[Left auricular dilatation in calcified aortic stenosis in adults]. / Dilatation auriculaire gauche dans le rétrécissement aortique orificiel calcifié de l'adulte.

Two groups of patients of comparable age, one comprising 12 subjects without detectable cardiac disease and the other comprising 38 patients with calcific aortic stenosis (CAS) underwent clinical, electrocardiographic, echocardiographic and haemodynamic studies to assess the degree and significance of left atrial hypertrophies in CAS. The volume of the left atrium (LA) was globally increased in CAS (maximum volume 68 per cent: 26/38) and LA ejection fraction was decreased in 60 per cent of patients (23/38). However, the maximum volume was only moderately greater than that of normal subjects (+38 per cent). The most specific non-invasive investigation for left atrial assessment is echocardiography. There was a linear relationship between LA angiographic volume and echocardiographic antero-posterior dimension (r = 0.43; p less than 1 x 10(-2)). The duration of the P wave in S2 was a specific (75 per cent) but relatively insensitive (27 per cent) sign of LA dilatation in pure CAS. On the other hand, the Morris index based on the surface of the P terminal force in V1 was quite sensitive (77 per cent) but not very specific (25 per cent). The maximum LA volume was not related to left ventricular volume, the severity of CAS, diastolic indices of compliance or left ventricular mass. However, the minimum LA volume (after atrial systole) was related to left ventricular end diastolic (r = 0.35, p less than 0.05) and end systolic volume (r = 0.34, p less than 0.05). The LA ejection fraction was inversely related to mean pulmonary capillary pressure (r = 0.34, p less than 5 x 10(-2).(ABSTRACT TRUNCATED AT 250 WORDS)

[Myocardial radionuclide tomography using Thallium 201 and detection of coronary re-stenosis after single-vessel angioplasty]. / Tomoscintigraphie myocardique au Thallium 201 et détection de la resténose coronaire après angioplastie monotronculaire.

Among non-invasive methods for the detection of coronary restenosis after successful transluminal coronary angioplasty, the contribution of exercise myocardial Thallium 201 tomoscintigraphy (MTS) was assessed in a prospective study involving 168 patients with a mean age of 56 (range 32-75) who had undergone 174 successful single vessel angioplasties (86 AIV, 35 Cx, 53 RC) with residual stenosis of 50% or less. After an interval of 6 +/- 2 months, patients were reassessed without treatment by a maximum exercise test (ET) combined with Thallium 201 MTS, 24 hours before follow-up coronary arteriography. Restenosis, defined by a greater than 50% loss of the gain achieved by the initial angioplasty, was seen in 53 patients (30.4%). MTS, with the exception of any necrosed area, was read as positive in case of reversible exercise hypofixation with redistribution. Sixty seven tests were positive, 49 corresponding with restenosis. Four were normal despite restenosis. The diagnostic values of the 3 methods of angina, ET and MTS were 0.43, 0.74 and 0.92 respectively for sensitivity, 0.89, 0.85 and 0.85 for specificity, 0.64, 0.68 and 0.73 for positive predictive value and 0.78, 0.88 and 0.96 for negative predictive value. In total, MTS at 6 months had the best sensitivity for the detection of coronary restenosis after single vessel angioplasty and an excellent negative predictive value (96% alone, 100% combined with ET), eliminating the need for coronary arteriography when it is negative.

[Left auricular hypertrophy in aortic stenosis in adults]. / L'hypertrophie auriculaire gauche dans le rétrécissement aortique orificiel de l'adulte.

Left atrial hypertrophy (LAH) was noted from the electrocardiograms of 72 of 98 adult patients (81%) who underwent hemodynamic evaluation of calcified aortostenosis (CAS). The relations between LAH and clinical, echographic and hemodynamic findings are specified. The frequency of LAH was not higher in cases of a history of hypertension, angina pectoris, lipothymia or exercise-induced syncope. In contrast, dyspnea was more frequently associated with LAH (84%) than not (17%). An approximately linear relation was seen between LAH and the mean pulmonary capillary pressure, the mean rate of circumferential decrease (RCF), the coefficient of muscle rigidity (ks of Mirsky), the left ventricular mass (LVM) and the left ventricle-aorta gradient. LAH is, therefore, a frequent sign in patients presenting CAS. Its origin is multifactorial, with a predominance of increased mean capillary pressure in cases of clinical signs of poor safety.