Interest of speckle tracking in the detection of cardiac involvement in pregnant women with hypertensive disorder.

INTRODUCTION: Pre-eclampsia is associated with many cardiovascular disorders present even in asymptomatic women. Several echocardiographic parameters are used to identify them. However, these parameters may be normal until late in the course of the disease process. Which justifies using new and more sensitive techniques. PURPOSE: We sought to test the hypothesis of subclinical cardiac involvement in such patients, based on speckle tracking, and to check its sensitivity compared to the usual methods. METHODS: We conducted a comparative case-control study, which included thirty pregnant women with hypertensive disorder and thirty healthy ones. The filling pressure of the left ventricle (LV) and strain peaks are measured for all women. RESULTS: Usual parameters were in favour of diastolic dysfunction in patients. Eighteen patients with high LV filling pressure were recorded, eight of them had at least one complication, which corresponded to a specificity of 77% and a sensitivity of 47%. However, global longitudinal strain (GLS) was severely altered in patients (p < .001). Moreover, there was a strong correlation of GLS with the usual parameters. Thus, for a threshold value of -18%, GLS had the best sensitivity of 87% and a specificity of 42% to predict complications. There was no significant difference for the radial and circumferential strain. CONCLUSION: GLS is more sensitive than other usual echocardiographic parameters in the detection of subclinical cardiac dysfunction in pregnant women with hypertensive disorder. It is strongly correlated with complications. Future larger studies could validate the integration of 2D-strain in the management of such patients.

[Exercise-induced coronary thrombosis]. / Thrombose coronaire à l'effort.

Heavy exertion as a trigger of cardiac events has been known since antiquity as it was already described in 492 BC in the famous Athens Marathon. Myocardial infarction occurring after physical exertion accounts for about 4% of myocardial infarctions. It is more common in men and younger patients. It usually occurs during intense efforts and especially in inactive people with multiple risk factors. It would be more severe with more frequent Q waves of necrosis on the victims' electrocardiograms, with greater troponin release and a more raised GRACE score. Atherosclerotic plaque rupture is at the center of its pathophysiology, this event is responsible of a thrombus formation occluding the coronary artery. The hemodynamic stress imposed on the often-atheromatous coronary arteries during exercise, favor the plaque rupture and the occurrence of myocardial infarctions. To these hemodynamic constraints, are added biochemical and rheological modifications, which favor the formation of an intra-coronary thrombus. The occurrence of acute coronary events during heavy exertion in patients who are often untrained must not make us forget about the benefit of regular exercise on both the life quality and morbimortality levels.

Analysis of tendinous actuation in balancing the maximal fingertip force for normal and abnormal forefinger system.

This work displayed the force capabilities of the musculoskeletal system of the forefinger under external loading. Different states of normal and pathological fingers are studied. We evaluated the impact of losing musculo-tendon unit strength capacities in terms of maximal output fingertip force and tendon tensions distribution. A biomechanical model for a static force analysis is developed through anatomical and kinematic studies. An optimisation approach is then used to determine tendon tension distribution when performing an isometric task. Furthermore, pathological fingers with common cases of injured flexors and extensors are analysed. The method of simulation for forefinger abnormities is described. Furthermore, the simulation results are interpreted.