[First case of myocardial metastasis of an epidermoid tumor. Value of Doppler tissue imaging]. / Premier cas d'envahissement myocardique par une tumeur épidermoïde. Apport du doppler tissulaire.

The authors report the first case of a poorly differentiated epidermoid oesophageal cancer with myocardial metastasis. The diagnosis of malignant invasion of the myocardium was made by transthoracic echocardiography with electrocardiographic changes of subepicardial ischaemia. The authors review the literature of metastasic cardiac disease after the study of this particular case and underline the value of Doppler tissue imaging for myocardial characterisation.

[Effect of age on the prognosis of infectious endocarditis]. / Influence de l'âge sur le pronostic de l'endocardite infectieuse.

The aim of this study was to evaluate the influence of age on the prognosis of infectious endocarditis. A retrospective study from 1987 to 1997 of 136 patients with infectious endocarditis on native, prosthetic valves or cardiac pacing catheter was performed. The outcome was analysed with the help of general practitioners. Two groups of patients were compared: 87 patients of 65 years of age or more (Group 1) and 49 patients under 65 years of age (Group 2). With a follow-up period of 5 years, the global mortality was 35%, but greater in Group 1 (p = 0.06). Cardiac failure was the main cause of death. The mortality was significantly higher in patients who were not operated (p < 0.002). The authors conclude that age of over 65 does not significantly worsen the prognosis of infectious endocarditis. The absence of surgery seems to be an indirect factor of a poor prognosis. Long-term follow-up of patients is necessary to diagnose and treat cardiac failure at an early stage and to consider referral for surgery.

[Comparison of tissue harmonic imaging and standard imaging in echocardiography based on 4 different emission frequencies]. / Comparaison de l'imagerie fondamentale et d'harmonique en échocardiographie: étude de deux fréquences d'imagerie fondamentale et de deux fréquences d'imagerie d'harmonique.

Harmonic imaging is an innovative technique which is now available in most of the echographic equipment currently on the market. The use of echographic contrast agents led to the introduction of this particular technology, which has largely superseded the former method. In everyday medical practice, it seems to provide a better definition of endocardial contours. In this article, the authors have described a prospective study including 32 patients with an average age of 64 years (+/- 5 years). The aim was to compare imaging quality obtained by 2 acquisition frequencies for standard imaging with that procured by harmonic imaging (emission and reception frequency, 2.5 and 3.3 MHz respectively for the former technique; emission and reception frequency, 1.7 and 2.2 MHz respectively for the latter). The overall scores given by 2 different examiners for emission and reception frequency were as follows: 3.28 and 3.15 for 2.5 MHz, 2.84 and 2.56 for 3.3 MHz regarding the standard technique; 2.56 and 3.031 for 1.7 MHz and 2.56 and 2.063 for 2.2 MHz for the harmonic imaging technique. The superior performance of tissue harmonic imaging has been confirmed in the endocardial study of the left ventricular segments and in the analysis of the mitral valve. This study shows that harmonic imaging, a technique which was easy to use in the present study, provides a means of obtaining an average level of ultrasound imaging that facilitates the interpretation of the clinical picture.

[Traumatic coronary dissection caused by deceleration. Report of a case]. / Dissection coronaire traumatique par décélération. A propos d'un cas.

Myocardial infarction is a rare complication of traumatic thoracic deceleration. The authors report the case of anterior myocardial infarction with dissection of the left anterior descending artery in a 16 year old boy who was injured in a motorbike accident without a penetrating thoracic wound. Therefore, the only pathological mechanism was deceleration. The authors review the 12 previously reported cases.

[Short term blood pressure variability and baroreflex sensitivity in mild and moderate hypertensive patients "dipper and non dipper"]. / Variabilité tensionnelle à court terme et sensibilité du baroréflexe chez l'hypertendu léger à modéré "dipper et non dipper".

AIM OF THE STUDY: To compare heart rate (HR) and blood pressure (BP) variability in hypertensive patients with or without a fall in BP during the night. METHODS: 33 mild to moderato hypertensive patients, mean age 45 +/- 15 years, underwent an echocardiogram, a 24-hr ambultory BP monitoring (ABPM), and a 24-hr ECG monitoring. In addition, a continuous BP recording over 15 minutes was performed between 9 and 11 a.m. both in supine and standing positions, by using digital plethysmography (Finapres device). STATISTICAL ANALYSIS: non parametric tests. RESULTS: [table: see text] CONCLUSION: In non dippers, morning BP and HR low-frequency oscillations are shifted to a lower level, as compared to dippers. This characteristic is associated with a reversed circadian pattern of sympathetic activity.

[Regression towards the mean and repeated echocardiographic measurements of the left ventricular mass]. / Régression vers la moyenne et mesures échocardiographiques répétées de la masse ventriculaire gauche.

The selection of a group of patients based on a high value of a clinical or biological parameter leads to the finding of a tendency to a reduction of this value when remeasured, known as "regression towards the mean". The amplitude of this phenomenon is greater when the selected subjects are far from normal values and the intra-individual variability of the parameter under consideration is very high. Measurement of left ventricular mass is very affected by this statistical phenomenon. The authors undertook a prospective study to analyse the components of variability of repeated echocardiographic measurements of left ventricular mass and to quantify the expected effect of regression towards the mean in the follow-up of patients with left ventricular hypertrophy. Twenty-five randomly chosen subjects underwent 2 echocardiographic examinations at 2 week intervals: at each visit, the patient had two recordings and each recording was measured twice by the same "blinded" operator. Variance analysis showed intra-individual variability represented 30% of total variability, comprising only 2% for the measurements and 28% for the recordings and the visits. The importance of regression towards the mean was calculated with respect to the initial value of the left ventricular mass index: for example, when the left ventricular mass index was 150 g/m2, a spontaneous regression of 18 g/m2 can be expected at the next measurement. This phenomenon should be taken into consideration in the interpretation of longitudinal echocardiographic studies.

[Cardiotoxicity of 5-fluorouracil. Clinical picture of 4 cases and a prevention proposal]. / Cardiotoxicité du 5-fluoro-uracile. Tableaux cliniques à propos de 4 cas et proposition de prévention.

5-fluoro-uracil (5-FU) cardiotoxicity has been often reported during chemotherapy. We collect four atypical cases of cardiac side effects in patients treated by 5-FU for head and neck tumors. We review the literature about the subject, and we propose criteria to detect patients with a high risk level, and to prevent this adverse effect incidence.

[Comparative effects of angiotensin converting enzyme inhibitors and calcium inhibitors related to baseline ambulatory blood pressure. A French multicenter study]. / Effets comparés des inhibiteurs de l'enzyme de conversion et des inhibiteurs calciques en fonction du niveau tensionnel ambulatoire de base. Etude multicentrique française.

OBJECTIVE: This multicenter study was aimed at determining whether the baseline ambulatory blood pressure (BP) level does influence the efficacy of angiotensin-converting enzyme inhibitors (CEI) and that of calcium antagonists (CA) to the same degree. METHODS: The BP recordings of 236 patients with mild to moderate hypertension were reviewed: these subjects previously entered clinical trials comprising a mean 2-week placebo period and a mean 6-week active treatment phase (CEI = 115, CA = 121). The 24-hour baseline ambulatory BP was considered as high when greater than 139/87 mmHg, according to Staessen's meta-analysis. RESULTS: In the patients with an high baseline ambulatory BP, CEI and CA have had roughly a similar effect (reduction in systolic = 9.5 +/- 7.8% vs 7.7 +/- 6.3%, NS; reduction in diastolic = 9.8 +/- 8.6% vs 8.3 +/- 5.8%, NS). Conversely, the patients with a baseline ambulatory BP level lower than or equal to 139/87 mmHg experienced a greater reduction in ambulatory BP with CEI than with CA (systolic = 7.9 +/- 7.0% vs 0.6 +/- 6.7%, p = 0.0001; diastolic: 5.0 +/- 7.4% vs 1.9 +/- 7.6%, p = 0.040). Finally, further analysis found the threshold of drug efficacy to be 120/80 and 135/85 mmHg in CEI and CA patients respectively. CONCLUSIONS: 1) CEI are more effective than CA in patients with a low ambulatory BP only. 2) The risk of a visceral hypoperfusion seems however to be limited, since CEI do not reduce diastolic ambulatory BP further, when its baseline level is lower than 80 mmHg.

[Identification of overtreated hypertension with statistical analysis of 100 consecutive ambulatory blood pressure monitoring]. / Identification des hypertendus surtraités par analyse statistique de 100 enregistrements tensionnels ambulatoires consécutifs.

The data obtained from 100 consecutive ambulatory blood pressure (BP) recordings performed in treated hypertensive patients (60 men, 40 women, mean age 52 +/- 14 years) were analysed to make a choice between several possible definitions of overtreatment and to evaluate the prevalence of patients thus defined as overtreated. Recordings were studied over two periods: diurnal from 9 a.m. to 7 p.m. (100 patients, 37 +/- 5 measurements/patient), and nocturnal from 11 p.m. to 7 a.m. (98 patients, 19 +/- 2 measurements/patient). The patients were first classified on the basis of reference ambulatory BP values according to sex and age. Subnormal levels were found in 25 patients for diurnal SBP, 25 for nocturnal SBP, 13 for diurnal DBP and 33 for nocturnal DBP. Several criteria of overtreatment were then tested, based on the percentile method and on the number of subnormal values: the median DBP was below the 30th reference percentile in 16 patients, and the percentage of subnormal DBP values was above 80% in 18 patients. Clinically, there was little to differentiate these patients from the rest of the population treated. The goal of treatment which, in terms of BP values, is to normalize the ambulatory BP was therefore overshot in 1 out of 5 or 6 patients depending on the criteria adopted. The significance and consequences of overtreatment cannot yet be evaluated.

[Average level and variability of 24 hour blood pressure in the normotensive insulin-dependent diabetic patient]. / Niveau moyen et variabilité de la pression artérielle des 24 heures chez le diabétique insulinodépendant normotendu.

This prospective study was designed: 1. to determine both the mean level and the intrinsic variability of blood pressure (BP) and heart rate (HR) in normotensive patients with insulin-dependent diabetes mellitus (IDDM), by using a nonambulatory recorder; 2. to look for a relationship between these parameters and the indices of diabetic target-organ damage. The patient group consisted of 21 subjects with IDDM (6 females, 15 males), aged 19 to 70 years, who were normotensive according to WHO criteria. The duration of the diabetics ranged from 1.5 to 32 years. A control group of 17 age and sex-matched normal volunteers was also examined. Each subject underwent a 24 h non ambulatory BP recording, a 2-dimensional echocardiography and a pulsed doppler examination; furthermore, an index of autonomic nervous system dysfunction was established, as well as an index of microangiopathy. Twenty-four hour BP and HR mean levels appeared to be slightly higher in IDDM patients than in control group, but the difference was significant for night SBP and 24 h DBP only. No difference was found with regard to BP and HR absolute variabilities; the relative variability of night DBP was slightly lower in IDDM group (p less than 0.05). A loss of nocturnal decline in BP was noted in 2 control subjects and in 9 IDDM patients: 8 out of these IDDM patients had an autonomic dysfunction. An abnormal HR circadian pattern was seen in 1 control and in 2 IDDM subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relaxation and diastolic filling of the left ventricle]. / Relaxation et remplissage diastolique du ventricule gauche.

The cardiac cycle, as revisited by modern authors, consists of 3 fundamental phases: contraction, which includes isovolumic contraction and first part of ejection; relaxation which begins with left ventricular peak pressure, continues with second part of ejection and isovolumic relaxation, and ends together with ventricular rapid filling (i.e. as filling rate has decreased by 50 p. cent); finally compliance or slow filling which lasts until atrial systole. The LV diastolic dysfunction refers to filling abnormalities which are related to either relaxation abnormalities or compliance troubles or both. The mechanisms of these abnormalities are biochemical (deficiency in cyclic AMP resulting in calcium handling dysregulation) and mechanical: right ventricular filling, pericardial restraint, coronary arteries perfusion, myocardial inertial forces, myocardial visco-elastic properties, ventricular wall elasticity (depending itself on its thickness and its collagen content). The methods of analysis of LV filling are: left ventriculography, gamma angiography, digitized M-Mode echography and, mainly, Doppler echocardiography. This technique allows 2 types of mitral flow abnormalities to be distinguished: 1) the abnormal relaxation which combines an increased isovolumic relaxation time, an increased deceleration time and a diminished E/A ratio, but this pattern may be "normalized" by an increase in filling pressure; 2) the restriction to filling which results in an increased E/A ratio, a diminished deceleration time and, sometimes, a diastolic mitral regurgitation. The effects of drugs on LV diastolic function are difficult to assess: a beneficial result may be due either to a direct effect on the myocardium or to an improvement in load conditions, heart rate or contractility.