HRV Analysis: Unpredictability of Approximate Entropy in Chronic Obstructive Pulmonary Disease

Introduction: Approximate entropy (ApEn) is a widely imposed metric to evaluate a chaotic response and irregularities of RR-intervals from an electrocardiogram. Yet, the technique is problematic due to the accurate choice of the tolerance (r) and embedding dimension (M). We prescribed the metric to evaluate these responses in subjects exhibiting symptoms of chronic obstructive pulmonary disease (COPD) and we strived to overcome this disadvantage by applying different groupings to detect the optimal. Methods: We examined 38 subjects split equally: COPD and control. To evaluate autonomic modulation the heart rate was measured beat-by-beat for 30 min in a supine position without any physical, sensory, or pharmacological stimuli. In the time-series obtained the ApEn was then applied with set values for tolerance, r and embedding dimension, M. Then, the differences between the two groups and their effect size by two measures (Cohen’s ds and Hedges’s gs) were computed. Results: The highest value of statistical significance accomplished for any effect size statistical combinations undertaken was -1.13 for Cohen’s ds, and -1.10 for Hedges’s gs with embedding dimension, M = 2 and tolerance, r = 0.1. Conclusion: ApEn was capable of optimally identifying the decrease in chaotic response in COPD. The optimal combination of r and M for this were 0.1 and 2, respectively. Despite this, ApEn is a relatively unpredictable mathematical marker and the use of other techniques to evaluate a healthy or pathological condition is encouraged.

Intracardiac Thrombus Revealing Coronavirus Disease 2019 (COVID-19). About a Case, Renaissance University Hospital Center in N’Djamena (Chad)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) called COVID-19 is often associated with thrombotic complications, especially in severe cases. We report a case of COVID-19 revealed by a right intraatrial thrombus to emphasize the risk of thromboembolic diseases linked to this pathology. He was a young subject, 41 years old, with no notable history. He complained of asthenia and precordialgia. Echocardiography showed the presence of a right intraatrial thrombus and laboratory tests confirmed COVID-19. Under medical treatment combining antithrombotics, chloroquine and azithromycin, the thrombus regressed, and the markers of inflammation were normalized after 12 days. One month later, the patient remained clinically stable with normal echocardiography.

Obesity in Relationship with Different Forms of Myocardial Infarction (Data of Registry on Acute Myocardial Infarction)

In today’s world, the growth of technical progress has increased the number of people with obesity, which is one of the main risk factors for the development of acute myocardial infarction (MI). Objective: To evaluate the effect of obesity on some clinical and anthropometric characteristics in patients with acute MI. Material and Methods: A special questionnaire – a “registry card” was developed for monitoring patients with acute MI and collecting the necessary and complete information from employees of the Cardiovascular Diseases (CVD) Prevention Department. The presented article describes the data of a preliminary analysis of patients with acute MI treated in the clinic. Of the 202 people, 191 (94.6%) had a body mass index (BMI) calculated. Depending on the level of BMI, three groups were selected: 1 g (BMI < 25 kg/m2) – 36 (18.8% of 191) patients with acute MI with normal weight (control group); 2 g (BMI = 25–30 kg/m2) – 84 (44.0% of 191) overweight people; 3 g (BMI > 30 kg/m2) – 71 (37.2% of 191) people with obesity. Differences were considered significant at p < 0.05. Results: Despite the fact that acute MI developed in women 2.6 times less frequently and 8.7 years later in age than in men, nevertheless, obesity in women was recorded more often, while in men overweight prevailed. In acute MI between the age of the respondents and the presence of increased weight, an inverse relationship was revealed (p > 0.05), i.e., as the weight category increased, the age of the patients decreased. In patients with MI, as the weight increased, there was an increase in comorbid pathology, especially associated with impaired carbohydrate metabolism (p < 0.0001). A more severe form of MI (STEMI) was more often recorded in persons with a BMI > 25 kg/m2, while the front wall was the most vulnerable to the development of acute MI, regardless of the weight category of patients. The back wall was involved in the pathological process both in individuals with overweight and in patients with obesity. The apical segment in the largest number of cases was only affected in people with obesity. Conclusion: Obesity is a kind of epidemic of modern society. Its effects on the quality of life, prognosis, and effectiveness of conservative or minimally invasive treatment methods in patients with acute cardiovascular catastrophes, such as acute MI, are still a very controversial issue that requires furthermore in-depth study and analysis.

Non-ST-Elevation Acute Coronary Syndrome and Predictors of Severity Coronary Artery Disease at the Oran University Hospital Center (Algeria)

Introduction: Non-ST-elevation (NSTE) acute coronary syndrome (ACS) is a common and polymorphic condition. Predicting significant coronary artery disease (CAD) is sometimes difficult. The objective of this study was to identify predictors of CAD severity in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Patients and Methods: We prospectively evaluated 296 patients with NSTE-ACS who underwent a coronary angiography. Significant CAD was defined as ≥70% stenosis in at least one major coronary artery. Clinical characteristics in the hospital for 30 days and one-year outcomes were prospectively noted and a multivariate analysis was performed. Results: The study included 296 NSTE-ACS patients. The mean age of the patients was 62.1 ± 12.6 years old while 58.1% of the patients were males. A multivariable analysis for the significant CAD predictors is shown (Figure 1), representing current smoking (ORa = 4.4; 95% confidence interval [CI] = 1.5–13.0, p = 0.007), a diabetic under insulin (Ora = 6.4; 95% [CI] = 2.4–17.4, p < 10-3), typical angina (ORa = 5.4; 95% [CI] = 1.7–16.8, p = 0.003), persistent angina (ORa = 5.3; 95% [CI] = 1.3–21.8, p = 0.019), recurrence of angina (ORa = 8.9; 95% [CI] = 1.5–51.4; p = 0.015), down sloping ST depression (ORa = 6.1; 95% [CI] = 2.4–15.3, p < 10-3), positive troponin (ORa = 4.2; 95% [CI] = 1.9–9.2, p < 10-3), kinetic disorder > 2 segments (ORa = 2.5; 95% [CI] = 1.1–6.0, p = 0.049), intima-media thickness (IMT) > 0.8 mm (ORa = 5.2; 95% [CI] = 2.3–12.1, p < 10-3). Conclusion: In this study, the severity of CAD was predicted by parameters such as typical or recurrent angina pectoris, current smoking, diabetic on insulin, down sloping ST depression, elevation of troponin, kinetic anomaly in more than two segments and the IMT greater than 0.8 mm.

Non-Bacterial Thrombotic Endocarditis: A Manifestation of Lung Cancer

Non-bacterial thrombotic endocarditis (NBTE) is characterized by vegetations on cardiac valves consisting of fibrin and platelet aggregates that are devoid of inflammation or bacteria. Diagnosis is often challenging and is aided by a high index of suspicion. These factors are reflected by the case of a 53 year old woman with a history of recurrent idiopathic deep vein thrombosis (DVT) prior to presentation at our institution to which she was admitted because of right upper extremity numbness and weakness.

Contribution of Transesophageal Echocardiography in the Etiological Diagnosis of Ischemic Stroke: Retrospective Study of 56 Cases

Introduction: Strokes constitute a public health problem. Ischemic strokes are caused by cardioembolic diseases in 20% of cases. We have realized this study in order to situate the role of transesophageal echocardiography in the search of cardioembolic diseases during ischemic strokes. Materials and Methods: We have realized a retrospective study in the Cardiology Department of “Hopital Général de Grand Yoff” at Dakar, during two years from June 2003 to July 2005. Our patients received benefits from medical examination, biological exams, an ECG, a recording ECG, a transesophageal echocardiography, transthoracic echocardiography, a brain scan and echodoppler of neck vessels. Results: Fifty-six cases have been identified. The average age was of 60.3 ± 14.3 years (extremes: 21–87 years). The sex-ratio (men over women) was of 0.75. The cardiovascular risk factors were dominated by blood hypertension and diabetes. On the standard electrocardiogram, we noted eleven cases of atrial fibrillation and one case of atrial flutter. Two patients have presented a paroxystic atrial fibrillation on recording electrocardiogram and six (10.7%), either a significative stenosis or carotid thrombosis at neck vessels echodoppler. The board number V is the summery of the etiology of ischemic strokes found by transesophageal echocardiography.