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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S10
Is obesity a prognostic risk factor in pulmonary embolism? A Moroccan experience
Monia El Mourid, Fatima Ez-zahraa Talhi, Zakaria Qechchar, Salma Zenouaki and Leila Azzouzi
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
Introduction:
Obesity is associated with many cardiovascular risk factors which could trigger venous thrombo-embolism such as venous stasis and
decreased mobility. Its prevalence is rapidly increasing, not only in developed countries but across the world. It has been demonstrated as an independent
risk factor to pulmonary embolism (PE). However, only few studies have investigated this parameter as a prognostic factor in PE. We suggest that obesity
could be associated with a worst clinical presentation, echocardiographic parameters, prognosis and mortality.
Methods:
This prospective study was conducted with 120 patients admitted for PE to the cardiology intensive care unit at Ibn Rochd University Hospital in
Casablanca, Morocco, between January 2016 and December 2018. We divided our patients into: G1 with obesity (BMI >30kg/m²) and G2 without obesity (BMI
<30g/m
2
). We compared clinical features, echocardiography characteristics and prognosis.
Results:
Mean age was 54.3 ± 16.77, sex ratio=0.3. G1 represented 28%. Clinically, 56% in G1 vs. 43% in G2 had dyspnea, 20% vs. 10% had oedema,12% vs.
2% had hemoptyisis and 10% vs. 3% presented with signs of cardiogenic shock (p<0.001). Rhythm disorders were not more frequent than in G2. Diagnosis
was assessed by echocardiography and thoracic angio scanner. An intracavity thrombus was found in 8% vs. 2%, right ventricular dysfunction in 24% vs. 15%
(p=0.016). Paradoxal septum and pulmonary hypertension occurred in more than 56% of G1 vs. 34% in G2 (p=0.004). Thrombolysis was used in 4% of G1 and
not done in G2 (p<0.001). Treatment with non-fractional heparin and oral anticoagulation was initiated in all the other patients without any difference being
noted in the 2 groups. Mortality occurred in 3% of G1 vs. 1% of G2 (p>0.01).
Conclusion:
In our study, obese patients were more symptomatic, had more echocardiographic signs of pulmonary embolism and presented more
cardiogenic shock than the non-obese group. However, mortality was not significantly more prevalent.
Persistent pre-eclampsia: A survey of Moroccan women
Monia El Mourid*, Fatima Ez-zahraa Talhi*, Zakaria Qechchar*, Hind Tahri*, Asmaa Assal
†
, Houcine Boufettal
#
, Leila Azzouzi*
and Rachida Habal*
*Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
#
Gynaecology Department, Ibn Rochd University Hospital, Casablanca,
Morocco.
†
Ibn Rochd University Hospital, Casablanca, Morocco
Introduction:
Pre-eclampsia (PE) is a combination of pregnancy-induced hypertension (≥140/90mmHg) and proteinuria greater than or equal to 300mg per
24 hours above 20 weeks of amenorrhea. It usually disappears within 24 - 48 hours after delivery. However, it can persist after placental evacuation and up to
6 weeks after delivery.
Methods:
This is a retrospective study of 547 cases of PE collected in the Gynaecology and Obstetrics C department of Ibn Rochd Hospital, Casablanca, for
a period of 3 years (2016 - 2018). Two groups were identified. In Group 1 (n=504) PE immediately disappeared in the postpartum and a Group 2 (n=43) PE
persisted. We tracked patients’progress, before and after delivery.
Results:
PPE represented 8%. Mean age was 29.15 ± 15.13 years, with a prevalence of 72% between 25 and 35 years, age >35 years was a factor of
disappearance of PPE. Factors related to the persistence of pre-eclampsia were mainly: pauciparity in 61%, history of PE in 4.7%, gestational age <36 weeks
in 56%, severe PE in 14.7%, hypotrophy in 6%, eclampsia in 2% and massive 24 hours proteinuria ≥3mg/24h in 60% (all p were <0.001%) in comparison with
Group 2 . The clinical examination showed blood pressure >160/110mmHg in 20.4%, SBP >170mmHg in 13%, DBP >110 mmHg in 9%. Oedema was present
in 70%. A vaginal delivery was done in 44% of cases, caesarean section was recommended in 56% of cases. Conservative treatment was adopted in 22% of
cases; 15.05% required immediate use of intravenous antihypertensive treatments.
Conclusion:
PE is still common in developing countries. It remains a major cause of maternal and foetal morbidity and mortality. Our study confirms the
seriousness of persistent pre-eclampsia which carries a high risk of maternal complications.
Is the presence of an initial hypo albuminemia at admission for acute coronary syndrome a bad prognostic?
Monia El Mourid, Zakaria Qechchar, Fatima Ez-zahraa Talhi, Amine Boutaleb, Salim Arous, Ghali Bennouna and Rachida Habbal
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco
Introduction:
Several studies have shown that a decrease in serum albumin level is associated with an increased risk of occurrence of a cardiovascular
event and heart failure. In acute coronary syndrome, a decrease in serum albumin is generally associated with severe coronary lesions, increased long-term
mortality and the occurrence of heart failure. The aim of our study is to ascertain whether the presence of such hypo albuminemia during admission to
hospital for acute coronary syndrome is, or is not, a risk factor for the development of cardiac insufficiency de novo during hospitalisation, as well as its precise
impact on hospital mortality.
Methods:
This is a retrospective study of 132 patients hospitalised for acute coronary syndrome in the cardiology department of CHU Ibn Rochd Casablanca
between April 2016 and September 2017. Patients with heart failure were excluded. Patients were divided into quartiles (Q) according to their initial serum
albumin level: Q1: <35.0g/l; Q2: 35.1 - 38.0g/l; Q3: 38.1 - 40.8g/l; Q4: >40.8g/l.
Results:
The mean age was 58 ± 11.2 years, with a clear male predominance (64.3%), the rate of hypertension was 39%, diabetes was 42.9% and smoking was
47%. The rate of onset of de novo heart failure (36%, 21.9%, 13.2% and 12.9% for Q1, Q2, Q3 and Q4, respectively, p<0.0001) and hospital mortality (7.8%, 3.5%,
1.90%, and 1.2% for Q1, Q2, Q3 and Q4, respectively, p<0.0001) were significantly higher when albumin levels were lower.
Conclusion:
In patients with ACS, an initial serum albumin level <35.0g/l is a predictive criterion for de novo heart failure and hospital mortality. In this clinical
situation, hypoalbuminemia would reflect the presence of an underlying inflammatory state.