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In STEMI patients without cardiogenic shock and without a priori indication for TFI, PCI can be performed via the radial artery in more than 90% of cases with high procedural success rate. Operator's judgement of eligibility for TRI based on radial pulse quality is predictive of successful TRI in 95% of cases. TR failure is significantly more common in the elderly and in patients with low body weight.

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Toxicomania is a worldwide emerging problem threatening young population. Several reports highlighted its hazardous cardiovascular effects. Sudden cardiac death secondary to cardiac arrhythmias is the most occupying issue. Different forms of cardiac rhythm disorders may be induced by illicit drug abuse according to the type of drug and the mechanism involved. In this review, we exposed the main ventricular and supraventricular arrhythmia complicating the common recreational drugs, and we explained their different mechanisms as well as the particularities of management.

Key Clinical MessageIllicit drugs are an uncommon etiology of acute myocarditis but should be evocated in young population. This association may result in further complications, mainly ventricular arrhythmia and therefore increases sudden cardiac deaths among young abusers. Withholding drug intoxication to prevent recurrent events is a major key of management.

Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

In the acute phase of ST-elevation myocardial infarction (STEMI) viability imaging techniques are not validated and/or not available. This study aimed to evaluate the ability of strain parameters assessed in the acute phase of STEMI, to predict myocardial viability after revascularization. Thirty-one STEMI patients whose culprit coronary artery was recanalized and in whom baseline echocardiogram showed an akinesia in the infarcted area, were prospectively included. Bidimensional left ventricular global longitudinal strain (GLS), and territorial longitudinal strain (TLS) in the territory of the infarct related artery were obtained within 24 hours from admission. Delayed enhancement (DE) cardiac magnetic resonance imaging (CMR) was used as a reference test to assess post-revascularization myocardial viability. DE-CMR was performed 3 months after percutaneous coronary intervention. According to myocardial viability, patients were divided into 2 groups; CMR viable myocardium patients with more than half of infarcted segments having a DE <50% (group V) and CMR nonviable myocardium patients with half or more of the infarcted segments having a DE >50% (group NV). GLS and TLS were lower in group V compared to group NV (respectively: −14.4% ± 2.9% vs −10.9% ± 2.4%, P = .002 and −11.0 ± 4.1 vs −3.2 ± 3.1, P = .001). GLS was correlated with DE-CMR (r = 0.54, P = .002) and a cut off value of −13.9% for GLS predicted viability with 86% sensitivity (Se) and 78% specificity (Sp). TLS showed the strongest correlation with DE-CMR (r = 0.69, P < .001). A cut off value of −9.4% for TLS yielded a Se of 78% and a Sp of 95% to predict myocardial viability. GLS and TLS measured in the acute phase of STEMI predicted myocardial viability assessed by 3 months DE-CMR. They are prognostic indicators and they can be used to guide the priority and usefulness of percutaneous coronary intervention in these patients.

Funding Acknowledgements Type of funding sources: None. Background Aortic coarctation accounts for 5 to 8 % of the congenital heart diseases.  In adult patients, an expected mortality of 75 % at 43 years old was reported. conventional surgery was the gold standard in the treatment of these patients. Currently with the advancement of endovascular procedures, angioplasty with ou no stenting is increasingly indicated. Methods We report a retrospective, monocentric observational study of 57 patients treated for aortic coarctation surgically or by endovascular approach over a period of 20 years, from 2000 until 2020. Results The median age was 22 years with extremes of 15 and 65 years and the sex ratio was 1.42. All patients were hypertensive. The median of the trans-stenotic gradient was 60 mmHg. Surgical repair consisted mainly of resection-anastomosis using the Crafoord technique in 25 patients (44%) and interposition of a Dacron tube in 22 patients (39%). Endovascular treatment with stenting was done in seven patients. Post treatment gradient was 10 mm Hg ± 5 and no deaths were observed at 30 days. After an average follow-up of 70 months, residual hypertension was found in seven cases without any re-coarctation and in the univariate analysis, the main factors significantly associated with this residual  hypertension were: age (p = 0.11), pre and post-operative gradient (p = 0.097), severe hypertension (p = 0,12), developed collateral circulation (p = 0.07), bicuspid aortic valve (p = 0.15) and diaphragm shape (p = 0.07). Conclusion The gold standard treatment remains the surgical correction but in selected patients, the endo-vascular repair is a valid option.we propose a decision-making algorithm based on the results of our study (Fig) Abstract Figure. decision-making algorithm