[Comparison between definite endocarditis and possible endocarditis according to the Duke Criteria, in a monocentric study of 45 patients]. / Comparaison entre endocardite <> et endocardite <> selon la classification de la Duke University, dans une série de 45 patients.

AIM OF THE STUDY: To compare definite endocarditis (DE) and possible endocarditis (PE) according to the Duke criteria, in a monocentric cohort of 45 patients. METHOD: From the registers of the Cardiology Department and medical database of the hospital informatic department, 45 cases of endocarditis are colliged, 29DE and 16PE. RESULTS: DE age is 66 years, PE age is 74 years, (p<0,02), 17 male (59%) in DE, eight in PE, 21 (72%) DE have a preexisting cardiopathy versus 15 (94%) PE, seven native valve and six prosthetic valve in PE, 11 native valve and nine prosthetic valve in DE. Twenty-six (90%) DE and 16 (100%) have fever, 14 (48%) DE and nine (56%) PE have a cardiac failure, one DE (3%) and 14 (87%) have no echographic sign of endocarditis (transthoracic echo or transthoracic and transesophagal echo) (p<0.001). Blood cultures are positive in 23DE (79%), and 14 (87%) PE (NS) Streptococcus and Enterococcus are the most common bacterial species (62%) in the two groups. Treatment duration is 64 days for DE and 43 days for PE, hospitalisation duration is 33 days for the DE and 27 days in PE. CONCLUSIONS: PE group and DE group are similar concerning fever cardiac failure, preexisting cardiopathy, blood cultures and bacterial species. PE group is older than DE group, echography is more often negative in PE group. A patient with a preexisting valvulopathy and a septicemia without echographic sign of endocarditis is the most frequent clinical pattern in PE.

[Doppler echocardiographic study of arterial distensibility. Comparison with ambulatory arterial pressure monitoring]. / Etude par échocardiographie doppler de la distensibilité artérielle. Comparaison avec la mesure ambulatoire de la pression artérielle.

UNLABELLED: Echocardiography Doppler (ED) is a common tool in hypertension to assess left ventricular (LV) mass or LV function. Echography doppler is also available to assess some arterial distensibility (AD) indexes, but it is less frequently used. The aim of this study is to compare AD indexes obtained from échographie doppler with timing of Korotkoff sound (QKd interval), obtained from ambulatory blood pressure monitoring (APM). Sixty-two patients with or without cardiac diseases were prospectively enrolled, except those with left bundle branch, atrial fibrillation or pacemaker. Echography doppler study collected timing of abdominal pulse (QtAA), interval time between Q ECG and the foot of doppler wave velocity in abdominal aorta pulse wave velocity (PWV) between two points of descending thoracic aorta; and Stroke index. APM study collected simultaneous usual pressure indexes (systolic diastolic, pulse pressure) instantaneous and over 24 h, and QKd interval times between Q ECG and diastolic Korotkoff sound instantaneous and over 24 h. Absolute AD Index (Burton index) was defined as Stroke index/pulse pressure. QtAA intra observer variability was the coefficient of variation (mean/SD). QtAA inter observer variability was QtAA assessments by two observers. RESULTS: QtAA was correlated with QKdi (r = 0.78; p < 0.001) and QKd24 h (r = 0.64; p < 0.001). PWV was correlated with QKdi (r = 0.35; p = 0.009), but not with QKd24 h (r = 0.17; p = 0.24, NS). Burton index was correlated with QKdi (r = 0.48; p < 0.001), and QKd24 h (r = 0.53; p < 0.001). CONCLUSION: Echography doppler may provide some arterial distensibility indexes. Among these indexes, QtAA is easy to obtain and well correlated with QKd. However, further studies are needed to assess normal and pathological values.

[Aorta-left ventricular relationship evaluated by Doppler echocardiography and ambulatory arterial prsesure monitoring]. / Etude du couple aorte-ventricule gauche par échocardiographie Doppler et mesure ambulatoire de la pression artérielle.

UNLABELLED: Arterial distensibility is one of the components of afterload. Arterial distensibility, left ventricular (LV) mass and LV function are closely linked. The aim of this study is to describe the relations between LV mass LV function and arterial distensibility evaluated by echography Doppler (échography Doppler) and ambulatory monitoring pressure. Sixty-two patients with or without cardiac disease were prospectively enrolled excepted those with atrial fibrillation, left bundle branch block pace maker, or valvulopathy. Echography Doppler study collected stroke volume, LV diameters and wall thickness, ejection time (ET) and preejection time (PET); were calculated ejection fraction (EF), systolic pressure/systolic diameter ratio, LV mass index (LVMI), relative wall thickness ratio (e/r). AMP collected usual pressure datas and QKd, time interval between QECG and diastolic Korotkoff sound, instantaneous, over 24 h (i, 24 h), and for a pressure of 100 mm Hg and a heart rate of 60 bpm (QKd 100-60). RESULTS: QKd 24 h was correlated with LVMI (r = 0.40, p = 0.006) and e/r (r = 0.32, p = 0.028). QKdi was correlated with EF (p < 0.001, r = 0.65), with systolic pressure/systolic diameter ratio (p < 0.001, r = 0.75), and with ET/PET (r = 0.56, p < 0.001). When PET was withdrawn from QKd, no correlation exist between QKd-PET and LV function index, excepted QKd-PET versus systolic pressure/systolic diameter (r = 0.46, p = 0.005). CONCLUSION: QKd is not only an arterial distensibility index but also a LV function index, because PET is included in it. Echography Doppler and AMP are available and common tools to study the aorta/LV relationship.

[Comparison of two indices of arterial distensibility: temporal apparitions of Korotkoff sounds and pulse wave velocy. A Doppler echocardiography and ambulatory blood pressure monitoring study]. / Comparaison de deux indices de distensibilité artérielle: le temps d'apparition des bruits de Korotkoff et la vélocité de l'onde de pouls. Une étude par échocardiographie-Doppler et mesure ambulatoire de pression artérielle.

Arterial distensibility, one of the factors influencing afterload, plays a role in the development of left ventricular hypertrophy. The QKd, the delay before the perception of the Korotkoff sounds, is an index of arterial distensibility available from ambulatory blood pressure monitoring. The pulse wave velocity (PWV), another index of arterial distensibility, can be measured by Doppler echocardiography. The aim of this study was to compare these two indices with haemodynamic parameters of arterial distensibility and to determine their relationship to left ventricular geometry and function. Sixty-two consecutive patients, with and without cardiac disease, underwent simultaneous Doppler echocardiography and ambulatory blood pressure monitoring. A correlation was observed between QKd and PWV (N = 53, p = 0.007, r = 0.37). The QKd and PWV were correlated to the absolute index of arterial distensibility (systolic index/pulse pressure) (N = 51, p < 0.001, r = 0.48). QKd was correlated with indices of left ventricular function such as EF (N = 55, p < 0.001, r = 0.66) or the systolic pressure/end systolic dimension ratio (N = 54, p < 0.001, r = 0.75). When the ejection time was subtracted from QKd, only the end systolic pressure/end systolic dimension remained significantly correlated (N = 37, p = 0.005, r = 0.40). The authors conclude that PWV and QKd were correlated and were also correlated with indices of arterial distensibility. QKd is a composite index of left ventricular function and arterial distensibility. Doppler echocardiography and ambulatory blood pressure monitoring provide a non-invasive assessment of the aorta/LV couple.

[Aneurysm of the interatrial septum and right-to-left shunt during biventricular infarction. Diagnosis by transesophageal echocardiography]. / Anévrisme du septum interauriculaire et shunt droite-gauche au cours d'un infarctus biventriculaire. Diagnostic par échographie transoesophagienne.

A right-to-left shunt during infarction with right ventricular extension is a rare and recently described complication. It results from opening of a foramen ovale due to increased right heart pressures. The authors describe another case occurring in a patient with an interatrial septal aneurysm, the diagnosis of which was made by transoesophageal echocardiography.

[Campylobacter fetus subspecies fetus endoaortitis on a Bentall tube prosthesis. Apropos of a case]. / Endoaortite à Campylobacter fetus sous-espèce fetus sur tube prothétique de Bentall. A propos d'un cas.

Campylobacter fetus is a rare cause of endocarditis and endoaortitis: the authors believe this to be the second reported case of infection of an intracardiac prosthesis. The patient was a man who had already undergone replacement of the aortic valve and ascending aorta, and a gastrectomy, which were predisposing factors. The portal of entry was not found. The diagnosis was confirmed by positive blood cultures and transoesophageal echocardiography. The outcome was rapidly fatal despite antibiotic therapy and surgery, because of the seriousness of the lesions (pseudo-aneurysm of the aorta ruptured into the right atrium), the precarity of the terrain and surgical difficulties.

[Effects of sublingual nifedipine on the velocity of pulse wave evaluated by Doppler echocardiography of the thoracic aorta]. / Effets de la nifédipine sublinguale sur la vélocité de l'onde de pouls évaluée par échocardiographie Doppler de l'aorte thoracique.

Sublingual nifedipine has a rapid and powerful hypotensive effect. Its action on arterial distensibility can be assessed by measurement of pulse wave velocity (PWV) by Doppler echocardiography (DE). Ten patients were used to evaluate intra-observer reproducibility (Group 1). Fifteen hypertension patients (Group 2), not taking a calcium antagonist, 64 +/- 13 years-old, were studied by DE before and 15 minutes after 10 mg of SL nifedipine. The following were measured: systolic and diastolic blood pressures (SBP and DBP), heart rate (HR), echocardiographic shortening fraction (SF) and PWV, with sternal length (SL) taken as being identical to the length of the abdominal aorta between the isthmus and the coeliac region, and by measuring delta t: time interval for propagation of the pulsed Doppler velocimetric wave between the isthmic aorta and the coeliac aorta located by echocardiography: PWV = SL/delta t. Evidence was found in the nifedipine group (n = 15) of a fall in SBP (159.5 +/- 27.8 cf. 140.9 +/- 21 mmHg; p = 0.002); in DBP (88.6 +/- 13 cf. 79.6 +/- 8.3 mmHg; p = 0.005) and an increase in HR (72.3 +/- 10.7 cf. 76.8 +/- 12.9 bpm; p = 0.04). PWV decreased after nifedipine (10.5 +/- 3.9 cf. 7.15 +/- 12.9 bpm; p = 0.002). There was a linear correlation between the percentage reduction in PWV and left ventricular HR: y = 194x - 53; r = 0.56; p = 0.029.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in plasma atrial natriuretic factor, plasma and urinary cyclic GMP during exercise in coronary patients and healthy subjects]. / Variations du facteur atrial natriurétique plasmatique et du GMP cyclique plasmatique et urinaire au cours de l'exercice chez le coronarien et le sujet sain.

The concentrations of plasma ANF and plasma and urinary cyclic GMP were measured at rest and during exercise in 12 normal subjects (reference group) and 20 patients with coronary artery disease (coronary group). In both groups, plasma ANF and c GMP increased during exercise and fell one hour after (F = 3.8, p = 0.029 and F = 13.3, p = 0.0001, respectively) whereas the urinary c GMP increased one hour after exercise (F = 5.3, p = 0.029). In the control group, ANF increased on effort and fell during recovery to above its resting value whereas the plasma c GMP remained unchanged throughout the test. In the coronary group, no significant increase in ANF was observed on effort (wide dispersion of values) whereas the c GMP increased during effort and fell to below testing value during the recovery phase. The ANF of the coronary group was globally higher than the ANF of the control group (F = 4.7, p = 0.04). The plasma c GMP of the coronary group was comparable to that of the controls (F = 2.1, p = 0.15) despite higher concentrations at rest (p < 0.05) and during exercise (p < 0.05). However, there was a positive interaction between the efforts of exercise and the pressure of coronary disease on the concentration of plasma c GMP (F = 6.7, p = 0.0024). There was no difference in urinary c GMP between control and coronary subjects (F = 1, p = 0.33).(ABSTRACT TRUNCATED AT 250 WORDS)

[Jejunal perforation by cholesterol embolus: a case treated surgically]. / Perforation jéjunale par embolie de cholestérol: à propos d'un cas traité chirurgicalement.

A case of ischaemic jejunal perforation which could be attributed to mesenteric cholesterol emboli is reported. The jejunal pathology had been preceded by other, more classical sites of systemic cholesterol embolization that occurred immediately after arterial catheterization in this male patient with aneurysm of the abdominal aorta. Emergency segmental resection of the jejunum was performed with satisfactory immediate results. Histological examination of the operative specimen confirmed that the perforation was caused by cholesterol emboli. Cholesterol embolization of the intestine may have various clinical consequences which are reviewed by the authors.

[Incidence of cholesterol embolisms in 70 atheromatous patients hospitalized for cardiovascular evaluation]. / Incidence des embolies de cholestérol chez 70 patients athéromateux hospitalisés pour bilan cardio-vasculaire.

Cholesterol crystal embolization must be considered in all atheromatous patients hospitalized for cardiovascular evaluation. Because this is a difficult and often belated diagnosis, between June 1989 and June 1990 a prospective study was conducted on 70 patients. Clinical monitoring, including examination of the fundus oculi, was performed before, and on the 5th day of cardiovascular investigations. The incidence of systemic emboli (12.8%) detected in this way corresponds to that reported in rare published series. Funduscopy is a simple, rapid and little expensive examination which should improve the investigative procedures and point to the best treatment.

[Spontaneous complete rupture of the thoracic aorta. Apropos of a case surgically treated with success]. / Rupture spontanée complète de l'aorte thoracique. A propos d'un cas opéré avec succès.

The authors report the case of a 74-year-old hypertensive man hospitalised with chest pain accompanied by shock and hemo-mediastinum. The diagnosis of spontaneous rupture of the thoracic aorta, suspected by aortic arteriography, was confirmed by thoracic CT scan with injection of contrast medium. Emergency surgery revealed a 4 cm longitudinal linear tear of the horizontal aorta, with neither dissection nor aneurysm. Simple suture during extra-corporeal circulation with normothermia and the heart beating, was successful after prolonged postoperative intensive care. This case of complete and spontaneous acute rupture of the horizontal thoracic aorta appears to be the first to have been successfully treated surgically.

[Evaluation of urinary excretion of cyclic guanosine monophosphate in clinical cardiology]. / Evaluation de l'excrétion urinaire du GMP cyclique en clinique cardiologique.

The prognostic importance of levels of urinary excretion of cyclic GMP (cGMPu), the second messenger of the atrial natriuretic factor (ANF) was studied in different cardiac pathologies in 31 patients (19 males and 12 females, average age 66 +/- 15 years) and compared with 31 control subjects of the same age (+/- 4 years) and sex. In the control group, the average cGMPu was 0.35 +/- 0.17 mumoles/24 hours/m2, and, with respect to urinary creatinine, increased with age (r = 0.54, p = 0.002). In the 16 patients with cardiac failure, the cGMPu was very high (1.03 +/- 0.59 mumoles/24 hours/m2, p less than 0.001) without any significant correlation with NYHA functional class although it fell after treatment. After myocardial infarction (8 cases including 3 with cardiac failure), the cGMPu was also high (0.49 +/- 0.33 mumoles/24 hours/m2) but it did not differ significantly from the control values in the 9 atrial arrhythmias without cardiac failure. The cGPMu was related to the cardiothoracic ratio but not to any blood gas parameter or echocardiographic measurement. In conclusion, the cGMPu is more stable and easier to measure than the ANF. It would seem to be a sensitive marker of cardiac failure complicating the most common cardiac pathologies observed in clinical practice.

[Bilateral renal embolism during thrombolytic therapy with tissue-type plasminogen activator in a patient with thrombosis of the left ventricle]. / Embolie rénale bilatérale au cours d'une fibrinolyse par l'activateur tissulaire du plasminogène, chez un patient porteur d'un thrombus ventriculaire gauche.

The authors report a case of bilateral renal embolism during thrombolytic treatment in the acute phase of myocardial infarction in a 77 year old patient in whom echocardiography had shown a left ventricular thrombus. After reviewing the literature, the risk of embolic complications of thrombolytic therapy would seem difficult to evaluate because of the difficulty of diagnosis, but they exist irrespective of the type of thrombolytic agent used.

[The left ventricular diastolic function in patients with hypertension and calcium inhibitors]. / La fonction diastolique ventriculaire gauche de l'hypertendu et les inhibiteurs calciques.

One of the first detectable signs of hypertensive heart disease is impairment of left ventricular filling. This filling defect depends, although not exclusively, on left ventricular hypertrophy (LVH), load factors and ischemic factors. LVH is an adaptive phenomenon triggered by the dysfunction of various parameters, such as increased in peripheral resistance, reduced arterial elasticity and increased sodium reserve. Calcium channel inhibitors act at several levels to permit regression of the LVH and contribute to improved left ventricular filling conditions.

[Evaluation of the myocardial ischemic and arrhythmogenic risk of digitalized angiography by venous route. Apropos of a comparative trial of ioxaglate and iopamidol]. / Evaluation du risque ischémique myocardique et arythmogène des angiographies numérisées par voie veineuse. A propos d'un essai comparatif de Ioxaglate et de Iopamidol.

Cardiac tolerance to digital subtraction angiography by venous route (DSAV) was evaluated during a prospective study of a continuous series of 100 patients of both sexes investigated for various arterial diseases, and classified previously as "cardiac" and "non-cardiac". A permanent 12 lead ECE recording by sequences of 3 allowed study of ischemic and rhythmic changes provoked by randomly allocated injections of contrast media, Ioxaglate or Iopamidol. Major cardiac complications were not observed in the 98 patients studied (2 excluded), but in 32.6% auricular extrasystoles (AES) and/or ventricular extrasystoles (VES) were noted and in 19.4% a painless widening of the ST segment of 0.5 mm or more. The and ST widening were more frequent in the VES 40 patients classed as "cardiac" than in the 58 "non cardiac" (35% against 8.6%, p less than 0.01 and 37.5% against 6.9%, p less than 0.001 respectively). The two products did not differ with respect to their effect on frequency of repolarization anomalies, whereas Ioxaglate provoked more VES than Iopamidol (30% against 8%, p less than 0.02). It is concluded that cardiac tolerance to DSAV is good, but that the frequency of VES and painless repolarization ischemic disorders observed, even with only weakly hypertonic contrast media of non ionic type, suggests that their indications be limited and that certain precautions are necessary in cardiac patients.

[An unusual complication of percutaneous aortic valvuloplasty: rupture of an aberrant mitral chorda]. / Une complication exceptionnelle de la valvuloplastie aortique percutanée: la rupture d'un cordage mitral aberrant.

The case of a 77-year old woman who died of refractory pulmonary oedema 36 hours after percutaneous valvuloplasty for tight calcified aortic valve stenosis is reported. Post-mortem examination showed satisfactory opening of the aortic orifice but also rupture of an aberrant chorda which crossed the outflow tract below the aortic sigmoid valves, between the mitral valve and the interventricular septum. This case suggests that before all aortic valvuloplasties the absence of aberrant chorda or suspicious subaortic acceleration should be confirmed by Doppler echocardiography; moreover, during the procedure the balloon should not be inserted too deeply into the left ventricle.

[Evaluation of cardiac tolerance of intravenous digital angiography]. / Evaluation de la tolérance cardiaque des angiographies numérisées par voie veineuse.

Cardiac tolerance to intravenous digital subtraction angiography (ANVV) was evaluated by a prospective study in a continuous series of patients of both sexes investigated for various arterial diseases and classified initially into "cardiac" and "non-cardiac" cases. Ischemic and rhythmic electrocardiographic modifications were monitored, the contrast medium (PC) used being randomly selected between Ioxaglate and Iopamidol. Of the first 46 patients studied, 40% had had more than one auricular and/or ventricular extrasystole (ES), 18% had painless depression of the ST segment (greater than or equal to 0.5 mm) and 46.7% both effects. In the 17 "cardiac" patients, depression of ST and the ES were more frequent (p less than 0.02 and p less than 0.05 respectively) than in the 29 "non-cardiac" cases. There was absence of difference between Ioxaglate and Iopamidol with respect to frequency of disorders of repolarization, but Ioxaglate appeared to provoke more ES than Iopamidol (respectively 13 of 23 and 5 of 22 cases, p = 0.02). Major cardiac complications were not reported, and it is concluded, after discussion of cardiovascular effects of PC injection, that intravenous digital subtraction angiography is generally well tolerated but requires some precautions in patients with cardiac affections.

[Adiastole caused by a secondary cardiac hemochromatosis. Successful treatment with an iron chelating agent]. / Adiastolie par hémochromatose cardiaque secondaire. Guérison par traitement chélateur du fer.

Severe congestive cardiac failure developed in a few weeks in a 44 year old man who had undergone porto-caval anastamosis for post-hepatitis cirrhosis one year previously and then treated for anaemia by repeated blood transfusion and chronic daily oral iron therapy. Infiltrative, congestive and restrictive cardiomyopathy was diagnosed in the presence of global cardiomegaly, electrocardiographic changes (microvoltage, diffuse ST-T wave changes), echocardiographic appearances (dilatation of the left ventricle, with hypertrophic and hypokinetic walls), and hemodynamic signs of adiastole with equalisation of filling pressures at 15 mmHg and a cardiac index of 1,88 l/min/m2. Cardiac haemochromatosis was confirmed by the laboratory (serum iron: 35 mumol/l; siderophilin saturation: 100 p. 100; serum ferritin: 1854 ng/ml; induced siderouria: 51 mg/24 hours) and histological findings (endomyocardial biopsy showing pigment overload). The absence of a family history, of homozygote A3 antigen, of diabetes, of iron overload on hepatic biopsy one year previously, excluded the diagnosis of familial idiopathic haemochromatosis. A secondary form of the disease was diagnosed on a possible genetic predisposition (heterozygote A3 antigen) and on environmental factors (blood transfusions, iron therapy, cirrhosis, alcoholism and perhaps the porto-caval anastamosis. Cardiac haemochromatosis was cured in this case by iron chelating therapy comprising daily subcutaneous infusions of 2 g of desferrioxamine for 2 months. The cure was confirmed by regression of the signs of clinical cardiac failure and of cardiomegaly, the increase in QRS voltages and the near normalisation of the hemodynamic and laboratory findings.