[Normal coronary angiography. Have the indications changed during the 1980's?]. / La coronarographie normale. Les indications ont-elles varié au cours des années 1980?

If the indications of coronary angiography are well chosen, the percentage of normal coronary angiographies should decrease. The authors analysed 7858 primary coronary angiographies performed between 1981 and 1990 in patients without valvular or congenital heart disease. The second 5 years were compared to the first. The percentage of primary coronary angiographies decreased (63% vs 75%; p < 0.01), the percentage of women increased (21.7% vs 18.4%; p < 0.001), and the mean age increased (58.5 +/- 0.3 vs 53.9 +/- 0.3; p < 10(-9)). The lesions were less extensive: 16.3% triple vessel disease versus 24.2% (p < 0.001); 31.3% double vessel disease versus 28.1% (p < 0.02); 49.1% single vessel disease versus 44.2% (p < 0.001). The percentage of normal coronary angiographies remained constant: 20.2% in the second five years versus 19.9% in the first. Over the 10 year period, there was no significant difference one year from another. The percentage of normal investigations remained the same in men (15.7%), decreased in women (34.7 vs 40.1%, p < 0.04), remained constant in patients under 60 years of age (24.5 vs 23.8%), but increased in the more elderly (14.9 vs 10.2%; p < 0.001). The percentage remained unchanged in stable angina (19.6 vs 19.8%) and in unstable angina (12.3 vs 11.2%): it increased in cases of atypical chest pain (72.2 vs 54.3%; p < 0.01). Although, globally, the number of normal coronary angiographies was unchanged at 20%, the indications of this investigation were more selective in the younger patients, especially women, in the second five years, but coronary angiography was more commonly performed in elderly patients because of the possibility of benefiting from coronary angioplasty.

[Prognostic value of a new perfusion index calculated from coronarography]. / Valeur pronostique d'un nouvel index de perfusion calculé à partir de la coronarographie.

A new perfusion index was determined from the study of the coronary vascular bed in 8 myocardial territories: upper septal, lower septal, upper anterior, lower anterior, apical, lateral, posterior and inferior. Stenosis of a vessel reduces perfusion in all territories fed by that vessel, downstream of the stenosis. The perfusion index is calculated by adding up the lesions in all 8 territories. In a population of 418 consecutive patients who had undergone coronary arteriography in 1972 and 1973, survival was evaluated according to the perfusion index and to those parameters which classically have the greatest influence on survival. The perfusion index came out as the most important prognostic factor since such parameters as the number of stenotic vessels and ventricular kinetics lose their prognostic value when adjusted to that index. According to the perfusion index, the 8-year prognosis is the same as in subjects without coronary disease when the reduction in overall perfusion does not exceed 40%. With a 40 to 79% reduction the death risk at 8 years is 30% whatever the exact percentage in each individual. When perfusion is reduced by 80% the death risk at 8 years rises to 72%. This perfusion index, easy to determine, provides a better evaluation of prognosis than the conventional parameters.

[The prognostic value of haemodynamic tests in chronic bronchitis (author's transl)]. / Valeur pronostique du bilan hémodynamique des bronchiteux chroniques.

The prognostic value of several functional respiratory and haemodynamic variables was studied in a group of 212 patients with chronic bronchitis, who were examined in steady state, without cardiac or respiratory failure, at rest and when possible during moderate exercise (195 patients). Follow-up interval ranged from 5 to 12 years. Results were processed using two methods: estimation of actuarial survival rate and discriminant analysis. Survival rate curves for the patients showed a reduction relative to the general population of the same ages: 74% within five years compared to 91% in the general population, 56% within nine years compared to 82%. Survival rate was significantly lower in patients with PPA above 30 mmHg, or driving pressure (PPA--PW) above 15 mmHg, or pulmonary vascular resistance higher than 210 dyn . s . cm-5, or when PPA increased more than 10 mmHg during exercise. Discriminant analysis underlined the predictive value of three haemodynamic variables: PPA change from rest to exercise, pressure developed by the right heart (PPA--PRVED) and stroke volume: together, they predict the death of 3 over 4 patients with the criteria chosen.

[Thymolipomas simulating cardiomegaly]. / Les thymolipomes simulant une cardiomégalie]

With reference to three personal observations, the authors discuss the problems raised by the diagnosis of thymolipomas, which are benign asymptomatic tumors discovered on a plain chest film and simulating cardiomegaly. On careful analysis of a high voltage plain chest film, the pulmonary vasculature can be detected through the cardiomediastinal opacity. Total body scan is also useful for establishing diagnosis before surgery.