[Early diagnosis of postinfarction ventricular aneurysm. Value of contrast scintigraphy]. / Le diagnostic précoce de l'anévrysme ventriculaire post-infarctus. Intérêt de la scintigraphie de contraste.

Early diagnosis of a ventricular aneurysm after myocardial infarction may provide a valuable means of preventing certain complications. We studied 55 patients with acute myocardial infarction on the 8th day by Technetium 99 angioscintigraphy with study of wall motion and ejection fraction at equilibrium. The results were compared with left ventriculography performed three months after infarction. Angioscintigraphy demonstrated 17 cases of dyskinesia, 16 cases of hypokinesia, and 22 cases of akinesia, divided into two subgroups depending on whether the ejection fraction was lower (n = 11) or higher than 40% (n = 11). Contrast angiography at 3 months confirmed the presence of 27 aneurysms, 17 akinetic plaques and 11 cases of hypokinesia. Comparison between the two series of investigations showed excellent correlations: in the group of dyskinesia (17 cases) an aneurysm was confirmed in 15 cases; in the group of hypokinesia (16 cases) only one aneurysm was demonstrated by the reference angiography. The results were less uniform in the group with akinesia. In the subgroup with a low ejection fraction, 9 out of 11 cases progressed to aneurysm and, in retrospect, should be considered as likely aneurysms. There were only 2 aneurysms (2/11) in the subgroup with localised akinesia and a high ejection fraction. The overall results suggest that angioscintigraphy at the 8th day of myocardial infarction is a reliable means of detecting left ventricular aneurysm; in cases of dyskinesia or widespread akinesia with an ejection fraction of less than 40% the presence of an aneurysm was confirmed in 24 out of 28 patients (86%).(ABSTRACT TRUNCATED AT 250 WORDS)

[The electrophysiologic effects of intravenously administered bepridil]. / Etude des effets électrophysiologiques du bépridil utilisé par voie veineuse.

The electrophysiological effects of intravenous bepridil were studied at doses of 2 mg/kg and 3 mg/kg. The drug was tested on 25 patients of both sexes who were undergoing electrophysiological investigation for other reasons (11 normal ECGs, 11 pathological ECGs, 3 WPW syndromes). Electrophysiological parameters before and after bepridil were compared. The following changes were noted: - the refractory period was significantly prolonged at all conducting levels; - the sinus cycle was significantly lengthened in a practically constant fashion (+9,2 p. 100); - conduction in the sinoatrial and atrioventricular nodes was significantly prolonged (+15 p. 100 and + 11 p. 100); - the Luciani-Wenckebach point was significantly decreased in the anterograde, and even more so in the retrograde, directions (-20 and -23 p. 100 respectively); - however, infrahisian conduction was not affected either in patients with normal or pathological ECGs. The drug was effective in blocking the accessory pathway in two of the three patients with the WPW syndrome. A study of drug plasma levels did not show a dose-effect relationship. The plasma levels were extremely variable from one subject to another, suggesting tissue fixation of the active part of the molecule. These results demonstrate the valuable electrophysiological effects of bepridil which, by its mode of action, is very similar to amiodarone.