To accelerate the Zika beat: Candidate design for RNA interference-based therapy.

Zika virus infection is associated with the development of severe neurological disorders in adults and newborns. Although at the moment Zika virus outbreak is not threatening to become again an emergency, infection cases are still being sporadically reported and there is still no effective therapy available. A possible treatment to suppress Zika replication is represented by short interfering RNAs (siRNAs), since they have been successfully used even against Ebola, H5N1 and SARS viruses and clinical trials of siRNA-based drugs are ongoing. In order to speed up the time consuming experimental validation of effective siRNAs, we have performed a comprehensive bioinformatic analysis to design only a few promising siRNAs against Zika virus. Besides siRNA efficacy, we paid attention to broad-spectrum antiviral activity, obtained by analysing all known Zika genomes, and siRNA safety, by excluding siRNAs that could potentially provoke an immune response or interfere with host mRNAs, lncRNAs, circRNAs and RNA binding proteins. In Zika genome we identified several highly conserved regions targetable by only 20 siRNAs. In particular, only a few siRNAs survived highly stringent criteria for siRNA safety. Notably, two of our candidate siRNAs have been successfully used against other flaviviruses like Zika, both in in vitro and in vivo models. Since they were effective against two different flaviviruses, by targeting a highly conserved region, it is reasonable to hypothesize that they could be active also against Zika. Therefore, we encourage researchers to experimentally validate these promising siRNAs.

[Identification of the intercycle FSH signal in urine samples (uFSH)]. / Identification du signal FSH intercycle par la mesure de la FSH urinaire (FSHu).

OBJECTIVE: The intercycle FSH signal that initiates follicular recruitment and marks the functional onset of the menstrual cycle is of small amplitude and while it commonly occurs on cycle day 3, this often varies. Hence, its identification and measurement in serum (sFSH) requires serial daily samplings. We attempted to determine whether urine measurements of FSH (uFSH) could offer a non-invasive alternative, using a model where the intercycle FSH signal is controlled by timely use of exogenous E2. PATIENTS AND METHODS: Pilot prospective trial in 21 infertile women having received E2, from day 25 of the previous cycle until the 1st Friday after menses. Blood and first void urine samples were collected, starting on the last day of E2 (baseline) for assessing FSH and creatinin. A sonogram was performed for identification of maturing follicles (>12 mm). RESULTS: uFSH and uFSH/Cr showed good correlation with sFSH (R = 0.52 and 0.63, P < 0.0001 and P < 0.0001, respectively). In 15/21 patients who had an intercycle sFSH elevation, this was confirmed by uFSH elevation, both occurring within 2-4 days after stopping E2. In all these women, the sonogram showed evidence of impending ovulation. The amplitude of the uFSH signal was on average 3 times higher than its sFSH counterpart. In 6/21 women, no intercycle FSH elevation was detected and no ovulation occurred. DISCUSSION AND CONCLUSION: Our results show that the intercycle FSH signal can easily be identified and measured in urine. This novel approach permits more precise assessments of ovarian physiology than with blood measurements.

[Should we treat all diabetic patients with aspirin in primary prevention?]. / Faut-il donner de l'aspirine en prévention primaire a tous les patients diabétiques?

Patients with diabetes have a higher risk of atherothrombotic disease. These patients have up to 4-fold more coronary artery diseases compared with patients without diabetes. Aspirin is one of the most prescribed treatments in the prevention of cardiovascular diseases. This article focuses on the effect of aspirin in primary prevention with a summary of interventional studies including diabetic patients. The guidelines from different speciality societies, notably the American Diabetes Association, are positive. However, the results of these studies are not conclusive. Cautions recommendations are proposed.

[Study of left ventricular function at rest and post-exercise with thallium-201 myocardial scintigraphy synchronized with ECG]. / Etude de la fonction ventriculaire gauche au repos et dans le post-effort par la tomoscintigraphie myocardique au thallium-201 synchronisée à l'ECG.

ECG-gated Thallium 201 myocardial scintigraphy provides a simultaneous evaluation of left ventricular perfusion and function. The aims of this study were to determine the changes in left ventricular ejection fraction (LVEF) after exercise and at rest 4 hours after exercise and to compare the results with changes in myocardial perfusion and the severity of the coronary artery disease. Sixty-four men with myocardial ischaemia on scintigraphy who had undergone coronary angiography showing significant lesions within 3 months, were compared with 38 normal men. The ejection fraction was calculated with a validated programme (QGS). The change in LVEF between the post-exercise and resting measurement 4 hours after exercise (delta LVEF) was compared in the normal and ischaemic groups (+7 +/- 6.8% vs -5.6 +/- 5%, p < 0.001). The extent of the ischaemia (percentage myocardium unperfused) was significantly greater in the 34 patients who had an over 5% reduction in LVEF on exercise compared with the 30 others who has a less than 5% reductionin LVEF (11.8 vs 6.3%, p < 0.001). There was a linear correlation between the degree of ischaemia and delta LVEF in the 30 patients without a history of infarction (r = -0.76, p < 0.01). The delta LVEF also correlated with the number and site of the coronary lesions. The authors conclude that in this male population, ECG-gated Thallium 201 myocardial scintigraphy can demonstrate a decrease in LVEF after exercise in ischaemic coronary patients whereas it increases in normal subjects. This decrease in LVEF on exercise is correlated with the extent of ischaemia and the severity of the coronary disease and should therefore be taken into account in patient management.

[Comparative study of left ventricular ejection fraction and volume by 2 isotopic methods and contrast angiography]. / Etude comparative des fractions d'éjection et volumes ventriculaires gauches obtenus par deux méthodes isotopiques et par l'angiographie de contraste.

The tomographic mode has replaced the planar mode for radióisotopic studies of myocardial perfusion but not for the study of systolic ventricular function. The aim of this study was to compare monophotonic emission tomography (MPET), the planar mode (PM) and contrast angiography (Angio). The left ventricular volumes and ejection fractions were measured in 111 patients by the tomographic and planar modes and by biplane angiography in 70 of them. The MPET algorithm (QBS software) identified the ventricular endocardium in 96 of the 111 procedures (86%). The mean left ventricular ejection fractions (LVEF) were 57 +/- 17% (MPET, N = 96), 55 +/- 15% (PL, N = 96) and 57 +/- 15% (Angio, N = 70). There was a good correlation of LVEF between MPET and PL and MPET and Angio with negligible bias of 3 +/- 6% and 2 +/- 4% respectively and high correlation coefficients, r = 0.94 (MPET = 1.05*PL-0.2) and r = 0.93 (MPET = 1.1 x Angio-3). The differences between the 95% confidence intervals between MPET and PL and MPET and Angio may be explained by an overestimation of normal LVEF by MPET, especially in patients with low end systolic volumes. In these cases, the difference in LVEF by MEPT and the average LVEF from the 3 techniques was greater: 6 +/- 4% (< or = 20 ml) vs 0 +/- 3% (> 20 ml) (p < 0.0001). The authors conclude that, with the reserve that a high percentage of investigations could not be analysable. MPET seems to be a method of choice for assessing left ventricular systolic function.

[Prognostic value of thallium 201 myocardial scintigraphy with dipyridamole before peripheral arterial surgery]. / Valeur pronostique de la tomoscintigraphie myocardique au thallium-201 sensibilisée au dipyridamole avant chirurgie artérielle périphérique.

The evaluation of patients who are candidates for peripheral arterial surgery is difficult. The aim of this study was to show that dipyridamole stress scintigraphy could be a prognostic aid for patient selection. Between 1991 and 2000, 275 patients underwent dipyridamole stress myocardial scintigraphy before peripheral arterial surgery of the lower limbs (49%), the aortic (33%) or carotid arteries (18%). A perfusion defect was observed in 145 patients suggesting myocardial ischaemia in 79 cases and myocardial infarction in 66 cases. Twenty-seven of the 79 ischaemic patients underwent a preoperative coronary revascularisation. The operative adverse coronary events (5%) were: 7 non-fatal myocardial infarctions and 7 acute coronary syndromes. The 79 ischaemic patients had a higher risk of adverse coronary events: 11% (ischaemia) versus 3% (no ischaemia) (p < 0.01). Myocardial scintigraphy allowed stratification of patients with an intermediate risk of Eagle's score into high coronary risk (15%, ischaemia) or low coronary risk (2%, no ischaemia) (p < 0.01). The extent of the ischaemia was associated with a higher risk of adverse coronary events: 4 zones (20%) versus 1 zone (5%) (p = 0.02). Preoperative coronary revascularisation tended to reduce the risk of adverse coronary events from 15% to 4% (p = NS). Myocardial ischaemia (p < 0.0001) and left bundle branch block (p = 0.002) were the two predictive factors of an adverse operative coronary event. Thallium-dipyridamole myocardial scintigraphy with a high negative predictive value (97%) is a useful tool for the identification of high risk patients for whom an aggressive preoperative therapeutic strategy may be beneficial.

The presence of genetic hypertension stimulates early renal accumulation of fibronectin in experimental diabetes mellitus.

AIMS/HYPOTHESIS: To investigate the interaction between hypertension and diabetic nephropathy, we studied the renal accumulation of fibronectin in a genetic model of hypertension with streptozotocin-induced diabetes mellitus. METHODS: Spontaneously hypertensive rats (SHR) and their genetically normotensive control Wistar Kyoto rats (WKY) were studied at 4 weeks of age. The rats were killed 20 days after the induction of diabetes mellitus. The renal accumulation of fibronectin was estimated using Western blot analysis as well as immunofluorescence technique and confocal microscopy. RESULTS: Blood glucose concentrations were similar in diabetic SHR rats (27 +/- 3.3 mmol/l) and WKY rats (25.5 +/- 2.7 mmol/l). The systolic blood pressure was higher in both groups of SHR rats than in the control rats. The abundance of renal fibronectin as detected by Western blot analysis was (p < 0.05) higher in the diabetic SHR rats (41.4 +/- 15.0 densitometric U, n = 8) than in the control rats, and no difference was observed between diabetic and control WKY rats (20.8 +/- 6.2, n = 8) and (27.8 +/- 17.2, n = 8). The mean peak intensity of fibronectin signal within the glomerulus as estimated by confocal microscopy was higher (p < 0.05) in the diabetic SHR rats (32.9 +/- 3.5) than in control SHR rats (11.9 +/- 5.7) or diabetic (7.4 +/- 2.2) and control (15.2 +/- 7.9) WKY rats. CONCLUSION/INTERPRETATION: In experimental diabetes the presence of genetic hypertension promotes earlier accumulation of renal fibronectin, a matrix protein implicated in renal glomerulosclerosis.

Paraoxonase promoter polymorphism T(-107)C and relative paraoxonase deficiency as determinants of risk of coronary artery disease.

This study tested the hypothesis that promoter polymorphism T(-107)C of the human paraoxonase gene (PON1) is associated with risk of coronary disease. Participants (n=897) were recruited from a cardiology department. All underwent coronary arteriography and were defined as coronary artery disease positive (n=699) or negative (n=198). No association of the promoter genotypes with coronary disease was observed in the overall population, but the high expressor genotype (-107CC) was associated with decreased risk of disease in patients aged 60 years or under in univariate and multivariate analysis independently of established risk factors. A significant deficiency in paraoxonase relative to cholesterol was apparent in patients, even when they were matched with controls for total and low-density lipoprotein cholesterol levels. The -107 polymorphism was not associated with risk in older patients (61 years or over). Age was negatively associated with serum concentrations and activities of paraoxonase; serum paraoxonase was significantly higher in those aged under 61 years than in those aged 61 or over. Age was an independent predictor of paraoxonase concentrations. The results indicate that in this population of patients the promoter polymorphism T(-107)C of the PON1 gene is an independent risk factor for coronary disease in those 60 years or younger. The data are consistent with the hypothesis that lower expression of this anti-oxidant enzyme increases risk of coronary disease. Ageing has also been identified as an independent determinant of serum paraoxonase levels. Ageing is correlated with reduced serum paraoxonase levels, which may compromise the protective influence of enzyme. The results are consistent with the contention that the protective, anti-oxidant capacity of high density lipoproteins is at least in part genetically determined.

Smoking is associated with reduced serum paraoxonase activity and concentration in patients with coronary artery disease.

BACKGROUND: Paraoxonase is an HDL-associated enzyme that protects lipoproteins from oxidative modifications. Smoking is a major cardiovascular risk factor that promotes lipid peroxidation. Cigarette smoke has been shown in vitro to inhibit paraoxonase. The present study examined the hypothesis that smoking is associated with modulated serum activities and concentrations of paraoxonase. METHODS AND RESULTS: Coronary artery disease was assessed with the use of coronary arteriography in participants recruited from a hospital cardiology division. Medical and lifestyle data were obtained, and a fasting blood sample was provided. Three smoking categories were established (never, ex-smokers, and current smokers), and serum paraoxonase variables were compared among them. The activities and concentrations of paraoxonase were significantly lower in current than in never smokers. Ex-smokers had values comparable to those of never smokers. Ex-smokers who had recently stopped (<3 months) had activities and concentrations comparable to those of current smokers; values returned to the levels of never smokers within 2 years of cessation of smoking. Smoking status was an independent determinant of paraoxonase activity and concentration in multivariate analysis. Finally, lower paraoxonase was associated with more severe coronary disease and a reduced capacity to protect LDL from oxidation. CONCLUSIONS: Smoking is independently associated with significant decreases in serum paraoxonase activities and concentrations, which normalize within a relatively short time of cessation. Lower serum paraoxonase is linked to more severe coronary artery disease and a lower antioxidant capacity. The data are consistent with the hypothesis that smoking modifies serum paraoxonase such that there is an increased risk of coronary artery disease due to a diminished capacity to protect lipoproteins from oxidative stress.

Role of the vascular endothelium in patients with angina pectoris or acute myocardial infarction with normal coronary arteries.

Chest pain with normal coronary angiograms is a relatively common syndrome. The mode of presentation of this syndrome includes patients with syndrome X and patients with an acute myocardial infarction and angiographically normal coronary arteries. Different mechanisms have been proposed to elucidate the exact cause and to explain the various clinical presentations in these patients. Abnormalities of pain perception and the presence of oesophageal dysmotility have all been reported in patients with syndrome X. In situ thrombosis or embolization with subsequent clot lysis and recanalization, coronary artery spasm, cocaine abuse, and viral myocarditis have been described as potential mechanisms responsible for an acute myocardial infarction in patients with angiographically normal coronary arteries. Recent data suggest that both microvascular and epicardial endothelial dysfunction may play an important role in the pathophysiological mechanism of the syndrome of stable angina or acute myocardial infarction with normal coronary arteries.

[Diagnosis of coronary disease: thallium-201 dipyridamole tomoscintigraphy of the myocardium]. / Détection de la maladie coronarienne: performances diagnostiques de la tomoscintigraphie myocardique au thallium-201 après dipyridamole.

OBJECTIVES: Determine the diagnostic performance of thallium-201 myocardial scintigraphy using dipyridamole injection for the detection of coronary heart disease (myocardial ischemia and/or necrosis). Determine for each coronary artery the degree of angiographic stenosis for optimal diagnostic performance. PATIENTS AND METHODS: The study included 309 patients who underwent coronarography within 6 months of the scintigraphy examination. None of the patients experienced a coronary event during this interval. Diagnostic performance of the scintigraphic exploration was compared with angiographic findings (stenosis 70%) used as the gold standard. The degree of angiographic stenosis for optimal scintigraphic performance was determined from the receiver operating characteristic (ROC) curves. RESULTS: The sensitivity of scintigraphy to detect angiographically demonstrated coronary disease was 84% with a specificity of 72%. The positive and negative predictive values were 87% and 66% respectively. Test accuracy was 80%. Sensitivity was better for detecting lesions of the anterior interventricular coronary than for the right coronary or circumflex. In addition, sensitivity varied with the number of vessels involved: 76% for single-vessel disease versus 90% for two- or three-vessel disease. The data analysis also suggested that an angiographic stenosis threshold of 50% provided optimal predictive value for scintigraphy for each of the three vessel territories. An analysis based on maximal stenosis in each patient, notwithstanding the congruency between lesion localization and diseased vessel territories, was found to provide less diagnostic precision. CONCLUSION: Thallium-201 dipyridamole myocardial scintigraphy offers diagnostic performance comparable to that established with thallium-201 scintigraphy performed after exercise alone. Scintigraphic detection of a perfusion defect generally corresponds to an angiographic stenosis of 50%.

Quantification of myocardial perfusion with FAST sequence and Gd bolus in patients with normal cardiac function.

The present study reports on a new calibration of the magnetic resonance imaging (MRI) signal intensity of a fast gradient-echo sequence used for in vivo myocardial perfusion quantification in patients. The signal from a FAST sequence preceded by a arrhythmia-insensitive magnetization preparation was calibrated in vitro using tubes filled with various gadolinium (Gd) solutions. Single short-axis views of the heart were obtained in patients (n = 10) with normal cardiac function. Myocardial and blood signal intensity were converted to concentration of Gd according to the in vitro calibration curve and fitted by a one-compartment model. K1 [first-order transfer constant from the blood to the myocardium for the gadolinium-diethylenetriamine-pentaacetic acid (Gd-DTPA)] and Vd (distribution volume of Gd-DTPA in myocardium) obtained from the fit of the MRI-derived perfusion curves were 0.72+/-0.22 (mL/min/g) and 15.3+/-5.22%. These results were in agreement with previous observations on animals and demonstrated that a reliable measurement of myocardial perfusion can be obtained by MRI in patients with an in vitro calibration procedure.

[Assessment of cardiac insufficiency]. / Evaluation de l'insuffisance cardiaque.

Heart failure is a common clinical syndrome caused by different cardiovascular diseases. The prognosis is poor once the stage of congestive failure is reached. Several non-invasive and invasive techniques, described in this article, are used to objectively diagnose systolic or diastolic failure at its early stage. These investigations are needed to assess, not only the cardiac dysfunction, but also the underlying cause of the failure. Early and effective treatment should prevent or delay the occurrence of the signs of congestive failure and thus improve the prognosis.

Long-term (10 years) prognostic value of a normal thallium-201 myocardial exercise scintigraphy in patients with coronary artery disease documented by angiography.

In order to assess the prognostic significance of normal exercise thallium-210 myocardial scintigraphy in patients with documented coronary artery disease, we studied the incidence of cardiac death and non-fatal myocardial infarction in 69 symptomatic patients without prior Q wave myocardial infarction, who demonstrated one or more significant coronary lesions (stenosis > or = 70%) on an angiogram performed within 3 months of scintigraphy (Group 1). These patients were compared to a second group of 136 patients with an abnormal exercise scintigram, defined by the presence of reversible defect(s) and angiographically proven coronary artery disease (Group 2), and to a third group of 102 patients with normal exercise scintigraphy without significant coronary lesions (stenosis < or = 30%) or with normal coronary angiography (Group 3). In contrast to coronary lesions observed in Group 2, patients in Group 1 presented more frequently with single-vessel disease (83% vs 35%, P < 0.0001) and with more distal lesions (55% vs 23%, P < 0.0001). Over a mean follow-up period of 8.6 years, one fatal and eight non-fatal cases of myocardial infarction were observed in Group 1. The majority of patients in Group 1 were treated medically: only 24 (35%) underwent myocardial revascularization, usually by coronary angioplasty. There was no significant difference in the incidence of combined major cardiac events (cardiac death, non-fatal myocardial infarction) in patients with normal exercise scintigraphy, with or without documented coronary artery disease (Groups 1 and 3), while the incidence was higher in Group 2. However, while the mortality remained very low in Group 1, the incidence of non-fatal myocardial infarction was not different from that of Group 2, where most patients underwent revascularization procedures. In conclusion, patients with coronary artery disease and a normal exercise thallium-201 myocardial scintigram usually have mild coronary lesions (single-vessel disease, distal location) and good long-term prognosis, with a low incidence of cardiac death.

[Stress echocardiography versus scintigraphy in coronary disease: scintigraphy is the method of choice]. / Echocardiographie de stress versus scintigraphie dans la maladie coronarienne: la scintigraphie est la méthode de choix.

Myocardial perfusion imaging and stress echocardiography play a major role in the non-invasive evaluation of patients with known or suspected coronary artery disease. Data of the literature indicate that the two techniques are practically equivalent for the diagnosis of coronary artery disease. However, tomoscintigraphic imaging is more sensitive than exercise echocardiography for localizing lesions, correctly identifying the presence of multivessel coronary disease and distinguishing viable from nonviable myocardium in a ventricular territory with abnormal contraction. Both techniques require specialized equipment and technical expertise and thus, in a given institution, one technique could be more accurately performed and provides better results. Therefore, it is preferable to underline the complementary aspects of the two techniques rather than opposing them to each other.

Haemodynamic and endocrinological effects of noninvasive mechanical ventilation in respiratory failure.

The aim of this study was to investigate the haemodynamic and endocrinological effects of noninvasive positive pressure ventilation (NIPPV). Eleven patients with oedema and recent hypercapnic and hypoxaemic worsening of a chronic respiratory insufficiency were included. Echocardiography, cardiac radionuclide assessment, blood catecholamines, salt and water handling hormones were measured at admission and discharge (long study (LS)). To discriminate between the action of NIPPV and other treatments, measurements were performed on the fourth day, for 4 h without NIPPV and 4 h with NIPPV (short study (SS)). NIPPV entailed a correction of P(a,CO2) and an increase of P(a,O2) in LS and SS. Oedema disappeared. Body weight decreased (from 85+/-42 to 81+/-40 kg) during LS. Systolic and mean pulmonary arterial pressure decreased in LS and SS. Right ventricular ejection fraction increased in LS. Left ventricular ejection fraction did not change. Cardiac index was normal on admission and then decreased. Natriuretic peptides and catecholamines were increased on admission, whereas plasma renin activity, aldosterone and vasopressin were normal. We suggest that in these patients, oedema can occur independently of renin-angiotensin-aldosterone-vasopressin and with a normal cardiac output. Noninvasive positive pressure ventilation allowed a correction of blood gases, associated with the resolution of oedema, a decrease in pulmonary arterial pressures and an increase in right ventricular ejection fraction.

Cardiac function improvement 24 hours after isradipine SRO in patients with chronic stable angina: a double-blind randomized study.

We recently showed that Isradipine, a calcium antagonist from the dihydropyridine group, reduces ischemia and improves ventricular function at rest and during exercise, 2 hours after a single oral dose, in patients with chronic stable angina. In the present study, we evaluated the effects of long acting slow release oral (SRO) Isradipine (5 mg) compared to a placebo in 30 coronary patients with stable chronic angina, randomized in a double blind-fashion. The following parameters were obtained at rest and during submaximal exercise: left and right ventricular (LV, RV) ejection fractions (EF; %) and peak filling rate (PFR; EDV/s), assessed by gated radionuclide angiography, clinical symptoms, electrocardiograms (ECG, ST segment depression; mm), systolic and diastolic blood pressure (SBP and DBP; mm Hg). Patients were then given two oral doses of either Isradipine or placebo (one a day). The same parameters were reassessed, at rest and during n equivalent exercise, 48 hours later (24 hours after the last administration of the drug). The results after Isradipine (n = 14) showed, at rest, a significant increase in LVEF and Pfr (51 +/- 9 to 54 +/- 8 and 1.97 +/- 0.44 to 2.36 +/- 0.71, respectively) and a decrease in DBP (93 +/- 11 to 87 +/- 13); and during exercise, a significant increase in LVEF (51 +/- 11 tot 55 +/- 13) and a decrease in ST segment depression (2.3 +/- 1.9 tot 1.9 +/- 1.6). No significant change was observed after placebo in the other 16 patients. We conclude that even 24 hours after an oral administration, Isradipine SRO maintains its beneficial effects both, at rest on LV systolic and diastolic function and pressure, and during exercise on ECG signs of ischemia with improvement in LV ejection fraction.

Standard views in cardiac multimodality tomographic imaging.

In cardiology, it is often necessary to acquire more than one type of image to investigate a given clinical problem of a single patient. Images obtained from different imaging modalities are usually recorded and displayed in different orientations, at different positions, and at different scale factors. It is then necessary for the physician to mentally integrate the image information from the different imaging modalities. This phenomenon is particularly true with tomographic imaging techniques that allow complete freedom of the acquisition plane. In particular, when comparing images obtained from ultrasound, computed tomography, magnetic resonance imaging, positron-emission tomography, and single-photon emission computed tomography. The purpose of this article is to propose a standard set of slice orientations that could be easily applied to all modalities. Such common views could greatly facilitate the user's perception of the regional abnormalities observed in the different imaging modalities. This standardization is certainly useful for clinical application but also for every research study that requires a comparative evaluation of the different imaging modalities. Although exact registration of the images from the different modalities requires sophisticated computer programs, the simple reference method in plane positioning proposed here based on plane orientation according to the cardiac geometry can certainly provide a practical and convenient method for the reasonably accurate image registration required for visual comparative studies.

[Myocarditis mimicking myocardial infarct]. / Myocardite se présentant comme infarctus du myocarde.

We describe 3 patients with an initial diagnosis of myocardial infarction, in whom a definitive diagnosis of myocarditis was subsequently established. All had precordial chest pain, electrocardiographic changes, elevated cardiac enzyme levels and regional wall motion abnormalities of the left ventricle compatible with myocardial infarction. During follow-up, all symptoms subsided and electrocardiographic tracings normalized. Regional wall motion abnormalities disappeared in two and persisted in one patient. These findings show that myocarditis may mimic myocardial infarction, and that the definitive diagnosis is generally established retrospectively.