An unusual case of Behçet's disease presenting with postpartum ovarian iliac vein thrombosis and pulmonary embolism

Thrombosis of the ovarian vein is a rare complication which arises classically in the postpartum. We report a case of 24-year-old woman with a history of Behçet's disease, who presented with pelvic and thoracic pain, tachycardia, dyspnea and fever occurring 2 weeks after delivery. Computed tomography revealed an ascending thrombosis of the iliac and right ovarian veins complicated by bilateral pulmonary embolism. The patient responded well to the combination of anticoagulants and immunosuppressive agents. Behçet's disease should also be considered as an etiologic factor for ovarian vein thrombosis

0380: Study of anatomical features of pulmonary veins assessed by computed tomography according to age

IntroductionPulmonary veins (PV) play a crucial role in triggering and generating atrial fibrillation (AF). Isolation of PVs is fundamental in the AF ablation whether paroxysmal or persistent. The presence of four distinct pulmonary veins (two left PVs and two right PVs) has been described as the normal variant.AimThe purpose of our study was to investigate whether the age of the patients had an influence on the incidence of anatomical abnormalities of PVs.MethodsOur study was a prospective study which has included 38 patients followed for AF in the cardiology’s department of our hospital. All patients underwent a CT scan of PVs in order to characterize their anatomy. PVs’ size was represented by the largest diameter. We have divided our cohort into two groups: group 1: patients aged more than 50 years and group 2: patients aged less than 50 years.ResultsOur patients had a mean age of 50.5±13 years. The majority of our patients had paroxysmal AF (65%), 4 had persistent AF (10%), 9 had prolonged persistent AF (25%).CT Scan of PV results according to age are summarized in table.ConclusionIn our study, we found no significant relationship between age and anatomical abnormalities of the PVs. Hence, it is important to look for these anatomical anomalies whatever was the age of the patients to increase the success rate and to avoid complications during the AF ablation procedures.Abstratct 0380 – Table: Comparison of PV features evaluated by CT scan according to ageGroup 1 Age>50 years old N=20 patientsGroup 2 Age≤50 years old N=18 patientsPThe average left atrium volume140.8±75.78ml75.72±29.10mLP=0.01Mean number of PV3.85±0.484±0.65NSAverage diameter of left PV26.82±8.6825.03±12.29NSAverage diameter of right PV20.58±5.3522.81±6.05NSLeft single ostium forming a core collector4 (20%)3 (16.6%)NSRight single ostium forming a core collector1 (5%)4 (22%)N

201: Are QT intervals correlated to apnea-hypopnea index in obstructive sleep apnea?

IntroductionSeveral studies proved that obstructive sleep apnea (OSA) is associated with cardio-vascular diseases such as cardiac arrhythmia. QT duration and dispersion reflect the heterogeinity of ventricular repolarization and are considered as precursors of ventricular arrhythmiaAimThe aim of this study is to assess the relation between the severity of OSA parameters as apnea hypopnea index and QT intervals.MethodsForty patients (18 men and 22 women) who were diagnosed with OSA by overnight polysomnography were included in this prospective study. The mean age was 56±10 years old. They were all in sinus rhythm. Before initiating continuous positive airway pressure therapy, we calculated on a 12 lead ECG : QT duration (QTend) corrected to Bazett formula and QT dispersion (QT end max -QT end min).ResultsTwenty four patients had severe OSA (AHI >30), 4 had moderate OSA (AHI between 15 and 30) and 12 had a mild OSA (AHI between 5 and 15). There was a significant positive correlation between QT dispersion and AHI (r=0.48, p=0.001)ConclusionThe severity of OSA seems to be correlated with ventricular repolarization heterogeinity These results suggest that the higher is the AHI the higher is the risk of ventricular arrhythmia occurence. Further studies are needed to validate these results

Authorship: From credit to accountability. Reflections from the Editors´ Network

The Editors´ Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasised that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices

European Society of Cardiology: Cardiovascular Disease Statistics 2019

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest

–308G>A and –1031T>C tumor necrosis factor gene polymorphisms in Tunisian patients with coronary artery disease

Background: Recent research has shown that inflammation plays a key role in coronary artery disease (CAD) and other manifestations of atherosclerosis. Several lines of evidence support a key role for tumor necrosis factor-α (TNF-α), a potent immunomodulator and pro-inflammatory cytokine, in the development of atherosclerosis and in complications of CAD. Methods: We investigated the possible association between CAD and the TNF gene promoter polymorphisms –308G>A and –1031T>C in a Tunisian population. We compared the distribution of these polymorphisms between 418 patients with CAD and 406 healthy controls using polymerase chain reaction restriction fragment length-polymorphism analysis. Results: The frequency of the TNF-α –308A allele in the control group was similar to that observed in CAD patients [p=0.78; odds ratio (OR)=1.15; 95% confidence interval (CI)=0.86–1.55], but higher than those described in other Europeans, such as in the French, Finnish and Spanish. Concerning the TNF-α –1031T/C polymorphism, the same distribution was observed between patients with CAD and controls (p=0.12; OR=1.27; 95% CI=0.94–1.72). In addition, the genotype and allele frequencies of control individuals were comparable to those previously reported in healthy Tunisian controls and other ethnic groups. Haplotype analysis (TNF-α –308G>A and –1031T>C) demonstrated no significant association between TNF haplotypes and CAD. Conclusions: We conclude that TNF promoter gene polymorphisms at position –308G>A and –1031T>C do not play a major role in the pathogenesis of CAD in the Tunisian population. Clin Chem Lab Med 2009;47:1247–51.Peer Reviewe