Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence tomography analyses.

AIMS: We investigated the feasibility of thrombus quantification by frequency-domain optical coherence tomography (FD-OCT) methods in patients with highly thrombotic acute coronary syndrome (ACS) treated by deferred stenting strategy. METHODS AND RESULTS: Patients were suitable for inclusion if they presented (i) an ACS that was successfully revascularized by manual thrombo-aspiration and (ii) a large residual thrombus on coronary angiography and initial FD-OCT analysis. These patients underwent a second procedure including FD-OCT analysis after several days of optimal antithrombotic therapy. Serial area measurements within the athero-thrombotic culprit lesion were performed to evaluate the OCT-thrombus score, volume, and length. Sixteen patients (88% men/age = 59.3 ± 4.1 years/94% STEMI) were included in the study. The mean delay between OCT analyses was 3.9 ± 0.3 day. No adverse event was observed during this interval. We observed a reduction of thrombus burden between the two analyses, as assessed by the significant reductions in OCT-thrombus score (22.3 ± 2.6 vs. 10.3 ± 1.3, P < 0.001), OCT-thrombus volume (9.6 ± 2.3 vs. 3.6 ± 0.9 mm(3), P = 0.003), and OCT-thrombus length (11.1 ± 1.4 vs. 7.4 ± 0.8 mm, P = 0.01). The percentages of OCT-thrombus score and volume reduction were highly correlated with the inter-OCT analyses delay (respectively ρ = 0.65 and ρ = 0.84, P < 0.01 for both). CONCLUSION: FD-OCT assessment of thrombus volume in selected ACS patients is feasible, safe, and could allow clot regression monitoring in vivo.

[The QT interval: standardization, limits and interpretation]. / L'intervalle QT: standardisation, limites et interprétation.

Despite clinical importance of ventricular repolarisation, it remains difficult to analyse. Conventionally, quantification of the electrocardiographic ventricular repolarization is usually performed with reference to axis of the T wave and QT interval duration. A variety of factors can prolong the QT interval, such as drug effects, electrolyte imbalances, and myocardial ischemia. The biggest risk with prolongation of the QT interval is the development of torsades de pointes. Commonly accepted reference ranges for the electrocardiogram (ECG) have been in use, with little change, for many years. Populations throughout the world present several differences: age, ethnic compositions, and are exposed to different environmental factors. Recent studies have reported reference data for QT interval in healthy population and have evaluated the influence of age, gender, QRS duration and heart rate on this interval. In this review, we address several issues relative to the measurement, and interpretation of QT interval and its adjustment for rate, age, gender and QRS duration.

[Correlation of TIMI risk score with angiographic extent and severity of coronary artery disease in non-ST-elevation acute coronary syndromes]. / Corrélation du score TIMI avec l'étendue et la sévérité de l'atteinte coronaire dans les syndromes coronariens aigus sans sus-décalage de ST.

AIM OF STUDY: To determine whether the TIMI risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization. PATIENTS AND METHOD: We conducted a retrospective review of 239 medical records of patients who underwent coronary angiography secondary to non-ST-elevation acute coronary syndrome between 2002 and 2006. Patients were classified into three groups according to TIMI risk score: TIMI scores 0 to 2 (group 1: n=121), 3 to 4 (group 2: n=100), and 5 to 7 (group 3: n=18). We compared the coronary angiography findings of the three groups. RESULTS: Patients of group 1 had a greater likelihood of normal or non significant CAD than patients of group 2 (36.3 % vs 13 %, P<0.001) and than patients of group 3 (36.3 % vs 0 %, P=0.002). One-vessel disease was found more often in patients with TIMI score 0 to 2 than in patients with TIMI score 5 to 7 (28.9 % vs 0 %; P=0.01), and in patients with TIMI score 3 to 4 than in those with score 5 to 7 (35 % vs 0 %, P=0.006). However, 1-vessel disease was found in patients of group 1 as often as in patients of group 2. The frequency of two-vessel disease was similar whatever the level of TIMI score was low, intermediate or high. Three-vessel or left main disease was more likely found in patients of group 3 than in patients of group 2 (66.7 % vs 26 %; P=0.01), and than patients of group 1 (66.7 % vs 13.2 %; P<0.001). Chronic coronary occlusions and coronary calcifications were also more likely found in patients with TIMI score 5 to 7. CONCLUSION: In patients with non-ST-elevation acute coronary syndrome undergoing cardiac catheterization, the TIMI risk score correlated with the extent and severity of coronary artery disease.

[Influence of diabetes mellitus on the prognosis of non-ST-elevation acute coronary syndromes]. / Influence du diabète sucré sur le pronostic des syndromes coronariens aigus sans sus décalage de ST.

AIM OF STUDY: Analyze the influence of diabetes mellitus on the prognosis, at short and middle term of patients with non-ST-segment-elevation acute coronary syndrome. PATIENTS AND METHOD: We conducted a retrospective review of 308 consecutive medical records of patients admitted to the care unit of our department with a non-ST-segment-elevation acute coronary syndrome. One hundred and fifty-six patients were diabetics (group 1) and 152 were not (group 2). We compared the demographic, clinical, angiographic and therapeutic characteristics of the two groups and we analyzed the prognosis of diabetic and non-diabetic patients at short term (30 days) and at middle term (average: 28 months; extreme: 12 months, 72 months). RESULTS: The mean age was similar into both groups (60.8 years). Diabetic patients were more often women (42.1% vs 23.1%) and presented a higher prevalence of systemic hypertension, dyslipidemia and family history of coronary artery disease. Smoking was more frequent in group 2. The rates of coronary angiography, percutaneous transluminal coronary angioplasty, and coronary bypass surgery were similar in the two groups. At 30 days, diabetic patients were at increased risk for acute heart failure (19.1% vs 6.4%) and for major cardiac events (12.5% vs 6.4%). A pejorative prognosis was also observed at middle term among diabetic patients. They were at greater risk for readmissions for non-ST-segment-elevation acute coronary syndrome (42% vs 25%), for major cardiac events (49.3% vs 31.6%) and for new revascularizations (17.3% vs 7.2%). In a Cox multivariate analysis, diabetes mellitus remains an independent risk factor for major cardiac events at middle term. CONCLUSION: Our study confirms the pejorative prognosis of acute coronary syndromes without ST elevation at short and middle term in diabetic patients.

[Effects of acute decrease in preload on echocardiographic indices of systolic and diastolic function of the left ventricle in children with end-stage renal disease (ESRD). Comparative study before and after hemodialysis]. / Effets de la réduction de la précharge sur les paramètres échographiques de la fonction systolique et diastolique du ventricule gauche de l'enfant en insuffisance rénale terminale: étude comparative avant et après hémodialyse.

PURPOSE: Contrasting data exist about the hemodialysis induced changes of ventricular diastolic and systolic functions in adults. Few data in children with end-stage renal disease (ESRD) are reported. The aim of the present study was to evaluate the effect of a single hemodialysis (HD) session on left ventricular (LV) systolic and diastolic function using conventional pulsed-Doppler echocardiography and pulsed tissue Doppler imaging (TDI) in hemodialysis children. METHODS: Thirty-five children with chronic renal failure (15 males, aged 12.8+/-3.8 years) on maintenance hemodialysis underwent conventional 2D and Doppler Echo together with measurement of longitudinal mitral annular motion velocities. Echocardiographic parameters were obtained 30 minutes before and 30 minutes after HD. Paired data were compared. RESULTS: Hemodialysis led to reduction in LV end-diastolic volume (p=0.001), end-systolic volume (p=0.05), left atrium area (p<0.0001), peak early (E wave) transmitral flow velocity (p=0.005), peak S velocity of pulmonary vein flow (p=0.002), aortic time velocity integral (p<0.0001) and aortic ejection time (p<0.0001). No significant change in Tei Index was observed after HD. Regarding TDI measures, velocities were not affected by preload reduction. Only the early diastolic velocities on the septal side of the mitral annulus decreased significantly (p=0.001) and the systolic velocities on the lateral side of the mitral annulus increased significantly (p=0.042) after hemodialysis. CONCLUSIONS: Most of Doppler-derived indices of diastolic function are preload-dependent. TDI velocities and Tei Index were not or minimally affected by preload reduction in hemodialysis children.