- Email: [email protected]
0528 : Incidence and predictors of stroke among patients with chronic heart failure
195
Archives of Cardiovascular Diseases Supplements (2016) 8, 195-196
Conclusion Our study suggest that Dopper ultrasound might prove especially efficient and safe as a frontline test in elderly patients with suspected pulmonary embolism.
Topic 2 – Thrombosis
The author hereby declares no conflict of interest
April 08th, Friday 2016
0186 0231
Clinical practice on the management of deep venous thrombosis and evaluation of performance diagnostic in Moroccan center
Clinical features of pulmonary embolism in elderly Mariame Abelhad *, Fatima Ezzahra Sabri, Hayat Najih, Laila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Mariame Abelhad) Purpose The aim of this study was to determine the clinical features of pulmonary embolism in elderly patients (≥70 years).
Ichraq Nassiri *, Mariame Abelhad, Fatima Aghlad, Hayat Najih, Leila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Ichraq Nassiri) Background Venous thromboembolism (VTE) is a major public health problem in Morocco. The increase in life expectancy, changes of the epidemiological profile of VTE counteracts the constant efforts made in terms of prevention and disease remains ever.
Methods All patients hospitalized for PE in our cardiology department from January 2013 to December 2014 were included in the study. The aim was to compare the features of pulmonary embolism in elderly patients (≥70 years) (Group 1) to those of patients younger than 70 years (Group 2). The following data were recorded: past medical history, risk factors for venous thrombo-embolism (VTE), clinical features, and echocardiographic data.
Methods Prospective study to host emergency department over a period of 10 months including all deep vein thrombosis (DVT) admitted to the University Hospital of Casablanca. DVT was suspected clinically and retained on the presence of a thrombus in the lower-extremity on venous Doppler. We excluded patients with superficial thrombophlebitis and patients already diagnosed with VTE.
Results The population was composed of 50 patients (women 78%) with a median age of 55,4 years ± 15,8. There was no statistical difference for risk factors of VTE. Syncope/faintness was more frequent in elderly patients (21% versus 0%, P=0.019). On admission we note the predominance of shock in group 1 (42% versus 11%, p=0.020). The diagnosis of PE was often mentioned and even confirmed by Transthoracic echocardiography allowing us to start thrombolysis without waiting for confirmation by chest CT. TTE has shown a thrombus in the right cavities in 35% of patients in Group 1 against only 2.7% of patients in group 2 (P=0.005) and right ventricular (RV) dysfunction in 85% of group 1 versus 25% group 2 (P <0.0001), as well as RV dilatation, the paradoxical septum and pulmonary hypertension who were more frequently found in elderly subjects (100% vs 63% P = 0.010; 92% vs 61% P=0.039 and 71% vs 38% P=0.039 respectively). Was used to thrombolysis in 6 patients (42%) in group 1 vs 3 patients (8%) in group 2 (P=0.009).
Results The mean age of our patients was 49 years, with female predominance. A thromboembolic risk factor was found in 88% of patients. The main etiology: immobilization, surgery, heart disease and cancer pathology. Pain and the increase in calf circumference were the signs giving rise to the emergency department visit. The Doppler ultrasound has objectified a proximal localization in 38 patients (47%), distal in 12 patients (15%) and extended to the whole limb in 30 patients (38%). An association to pulmonary embolism was found in 10 patients (12%) and the association with arterial impairment was found in 4 patients (5%). The Wells score was calculated on only 12 patients (15%) and the results of thrombophilia requested in 8 patients (10%). 54 patients (67%) were treated in ambulatory and 26 patients were hospitalized. All patients were started on heparin and 92% have vitamin K antagonists (VKA). The causes of non-prescription VKA were: pregnancy in two patients, breakthrough bleeding on cervical cancer, active duodenal ulcer, immune thrombocytopenic purpura and erosive gastritis scalable.
Conclusion Our work emphasizes the seriousness of pulmonary embolism in the elderly. We confirm the difficulty of diagnosis of PE in this population. The author hereby declares no conflict of interest
Conclusion DVT remains a topical issue especially with the advent of new anticoagulants. In our current practice, a prospective study in more Moroccan university hospital – including large population – is desirable for a better management. The author hereby declares no conflict of interest
0272 Deep venous thrombosis in patients with acute pulmonary embolism
0528
Mariame Abelhad *, Fatima Ezzahra Sabri, Ichraq Nassiri, Hayat Najih, Laila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Mariame Abelhad)
Incidence and predictors of stroke among patients with chronic heart failure
Study objective To determine the prevalence of lower-limb deep venous thrombosis (DVT) that can be detected by Doppler ultrasound in patients with symptomatic pulmonary embolism (PE); and to explore the prognostic significance of such findings. Patients and methods All patients hospitalized for PE in our cardiology department from January 2013 to December 2014 were included in the study. Results Mean age was 55,4 years; 39 patients (78%) were woman. DVT signs or symptoms were present in 18 patients (36%). CUS detected DVT in 29 patients (58%). Multivariate analysis showed that an age >70 years (p=0,39; 95% CI, – 0,651 to –0,018), the presence of DVT signs or symptoms (p<0,0001; 95% CI, 0,411 to 0,961) and the presence of thrombosis of right cavities in transthoracic echocardiography (p=0,019; 95% CI, –0,997 to –0.097) were independent risk factors for positive CUS results. The intra-hospital mortality was not significantly different among patients with and without DVT (3,44% vs 9,52%, p=0,85).
Dalila El Baghdadi *, Ghita Mouhsine, Chafia Chehbouni, Leila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Dalila El Baghdadi) Background Stroke is associated with poor prognosis in patients with heart failure.This study investigated the incidence and predictors of stroke among this population. Methods and results We examined the prevalence, risk factors of stroke in ambulatory HF with reduced EF; The cohort consisted on 3000 patients admitted in the therapeutic unit of heart failure (TUHF) between 2006 and 2015. During, the study period 3042 patients were diagnosed with heart failure with reduced ejection fraction <0.50. Thirty-five per cent were women. Of these patients, 11% of them presented an ischemic stroke with a male predominance (12% versus 11%, sex ratio 2). Patients with HF with ejection fraction superior to 30% exhibited similar risk of stroke as those with reduced ejection fraction inferior to 30%: 13% versus 8% per 100.Eleven per cent of patients without atrial fibrillation presented a stroke.Among the studied
© Elsevier Masson SAS. All rights reserved.
196
Archives of Cardiovascular Diseases Supplements (2016) 8, 195-196
population, 17,5% had a prior history of myocardial infarction; When we compared the incidence of stroke among patients without atrial fibrillation in terms of medical treatment, there was 10% of stroke in the group taking vitamin K antagonist and 11% in the group taking antiplatelet therapy. Conclusion In our study, it seems that femal patients were at lower risk of stroke , in the other hand , prior history of myocardial fraction was predictor of stroke; however the severity of left ventricule systolic dysfunction did not influence the risk of embolic events. The author hereby declares no conflict of interest
(43%) an elevated BNP levels (mean: 454±494 pg/mL) and 17 patients (29%) an elevated troponin levels (mean: 0.36±0.46 μg/L). According to the ESC guidelines, 14 patients (24%) were classified at low risk PE, and 44 (76%) at intermediate-to-high risk. Global 2D RV strain differed significantly between the 2 groups (23.0% vs. 19.3%, p=0.0035), as did RV strain of the free wall (26.9% vs. 21.1%, p=0.0038). However, 2D RV strain of the septal wall did not differ significantly in the 2 groups (20.0% vs. 18.5%, p=0.12). ROC curves were determined to evaluate the ability of RV strain parameters derived from STI to identify low risk patients. The best performance was obtained with global 2D RV strain and a cut off value of 23.0%. Conclusion Global longitudinal 2D strain is significantly reduced in patients with intermediate-to-high risk PE compared with low risk PE. A cut off value of 23% allowed to identify PE patients at low risk.
0554 Right ventricle 2D strain derived from speckle tracking imaging might help to identify patients with pulmonary embolism at low risk
The author hereby declares no conflict of interest
Arnaud Etienney, Stéphane Ederhy *, Sylvie Lang, Laurie Soulat-Dufour, Saroumadi Adavane-Scheuble, Yann Ancedy, Marion Chauvet, Franck Boccara, Ariel Cohen APHP-Hôpital Saint-Antoine, Paris, France * Corresponding author: [email protected] (Stéphane Ederhy) Background We sought to investigate whether right ventricular deformation parameters as assessed with two-dimensional (2D) speckle tracking imaging (STI) could help in identifying patients at low risk according to the ESC guidelines. Methods From February 2015 to September 2015 all consecutive patients with a PE confirmed by thoracic computed tomography scan or by ventilation/ perfusion scintigraphy were included in the study. 2D Echocardiography was performed at admission. STI Longitudinal strain for the RV free wall and septal wall. We defined as intermediate-to-high risk PE patients with RV systolic dysfunction on echocardiography (defined as RV/LV ratio>0.9) and/or troponin I >0.04 μg/L and/or brain natriuretic peptide >100 pg/mL. When none of these criteria were present, patients were considered at low risk. Results Fifty-eight patients (mean age 66.1 ± 18.5 years, 55% male) were prospectively included. None of these patients exhibit hemodynamic instability. Twenty-three patients (40%) showed a RV/LV ratio > 0.9, 25 patients
Abstract 0554 – Figure: Comparative receiver operative character
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2016) 8, 195-196
Conclusion Our study suggest that Dopper ultrasound might prove especially efficient and safe as a frontline test in elderly patients with suspected pulmonary embolism.
Topic 2 – Thrombosis
The author hereby declares no conflict of interest
April 08th, Friday 2016
0186 0231
Clinical practice on the management of deep venous thrombosis and evaluation of performance diagnostic in Moroccan center
Clinical features of pulmonary embolism in elderly Mariame Abelhad *, Fatima Ezzahra Sabri, Hayat Najih, Laila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Mariame Abelhad) Purpose The aim of this study was to determine the clinical features of pulmonary embolism in elderly patients (≥70 years).
Ichraq Nassiri *, Mariame Abelhad, Fatima Aghlad, Hayat Najih, Leila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Ichraq Nassiri) Background Venous thromboembolism (VTE) is a major public health problem in Morocco. The increase in life expectancy, changes of the epidemiological profile of VTE counteracts the constant efforts made in terms of prevention and disease remains ever.
Methods All patients hospitalized for PE in our cardiology department from January 2013 to December 2014 were included in the study. The aim was to compare the features of pulmonary embolism in elderly patients (≥70 years) (Group 1) to those of patients younger than 70 years (Group 2). The following data were recorded: past medical history, risk factors for venous thrombo-embolism (VTE), clinical features, and echocardiographic data.
Methods Prospective study to host emergency department over a period of 10 months including all deep vein thrombosis (DVT) admitted to the University Hospital of Casablanca. DVT was suspected clinically and retained on the presence of a thrombus in the lower-extremity on venous Doppler. We excluded patients with superficial thrombophlebitis and patients already diagnosed with VTE.
Results The population was composed of 50 patients (women 78%) with a median age of 55,4 years ± 15,8. There was no statistical difference for risk factors of VTE. Syncope/faintness was more frequent in elderly patients (21% versus 0%, P=0.019). On admission we note the predominance of shock in group 1 (42% versus 11%, p=0.020). The diagnosis of PE was often mentioned and even confirmed by Transthoracic echocardiography allowing us to start thrombolysis without waiting for confirmation by chest CT. TTE has shown a thrombus in the right cavities in 35% of patients in Group 1 against only 2.7% of patients in group 2 (P=0.005) and right ventricular (RV) dysfunction in 85% of group 1 versus 25% group 2 (P <0.0001), as well as RV dilatation, the paradoxical septum and pulmonary hypertension who were more frequently found in elderly subjects (100% vs 63% P = 0.010; 92% vs 61% P=0.039 and 71% vs 38% P=0.039 respectively). Was used to thrombolysis in 6 patients (42%) in group 1 vs 3 patients (8%) in group 2 (P=0.009).
Results The mean age of our patients was 49 years, with female predominance. A thromboembolic risk factor was found in 88% of patients. The main etiology: immobilization, surgery, heart disease and cancer pathology. Pain and the increase in calf circumference were the signs giving rise to the emergency department visit. The Doppler ultrasound has objectified a proximal localization in 38 patients (47%), distal in 12 patients (15%) and extended to the whole limb in 30 patients (38%). An association to pulmonary embolism was found in 10 patients (12%) and the association with arterial impairment was found in 4 patients (5%). The Wells score was calculated on only 12 patients (15%) and the results of thrombophilia requested in 8 patients (10%). 54 patients (67%) were treated in ambulatory and 26 patients were hospitalized. All patients were started on heparin and 92% have vitamin K antagonists (VKA). The causes of non-prescription VKA were: pregnancy in two patients, breakthrough bleeding on cervical cancer, active duodenal ulcer, immune thrombocytopenic purpura and erosive gastritis scalable.
Conclusion Our work emphasizes the seriousness of pulmonary embolism in the elderly. We confirm the difficulty of diagnosis of PE in this population. The author hereby declares no conflict of interest
Conclusion DVT remains a topical issue especially with the advent of new anticoagulants. In our current practice, a prospective study in more Moroccan university hospital – including large population – is desirable for a better management. The author hereby declares no conflict of interest
0272 Deep venous thrombosis in patients with acute pulmonary embolism
0528
Mariame Abelhad *, Fatima Ezzahra Sabri, Ichraq Nassiri, Hayat Najih, Laila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Mariame Abelhad)
Incidence and predictors of stroke among patients with chronic heart failure
Study objective To determine the prevalence of lower-limb deep venous thrombosis (DVT) that can be detected by Doppler ultrasound in patients with symptomatic pulmonary embolism (PE); and to explore the prognostic significance of such findings. Patients and methods All patients hospitalized for PE in our cardiology department from January 2013 to December 2014 were included in the study. Results Mean age was 55,4 years; 39 patients (78%) were woman. DVT signs or symptoms were present in 18 patients (36%). CUS detected DVT in 29 patients (58%). Multivariate analysis showed that an age >70 years (p=0,39; 95% CI, – 0,651 to –0,018), the presence of DVT signs or symptoms (p<0,0001; 95% CI, 0,411 to 0,961) and the presence of thrombosis of right cavities in transthoracic echocardiography (p=0,019; 95% CI, –0,997 to –0.097) were independent risk factors for positive CUS results. The intra-hospital mortality was not significantly different among patients with and without DVT (3,44% vs 9,52%, p=0,85).
Dalila El Baghdadi *, Ghita Mouhsine, Chafia Chehbouni, Leila Azzouzi, Rachida Habbal CHU Ibn Rochd, Casablanca, Maroc * Corresponding author: [email protected] (Dalila El Baghdadi) Background Stroke is associated with poor prognosis in patients with heart failure.This study investigated the incidence and predictors of stroke among this population. Methods and results We examined the prevalence, risk factors of stroke in ambulatory HF with reduced EF; The cohort consisted on 3000 patients admitted in the therapeutic unit of heart failure (TUHF) between 2006 and 2015. During, the study period 3042 patients were diagnosed with heart failure with reduced ejection fraction <0.50. Thirty-five per cent were women. Of these patients, 11% of them presented an ischemic stroke with a male predominance (12% versus 11%, sex ratio 2). Patients with HF with ejection fraction superior to 30% exhibited similar risk of stroke as those with reduced ejection fraction inferior to 30%: 13% versus 8% per 100.Eleven per cent of patients without atrial fibrillation presented a stroke.Among the studied
© Elsevier Masson SAS. All rights reserved.
196
Archives of Cardiovascular Diseases Supplements (2016) 8, 195-196
population, 17,5% had a prior history of myocardial infarction; When we compared the incidence of stroke among patients without atrial fibrillation in terms of medical treatment, there was 10% of stroke in the group taking vitamin K antagonist and 11% in the group taking antiplatelet therapy. Conclusion In our study, it seems that femal patients were at lower risk of stroke , in the other hand , prior history of myocardial fraction was predictor of stroke; however the severity of left ventricule systolic dysfunction did not influence the risk of embolic events. The author hereby declares no conflict of interest
(43%) an elevated BNP levels (mean: 454±494 pg/mL) and 17 patients (29%) an elevated troponin levels (mean: 0.36±0.46 μg/L). According to the ESC guidelines, 14 patients (24%) were classified at low risk PE, and 44 (76%) at intermediate-to-high risk. Global 2D RV strain differed significantly between the 2 groups (23.0% vs. 19.3%, p=0.0035), as did RV strain of the free wall (26.9% vs. 21.1%, p=0.0038). However, 2D RV strain of the septal wall did not differ significantly in the 2 groups (20.0% vs. 18.5%, p=0.12). ROC curves were determined to evaluate the ability of RV strain parameters derived from STI to identify low risk patients. The best performance was obtained with global 2D RV strain and a cut off value of 23.0%. Conclusion Global longitudinal 2D strain is significantly reduced in patients with intermediate-to-high risk PE compared with low risk PE. A cut off value of 23% allowed to identify PE patients at low risk.
0554 Right ventricle 2D strain derived from speckle tracking imaging might help to identify patients with pulmonary embolism at low risk
The author hereby declares no conflict of interest
Arnaud Etienney, Stéphane Ederhy *, Sylvie Lang, Laurie Soulat-Dufour, Saroumadi Adavane-Scheuble, Yann Ancedy, Marion Chauvet, Franck Boccara, Ariel Cohen APHP-Hôpital Saint-Antoine, Paris, France * Corresponding author: [email protected] (Stéphane Ederhy) Background We sought to investigate whether right ventricular deformation parameters as assessed with two-dimensional (2D) speckle tracking imaging (STI) could help in identifying patients at low risk according to the ESC guidelines. Methods From February 2015 to September 2015 all consecutive patients with a PE confirmed by thoracic computed tomography scan or by ventilation/ perfusion scintigraphy were included in the study. 2D Echocardiography was performed at admission. STI Longitudinal strain for the RV free wall and septal wall. We defined as intermediate-to-high risk PE patients with RV systolic dysfunction on echocardiography (defined as RV/LV ratio>0.9) and/or troponin I >0.04 μg/L and/or brain natriuretic peptide >100 pg/mL. When none of these criteria were present, patients were considered at low risk. Results Fifty-eight patients (mean age 66.1 ± 18.5 years, 55% male) were prospectively included. None of these patients exhibit hemodynamic instability. Twenty-three patients (40%) showed a RV/LV ratio > 0.9, 25 patients
Abstract 0554 – Figure: Comparative receiver operative character
© Elsevier Masson SAS. All rights reserved.