Papers by Dhaker Lahidheb
Pan African Medical Journal
Although pericarditis is the most prevalent cardiac involvement in systemic lupus erythematosus (... more Although pericarditis is the most prevalent cardiac involvement in systemic lupus erythematosus (SLE), cardiac tamponade is extremely infrequent notably as the first manifestation of the disease. Here we report the case of a 22-year-old woman presenting with cardiac tamponade as the initial presentation of SLE.
Is there a latent left ventricular dysfunction in hypertensive patients with preserved ejection fraction ?
La Tunisie Médicale, 2021
SUMMARY Introduction: Early detection of left ventricular(LV) dysfunction may represent a clinica... more SUMMARY Introduction: Early detection of left ventricular(LV) dysfunction may represent a clinical finding that would justify aggressive treatment aimed to reduce cardiovascular morbidity and mortality. Aim: To evaluate longitudinal contractility in patients with essential hypertension and preserved LV ejection fraction (EF), in an attempt to detect latent impairment of LV systolic function. Methods: Prospective case-control study, carried out on 121 (67 male/54 female) hypertensive patients (HTN group) with preserved EF and without any symptoms of heart failure and 39 age- and gender-matched healthy subjects as a control group. Conventional echocar¬diographic study, as well as 2D Longitudinal strain imaging by 2D-speckle tracking echocardiography (2D-STE), were performed. Results: Mean age of patients was 60,48 ± 10.5 years old. The LVend-diastolic diameter and LVEF were comparable between the two groups. Hypertensive patients had greater septal thickness, left ventricular mass,and...
Stent implantation for ostial left anterior descending coronary artery stenosis: clinical particularities, therapeutic strategies, and medium-term outcomes
La Tunisie medicale, 2019
BACKGROUND The stenosis of the ostial left anterior descending artery represents one of the chall... more BACKGROUND The stenosis of the ostial left anterior descending artery represents one of the challenges for the interventional cardiologist. The aim of our study was to define the characteristics of this population and to analyze their results in medium term. METHODS We had undertaken a retrospective study of 76 patients treated in the Cardiology Department of the Military Hospital of Tunis, between January 2014 and March 2017. Percutaneous coronary revascularizations of de novo ostial lesions of the left anterior descending artery were included. RESULTS The mean age was 59.8 years with a male predominance. Two dilation strategies were adopted: 39% of patients had a "provisional-T-stenting" of the left main coronary artery versus 61% of patients who had a floating stent technic. The main immediate complication was acute occlusion of the circumflex artery ostium. After 12 months, the thrombosis and restenosis rates were 5,2% and 6,5%. Predictors of MACE were: Insulin-requiri...
Place des héparines de bas poids moleculaire dans les syndromes coronariens aigus
Apres avoir confirme leur efficacite dans le traitement des thromboses veineuses et vu les proble... more Apres avoir confirme leur efficacite dans le traitement des thromboses veineuses et vu les problemes poses par les heparines non fractionnees dans le traitement des syndromes coronariens aigus,plusieurs etudes ont ete realisees pour prouver l'interet des HBPM comme une alternative therapeutique Un premier essai, l'etude FRISC, a montre que la dalteparine etait superieure au palaite chez des patients recevant l'aspirine (75 mg/jour). Dans l'etude FRIC, la poursuite de la dalteparine a dose reduite entre le 6 eme et le 40 eme jour, n'a pas apporte de benefice supplementaire par rapport a l'aspirine prescrite isolement. L'enoxaparine apparait superieure a heparine non factionnee a travers l'etude ESSENCE et TIMI 11. Dans l'etude ESSENCE qui a inclus 3171 patients presentant un angor spontane ou un infarctus sans onde Q et recevant l'aspirine l'enoxapaine par rapport a l'HNF, a diminue significativement le risque combine de deces, d'in...
Les anti-GPIIB/IIIA, de l'angioplastie à haut risque vers de nouvelles perspectives
Le traitement du syndrome coronarien connait actuellement une revolution avec l'utilisation d... more Le traitement du syndrome coronarien connait actuellement une revolution avec l'utilisation de nouvelles molecules : les inhibiteurs des recepteurs membranaires plaquettaires glycoproteiques IIb/IIIa. Ces molecules ont prouve leur efficacite dans les situations a haut risque de l'angioplastie coronaire elective. En revanche, leur efficacite, en complement du traitement medical dans le syndrome coronarien aigu ou du traitement thrombolytique au cours de la phase aigue de l'infarctus du myocarde, a ete mise en question par les dernieres etudes, du moins chez les patients a faible risque. Dans cette mise au point, nous rappellerons les principales notions pharmacologiques des anti GP IIb/IIIa et essayerons de preciser la place de cette classe therapeutique, dans le traitement du syndrome coronarien aigu et a la phase aigue de l'infarctus du myocarde a travers les principales etudes qui l'ont evaluee.
Obstructive primary cardiac lymphoma
Hématologie, 2012
hma.2012.0729 Auteur(s) : Thouraya Filali1 filalithouraya@voila.fr, Dhaker Lahidheb1, Walid Ghodb... more hma.2012.0729 Auteur(s) : Thouraya Filali1 filalithouraya@voila.fr, Dhaker Lahidheb1, Walid Ghodbene2, Wafa Fehri1, Slim Chenik2, Habib Haouala1 1 Service de cardiologie, hopital militaire de Tunis, Tunisie 2 Service de chirurgie cardiaque, hopital militaire de Tunis, Tunisie Tires a part : T. Filali Le lymphome cardiaque primitif (LCP) est la tumeur cardiaque primitive la plus rare (1,3 %) [1]. Cette entite exceptionnelle, parfois meme discutee, correspond a un lymphome confine exclusivement [...]
Is left atrial expansion index a reliable predictor of increased left ventricular filling pressures?
Archives of Cardiovascular Diseases Supplements, 2017
Journal of the Saudi Heart Association, 2017
Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is com... more Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease. She was referred to our department for coronary catheterization because of angina symptoms upon minimal exertion. The lesion was detected during echocardiography and was defined as a mass of heterogeneous content with calcification points, located at the posterior side of the mitral valve annulus. Restricted motion of the posterior leaflet and the mass effect caused only minimal mitral regurgitation. To establish the correct diagnosis, we performed the full spectrum of noninvasive cardiac imaging modalities. Transesophageal echocardiography identified well-organized, composite lesion with regular edges, markedly calcified margins and more echolucent central portion. A computed tomography (CT) was performed, showing a hyperdense mass with hypodense center and a calcified peripheral rim located at the posterior mitral ring. Cardiac magnetic resonance imaging (MRI) showed that the mass was hypointense with respect to the myocardium in the T1 and T2-weighted sequences and only presented late-phase enhancement in the surrounding capsule. Based on the CT and MRI findings, the diagnosis of CCMA was established. The patient was managed conservatively.
0321 : Cardiogenic shock in acute myocardial infarction. The experience of the military hospital. About (7)0 cases
Archives of Cardiovascular Diseases Supplements, 2016
Introduction Cardiogenic shock remains the leading cause of death in the acute phase of myocardia... more Introduction Cardiogenic shock remains the leading cause of death in the acute phase of myocardial infarction (MI); it is the result of myocardial and / or mechanical failure complication. The aim of our study was to investigate the epidemiological, clinical and support of a serie of patients hospitalized for MI complicated by cardiogenic shock as well as the immediate and late prognosis. Methods It was a single-center retrospective study of 70 patients hospitalized in the service of cardiology of the military hospital for myocardial infarction complicated by cardiogenic shock, between 2005 and 2012. Results The mean age was 63 ± 10 years, 80% were men. The majority of myocardial infarction were anteriors. On admission 41% were in left ventricular failure, and 59% in shock. Thrombolysis was performed in 51% of patients. Angiography had identified a single truncal achieved in 28% of cases, bi -vessel in 44% of cases and tri- truncal in 28% of cases. The transcoronary angiolpasty was primary in 27% of cases and of rescue in 73% of cases. Revascularization was complete in 37% of cases. The success rate of TCA was 85%. The majority of bare stents were used (83%). The mean LVEF was 49 ± 14.4%. 70% of patients received vasopressor therapy with a mean duration of 3.5 days. IABP was placed in 2 patients with an average duration of 2 days. The average of hospital stay was 7 ± 8 days. Hospital mortality was 47%, occurring on average in the sixth day of hospitalization (6±9 days). We found that renal failure, late onset of shock, hyperglycemia, leukocytosis, use of vasopressors, and the anterior territory of MI were significantly predictive of hospital mortality. Conclusion Despite significant advances in the treatment of myocardial infarction, particularly techniques of reperfusion, therapeutic drug, and the advent of several circulatory support techniques, mortality of cardiogenic shock in acute phase of myocardial infarction remains high. The author hereby declares no conflict of interest
Dysfonction sinusale à cœur sain chez l'enfant: A propos d'un cas
Tunisie Medicale, 2002
La dysfonction sinusale est une cause exceptionnelle de bradycardie chez l'enfant indemne de ... more La dysfonction sinusale est une cause exceptionnelle de bradycardie chez l'enfant indemne de malformation cardiaque, et son association avec un trouble de la conduction a l'etage auriculo-ventriculaire est encore plus rare. Nous rapportons l'observation d'un nourrisson âge de 23 mois admis pour bradycardie symptomatique. L'electrocardiogramme de base et l'enregistrement Holter de 24 H objectivent un rythme jonctionnel permanent avec une frequence cardiaque minimale a 24 bpm et des pauses maximales de 3,7 secondes. Devant la mauvaise tolerance fonctionnelle, un pace maker programme en mode VVIR est implante par voie epicardique. L'evolution a ete marquee par la survenue quatre ans plus tard, d'un trouble de la conduction auriculo-ventriculaire decouvert suite a une cassure de la sonde de stimulation. L'enfant âge alors de 6 ans, a beneficie d'une implantation d'un deuxieme pace maker par voie endocavitaire programme en mode VVIR.
Archives of Cardiovascular Diseases Supplements, 2015
Introduction: Cardiovascular deaths are the leading cause of death among the elderly. Its inciden... more Introduction: Cardiovascular deaths are the leading cause of death among the elderly. Its incidence increases with age. The management of cardiovascular diseases raises many problems because of the fragile terrain and in the absence of appropriate studies in elderly patients. The objective of the study was to identify predictors of cardiovascular mortality in the elderly over 75 years hospitalized urgently. Patients and Methods: Retrospective study conducted over six months in all patients over 75 years hospitalized in the University Hospital center IBN ROCHD in Casablanca Results: A total of 90 patients, mean age 78 +/-7 years, 22.2% of subjects had died. The majority of patients was collected admitted for acute coronary syndrome, following by chronic heart failure decompensation. 77.8% of patients had no history of hospitalization. 82.2% had one cardiovascular risk factor (other than age), and 44.5% had comorbidity. The factors significantly influencing mortality during the stay were: diabetes (p <0.05), dementia and / or delirium (p <0.03), delay in delivery period (p <0, 05), acute coronary syndrome not revascularized (p <0.02), pulmonary embolism (p <0.001), cardiogenic shock, severe renal failure, LVEF <25%. The elderly are vulnerable terrain patients, often high cardiovascular risk. Neurological disorders must be recognized and taken care of properly. Susceptibility to venous thromboembolism and atypical symptoms characteristic of elderly must be considered.
[Influence of sex on immediate and late results of percutaneous coronary angioplasty]
La Tunisie médicale, 2006
Prior studies have reported worse results after percutaneous transluminal coronary angioplasty (P... more Prior studies have reported worse results after percutaneous transluminal coronary angioplasty (PTCA) in women than in men. However, recent data suggest that this difference is less marked. The aim of our study is to evaluate whether the procedural outcome is equal in the two genders. Six hundred and eighty-eight PTCA were studied in 96 consecutive women and 509 men who underwent the procedure in our catheterization laboratory between 1998 and 2004. Women undergoing PTCA were older than men and had a higher incidence of diabetes, hypercholesterolemia and hypertension. Multivessel disease and severe coronary lesions were more frequent in women. The stenting rates, the use of drug eluting stents and of glycoprotein IIbIIIa inhibitors were similar in the two sexes. Procedural success rate was similar in the two groups. No significant differences were found in in-hospital mortality and in the resort to emergency coronary artery bypass grafting (CABG). 14 month after the procedure there ...
[Role of fibrin D-dimer in acute coronary syndrome. Prospective study of 22 cases]
La Tunisie médicale, 2004
Fibrin D-dimer are the consequence of an excess of fibrinolysis. The raise of their level in coro... more Fibrin D-dimer are the consequence of an excess of fibrinolysis. The raise of their level in coronary heart disease seems to be helpful to enhance the diagnosis of coronary ischemia. Prospective study over 4 months, including 22 patients (16 male, 6 female) divided in 2 subgroups: Group I: 10 patients investigated for stable angina Group II: 12 patients investigated for ACS without ST elevation. All patients underwent fibrin D-dimer dosage and coronarography. Fibrin D-dimer levels were higher in group II (924.5 ng/ml vs 703.9 ng/ml; p < 0.0001). In group II, 6 patients had ST depression with a level of fibrin D-dimer 879.5 ng/ml vs 969.6 ng/ml in the other 6 patients. We found a positive correlation between level of fibrin D-dimer and complexity of coronary lesions (1007 ng/ml in type C vs 675 ng/ml in type A lesions; p < 0.0001). Fibrin D-dimer seems highly implicated in coronary disease and if these results are confirmed by larger studies their routine dosage will be helpful...
[Role of low-molecular-weight heparin in acute coronary syndromes]
La Tunisie médicale, 2002
Looking to their efficiency in the treatment of venous thrombosis and the problems caused by non ... more Looking to their efficiency in the treatment of venous thrombosis and the problems caused by non fractioned heparins (NFH) in the treatment of acute coronary syndromes, several studies were realised to prove the interests of fractioned heparins (FH) as good alternative therapeutics in acute coronary syndromes. A fist attempt, FRISC study, showed that dalteparin was superior to the placebo given in patients receiving aspirin (75 mg daily). In the FRIC study the pursuit of dalteparin between the sixth and the fortieth day, at a low dose, don't give benefits compared to aspirin given simply. Enoxaparin seems to be superior to the NFH in ESSENCE and TIMI IIB studies:--In ESSENCE study witch was included 3171 patients with unstable angina or non Q wave myocardial infarction and all patients received aspirin, enoxaparin compared to NFH reduced significantly the combined risk of death, myocardial infarction, recurrent ischemia and the need of revascularisation. These benefits persisted...
Archives of Cardiovascular Diseases Supplements, 2015
cardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed in s... more cardiographic findings. Accurate diagnosis by immediate coronary angiography can be followed in suitable candidates by coronary angioplasty, which seems to improve survival.
Archives of Cardiovascular Diseases Supplements, 2014
Archives of Cardiovascular Diseases Supplements, 2014
Maladie cœliaque et cardiomyopathie dilatée idiopathique : une association fortuite ?
La Presse Médicale, 2010
Archives of Cardiovascular Diseases Supplements, 2013
Methods: the study population consisted of 90 asymptomatic diabetic normotensive patients (group ... more Methods: the study population consisted of 90 asymptomatic diabetic normotensive patients (group 1) and 90 age-and sex-matched control subjects (group 2). All included subjects had no evidence of hypertension, valvular and ischemic heart diseases. Coronary heart disease was excluded in all diabetic patients by non-invasive testing. Conventional echocardiography and tissue Doppler imaging (TDI) analysis were performed in all patients and healthy controls. Results: LV diastolic diameter, LV wall thickness and LV ejection fraction were similar in both groups. The mitral annulus systolic velocities measured by TDI were significantly decreased in diabetic patients compared to controls but remained within the normal range. However, mitral annulus early diastolic velocities (Em) measured by TDI were markedly reduced in diabetic patients (7.6±1.3 cm/s vs. 11.9±1.6 cm/s, p<0.01) with higher ratio of early diastolic transmitral pulsed Doppler E to Em (E/Em) velocities (15.2±1.4 vs. 8.1±1.8, p<0.01) suggesting impaired LV diastolic function. Among diabetic patients, impaired diastolic LV function is significantly pronounced in the subgroup with increased duration of diabetes (≥10 years). with isolated diabetes mellitus and worsens with longer disease duration.
Archives of Cardiovascular Diseases Supplements, 2013
(35%) had a pre-capillary PH, 6 (23%) a post-capillary PH, and 11 (42%) a reactive post-capillary... more (35%) had a pre-capillary PH, 6 (23%) a post-capillary PH, and 11 (42%) a reactive post-capillary PH. By using transthoracic echocardiography, the right ventricular diameter was 32±5 mm and the right atrial area 29±11 cm². The right ventricular systolic function was impaired, with a tricuspid annular plane systolic excursion of 17±4 mm, a peak tricuspid annular S wave of 10±6 cm/s and a peak systolic strain of the right ventricular free wall of -16±6%. Factors associated to more severe symptoms were right atrial and ventricular dilatation and higher levels of PH. Reactive post-capillary PH is predominant in elderly patients with preserved left ventricular function and no valve disease. However, more than a third of these patients have pre-capillary PH, which needs a right heart catheterization to be assessed, and could benefit from specific treatments.
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Papers by Dhaker Lahidheb