[Utility of stress cardiography to identify myocardial ischemia]. / Apport de l'echographie de stress dans la recherche de l'ischemie myocardique.

BACKGROUND: The dobutamine echocardiography takes more and more an important place in diagnosis, prognosis and therapeutics strategies of the coronary disease. AIM: We prospectively enrolled 130 consecutive patients followed for a coronary insufficiency METHODS: the aim of determinating the diagnostic value of the dobutamine echocardiography in the myocardial ischemia compared with the classic means as the exercise test and the myocardial scintigraphy. RESULTS: Our results are comparable to the data of the literature, the dobutamine echocardiography is more specific than the exercise test and the myocardial scintigraphy (96 %, 61% and 53 %), more sensitive than exercise test (75 % versus 47 %) but less sensitive than the myocardial scintigraphy (75 % versus 96 %). The stress echocardiography has the best diagnosis precision 87% against 72 % for the scintigraphy and 56 % for the exercise test. The dobutamine echocardiography is a very feasible, tolerated well exam and especially very reliable in term of detection of the coronary disease in the feminine population, with a sensibility at 66,7 %, a specificity at 100 % and a diagnostic precision at 92 %, also in patient with hypertension the stress echocardiography is much more specific and reliable than the exercise test (100 % vs 22 % and 93 % vs 54 %, respectively),and it's superior to the exercise test in the presence of electric signs of systolic excess load and to the myocardial scintigraphy in case of left ventricular hypertrophy. The dobutamine echocardiography can be considered as safety and reliable means of investigation of the coronary insufficiency .

[Double chamber right ventricle. About 3 cases]. / Ventricule droit a double chambre. A propos de trois observations.

The double chambered right ventricle is a rare congenital abnormality. It creates an obstacle for the right ventricular ejection. The cardiac ultra sonography examination allows the diagnosis in most majority of cases. The angiography is performed in difficult cases. We report 3 cases of infundibular stenosis with normal interventricular septum. The diagnosis was suspected for the 3 cases by the constellation of clinical findings pointing to systolic murmur over the precordium, and the electrocardiography showing right ventricular hypertrophy. It is confirmed by the echocardiogram and the hemodynamic exploration with a trans stenotic gradient evaluated at 72,80 and 80mmHg. The 3 patients underwent surgery and had all good post operative follow up. These 3 observations allow us to recall the epidemiological, embryological, clinical and echocardiographic particularities of pure infundibular stenosis and to determin the adequate treatment and the prognosis.

[Predictive factors of significant coronary stenosis in women. Review of 230 patients]. / Les facteurs predictifs d'une atteinte coronaire significative chez la femme. Etude de 230 patientes.

To evaluate the predictive factors of significant coronary stenosis in women, we have studied retrospectively data from 230 women explored by coronary angiography. The population has been divided in 2 groups: one (G1) without significant coronary lesions; the second (G2) having at least one significant coronary stenosis (> 50%). The prevalence of the significant disease was 54.3%. Coronary risk factors associated with a significant disease were : age > 55 years, diabetes mellitus, menopause, high lipid levels, and the association of at least 3 risk factors. Typical angina and history of myocardial infarction were significantly more prevalent in the G2 as like as Q necrosis wave, ST segment modifications percritically and premature ventricular beats. A regional abnormal wall motion at rest echocardiography was independently associated with significant coronary artery lesions (OR = 7.35). Using these data we have established a score of prediction of significant disease in women. This score aided to classify our female patients into different levels of risk and to better indicate subsequent explorations. Thus. with a good evaluation of the clinical and at rest data in women, we could obtain a more accurate degree of suspicion of a significant coronary artery disease before the indication of a coronary angiography.

[Hypertrophic cardiomyopathy in Freidreich ataxia: about two cases]. / Cardiomyopathie hypertrophique dans le cadre d'une maladie de Freidreich: a propos de deux cas.

Freidreich ataxia is the most frequent ataxia of early onset and of autosomal recessive transmission. It is associated with hypertrophic cardiomyopathy in 34 to 77% of cases. The purpose of this article is to describe the cardiac manifestations of two patients affected by this disease. The first case report is about a 34-years-old, bedridden male patient having muscular hypotony and osteotendinous areflexia of the lower limbs. Chest x-ray findings showed a cardiac silhouette distorted by scoliokyphosis. ECG revealed frequent auricular extrasystoles. Cardiac US examination disclosed a pattern of concentric hypertrophic cardiomyopathy with systolic and diastolic dysfonction.

[Introduction to myocardial doppler imaging]. / Introduction au Doppler tissulaire myocardique: principes physiques et applications cliniques.

Introduced in 1989, the myocardial doppler tissue imaging has now many clinical applications. Doppler tissue imaging explores the proper systolic and diastolic regional function of myocardial fibers. We can measure myocardial velocities by recording signals of low velocitiy and high magnitude, the strain and the strain rate are then derived from velocities. Specific software is therefore necessary. There are many ways of recording and representing myocardial doppler tissue parameters. Diagnostic and prognostic value of myocardial doppler tissue imaging is now proved and this method has many applications in ischemic cardiopathy and in cardiomyopathies. The development of powerful software is promising for the applications of the strain in the future.

[Stress echocardiography and mitral stenosis: what interest?]. / Echocardiographie de stress et retrecissement mitral: quel interet?

The stress echocardiography is used extensively as a diagnostic and prognostic tool and the assessment of ischemic cardiopathies. Its use in valvulopathies is more limited, but is increasing with time. The discrepancies between the functional symptoms and hemodynamics at rest is frequently met in patients with mitral stenosis. By assessing changes of pressures, gradients and surface stress echocardiography helps to identify the real hemodynamic conditions permitting to recommend a more aggressive approach in certain situations.

[Indications for the implantable cardiac defibrillator]. / Les indications du defibrillateur automatique implantable.

The indications of the implantable cardiac defibrillator (ICD) have enlarged over the time. This has been facilitated by the technological progress which permit the device to be more effective and its implantation to be more simple. So, the implantation rate has increased all over the world but especially in the United States. The ICD was initially proposed in case of recurrent cardiac arrests due to ventricular fibrillation. Later, indications have enlarged. They concern at the present time not only the secondary but also the primary prevention of the sudden cardiac death. Indications in secondary prevention are based on the results of randomized studies which have clearly demonstrated the superiority of the device if compared to the antiarrhythmic drugs. The first indication of the ICD in the primary prevention has been defined by the MADIT study. Since, other studies have tried to define high risk population in whom a prophylactic implantation of an ICD should be justified. However, other clinical trials are still necessary to precise the indications of the ICD in some disease states (hypertrophic cardiomyopathy, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, Brugada syndrome) which can be complicated by arrhythmic sudden death. Indeed, indications in these diseases are still based on small studies and in the opinion of experts.

[Myocardial infarction revealed by ischemic stroke]. / Infarctus du myocarde révélé par un accident vasculaire cérébral.

Ischemic cerebral infarction associated with myocardial infarction is yet a real diagnosis challenge. If during the acute myocardial phase the mechanism is mostly embolic, at long-term, the mechanism is not clearant and other causes should be searched. We report a 50 year old man with ischaemic stroke with strong evidence of myocardial infarction in the late phase with wall-motion abnormality and mural clot revealed by echocardiography and Q waves. Atrial fibrillation was suspected and no other abnormalities could be found. The diagnosis of cardio-embolic ischaemic stroke could not be made with certainly.

[Congenital auriculo-ventricular block in the adult]. / Le bloc auriculo-ventriculaire congenital en milieu adulte.

In this work we report a consecutive series of ten patients having auriculoventricular block "presumed" congenital which is seen in adulthood between 1990 and 2001 to determine their clinical profile and forecast, and to deduct the therapeutic consequences. Our criteria of inclusion requires the existence of patients with a second or third degree heart block, who are less than 40 years old at the time of diagnosis, which is not totally regressive in the effort test and the atropine injection, and whose congenital origin was strongly suspected because of the notion of slow pulse during their youth and the absence of acquired affect which enables us to explain this disease. The population contains ten patients whose average age in hospitalization is 23 years old with the range of 11 to 39, while the average age of the discovery of the disease was 20 years old with the range of 8 to 34. Our patients were referred to us because of cardiac symptoms such as syncope or an equivalent, effort intolerance, asthenia, thoracic pain (like angina), or palpitations. The clinical exam, the electrocardiogram, and additional exams (holter, effort test, echocardiography, electrophysiological investigation) allowed us to retain six indications for the definitive cardiac stimulation, associating to different degrees the existence of worrying symptoms such as a syncope, a congenital heart disorder, a low heart frequency, the association in a sinus dysfunction. Short-term and long-term evolution is favorable for patients of the stimulated group as well as the non-stimulated group.

Clinical and angiographic outcome of paclitaxel-eluting stent implantation for unprotected left main coronary artery bifurcation narrowing.

AIMS: This study was designed to compare the clinical and angiographic outcomes of paclitaxel-eluting stent (PES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (LMCA) bifurcation narrowing. METHODS AND RESULTS: From November 2003 to December 2004, the technique of kissing balloon followed by T provisional stenting was applied for distal left main coronary lesion in 49 consecutive patients with PES stents. Data from this group were compared to those from 57 patients treated with BMS during the previous year. The procedural success rate was 100% for both groups. There were no incidents of death, stent thrombosis, Q-wave myocardial infarction (MI), or emergent bypass surgery during hospitalization in either group. Despite less acute gain (2.18+/-0.53 mm vs. 2.45+/-0.47 mm p= 0.078) in the PES group, PES patients showed a lower late lumen loss and a lower 8-month angiographic restenosis rate (6.1% vs. 35.1% p<0.0001) versus the BMS group. At 10 months, the rate of freedom from death,MI, and target lesion revascularization was 95.9+/-2.8% in the PES group and 66.1+/-6.3% in the BMS group (p<0.0001). CONCLUSION: Paclitaxel-eluting stent implantation for unprotected LMCA bifurcation narrowing appears safe with regard to acute and midterm complications and is more effective in preventing restenosis compared to BMS implantation.

Clinical and angiographic outcome of stenting of unprotected left main coronary artery bifurcation narrowing.

PURPOSE: Improvements in techniques and equipments may result in the wider applicability of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis. This report is a prospective study focused on the feasibility, effectiveness and long-term results of stenting for treatment of ULMCA bifurcation lesions. METHODS: From November 2002 to October 2003, 57 consecutive patients were stented with bare metal stents and the technique of kissing balloon followed by T-provisional stenting was applied for ostial left anterior descending, left circumflex or distal left main coronary lesion. RESULTS: Mean age was 69.5+/-10.7 years. Acute coronary syndrome occurred in 68.4% of patients with a majority of two or three vessel disease (45.10% and 35.30% respectively). GpIIbIIIa inhibitors were used in only 5.8% of cases. Angiographic success was obtained in 100% of patients. Hospital stay was 7.03+/-2.26 days without major adverse cardiac events. At eight months follow-up, cardiac death was 1.7%, non-fatal myocardial infarction 5.1% and target vessel revascularisation 22.8% including CABG 15.7% and repeated PCI 10.5% with an angiographic restenosis rate of 29.8%. CONCLUSION: In the setting of coronary stenting of the ULMCA stenosis, the use of bare metal stents can no longer be considered contemporary technique and another strategy such as coated stent may be needed.