Badanie porównawcze czynności lewej komory w grupie chorych z bezobjawową twardziną układową i w grupie kontrolnej

Introduction. Cardiac involvement in systemic sclerosis (SSc) represents a major cause of morbidity and mortality and constitutes a turning point in this disease. The aim of this study was to describe echocardiographic data in asymptomatic patients with SSc and compare them to results obtained in a control population in order to unmask subclinical cardiac involvement during systemic sclerosis. Material and methods. A prospective study was conducted between 2012 and 2017 including two groups: group A included 25 asymptomatic scleroderma patients without other comorbidities, while group B consisted of 25 control and healthy subjects. The two groups were examined by echocardiography coupled with tissue Doppler and 2D strain. Results. The mean age of our patients was 45 ± 7 years. The sex ratio was 0.8. The control population was epidemiologically similar to the group of patients. The anatomical data of the left ventricle and the ejection fraction were normal and comparable between the two groups, but the Tei index was significantly higher in group A (0.8 ± 0.04 vs. 0.28 ± 0.07, p &lt; 0.01). Tissue Doppler velocity S peak measurement was reduced in group A compared to group B (5.6 ± 0.5 vs. 9.30 ± 0.5, p &lt; 0.01), and global longitudinal strain was also altered in scleroderma patients (–11 ± 0.4 vs. –18 ± 0.3, p &lt; 0.01). There was no significant difference in E/A ratio, however early left ventricular diastolic dysfunction was revealed by a higher E/Ea and E/Vp ratio in group A compared to group B with respectively (13 ± 1.8 vs. 6 ± 1.6, p &lt; 0.01) and (2.2 ± 0.6 vs. 1.5 ± 0.6, p &lt; 0.01), a longer Ap–Am duration (≥ 20 ms), and a higher volume of the left atrium was noted in group A. The mean value of the pulmonary pressions was 37.9 ± 9 mm Hg in patients with scleroderma versus 25 ± 3 mm Hg for the control group (p &lt; 0.01). There was no right ventricular dysfunction. Conclusions. Cardiac involvement during systemic sclerosis precedes clinical expression. Echocardiography coupled with tissue Doppler and 2D strain are useful to detect these abnormalities at a subclinical stage of the disease.Wstęp. Zajęcie serca w twardzinie układowej (SSc) jest główną przyczyną chorobowości i śmiertelności oraz stanowi punkt zwrotny w przebiegu choroby. Celem pracy jest opisanie obrazu echokardiografii u niewykazujących objawów chorych z SSc i porównanie z wynikami uzyskanymi w populacji kontrolnej, by wykryć subkliniczny proces chorobowego w sercu w przebiegu twardziny SSc. Materiał i metody. Badanie prospektywne przeprowadzono w latach 2012–2017. Pacjentów podzielono na dwie grupy: grupa A składała się z 25 chorych z bezobjawową SSc bez chorób współistniejących, grupę B utworzono z 25 zdrowych osób stanowiących grupę kontrolną. W obu grupach przeprowadzono badania echokardiograficzne z doplerowskim obrazowaniem tkanek i badaniem odkształcenia miokardium w obrazowaniu dwuwymiarowym (2D strain). Wyniki. Średnia wieku pacjentów wynosiła 45 ± 7 lat. Współczynnik płci wynosił 0,8. Grupa kontrolna była podobna pod względem charakterystyki epidemiologicznej do grupy chorych na SSc. Parametry anatomiczne lewej komory i frakcja wyrzutowa były prawidłowe i porównywalne w obu grupach, natomiast wskaźnik Tei był istotnie wyższy w grupie A (0,8 ± 0,04 vs. 0,28 ± 0,07; p < 0,01). Maksymalna prędkość ruchu miokardium S w tkankowej echokardiografii doplerowskiej była zmniejszona w grupie A w porównaniu z grupą B (5,6 ± 0,5 vs. 9,30 ± 0,5; p < 0,01). Również globalne odkształcenie podłużne było mniejsze u chorych na SSc (–11 ± 0,4 vs. –18 ± 0,3; p < 0,01). Nie stwierdzono istotnej różnicy w wartości współczynnika E/A, jednak w grupie A wykryto dysfunkcję rozkurczową lewej komory na podstawie wyższych współczynników E/Ea i E/Vp niż w grupie B (odpowiednio 13 ± 1,8 vs. 6 ± 1,6; p < 0,01 i 2,2 ± 0,6 vs. 1,5 ± 0,6; p < 0,01). Ponadto w grupie A zaobserwowano dłuższy czas trwania Ap–Am (≥ 20 ms) oraz większą objętość lewego przedsionka. Średnia wartość ciśnienia w tętnicy płucnej wynosiła 37,9 ± 9 mm Hg u pacjentów z SSc i 25 ± 3 mm Hg w grupie kontrolnej (p < 0,01). Nie stwierdzono dysfunkcji prawej komory. Wnioski. Zajęcie serca w przebiegu SSc poprzedza pojawienie się objawów. Badanie echokardiograficzne z doplerem tkankowym i ocena odkształcenia miokardium w obrazowaniu 2D są pomocne w wykrywaniu zmian w subklinicznym stadium choroby

Lymphoedème unilatéral du membre supérieur au cours d’une polyarthrite rhumatoïde

Les lymphoedèmes chroniques et localisés des membres ne sont qu’exceptionnellement signalés au cours de la polyarthrite rhumatoïde (PR). Nous rapportons l’observation d’une patiente âgée de 63 ans ayant une PR diagnostiquée depuis dix ans et traitée par hydroxychloroquine, prednisone et méthotrexate avec une bonne évolution fût explorée pour une tuméfaction du membre supérieur gauche évoluant depuis deux ans. À l’examen clinique on notait un membre infiltré en totalité, indolore, élastique et recouvert d’une peau tendue, luisante mais d’aspect normal. Le reste de l’examen somatique était sans particularités. La biologie ne montrait pas d’anomalies. L’imagerie médicale (radiographies-X standards des os de l’avant bras et du thorax, scanner-X thoracique, échographie des parties molles et du creux axillaire, doppler artériel et veineux du membre atteint et écho-mammographie) se révélait normale. La lympho-scintigraphie concluait à l’absence de visualisation du réseau lymphatique superficiel gauche. Le diagnostic de lymphoedème secondaire associé à la PR était retenu devant la négativité du bilan étiologique. Une kinésithérapie de drainage lymphatique fût prescrite en association à des assauts cortisoniques mais l’amélioration n’était que partielle. Parmi les manifestations extra articulaires de la PR, les lymphoedèmes chroniques localisés des membres restent inhabituels et souvent méconnus. Leurs mécanismes physiopathologiques sont mal élucidés et leur traitement ne fait pas encore l’unanimité. Ils gardent en revanche une implication pronostique fonctionnelle majeure.Pan African Medical Journal 2015; 2

Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study

BackgroundThe frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). ObjectiveThe aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. MethodsA total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. ResultsAt the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. ConclusionsThe NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial RegistrationClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID)DERR1-10.2196/1226

Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

International audienceThe NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems