323: Pulmonary embolism: the value of transthoracic echocardiography

IntroductionAcute pulmonary embolism (PE) remains a life-threatening disease and one of three major disease entities with chest discomfort seen in the emergency room. Despite progress in imaging techniques and knowledge of this disease, its medical diagnosis is one of the most difficult to achieve. The clinical assessment of PE probability remains central to the diagnosis and evaluation. Presently, accepted diagnostic modalities for the confirmation of PE include V/Q scanning, chest CT, and standard angiography. All approaches have limitations. Because echocardiography is noninvasive, provides rapid bedside results. It is an attractive imaging modality to diagnose PE.PurposeThe purpose of this study is to assess the contribution of transthoracic echocardiography (TTE) in the clinical setting of PE.ResultsEighteen patients were included. There were 7 men and 11 women. The mean age was 57 years [28; 80]. TTE was performed in all patients within the first 24 to 72 hours of admission. The diagnosis of PE was confirmed by standard angiography in all cases. Tricuspid regurgitation was the most common TTE finding (16 of 18), followed by dilated right ventricle (15 of 18), pulmonary hypertension (11 of 18), paradoxical interventricular septal motion (7 of 18) and right ventricular hypokinesis (2 of 18). TTE revealed thrombi inside the right-sided heart cavities in 3 patients. The thrombus was detected at the apex of the right ventricle in the first case, at the right atria in the second case and many thrombi were objectified even at the right atria and ventricle, at the inferior vena cava and at the left pulmonary artery in the third case.ConclusionTransthoracic echocardiography may reveal findings that strongly support hemodynamically significant PE. In the majority of cases TTE provides only indirect signs of PE. It could, though, far less frequently visualise thromboembolic material inside the right-sided heart cavities. Direct visualisation of the thrombus, although confirming PE, remains an exceptional finding. This may be useful for prompt decision making in patients with haemodynamic compromise considered for thrombolysis or embolectomy

Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry.

BackgroundThe FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI).MethodsData for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%).ResultsAmong the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals (n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; pConclusionsData from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals

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