[Drug prescription in the post-percutaneous coronary interventions period: results of the ECART study]. / Prescription médicamenteuse au décours d'une angioplastie coronaire: résultats de l'enquête ECART (Evaluation du coronarien après revascularisation).

Among 1000 French cardiologists, the ECART study investigated drug prescription in 1041 patients with coronary heart disease, before and after percutaneous coronary interventions. The baseline drug prescription rate CAD patients were the following: beta-blockers 96%, antiplatelets agents 85%, statines 56%, nitrates 36%, calcium blockers 26% and ACE inhibitors 8.7%. The main changes in patients having undergone PCI were: a significant increase in antiplatelets agents (to 97%), ACE inhibitors (to 29%) and statins (to 94%), a significant decrease in nitrates (to 23%). The calcium blockers rate remains unchanged at 26%. Those results are discussed in the field of evidence based medicine and are compared with data from previous drug prescription studies in post myocardial infarction or in secondary prevention.

[Evaluation of continuing medical training in private sector French cardiologists in 1999]. / Evaluation des pratiques de formation médicale continue des cardiologues libéraux francais en 1999.

The authors present the results of a retrospective national enquiry which took place in 1999 and was mailed and faxed to the 3,800 cardiologists practising in the private sector in order to assess the different types of continuous, individual and collective postgraduate training which they had benefited from in the preceding 12 months. The data was analysed by comparison with that obtained from an individualized representative sample in a panel of private sector cardiologists. The results were then compared with the criteria of a yardstick proposed by the National Committee of Continuous Medical Education of 1997, according to the April 25th 1996 decree. The meeting of these criteria would require carrying out 114,000 to 76,000 hour-equivalents of continuous education whereas the present offer is about 100,000 hour-equivalents. The different forms of individual or collective training were compared in the 327 questionnaires which were exploitable following adhesion to the French Society of Cardiology, to the Cardiologists' Union, to local cardiological societies, by age, gender and type of practice. The average number of annual hours of collective education was 52.2 +/- 60.1 hours (25% quartile = 25 hours, 75% = 60 hours). The average value of hours of individual education was 89.7 +/- 89.3 hours (25% quartile = 25 hours; 75% = 120 hours). This evaluation indicates that about 15% of cardiologists practising in the private sector have inadequate continuous medical education and that 68% would satisfy the criteria laid down in 1997. Moreover, the present offer would seem to be adequate providing the criteria of accreditation have been met.

[Registry of cardiac insufficiency in cardiology]. / Registre de l'insuffisance cardiaque en cardiologie libérale.

The epidemiological data on cardiac insufficiency in cardiology are very scarce. Therefore, with its members the National College of French Cardiologists has conducted a survey in order to evaluate the clinical, biological and therapeutic characteristics of cardiac insufficiency patients, and thus the possible seasonal variations, and to compare them to the current recommendations and to the data from a previous survey with the same methodology performed in 1994. During each season of the year 622 cardiologists recruited the first 5 cardiac insufficiency patients who had been stable for at least three months. 8618 observations were analysed. The results showed 68% are male with an average age of 70 years, with an ischaemic aetiology in 47% of cases, hypertensive in 23%, and in NYHA stage II or III in 94% of cases. The left ventricular ejection fractions are < 30% in 22% of cases, between 30 and 50% in 62% of cases, and > or = 50% in 16% of cases (20% in those over 78 years). Medical treatment includes diuretics in 78% of cases, with 28% of patients on spironolactone, angiotensin converting enzyme inhibitors (ACE inhibitors) in 82% of cases, betablockers in 29% of cases; ACE inhibitors and betablockers are clearly prescribed more often than during the previous 1994 survey but at doses often lower than the recommendations. Lastly, there are no seasonal variations in prescriptions.

[Prognostic importance of ambulatory arterial pressure monitoring in France. Initial results of the OCTAVE II study. OCTAVE II Research Group]. / Intérêt pronostique de la mesure ambulatoire de pression artérielle en France. Premiers résultats de l'étude OCTAVE II. Groupe de Recherche OCTAVE II.

RATIONALE: Ambulatory blood pressure measurement (ABPM) is commonly used in clinical practice, whereas its added value to the management of hypertension is not definitely documented. OBJECTIVE: The OCTAVE II study was launched in 1991 to explore the prognostic value of ABPM, compared to that of the gold standard, the clinical blood pressure measurement. METHODS: Two hundred and six French cardiologists recruited 3569 participants over 18 years of age, provided they deemed ABPM was useful (mean age of 56 years, 52% of men, 65% already treated by antihypertensive drugs). The prognostic value of various blood pressure measurements, systolic or diastolic, clinical or ambulatory (diurnal, nocturnal or during 24 hours), has been assessed in multivariate models adjusted on the baseline characteristics associated with risk. The outcome was the occurrence of a major cardiovascular event, including stroke, myocardial infarction and cardiovascular death. RESULTS: After an average follow-up of five years, cardiovascular morbidity was known for 85% of the participants, and their vital status for 91%. On the whole population, the best prognostic indicators were systolic blood pressure compared with diastolic, ABPM compared with clinical blood pressure measurements, and nocturnal ABPM compared with diurnal ABPM. In the untreated participants at baseline, cardiovascular risk regularly increased among the four groups: normotensives, white-coat hypertensives, dippers, non-dippers. Between the extreme categories, the cardiovascular event rate was multiplied by 6.5. CONCLUSION: In this French population, ABPM and most of all its nocturnal component, was better correlated with cardiovascular prognosis. It remains to assess: 1) the general value of our findings, 2) the respective values of self blood pressure measurement versus ABPM, and 3) whether ABPM allows a better risk prevention.

[Presentation of OCTAVE II. A current epidemiologic study in France of the added prognostic value of ambulatory blood pressure monitoring]. / Présentation d'OCTAVE II. Une étude épidémiologique en cours en France sur la valeur pronostique ajoutée par la mesure ambulatoire de la pression artérielle.

The diagnosis of "white coat" hypertension, the measurement of indices of 24 hour variability of the blood pressure and increased accuracy of blood pressure estimation are some of the advantages of ambulatory blood pressure monitoring. They are part of the reason why the method has been adopted by ambulatory blood pressure monitoring is really useful in the treatment of hypertension is fragile: although the correlation with target organ complications seems better than with conventional blood pressure measurement, it remains to be shown that this information helps to predict and then improve the prognosis of hypertension. With respect to this first stage of demonstration of the added prognostic value attributable to ambulatory blood pressure monitoring, several studies have been undertaken, one of which is OCTAVE II. The goals were to analyse the predictive values of the indices obtained by ambulatory blood pressure monitoring in terms of cardiovascular morbidity and mortality after having described the correlations between these indices and the characteristics of individual patients. Two hundred and sixty six cardiologists, members of the French College of Cardiology, included 3,569 patients in whom an indication for ambulatory blood pressure monitoring had been retained, over a period of 10 months in 1991. These patients were 56.4 year old on average, with 52.6% men, hypertensive or not. The 5 year follow-up should end at the beginning of 1997.

[Evaluation of 3 functional classifications of cardiac insufficiency: a national multicenter study. National College of French Cardiologists]. / Evaluation de trois classifications fonctionnelles de l'insuffisance cardiaque: étude multicentrique nationale. Le Collège National des Cardiologues Français.

The scope of this study is a comparison of three functional classifications: the New York Heart Association classification, the Duke University classification, and the specific activity scale we propose. The NYHA classification is subjective, difficult to reproduce and poorly correlated to the functional capacity measured ergometrically (duration of exercise and/or VO2). A new classification must therefore be proposed. A specific activity scale adapted to our national requirements appears to be the best solution. Our study covered 15 successive days. All patients suffering from congestive heart failure who were examined over this period were included. 700 liberal cardiologists took part in this study. 2353 patients were reviewed, mean age 69 (58% male, 42% female). Heart failure was of an ichaemic origin in 37% of cases, idiopathic in 25% and due to hypertension in 25%. Symptomatology was left sided in most cases. Among NYHA Class IV patients, 75% belonged to Class IV of the specific activity scale (SAS) (23% Class III, 1% Class II), and 88% of the Duke classification (10% Class III, 1% Class II). For NYHA Class III patients, 80% were SAS Class III (5% Class IV, 13% Class II), and only 38% (42% Class IV and 16% Class II) of the Duke classification. Regarding NYHA Class II patients, 74% were SAS Class II (21% Class III and 4% Class I), and 26% of the Duke classification (39% Class I, 29% Class III and 3.6% Class IV). Finally, among NYHA Class I patients, 60% were SAS Class I (34% Class II, 5% Class III), and 74% of the Duke classification (11% Class II and 13% Class III).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical history and anatomic findings following the longest survival after cardiac transplantation]. / Histoire clinique et constatations anatomiques au terme de la plus longue survie après transplantation cardiaque.

The authors report the case history of the first patient in the world to have survived 18 and a half years with a heart transplant. This survival was marked by several episodes of rejection during the early years and various other incidents. The pathology encountered was primarily iatrogenic: diffuse osteoporosis sometimes limited the patient's activity. Two skin cancers and a lung cancer were diagnosed and treated. The patient died from progressive respiratory failure with pulmonary hypertension and signs of right ventricular failure. Pathological examination revealed a subnormal myocardium with a certain amount of overloading of the coronary arteries, confirmed the lung cancer and pulmonary hypertension and, most importantly, revealed the presence of nodular regenerative hepatic cirrhosis responsible for ascites during the last few months of life and a renal adenocarcinoma. These last two lesions are observed in immunosuppressed patients. The authors pay tribute to this patient who led an active and devoted life in the service of others.

[18 and one-half years' survival after cardiac graft. Clinical course and anatomical findings]. / Survie de 18 ans et demi après greffe cardiaque. Evolution clinique et constatations anatomiques.

Operated upon in November, 1968, the last survivor of heart transplant recipients in those times has died on May 11, 1987, having survived 18 years and 6 months. The active life of this patient, however, was marred by episodes of graft rejection during the first post-operative years and by various incidents. It was mainly the complications of the immunosuppressive treatment that hampered his activities (osteoporosis) and provoked his death. Post-mortem examination confirmed that the heart was in good condition, found an active bronchial epithelioma and revealed iatrogenic lesions, namely adenomas, adenocarcinoma of the kidney and "regenerative" nodular hyperplasia of the liver with portal hypertension. Such lesions are observed in patients under long-term treatment with immunosuppressants. A "sleep apnoea" syndrome might have accounted for the formation of pulmonary hypertension lesions. The authors wish to pay their respects to this man who devoted himself to the service of other men.

Triple valve procedures: an analysis of early and late results.

This study summarizes the results in 107 patients with triple valve procedures (TVP) performed between 1972 and 1983. Forty-five patients underwent double valve replacement with tricuspid annuloplasty, and 62 simultaneous triple valve replacement. The hospital mortality was 19.6% (21 patients) and was influenced by: the preoperative functional class: 4.7% (1 of 22 patients) in class II, 13.7% (7 of 51) in class III and 37.2% (13 of 35) in class IV (p less than 0.05). the urgency of operation: 13.2% in elective operations (11 of 83 patients) and 41.6% for emergencies (10 of 24) (p less than 0.02) the type of tricuspid procedure: 15.5% for annuloplasty (7 of 45 patients), 21.1% for bioprosthetic replacement (11 of 52) and 30% for mechanical valve replacement (3 of 10) (p less than 0.05). Other factors such as patient age, right ventricular systolic pressure (RVSP) and type of myocardial protection had no significant influence. The late mortality was 9% per patient-year (18 patients, 9 of whom died in the first year), the majority related to cardiac causes. The 5-year survival rate was 53%. It appears that the survival rate is higher if the patient is in preoperative functional class II (55%), the right ventricular pressure is below 60 mmHg (67%), and if the operation is performed electively (57%). The findings suggest that surgery should continue to be offered to such patients.

[Selective tricuspid annuloplasty without prosthetic support]. / Annuloplastie tricuspidienne sélective sans support prothétique.

Two techniques of plastic surgery are currently used to treat tricuspid insufficiency: a prosthetic reductor or a continuous running suture. In the technique advocated here a double continuous suture is inserted into the tricuspid annulus, one running from the antero-septal to the antero-external commissures and the other, from the postero-septal to the antero-external commissures. When these two sutures are tied separately, the circumferences of the two parts of the annulus, which are diversely dilated, can be reduced. The authors have used this technique in 141 patients and a Carpentier's annulus in 41 patients. Perioperative mortality and 5-year survival were the same in both series, but the incidence of postoperative atrioventricular block was much lower in the first one. Another advantage of the double continuous suture technique is that foreign material is reduced to a minimum.

[Reintervention on heart valve prostheses. Apropos of 78 cases]. / Les réinterventions sur prothèses valvulaires cardiaques. A propos de 78 observations.

78 patients with one or more prosthetic heart valves were reoperated on between 1972 and 1978, and comprised 12% of the work load of valvular surgery. There were two postoperative periods in which the incidence of reoperation was high: the first year, 38%, and the period between the 5th and the 8th year, 41%. The main causes of reoperation could be divided into two groups: those common to all valves with paravalvular leaks (25%), endocarditis (12%) being the principal causes, and those associated with particular valves: deterioration of Beall prosthesis 33%, and thrombosis mainly affecting the Bjork and Beall prostheses (25%). The operative mortality was 12%. The fact that urgent operation is required in severe cases is underlined. In the light of these results, the surgical indications of reoperation should be discussed at an earlier stage. These indications are based essentially on the clinical condition of the patient and objective confirmation by further investigation should not delay the operation, which, in our experience, has never been unnecessary.

[The fate of children who have undergone correction of Fallot's tetralogy. Report of fifty long term assessments (author's transl)]. / Le devenir des enfants ayant subi une correction de tétralogie de Fallot. A propos de cinquante évaluations à distance.

50 children who had beneficied of repair of Fallot's tetralogy with a follow up of 2 to 11 years, were psychologicaly and physicaly evaluated. Work capacity tests were performed in 12 cases. Children with early repair (before 5 years of age) have a very better result. Preliminary palliative treatment cause worse results. Physical capacities are normal in the majority of children. Work capacity is not different from normal children. Repair before school age is the best way for a normal life.

[Stenosis of the thoraco-abdominal aorta by endovascular calcification, with hypertension. Surgical treatment (author's transl)]. / Sténose de l'aorte thoraco-abdominale par calcification endovasculaire révélée par une hypertension artérielle. Cure chirurgicale.

A case of a 24 year-old man in whom, following acute pulmonary oedema complicating hypertension known for a period of three years, stenosis of the thoraco-abdominal aorta produced by a large calcification within a zone of the aorta with an inflammatory appearance was demonstrated. This case is included within the context of the aortic syndrome. Operation led to normalisation of blood pressure immediately afterwords, but there was moderate hypertension 56 months later.

[Human cardiac transplantation. Apropos of a case followed for more than 6 years]. / Transplantation cardiaque humaine. A propos d'un cas suivi depuis plus de six ans

A cardiac transplantation was performed on November 28, 1968. This was the only one undertaken at Marseilles. After a survival period, now exceeding 6 years, the patient has had an almost normal activity. The course of this patient, the follow-up elements, the incidents and complications during this period were analysed. It was insisted upon the interest of following up the coagulation tests for the preclinical detection of rejection or menacing rejection. Practically uninterrupted heparin treatment during the 6 years might have been an element for this prolonged survival.