest pain and muscle weakness, functional impotence of the left upper limb with intermittent palpitations. Thoraco-abdominal CT angiography was in favor of inflammatory arteritis of the thoraco-abdominal aorta, common carotids and the left subclavian artery. Sub-occlusive stenosis of the left axillary artery was noted, in favor of Takayasu disease. There was an aspect of aortic ductus diverticulum type III, 24mm from the emergence of the subclavian artery simulating aortic dissection or ulceration of the aortic isthmus. An electrocardiogram revealed Wolff Parkinson White syndrome with left lateral Kent. There was good clinical outcome after immunosuppressive drugs and antiarrhythmic therapy.

Impact of polyvascular disease on the prognosis of acute coronary syndrome

 

The polyvascular disease reflects a diffuse atherosclerotic disease. By a prospective and descriptive study, recruiting three hundred thirty-six inpatient coronary care unit for acute coronary syndrome, the aim is to estimate the prevalence, to identify predictors factors and to assess the impact of the polyvascular disease in term of mortality and cardiovascular events (MACE 4points) at one, six and twelve months after discharge.

The polyvascular disease is defined by the presence of cerebrovascular disease or peripheral artery disease. The cerebrovascular disease is defined in patients with documented stroke or carotid stenosis assessed by ultrasound; the peripheral artery disease is defined by an anchle brachial index (ABI) inferior to 0.9.

The prevalence of polyvascular disease in patients with acute coronary syndrome (Men = 69,0%; mean age = 63,3y) is 28.9%. In our study population, 20.8% have cerebrovascular disease. A significant carotid stenosis is seen in 57 patients (16,7%), half of which have bilateral stenosis. 16.1% of patients have a peripheral artery disease. an ABI less than 0.45 is found in 7 patients (2,1%). 1.8% of patients have abdominal aortic aneurysm.

Many factors statistically associated with the polyvascular disease are identified. High blood pressure, thinness, advanced age, prolonged smoking and diabetes are the most powerful predictors. On admission, the polyvascular patients have more likely a KILLIP than or equal to two, anemia and kidney failure. They have an ejection fraction of the left ventricle lower than patients with only coronary artery disease. Their coronary artery disease appears more severe and extensive in coronary angiography.

Polyvascular disease appears as an independent and powerful predictor of mortality and cardiovascular events in the short and medium term in patients with acute coronary syndrome. The hazard ratio of polyvascular disease mortality at day 30, 6 months and 12 months of hospitalization are respectively 6.16, 4.44 and 5.91. The hazard ratio for disease polyvascular for cardiovascular events at 6 months and 12 months of hospitalization are 2.79 and 2.90 respectively.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): University hospital of Bab ElOued AlgiersUniversity hospital of Douéra Algiers

Lung comets ultrasound and prediction of one year mortality and chronic ischemic heart faillure

Background

Lung ultrasound can be used to assess pulmonary congestion by imaging B-lines for patients with heart failure after acute coronary syndromes, it is a major risk marker for morbidity and mortality.

Purpose

The objective of the study is to determine the role of pulmonary B lines in the acute phase of acute coronary syndromes in the prediction of the risk of mortality and chronic ischemic heart failure after 1 year of discharge

Methods

We conducted a prospective monocentric follow-up study with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 with acute coronary syndromes. 304 consecutive patients underwent clinical examination, echocardiography, and lung ultrasound in the acute phase, independently of, and in addition to routine management by the attending physicians.

Results

We find in the general population, Killip stage ≥ II in 22.4% of patients, the median B-line count was 5 (0–16).In patients with ≥30 B-lines; we have 17.8% STEMI, 12.7% NSTEMI and 9.3% unstable angina, twelve-month event-free survival for the primary endpoint (all-cause death or heart faillure) was 31.7% in patients with ≥30 B-lines and 68.3% in those with &lt;30 B-lines (P&lt;0.0001), 33.5% of the general population have signs of chronic ischemic heart failure after one year of follow-up, 22.5% with HFpEF and 78.5% with HFrEF, B-lines ≥16 in 58.7% patients with HFrEF and 17.4% with HFpEF, Pulmonary ultrasound B-lines in admission are an independent risk factor for all-cause mortality and chronic ischemic heart failure after 1 year of acute coronary syndrome (HR 1.80; IC 95%=1.48–2.18, p&lt;0.001), Pulmonary comets are also an independent predictor of chronic ischemic HFrEF risk (HR 1.62; IC 95%=1.26–2.07, p&lt;0.001) and of chronic ischemic HFpEF (HR 1.54; IC 95%=1.01–2.37, p=0.04).

Discussion

With respect to B-line assessment as a prognostic tool at discharge in chronic ischemic HF patients, evidence is scarce, some studies reported that B-lines were associated with a two-fold increase in the rate of death, myocardial infarction, or HF hospitalisation at follow-up. However, in other study the B lines are part of the evaluation variables of an echocardiographic prognostic score as in the Bedetti series, their application as a simple prognostic tool for evaluation is an important contribution to guide management.

Conclusion

Ultrasonic pulmonary comets are a strong predictor of the residual risk of mortality and chronic ischemic heart failure and allowing a significant prognosis reclassification. Multicenter studies evaluating whether this tool could ultimately guide therapy optimization are warranted.

Funding Acknowledgement

Type of funding sources: None.

Increased arterial stiffness in Crohn's disease: Prevalence, associated factors and impact of anti-TNF therapy

INTRODUCTION

Recent studies have demonstrated the growing interest in cardiovascular risk in Crohn's disease (CD), the aim of our work is to highlight the need for research into the frequency of arterial stiffness (AS) and its link with certain associated factors, particularly those related to inflammation.

MATERIALS AND METHODS

This was a cross-sectional observational study involving 118 patients with CD. Pulse wave velocity (PWV) measured by applanation tonometry was the criterion for calculating AS, the study also investigated the association of AS especially the indicators of inflammation, as well as the impact of anti-TNF alpha therapy on AS.

RESULTS

The prevalence of AS, after adjustment for age and blood pressure level reached more than a quarter of patients compared to the cardiovascular risk which was low. The factors that were strongly associated with AS were age, systolic and diastolic blood pressure. Two parameters related to inflammation emerged as having a highly significant link after multivariate analysis: recurrence in the last year and length of disease with a p=0.008, and an OR of 5 and 9 successively. Patients treated with anti-TNF alpha had a significant reduction in PWV.

CONCLUSION

The prevalence of AS reached more than a quarter of patients with CD, the duration and recurrence rate of CD appear to be factors linked to inflammation. Treatment with anti-TNF alpha seems to slow down PWV in these patients.