Noninvasive assessment of the infarct-related coronary artery blood flow velocity using phase-contrast magnetic resonance imaging after coronary angioplasty.

This study assesses infarct-related coronary artery blood flow velocity using phase-contrast magnetic resonance imaging (MRI) in patients with reperfused acute myocardial infarction (AMI) and compares these results with flow measurements obtained nonsimultaneously by intracoronary Doppler ultrasound. MRI examination was performed in 17 patients with AMI within 1 to 4 days (mean 2.5 days) after direct or rescue coronary angioplasty using a 0.014-in Doppler guidewire. MRI was performed on a 1.5-T clinical imager. The fast gradient echo segmented k-space phase-contrast pulse sequence was employed during breath-hold. The MRI and Doppler parameters of average peak velocity and maximum peak velocity were measured. Mean phase contrast MRI average peak velocity was 13.3+/-10.7 cm/s, and mean phase-contrast MRI maximum peak velocity was 27+/-16.6 cm/s. Mean Doppler average peak velocity was 17.1+/-5.1 cm/s, and mean Doppler maximum peak velocity was 35.5+/-10.1 cm/s. At the same anatomic levels, phase-contrast MRI average peak velocity correlated significantly to Doppler average peak velocity (r = 0.52; p<0.006) and Doppler maximum peak velocity (r = 0.42; p<0.03). Phase-contrast MRI velocity measurements were correlated with the same heterogeneity of Thrombolysis In Myocardial Infarction 3 flow velocity observed during Doppler examination. Thus, by comparing phase-contrast MRI with invasive intracoronary Doppler flow measurements, the measured MRI values showed significant correlation with Doppler data. Phase-contrast MRI has the potential to noninvasively quantify coronary flow velocity and to evaluate quality of reperfusion in patients with AMI after reperfused therapy.

Three-dimensional coronary artery MR imaging using prospective real-time respiratory navigator and linear phase shift processing: comparison with conventional coronary angiography.

Respiratory gating with navigator echo is a recent technique to detect diaphragm position in 3D magnetic resonance (MR) coronary angiography. The purpose of our study was to image proximal coronary arteries and to detect significant stenoses in patients with coronary artery diseases and to compare with contrast enhanced angiography results. Twenty patients with coronary artery diseases who were referred for conventional angiography underwent magnetic resonance angiography (MRA). Three-dimensional gradient echo volumes were acquired using cardiac and respiratory gating and fat suppression. Using reformatted oblique planes and maximum intensity projection technique, visualization coronary segments and detection of significant coronary stenoses were made. Eighty-three coronary segments were analyzed. The sensitivity and specificity were 65% and 93%, respectively. The corresponding positive and negative predictive values were 69% and 91%. This study shows the ability to image correctly coronary arteries and to identify proximal stenoses, but image quality need to be improved for an efficiency detection of coronary artery stenoses in clinical practice.

[Noninvasive methods in the diagnosis of post-infarction false aneurysm. Apropos of a case]. / Apport des méthodes non sanglantes au diagnostic de faux anévrysme post-infarctus. A propos d'un cas.

A case of post-aneurysm detected by chance in an asymptomatic 41 year old man, 3 months after acute infarction, and managed by surgery is reported. Although the aneurysm was too small to cause chest X-Ray changes, the parietal defect was clearly defined by isotopic angioscintigraphy, CAT scanning and M-mode echocardiography. The features of pseudo-aneurysms on CAT scanning are discussed. The value of M-mode echocardiography is confirmed, it alone giving the precise diagnosis through the demonstration of one dynamic sign: systolic expansion of the aneurysmal pocket on a tracing more suggestive of a localised pericardial effusion than of ventricular aneurysm. Early diagnosis by these non-invasive methods of investigation, requested as a result of some initial clinical abnormality, confirmed by angiography, may benefit some patients as the risk of secondary rupture may be avoided by surgical cure. The rarity of this condition is also under question due to the increasing number of reported cases.

[Influence of intravenous clonidine on normal and pathological sinus and atrioventricular nodes and carotid sinus sensitivity]. / Influence de la clonidine intraveineuse sur les noeuds sinusal et auriculo-ventriculaire normaux et pathologiques et sur la sensibilité sino-carotidienne.

A number of clinical observations have suggested that clonidine may be responsible for dizziness and even syncope. The aim of this study was to assess the effects of this drug on normal and pathological sinus and AV nodes and on carotid sinus sensitivity. 19 patients were investigated (average age: 73 years). 14 patients complained of dizziness or syncope, including 3 patients with spontaneous sinus node dysfunction. 5 patients were asymptomatic; 3 were investigated for severe sinus bradycardia (1 on clonidine); 1 patient had sinoatrial block and 1 patient underwent pre-operative assessment for intraventricular block. The sinus node was studied using Mandel's method at 100, 120 and 150/min; the AV node was studied by the extrastimulus method with fixed atrial cycle of 600 ms. The following parameters were measured: Wenckebach point, AH interval in spontaneous and paced cycle length of 600 ms, effective refractory periods. Carotid sinus sensitivity was tested by right and left carotid sinus massage. These parameters were measured under basal conditions and 15 and 30 minutes after IV injection of 0.150 mg of clonidine. Two groups of patients were identified from the results under basal conditions: group 1:11 patients with corrected post-stimulation pauses less than 525 ms, and group 2:8 patients with at least one corrected post-stimulation pause of over 525 ms. Clonidine influenced the post-stimulation pauses significantly in both groups. However, the number of pathological pauses increased much more in group 2 than in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

[Relation between serum levels and inotropic effect of digoxin in advanced cardiac failure during long-term treatment]. / Relation taux sérique - effet inotrope de la digoxine dans l'insuffisance cardiaque avancée lors d'un traitement au long cours.

The aim of this study was to determine the relationship of digoxin serum levels to their inotropic effects in advanced cardiac failure during long-term therapy with different dosages. The study was based on the analysis of left ventricular systolic time intervals (STI) measured at 97 follow-up appointments of 20 patients in advanced, stable cardiac failure over an average period of 37 days. The dosage of digoxin was varied at successive consultations so that the serum digoxin levels reached 0.50 ng/ml on at least one occasion. The serum digoxin levels (SD) varied between 0 and 4 ng/ml. Four levels of SD were individualised: A) "control" SD less than 0.25 ng/ml (22 consultations); B) SD: 0.25 to 1 ng/ml (n = 25); C) SD: 1.0 to 2.0 ng/ml (n = 29); D) SD greater than 2 ng/ml (n = 21) including 6 cases with clinical and/or ECG signs of digoxin toxicity. A progressive significant shortening of the electromechanical systolic index (Q-S2 I) was observed up to levels of 2 ng/ml (B and C, -18 ms and -28 ms respectively). The same phenomenon was observed with the ejection time index (ETi) and pre-ejection time index (PETi) (-7 ms and -14 ms; -11 ms and -15 ms respectively) compared to the basal values. At SD greater than 2 ng/ml the reduction remained stable and then started to decrease (positive difference between C and D). These changes were observed in the absence of significant variations of the heart rate. There was a significant linear relationship between the variations of the STI and SD in 15 out of 18 patients (in whom the regression could be calculated, these patients having attended at least 3 appointments). These linear relationships were observed for the Q-S2 i (11-18), the ETi (9-18) and/or PETi (10-18). An unexpected increase in the pre-ejection period was observed in 2 patients. In conclusion, a linear relationship has been shown between SD and inotropic effect which is particularly noticeable at SD levels less than 2 ng/ml. When SD is greater than 2 ng/ml, further increases in SD are associated with smaller variations of the STI. On the other hand, a significant inotropic effect is observed with small doses and SD levels less than 1 ng/ml. This inotropic effect persists unchanged at long-term.

[Natural history of syncope of undetermined origin with inconclusive electrophysiologic examination]. / Histoire naturelle des syncopes d'étiologie indéterminée avec exploration électrophysiologique non concluante.

Between 1985 and 1986, 109 consecutive patients with unexplained syncope after clinical and standard electrocardiographic examination underwent electrophysiological investigation. In 61 cases (56%), 35 men and 26 women (mean age 69 +/- 13 years) no firm diagnosis could be made. These patients were the study group. Underlying cardiac disease was present in 23%, coronary artery disease in 10% of cases. In 33 cases, the basal ECG was normal (54%). Sixty patients (one lost to follow-up) were studied over an average of 38 +/- 12 months. Global mortality and recurrence rate were 13 and 18% respectively. There were no sudden deaths in the 8 fatalities. The mechanism of the 17 recurrent syncopes was cardiac in 5 cases, vasovagal in 1 case, uncertain in 11 cases. Of the 5 cardiac syncopes, 3 were related to 3rd degree atrioventricular block occurring 7 to 49 months after the initial electrophysiological investigation. No predictive criteria of recurrence could be identified. Empiric treatment proposed to 28% of patients did not prevent recurrent syncope and did not improve global survival. Inconclusive electrophysiological investigation of patients with unexplained syncope defines a population with a low risk of sudden death. Recurrent syncope is common. The recurrence of symptoms is an indication to repeat the aetiological investigations which should include a tilt-test ot another electrophysiological investigation. Empiric treatment has not been shown to be effective.

[Recanalization of chronic occlusions and myocardial infarction occurring during reocclusion. Apropos of 2 cases]. / Désobstruction des occlusions chroniques et survenue d'un infarctus lors de la réocclusion. A propos de deux observations.

Although recent techniques have significantly improved the frequency of disobliteration of chronic occlusions, the potential complications in terms of mortality, emergency bypass surgery and myocardial infarction seem as common as in angioplasty of stenosis. Of these complications, the occurrence of infarction during reocclusion at the site of angioplasty has not been described and even been refuted by some authors. We report two cases of acute infarction, one of which was transmural, occurring during late reocclusion after disobliteration of a chronically occluded artery.

[Arrhythmia and conduction defects in polymyositis]. / Troubles du rythme et de la conduction et polymyosite.

The prevalence of cardiac complications of dermatomyositis and polymyositis is generally underestimated. The authors report the case of heart block as the presenting symptom of the disease, situated in the atrioventricular node. Initially paroxysmal, it eventually became permanent. It was associated with atrial (fibrillation and flutter) and ventricular hyperexcitability (ventricular tachycardia in runs). Myocardial biopsy provided histological proof of the cardiac disease and the definitive link between the nodal conduction defect and the polymyositis.

[Reciprocal changes in the ST segment in acute inferior myocardial infarction. Value of delay in appearance]. / Modifications en miroir du segment ST dans l'infarctus myocardiques inférieur aigu. Importance du délai d'apparition.

The significance of a "reciprocal" ST depression (ST(-)) in the acute phase of myocardial infarction remains controverted. This may be due to ST(-) not having the same determinants when studied at an early stage (less than 6 hours) or later (greater than 6 hours). The purpose of this study was to find out whether "reciprocal" ST(-) correlates with the same parameters when measured on very early ECG's (before 6 hours) or at a distance from the onset of infarction. The parameters concerned are coronary lesions, extent of the infarction and left ventricular function. ECG was performed in 46 patients with inferior infarct aged from 26 to 70 years (mean 50.8 +/- 9.2 years) between 2-6 h, 6-12 h, 12-24 h and 24-48 h from the beginning of pain. The sum of ST(-) on V1V2V2V4 (V1-4), D1aV1V1 to V6 and L1aV1V5V6, and the sum of ST elevation on L2L3aVf were measured at each period of time. The extent of global and anterior territory hypokinesia, the ejection fraction and the left coronary impairment were evaluated between the 2nd and 4th weeks. At 2-6 hours (a) the sum of ST(-) was greater (though not significantly), and the sum of ST elevation on L2L3aVf was significantly greater (p less than 0.001) when the left anterior descending artery (LAD) was not involved than when it was involved; (b) there was no difference between patients with and without ST depression (on all lead groups) in the degree of left ventricular hypokinesia and ejection fraction value.(ABSTRACT TRUNCATED AT 250 WORDS)

[Influence of the autonomic nervous system on the normal and pathological atrioventricular node]. / Influence du système nerveux autonome sur le noeud auriculo-ventriculaire normal et pathologique.

The finding of a first-degree atrioventricular block suggests various mechanisms of atrioventricular (AV) node alteration: organic lesion, or functional disorder related to the autonomic nervous system, or a combination of both. The influence of the autonomic nervous system was evaluated by administration of Jose's regimen, i.e. intravenous injection of propranolol 0.2 mg/kg bodyweight and atropine 0.04 mg/kg bodyweight. This regimen was tested in 101 patients divided into two groups: 38 subjects with normal sinus node and AV node acting as controls, and 63 patients with abnormal AV node. In the control group the autonomic nervous system had no influence on atrio-hisian (AH) conduction time or on the effective refractory period of the AV node under an imposed cycle of 600 ms. Wenckebach's period significantly (p less than 0.01) increased from 352 +/- 40 ms to 376 +/- 47 ms. Parasympathetic activity was found to predominate in the sinus node. In the group with pathological AV node three types of response were observed after pharmacological inhibition of the autonomic nervous system: (a) improvement or even complete normalization (40%) of AV node conduction ability (AH, Wenckebach's period) suggesting vagal hyperactivity, as also found in the sinus node; (b) changes similar to those observed in the control group and reflecting the same behaviour of the autonomic nervous system, and (c) increase in AH conduction abnormalities reflecting the presence of a sympathetic overdrive tending to minimize the consequences of an atrioventricular organic lesion. This sympathetic overdrive was also found to be present in the sinus node.

[Value of radionuclide ventriculography and magnetic resonance imaging in the diagnosis of constrictive pericarditis]. / Intérêt de la ventriculographie isotopique et de l'imagerie par résonance magnétique dans le diagnostic de péricardite constrictive.

In suggestive clinical presentations, the diagnosis of constrictive pericarditis is confirmed by the haemodynamic findings of impaired ventricular filling (diastole). In this study of 15 patients with pure constrictive pericarditis, the diagnosis value of two non-invasive techniques little used in this indication until now was examined: radionuclide ventriculography (RV) and magnetic resonance imaging (MRI). The RV provides a "functional" diagnosis through the analysis of global and segmental left ventricular filling whilst MRI provides anatomical details of the pericardial thickening. Diastolic dysfunction on RV presented as an increased early diastolic filling time as shown by a shortening of the interval to third filling T1/3R (p < 0.0001), an increased peak diastolic E wave velocity (p < 0.01) and early onset (p < 0.001), increased one third (FR 1/3) and mid (FR 1/2) diastolic filling fractions (p < 0.01) and of the E wave velocity to maximal systolic ejection velocity (S) ration (p < 0.01). The atrial contribution to filling in end diastole decreased (NS). Asynchronous filling, shown by dispersion of the times of onset of segmental early diastolic E peak velocities (delta tE) or of one third diastolic filling delta T1/3R, decreased. Seven patients underwent MRI. Pericardial thickening was present in all patients. The pericardium varied from 6 to 14 mm thick (normal 2.5 +/- 0.7 mm), without any systolo-diastolic variation. The thickening was seen as a dark low intensity signal, indicating the fibro-calcific character of the tissues. Sagittal and coronal views clearly demonstrated the non-uniformity of pericardial thickening.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of magnetic resonance imaging in cardiac sarcoidosis. Apropos of a case]. / Intérêt de l'imagerie par résonance magnétique dans la sarcoïdose cardique. A propos d'une observation.

The authors report the value of magnetic resonance imaging (MRI) in a case of cardiac sarcoidosis presenting with syncopal ventricular tachycardia (VT). The images were acquired in a monomorphic multiplane echo spin sequence. A 25 millisecond interval was chosen for the weighted T1 sequence. A second weighted T2 sequence using an interval of 70 milliseconds was then performed. The acquisitions were recorded in these planes axial, sagittal and coronal. The thickness of the sections was 8 mm. MRI was useful in locating the exact site and extent of the lesions; this enabled the operators to perform "guided" endomyocardial biopsies. In the weighted T1 sequences, these biopsies showed zones of increased intramyocardial signal density, more pronounced on the second weighted T2 sequences. Moreover, it was possible to follow up the outcome of these lesions with steroid therapy and observe their partial regression. These non-specific appearances may be observed in all inflammatory conditions but, in the context of systemic sarcoidosis, are very suggestive of cardiac involvement. In view of the clinical latency of cardiac sarcoidosis and its poor prognosis, the non-invasive character of MRI should make this a routine investigation in all patients with systemic sarcoidosis.

[Isolated impairement of the regional filling of the left ventricle in the coronary patient with normal systolic function. A study by isotopic ventriculography during rest]. / Altérations isolées du remplissage segmentaire du ventricule gauche chez le coronarien à fonction systolique normale. Etude par ventriculographie isotopique au repos.

The aim of this study was to assess whether resting radionuclide angiography could detect isolated regional left ventricular filling abnormalities due to chronic ischemia. The authors studied global and regional (10 segments) variations of LV volume using an original computerised system in 29 patients with single vessel coronary artery disease and normal systolic function without any other known pathology which could have altered left ventricular filling. Purely diastolic regional wall abnormalities were detected in presumed ischemic territories in over 60% of patients. They were then observed mostly in early rather than late diastole and affected the chronological indices (time to 1/3 LV filling, or to peak early diastolic filling rate) more than those of velocity (peak E or A velocities) or volume (filling fraction at 1/3 and half-diastole or that due to atrial contraction). They suggested delayed relaxation in these regions. These segmental changes are associated with a significant increase in asynchronous filling as judged by the variation in the intervals to peak early diastolic filling (tE) (p less than 0.001) and to one third filling (T 1/3R) (p less than 0.02), in the absence of increased physiological asynchronous contraction. An inversed relationship was observed (p less than 0.01) between the global value of peak early diastolic velocity and the indices of early diastolic asynchronous filling tE (r = -0.48) and T1/3R (r = -0.54). As previously reported, these regional abnormalities are, however, generally too small to cause changes in global diastolic function.

[Corrected transposition of the great vessels in aged adults. Apropos of 2 patients aged 72 and 80]. / Transposition corrigée des gros vaisseaux de l'adulte âgé. A propos de deux patients âgés de 72 et 80 ans.

The authors report two unusual new cases of corrected transposition of the great arteries diagnosed in patients 72 and 80 years of age respectively, presenting with symptoms of cardiac failure of recent onset. Both patients had mild or moderate regurgitation of the systemic atrio-ventricular valve, associated in one case with aortic regurgitation. This association would appear to be fortuitous although already reported in six occasions. The diagnosis was made by echocardiography and confirmed by catheterisation in one case, and by digitised intravenous angiography in the other. These cases are of interest for three reasons: They are very rare: there have been only 20 comparable cases reported in patients over 40 years of age, the eldest being 73. This is probably explained by the high frequency of associated malformations. They illustrate the decisive role of echocardiography in the diagnosis of congenital heart disease, even in the adult. They constitute a "natural experimental model" of a right ventricle submitted to systemic pressures and tend to show that, in the absence of other abnormalities giving rise to an additional pressure or volume overload, the right ventricle is capable of long term adaptation to this situation. These observations indicate a favourable long-term prognosis for children who have undergone "corrective" surgery at atrial level for simple transposition and in whom the right ventricle is required to assume the function of the systemic ventricle for the rest of their life.

[Cardiac angioscintigraphy at equilibrium coupled with isoproterenol perfusion. Method of diagnosing chronic coronary insufficiency]. / Angioscintigraphie cardiaque à l'équilibre couplée à la perfusion d'isoprotérénol. Méthode diagnostique de l'insuffisance coronaire chronique.

The effects of isoproterenol (IPNA) on global and regional left ventricular wall motion were studied by cardiac angioscintigraphy at equilibrium performed under basal conditions, during IPNA administration (per IPNA) and 10 minutes after (post IPNA) in 50 patients classified by coronary angiography as coronary (C) (n = 37) and non-coronary (NC) patients (n = 13), 5 reference subjects (REF) and 8 non-coronary pathology. The effects were assessed from variations of global LV function and from indices of regional wall function (12 regional ejection fractions - REF). The IPNA perfusion was well tolerated, even in patients with severe coronary lesions. 1. Diagnosis of myocardial dysfunction due to coronary artery disease: it was possible to separate the patients into C and NC groups according to the variations in EF, end systolic (ESV) and REF, especially post IPNA: NC group: per IPNA: 12/13 NC patients showed an increase in EF (+10.7%), a decrease in ESV (-41%) and increased or stable REFs. Post IPNA: 10/13 had raised EF (+4.6%), 9/13 had a reduced ESV (-17.4%) and 10/13 had stable or increased REF. C group: per IPNA: 15/37 C patients showed decreased EF, 12/37 had increased ESV and 15/37 had a decrease in at least two ref greater than or equal to 5%. Post IPNA: 25/37 had decreased EF, 21/37 increased ESV, 34/37 had at least two reduced REFs. These results show that decreased ref post IPNA (sensitivity 91.9%, specificity 66.9%) was a better indicator of coronary artery disease than VEF (sensitivity 68%, specificity 54%), increased ESV (sensitivity 57%, specificity 77%) or ECG changes (sensitivity 54%, p 0.05; specificity 91%, p less than 0.1). 2. Diagnosis of the extent of coronary artery disease: the post IPNA abnormal ref were situated in zones compatible with the coronary lesions: 10/13 single vessel disease (2 false negatives, 1 false localisation); 8/11 double vessel disease (1 false negative, 2 single vessel disease); 5/10 triple vessel disease (2 single vessel and 3 double vessel disease); 2/3 left main stem disease (1 single vessel disease). The study of REF demonstrated at least 2 diseased zones in 15/24 patients with multiple diseased vessels. Independently, the diagnosis of multivessel disease may be suspected by the fall in EF per IPNA (4/13 single vessel cases compared to 11/24 multivessel disease) and, more generally, by the fact that the EF and ZSV per and post IPNA appear more pathological with respect to the reference group when the coronary lesions are most diffuse.(ABSTRACT TRUNCATED AT 400 WORDS)

[Results of radiofrequency ablation of the atrioventricular junction in patients with refractory atrial arrhythmia and severe impairment of the left ventricular systolic function]. / Résultats de l'ablation de la jonction auriculoventriculaire par radiofréquence chez des patients en arythmie auriculaire réfractaire présentant une altération sévère de la fonction systolique ventriculaire gauche.

Results of radiofrequency ablation of the atrioventricular junction on functional capacity and left ventricular systolic function were assessed in 8 patients (aged 68 +/- 12 years) with refractory atrial fibrillation and severe left ventricular dysfunction, the mean ejection fraction being 31 +/- 11% (range: 20-48%). A clinical, echocardiographic and angioscintigraphic follow-up was performed 24 hours (basal), 3 and 6 months after the procedure. During follow-up, all patients reported the disappearance of palpitations and tiredness, a significant and early regression of effort dyspnoea from average NYHA Class 3.4 +/- 0.7 to 2.2 +/- 0.4 (M3), (p < 0.01), a decrease in end diastolic echocardiographic dimensions (from 57 +/- 10 to 52 +/- 9 mm (M3); p < 0.05) resulting in an increase in fractional shortening from 26 +/- 7% to 34 +/- 6%; p < 0.05. The isotopic EF increased from 31 +/- 11% to 42 +/- 12% (M3) (p < 0.01), and attained 48 +/- 12% (M6). This study shows that controlling the frequency and regularity of cardiac rhythm by ablation of the atrioventricular junction in patients with refractory AF and left ventricular dysfunction results in functional and haemodynamic improvement, especially when there is no apparent underlying cardiac disease. This suggests that this method should be proposed in all patients with refractory atrial fibrillation and left ventricular dysfunction.

[Value of thyroidectomy in amiodarone-induced hyperthyroidism. Apropos of 3 cases]. / Intérêt de la thyroïdectomie dans les hyperthyroïdies induites par l'amiodarone. A propos de 3 cas.

Amiodarone-induced hyperthyroidism in a relatively rare complication of long-term treatment with this molecule. It usually carries a good prognosis with regression being the rule after withdrawal of the drug although lethal forms have been reported. Conventional medical therapy (synthetic antithyroid drugs, steroids, betablockers) used in severe forms, is not always effective. In addition, amiodarone may be essential for the treatment of life-threatening, poorly tolerated arrhythmias, refractory to other forms of treatment. The authors report the cases of three patients treated with amiodarone for malignant arrhythmias who developed severe hyperthyroidism resistant to medical therapy and who were treated by total thyroidectomy. Surgery was followed by rapid resolution of the thyrotoxicosis without significant complications and immediate represcription of amiodarone. Thyroidectomy therefore seems a simple solution for amiodarone-induced hyperthyroidism allowing very rapid resolution of the hyperthyroidism and the possibility of immediate represcription of amiodarone.

[Phentolamine in treatment of acute left ventricular insufficiancies]. / La phentolamine dans le traitement des insuffisances ventriculaires gauches aiguës

Phentolamine (Regitine) at the dose of 0.3 mg/mn behaves as an arterial and, above all venous, vasodilatator agent, resulting in a marked and early lowering of the pulmonary pressures in acute oedema of the lung and in cardiac asthma. It was used alone in 47 attacks of acute severe left ventricular failure with very favourable results in 43 cases, as proved by the rapid improvement of the haemodynamic status and of the aicd-base balance. Under strict observation, tolerance has been excellent. This therapeutic method seems of great interest in the cases of acute pulmonary oedema with a maintained blood pressure level, and in the forms with severe arterial hypertension which might tolerate larger doses.

[Determination of left ventricular volume by cardiac angio-scintigraphy at equilibrium. Comparison with a radiologic method]. / Détermination des volumes ventriculaires gauches par angio-scintigraphie cardiaque à l'équilibre. Confrontation à la méthode radiologique.

Cardiac angioscintigraphy at equilibrium was performed after in vitro red cell labelling in the left anterior oblique and anterior views. A syringe of 10 ml labelled blood was placed on the patient's chest over the left ventricle and in contact with the camera's collimator in the LAO incidence. This syringe plays a dual part: as a direct reference for left ventricular radio-activity and as a marker for measuring the distance between the centre of gravity of the LV and the collimator by Links' method. The correction factor for absorption varies with each individual. An algorithm integrating this data automatically calculates the EDV in millilitres (ml) and the end diastolic and systolic volumes from the ejection fraction (EF) determined by an independent method. The study group was 100 patients (91 men, 9 women; 81 coronary, 11 valvular heart and 8 other diseases) with radiological EDV ranging from 107 to 1 283 ml and radiological EF ranging from 14 to 75 p. 100. A very significant correlation was observed between the radiological and scintigraphic EDV with a regression line close to that of identity: EDVs = 1.05 . EDVR-5 ml (or -3 ml/m2); SD = 48 ml; r = 0.953; p less than or equal to 0.001. The mean deviation between the methods was 35.7 ml (median 24 ml) or 13.7 p. 100 (median 9.4 p. 100) of EDVR. A large discrepancy (over 90 ml or 30 p. 100) was observed in only 7 patients, 4 of whom had severe mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Plasma homocysteine is not a predictive factor of restenosis after coronary angioplasty]. / Le dosage plasmatique de l'homocystéine n'est pas un facteur prédictif de resténose après angioplastie coronaire.

Hyper-homocysteinaemia is a cardiovascular risk factor. In parallel, anatomopathological studies of post-angioplasty coronary restenosis show histological appearances similar to those observed in patients with severe hyper-homocysteinaemia. Based on these histological observations, the authors tried to assess the predictive value of raised plasma homocysteine levels for coronary restenosis after angioplasty. Two hundred and twenty-two patients treated by coronary angioplasty were followed up clinically for 6 months. Thallium 201 myocardial scintigraphy was performed in 179 patients and coronary angiography in 74 patients. Seventy-nine patients had coronary restenosis diagnosed by coronary angiography in 55 cases, by myocardial scintigraphy in 23 cases and strongly suspected clinically in only one patient. No significant differences in homocysteine levels were observed between patients with multiple restenosis or requiring revascularisation, and those without restenosis and not requiring revascularisation. Plasma homocysteine does not therefore seem to be a predictive factor of post-angioplasty coronary restenosis.