[Study of the arrhythmogenicity of cardiomyopathies. Hypertrophic cardiomyopathies]. / Etude du potentiel arythmogène des myocardiopathies. Les myocardiopathies hypertrophiques.

Forty-four cases of hypertrophic cardiomyopathy (23 men, 21 women; 55 +/- 15 years) referred for evaluation of chest pain (28 cases), dyspnoea (26 cases), palpitations (25 cases), dizziness (11 cases) and syncope (4 cases), were investigated prospectively between February 1983 and February 1989. The cardiomyopathy was concentric (N = 16), obstructive (N = 24) or apical (N = 4) and the diagnosis confirmed by angiography. Twenty-four hour Holter monitoring showed no ventricular extrasystoles in 43% of patients: the others had Grade I (25%), Grade III (2%), Grade 4A (14%) or 4B (16%) ventricular arrhythmias with diurnal predominance in half the cases. Patients with greater than or equal to Grade III ventricular extrasystoles had greater left axis deviation but did not differ from the others from the hemodynamic point of view. Exercise stress testing induced an isolated ventricular arrhythmia in 23% of patients and repetitive extrasystoles in 23%. The prevalence of surface late ventricular potentials was no greater in these patients than in normal subjects (4% vs 1%; NS). Programmed ventricular stimulation (N = 37) induced a repetitive response in only 25% of patients, with only two cases of sustained monomorphic ventricular tachycardia. There were no correlations between the results of programmed ventricular stimulation and those of Holter monitoring, exercise stress testing or late ventricular potential recording, but patients with inducible ventricular tachycardia or fibrillation had proportionally more syncopal episodes and greater than or equal to Grade III ventricular extrasystoles on Holter monitoring, but the difference was not statistically significant in this series.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arrhythmogenic potential of cardiomyopathies. Dilated cardiomyopathies]. / Etude du potentiel arythmogène des myocardiopathies. Les myocardiopathies dilatées.

Sixty-nine cases of non-ischemic dilated cardiomyopathy were studied prospectively from February 1983 to February 1989 (52 men: 53 +/- 13.5 years of age). There were 6 cases of sustained ventricular tachycardia. Thirty-seven patients were in Class III or IV of the NYHA Classification. In addition to echocardiography, radionuclide studies, cardiac catheterisation and coronary angiography, they all underwent 24 hour Holter monitoring, signal-averaged electrocardiography and, in 46 cases, endocavitary electrophysiological investigations. Holter monitoring showed ventricular extrasystoles greater than or equal to Grade 3 of Lown's classification in 72% of patients (26% had nonsustained ventricular tachycardia) and these patients had a significantly lower cardiac index. Twenty five per cent of patients had late ventricular potentials (versus 2% in 50 normal subjects; p less than 0.02); this proportion rose to 32% in those patients with greater than or equal to Grade 3 ventricular extrasystoles and to 66% in the patients with spontaneous ventricular tachycardia; the cardiac index was lower in patients with late ventricular potentials (2.3 vs 2.8 l/min/m2; p less than 0.01) and they had a higher incidence of greater than or equal to Grade 3 ventricular extrasystoles (94% vs 65% in patients without late ventricular potentials, p less than 0.05). Programmed ventricular stimulation induced sustained or nonsustained monomorphic ventricular tachycardia and ventricular fibrillation in 15% of cases. The 6 cases of induced sustained ventricular tachycardia were only observed in the 6 patients with spontaneous sustained ventricular tachycardia and they had the same electrocardiographic appearances.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary angioplasty in acute myocardial infarction. A one-year experience in a small urban community]. / Angioplastie primaire à la phase aiguë de l'infarctus du myocarde. Expérience d'une année d'activité dans une ville de moyenne importance.

The aim of this study was to assess the feasibility, safety and efficacy of primary angioplasty in acute myocardial infarction in a cardiology centre of a small urban community without on-site cardiac surgery. During 1995, 50 patients underwent angioplasty for MI in the first 12 hours. The average age was 66.7 +/- 12.6 years. Eighty six per cent of patients had at least one poor prognostic criteria (32% over 75 years of age, 70% anterior wall infarcts, 30% with heart rates > 100 min on admission). The angiographic result was successful in 45 patients (90%). The time between onset of pain and reopening the vessel was 240 +/- 116 min and between admission to the catheter laboratory and reopening 31 +/- 8 min. A coronary stent was implanted in 24 cases (48%) and intra-aortic balloon pumping was necessary in 14 cases (28%). Ischaemia recurred during the hospital phase in 7 cases (14%), 4 of which (8%) were caused by rethrombosis of the dilated artery: in 3 cases, the ischaemia was in another zone. No emergency coronary bypass surgery was required. The hospital mortality was 10%, always in patients over 80 years of age. The average duration of the hospital stay was 5.8 +/- 2.6 days with 15.7 +/- 7.3 days of convalescence. The average global cost was 61850 +/- 20686 F. These results were comparable to previously reported figures and confirm that primary angioplasty in acute infarction is possible and effective with an acceptable risk in a small urban community without on-site cardiac surgery.

[Evaluation of the arrhythmogenic potential of myocardiopathy. Apropos of 113 cases]. / Evaluation du potentiel arythmogène des myocardiopathies. A propos de 113 cas.

The exploration of 113 cases of myocardiopathy (69 cases of dilated myocardiopathy (DMC) and 44 of hypertrophic myocardiopathy (HMC) by a 24-hour Holter recording, exercise tests, recording of surface-delayed ventricular potentials (DVPs) and forced right ventricular stimulation (PVS), revealed an arrhythmogenic potential in both forms of this disorder. In cases of DMC, ventricular arrhythmias were common (81% of cases), frequently recurrent and may constitute one sign of the disease, although they are fairly independent of hemodynamic changes. The presence of DVPs in cases of DMC (25% of cases) was significantly correlated with ventricular extra-systole greater than or equal to grade 3 on the lown scale revealed by the Holter with induction of tachycardia or ventricular fibrillation in response to PVS. Ventricular arrhythmia is less common in HMC (57%). DVPs were rare, and spontaneous or induced ventricular arrhythmia appeared to be more closely correlated with syncope than with any other hemodynamic factor. This study of the arrhythmogenic potential therefore appears to be necessary in myocardiopathy in order to obtain a better definition of the prognostic risk.

[Exercise echocardiography in coronary disease]. / L'échocardiographie d'effort dans la maladie coronaire.

Exercise echocardiography is a new method used in the investigation of coronary disease. It evaluates the repercussions on regional contractile function of the increase in oxygen consumption induced by physical exercise. It makes it possible to analyse in real time not only the amplitude of endocardial displacement, but also that of parietal thickening and thereby seems to be more precise than conventional ergonomic tests in the diagnosis of myocardial ischaemia. Its recent development owes much to the advent of digital technologies which make it easier and more accurate to interpret the changes observed in left ventricular regional kinetics by comparing the data at rest with those recorded at peak physical effort. When associated with an equally non-invasive ergometric test it is well accepted by the patients. Another of its advantages is its moderate cost. Echocardiographists must devote as much time as necessary to training. Training is indispensable to rapidly capture the images, particularly during efforts, and to reliably interpret the variations observed in left ventricular wall contraction. Exercise echocardiography is still under evaluation. Experience is lacking for the cardiologist to choose, only on its results, the most appropriate treatment for each individual patient, but its help will be appreciated in some difficult therapeutic decisions. Behind this phase of training for, and evaluating this technique several of its main clinical indications can already be outlined.(ABSTRACT TRUNCATED AT 250 WORDS)