0222: The information provided by the monitoring of recovery during a treadmill test

IntroductionThe diagnosis of myocardial ischemia on exercise testing (ET) is typically based on ST segment during exercise and its recovery. However, according to recent studies attention should be paid on exercise capacity but also the heart rate profile, particularly its recovery in the first minute with a diagnostic and especially prognostic value. The importance of these variables is more pronounced in women posing positive diagnostic problem in the ET.MethodsThis study included 350 women with type 2 diabetes (TD2), with mean age of 58.84 years. It consisted of practicing a maximum treadmill test (TT) according to the Bruce protocol.ResultsAfter a positive TT, coronary angiography was proposed to135 cases. The results are in favor of a truly positive TT in 35 patients (25.62%), in 33.51% it is infiltrations and in 40.31% coronaries appear healthy. Univariate analyses according to the variables of the TT, the ones who have a statistically significant positive correlation, are: HRR 1’ (p=0.008), the reservation of HR (HR max – HR rest) (p=0.02), and recovery time of ST depression (p=0.006). Multivariate analysis in confrontation with coronary angiography, those among others predicts significant coronary lesions: -amplitude ST segment (p=107 5) and its recovery time (p=0.08) -the HRC 1 ’(p=0.02), the global recovery time (p=0.02). The prediction performance of coronary anomaly is 87.88%.ConclusionWomen in the interpretation of ST shift can lead to misinterpretation and necessitate the study of parameters which include those in recovery. This work by using exercise testing may therefore allow stratification of coronary risk and especially to avoid the practice of coronary angiography after weakly positive effort

0455 : Relationship of hyperglycemia to the no-reflow phenomenon in ST-elevation myocardial infarction patients treated by primary percutaneous coronary intervention

BackgroundIt has been shown that elevated blood glucose levels on admission are associated with worse outcome in ST elevation myocardial infarction.Impaired microvascular function and no-reflow phenomenon seem to be one of the underlying mechanisms of hyperglycemia deleterious effectsAimTo establish the relationship between hyperglycemia on admission and the no-reflow phenomenonMethodsPatients presenting with acute STEMI who underwent primary percutaneous coronary intervention (PCI) were enrolled. ST segment resolution was evaluated at 90 minutes in the worst lead. No-reflow was defined as a resolution of ST segment less than 50% in the worst lead at 90 minutesResults102 consecutive patients were enrolled (87 men and 15 women) with a mean age of 56.95±12.89 years. The no-reflow phenomenon was observed in 28 (27.45%) patients, their glucose level on hospital admission was significantly higher than in patients whithout no-reflow phenomenon (12.48±7.48 vs. 8.55±2.27 mmol/l; p = 0.01). Multivariate analysis showed that hyperglycemia defined as glycemia >11mmol/L was an independent predictor factor for no-reflow (OR = 2.18, CI = 1.42 – 3.84; p = 0.002)ConclusionHyperglycemia on admission is associated with higher risk of no-reflow in STEMI patients undergoing primary PCI

Obesity in hypertensive patients, a predictor of subclinical heart disease

Introduction :L’hypertension et l'obésité sont bien connus chacun aboutir à une insuffisance cardiaque à fraction d'éjection préservée. Les facteurs prédisposant à l’insuffisance cardiaque à FEVG préservée sont l'âge avancé, l'hypertension, le diabète, la dyslipidémie et l’obésité.Le développement du 2D strain a permis de faire un diagnostic précoce des dysfonctionnements ventriculaires chez les patients présentant des facteurs de risques cardiovasculaires.Matériels et méthodes :Ce travail consiste à réaliser chez une série de 128 patients hypertendus (âgés de 25 à 75 ans) répartis en deux sous-groupes : 58 patients obèses (IMC>30kg/m2) et 70 patients non obèses, une étude écho cardiographique complète, ainsi que l’étude de la déformation longitudinale du VG par la technique du speckle tracking (calcul du GLS).Résultats :La dyslipidémie et le diabète étaient nettement plus prévalents dans le bras HTA+obésité. La moyenne des chiffres tensionnels était légèrement supérieure dans le bras HTA+obésité.L’HVG était nettement prédominante dans le bras HTA+obésité avec une baisse plus conséquente de l’indice de contraction longitudinale. Chez les patients hypertendus obèses, l’HVG était le plus souvent concentrique (55,1%). Une élévation des pressions de remplissage a été retrouvée chez 15patients hypertendus obèses contre seulement 7 patients (p=0,0001) hypertendus non obèses, avec une bonne corrélation avec la baisse du GLS, dont le pourcentage de réduction était de 64% chez les patients obèses.Conclusion :La baisse de l'indice de fonction longitudinale, malgré la préservation de la FEVG, est bien corrélée à la présence d’une obésité chez les patients hypertendus, et ceci pourrait être dû à une plus forte prévalence de l’hypertrophie ventriculaire gauche chez ce sous-groupe de patients.Introduction:Hypertension and obesity are well known to each lead to heart failure with preserved ejection fraction. Predisposing factors for LVEF-preserved heart failure are advanced age, hypertension, diabetes, dyslipidemia and obesity.The development of the 2D strain has made it possible to make an early diagnosis of ventricular dysfunction in patients with cardiovascular risk factors.Materials and methods:This work consists in carrying out in a series of 128 hypertensive patients (aged 25 to 75 years) divided into two subgroups: 58 obesepatients (BMI>30g/m2) and 70 non-obese patients, a complete echocardiographic study, as well as than the study of the longitudinal deformation of the LV by the technique of speckle tracking (calculation of the GLS).Results:Dyslipidemia and diabetes were significantly more prevalent in the hypertension+obesity arm. The mean blood pressure figures were slightly higher in the hypertension+obesity arm.LVH was clearly predominant in the hypertension+obesity arm with a more significant drop in the longitudinal contraction index. In obese hypertensive patients, the LVH was most often concentric (55.1%). An increase in filling pressures was found in 15 obese hypertensive patients against only 7 non-obese hypertensive patients (p=0.0001), with a good correlation with the drop in GLS, whose percentage reduction was 64% in obese hypertensives.Conclusion:The decrease in the longitudinal function index, despite preservation of LVEF, is well correlated with the presence of obesity in hypertensive patients, and this could be due to a higher prevalence of left ventricular hypertrophy in this patient. subgroup of patients

Does Rivaroxaban Better than Vitamin K Antagonists in Atrial Fibrillation Patients Undergoing PCI?

ACS: Acute Coronary Syndrome; AF: Atrial Fibrillation; DAPT: Dual Antiplatelet Therapy; INR: InternationalNormalized Ratio; MI: Myocardial Infarction; PCI: Percutaneous Coronary Intervention; PIONEER AF-PCI: Open-Label, Randomized, Controlled, Multicenterstudy Exploring two Treatment Strategiesof Rivaroxaban and a Dose-Adjusted Oral Vitamink Antagonist Treatment Strategy in Subjectswith Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention; TIMI: Thrombolysis In Myocardial Infarction; VKA: Vitamin K AntagonistApproximately 15% of AF patients have a history of myocardial infarction. Between 5–15% of them will require stenting at some point in their lives with the need for a triple therapy combining an oral anticoagulant, a P2Y12 Inhibitor and aspirin [1-3]. This combination requires careful evaluation of bleeding risk, stroke risk and the risk of acute coronary syndromes (ACS) to reduce the risk of major hemorrhage [4-6]. In this context, the PIONEER AF-PCI [7], trial was conducted to evaluate the effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents.</p

Impact of Diabetes on Cardiac Function in Patients with High Blood Pressure

Background: Although the combination of high blood pressure (HBP) and type 2 diabetes (T2DM) increases the risk of left ventricular (LV) dysfunction, the impact of T2DM on LV geometry and subclinical dysfunction in hypertensive patients and normal ejection fraction (EF) has been infrequently evaluated. Methods: Hypertensive patients with or without T2DM underwent cardiac echocardiography coupled with LV global longitudinal strain (GLS) assessment. Results: Among 200 patients with HBP (mean age 61.7 ± 9.7 years) and EF &gt; 55%, 93 had associated T2DM. Patients with T2DM had a higher body mass index (29.9 ± 5.1 kg/m2 vs. 29.3 ± 4.7 kg/m2, p = 0.025), higher BP levels (158 ± 23/95 ± 13 vs. 142 ± 33/87 ± 12 mmHg, p = 0.003), a higher LV mass index (115.8 ± 32.4 vs. 112.0 ± 24.7 g/m2, p = 0.004), and higher relative wall thickness (0.51 ± 0.16 vs. 0.46 ± 0.12, p = 0.0001). They had more frequently concentric remodeling (20.4% vs. 16.8%, p &lt; 0.001), concentric hypertrophy (53.7% vs. 48.6%, p &lt; 0.001), elevated filling pressures (25.8 vs. 12.1%, p = 0.0001), indexed left atrial volumes greater than 28 mL/m2 (17.2 vs. 11.2%, p = 0.001), and a reduced GLS less than −18% (74.2 vs. 47.7%, p &lt; 0.0001). After adjustment for BP and BMI, T2DM remains an independent determinant factor for GLS decline (OR = 2.26, 95% CI 1.11–4.61, p = 0.023). Conclusions: Left ventricular geometry and subclinical LV function as assessed with GLS are more impaired in hypertensive patients with than without T2DM. Preventive approaches to control BMI and risk of T2DM in hypertensive patients should be emphasized

Does global longitudinal strain improve stratification risk in heart failure with preserved ejection fraction?

Background: Heart Failure with Preserved Ejection Fraction (HFPEF) accounts for more than half of the cases of heart failure.Long regarded as an abnormality of left ventricular diastolic function, recent studies using longitudinal strain (two-dimensional speckle tracking mode) have suggested that left ventricular longitudinal systolic function is altered in HFPEF.Despite these interesting pathophysiological perspectives, the data in the literature on the prognostic value of the alteration of longitudinal strain are controversial. Given these conflicting results, it is difficult to confirm the magnitude and prevalence of impaired LV longitudinal systolic function in patients with HFPEF and its prognostic relevance.&nbsp;Purposes: This work aims to study the prognostic value of Global the left ventricle&rsquo;s Global Longitudinal Strain (GLS) Algerian cohort of patients with HFPEF.&nbsp;Patients and methods: We conducted a monocentric prospective observational study from April 2018 to April 2020, with a minimum follow-up of 1 year for each recruited patient. We included patients over the age of 18 referred to the echocardiography laboratory for chronic or acute HFpEF, defined according to the criteria of ESC 2016. 153 consecutive patients underwent clinical examination, biological tests, and echocardiography with measurement of GLS at rest, in addition to routine management by the attending physicians.Results: 153 patients were collected. The average age of our patients is 73 +/- 11 years ranging from 42 to 91 years old. The female population is predominant with a rate of 67%. Comorbidities are predominant mainly by arterial hypertension (86%) and diabetes (64%), with a history of atrial fibrillation (46%).63% of patients have impaired GLS (&lt; 16%). Contrary to our hypothesis, GLS was not shown to be a powerful predictor of cardiovascular events in HFPEF patients either in dichotomous analysis (OR = 0.79; p = 0.64) or in continuous analysis (OR = 0.97; p = 0.69).We were able to identify that congestive venous signs, anemia, and pulmonary hypertension, are the main independent prognostic factors in our Algerian population study.&nbsp;Conclusion: We were unable to demonstrate the prognostic role of mpaired GLS in our population of patients with HFPEF

Impact of platelet inhibition level on subsequent no-reflow in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

International audienc

Correction: Acute Myocardial Infarction and Acute Heart Failure in the Middle East and North Africa: Study Design and Pilot Phase Study Results from the PEACE MENA Registry.

[This corrects the article DOI: 10.1371/journal.pone.0236292.]

Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry.

BackgroundThe Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF).MethodsThis prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes.ResultsBetween April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income ConclusionIn the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries

Key performance indicators for AMI patients in the MENA region.

Key performance indicators for AMI patients in the MENA region.</p