Archives des maladies du coeur et des vaisseaux最新文献

{"title":"[Cardiomyopathy of the right ventricle revealed by pulmonary embolism].","authors":"J Peyrou,&nbsp;V Richand,&nbsp;V Le Bouffos,&nbsp;P Réant,&nbsp;F Laurent,&nbsp;R Roudaut","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The authors report a case of cardiomyopathy of the right ventricle revealed suddenly in a presentation of pulmonary embolism in relation to a large thrombus that developed in an enormous, extremely hypokinetic right ventricle. The scenario suggests dysplasia without rhythm disorder. This case allows a discussion on the multiple variants of arhythmogenic dysplasia of the right ventricle.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 11","pages":"963-6"},"PeriodicalIF":0.0,"publicationDate":"2007-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41076626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Results of the French register of renal stenting: the Esternal study].","authors":"M-C Morice,&nbsp;J Marco,&nbsp;J-C Laborde,&nbsp;J-L Fourrier,&nbsp;A Raynaud,&nbsp;P Labrunie,&nbsp;Y Louvard,&nbsp;V Poyen,&nbsp;M Lambiez,&nbsp;E Mouton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Renal artery angioplasty using the same techniques employed for coronary arteries has developed considerably. A register was set up in France to evaluate the efficacy of this treatment for improving renal function and lowering blood pressure in cardiac patients. Between 2001 and 2005, 205 patients (234 lesions) were treated in 14 centres (mean age: 69.2 +/- 10.4 years, 59% male). All of the patients had hypertension and the majority of them (171) had renal failure (creatinine clearance<90 ml/min). Direct implantation of a stent was performed in 75.2% of the cases, successfully in 196 patients (96%) with 220 lesions (95.2%). The complications encountered were segmental renal infarction in two patients (0.9%), and four cases of minor vascular complications at the puncture site (2%). The mean value for pre-implantation creatinine clearance was 54.6 +/- 32.8 ml/min and 58.1 +/- 36.0 post- implantations. The duration of follow up was 5.9 +/- 2.7 months. Mortality was 3.5% (seven patients, of whom two died from renal causes). The mean systolic and diastolic blood pressure was 142.2 +/- 16.2 and 78.9 +/- 9.5 respectively versus 164.9 +/- 25.2 and 89.1 +/- 14.8 before treatment (p<0.0001). A non-significant improvement in creatinine clearance at six months was also observed in patients with renal failure prior to treatment: 48.7 +/- 17.1 ml/min vs. 69.2 +/- 160.3. Renal artery stenting in cardiac patients with renal artery stenosis is associated with a very high success rate, with few complications and an improvement in hypertension and renal function.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"827-32"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Long-term clinical benefits of using active stents in diabetic patients: two year follow-up of a consecutive series of 122 patients].","authors":"B Popovic,&nbsp;M Angiol,&nbsp;J Lemoine,&nbsp;F Moulin,&nbsp;A Chodek-Hingray,&nbsp;G Ethevenot,&nbsp;E Aliot","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The objective of our study is to evaluate the long-term results of coronary angioplasty using active stents in a population of diabetic patients. This is a single-centre study on a consecutive series of 122 diabetic patients (40% of them insulin dependent) who between January 2003 and June 2004 underwent angioplasty with implantation of an active stent (sirolimus Cypher(R) or paclitaxel Taxus(R)) for one or more de novo coronary lesions. The mean age was 66 +/- 10 years and a total of 171 coronary segments were treated. The lesions treated were complex (type B2 + C) in 69% of the cases, with a mean stent length of 21 +/- 15 mm and a mean stent diameter of 2.7 +/- 0.3 mm. Follow-up at two years for 119 patients (3 lost to follow-up) revealed a mortality rate of 4.2%, and a myocardial infarction rate of 7.5%. The rates for revascularisation of the target lesion and the target vessel were 11.4% and 17.8% respectively, with a rate of major cardiac events of 22.5%. During this period, 25.2% of the patients underwent revascularisation of at least one vessel. This study confirms the benefits of using active stents for revascularisation of the target lesion in diabetic patients. However, it serves as a reminder that the progression of coronary atheroma is global, and that the prognosis for these patients depends essentially upon managing risk factors, and particularly on controlling their diabetes.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"833-7"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Why screening for a renal artery stenosis?].","authors":"D Stéphan,&nbsp;C Griffon,&nbsp;A Hamade,&nbsp;C Jahn,&nbsp;M Welsch,&nbsp;C Mounier-Vehier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Diagnosis of renal artery stenosis (RAS) should be discussed in numerous clinical situations including refractory high blood pressure (HBP), HBP in a polyvascular patient, degradation of renal function following renin angiotensin inhibitor or flash pulmonary edema. Ultrasound-doppler coupled with gadolinium-enhanced MR or CT angiography has proven adequate for most patients with RAS. Digital subtraction angiography should be limited to revascularisation procedures. Functional testing are not sensitive or specific enough because the degree of renin activation differs widely among patients with RAS. Renal percutaneous angioplasty induces a light to moderate decrease in blood pressure, has no effect on renal function but allows to reduce the number of anti-hypertensive drugs. Stenting completed angioplasty is worthwhile in most patients with atherosclerotic RAS. ACE inhibitors decrease mortality and increase renal function in patients with RAS.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"872-7"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27103407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treating heart failure with carvedilol in private practice (initiating treatment and follow-up at one year. The KEOPS study].","authors":"M Komajda,&nbsp;P Amouyel,&nbsp;N Johnson,&nbsp;L Bergougnoux,&nbsp;T Laperche,&nbsp;P de Groote,&nbsp;P Jaillon,&nbsp;A Cohen-Solal","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed at describing usual conditions of carvedilol use in heart failure (HF) patients.</p><p><strong>Methods: </strong>KEOPS was a one-year, multi-centre, prospective pharmaco-epidemiological study in carvedilol treated HF patients recruited by private cardiologists.</p><p><strong>Results: </strong>Two thousand nine patients (mean age: 68) with heart failure were included by 401 cardiologists. 64% of patients were in class II of NYHA and 27% in class III, 87% of patients presented stable heart failure for at least four weeks. Contraindication to beta blocking was observed in 24% of patients, mean left ventricular fraction of ejection was 39% and only 39% of patients had mean left ventricular fraction of ejection<35%. Co-medications included a diuretic agent, ACE inhibitor or ARB in 68% of cases. Eighty three percent of patients had a titration of carvedilol (median duration=1 20 days). Thirty percent reached the recommended maximal dose. The dose of carvedilol at the titration's visit for all the patients (patient in stop included) was on average 30.5 +/- 22.1 mg/day with a median on 25 [confidence interval: 23-27] During the year of follow-up, 10% of patients have stopped the treatment (3% of patients having reached the maximum recommended dose of carvedilol versus 13% for the others), for cardiovascular reasons in 50% of patients (aggravation of heart failure: 28%, symptomatic arterial hypotension: 9%, symptomatic bradycardia: 5%). Finally, symptomatology of patients has improved during the study (59% of patients in class mild to severe at inclusion, versus 36% at the end of the observation), especially for the 30% of patients followed at one year and having reached the maximum recommended dose of carvedilol. Only in univariate analysis, patients with an inclusion high weight (>85 kg) were likely less to reach recommended maximal dose (37.2 versus 8.7%, p-value<0.0001), the patients with systolic heart failure had more chance than the patients with diastolic heart failure to reach the recommended maximal dose (31 versus 17.4%, p-value=0.006), in the same way, the lack of auricular supported more the reach of recommended maximal dose (31.2 versus 24.1%, p-value=0.018)</p><p><strong>Conclusion: </strong>KEOPS study suggests an improvement of usual conditions of carvedilol compared to the last investigation but the persistence of prescription outside medical authorization and less dosage of this product compared with clinical studies.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"818-26"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Study of a detection strategy for silent ischemia in diabetic patients: 18 month follow-up of the ARCADIA register].","authors":"G Vanzetto,&nbsp;S Halimi,&nbsp;O Ormezzano,&nbsp;J Steidel,&nbsp;L Belle,&nbsp;R Boizel,&nbsp;D Fagret,&nbsp;J Machecourt","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The prognostic impact of a myocardial ischemia-based therapeutic program in asymptomatic diabetic patients remains controversial. We prospectively assessed the benefit of a stratification algorithm based upon clinical and myocardial perfusion imaging (MPI) data on cardiovascular events in such patients in a non-randomized register.</p><p><strong>Method: </strong>701 consecutive asymptomatic diabetic patients were classified to be at low or intermediate-to-high cardiac risk according to 13 simple boil-clinical parameters. Intermediate-to-high risk patients were scheduled for MPI and underwent either a conventional (Group 1, n=180) or an intensive multifactorial (Group 2, n=245) therapeutic program. Low risk patients (Group 3, n=276) underwent no specific management.</p><p><strong>Results: </strong>At the end of the survey and as a consequence of intensive management, lipid lowering therapy, antiplatelet drugs, and beta-blockers were more often prescribed in Group 2 than in Group 1 (55, 31 and 17% versus 36, 23, and 8% respectively, p<0.01). Planned coronary angiography in case of severe ischemia on MPI and revascularization were more frequent in Group 2 (16.2 and 8.9%) than in Group 1 (8.0 and 2.8% - p<0.01). At 19-month follow-up (96.7% completed), major event rate in Group 2 was significantly lower than in Group 1 (3.9 versus 9.8%, p<0.01) and similar to that of Group 3 (2.2%, NS).</p><p><strong>Conclusion: </strong>Easy-to-perform risk stratification is able to select diabetic patients with good medium-term prognosis. In clinically selected higher risk patients, an intensive medical therapy combined with coronary angiography +/- revascularization in case of large ischemia on MPI is effective to improve prognosis.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"845-52"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of sudden death in a semi-rural district, Seine-et-Marne: the DEFI 77 study].","authors":"G Pochmalicki,&nbsp;J-Y Le Tarnec,&nbsp;J-P Franchi,&nbsp;J-P Empana,&nbsp;M Genest,&nbsp;R Foucher,&nbsp;F Compagnon,&nbsp;X Jouven,&nbsp;H Lardoux,&nbsp;L Guize","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sudden death is a major problem in public health, affecting around 50 000 people a year in France. The prognosis for cardiac arrest is abysmal because for every minute lost the chances of survival diminish by 10%. The aim of this work was to prospectively evaluate the characteristics of cardiac arrest victims across an entire 6000 km? area, the Seine-et-Marne district, distinguished by the paradox of lying just outside the capital whilst actually being semi-rural, and to determine the current methods of dealing with this emergency. The DEFI 77 prospective epidemiological survey was carried out with the collaboration of the SAMU emergency medical service, the SDIS fire/ambulance service, the general hospitals and the Paris-Ile-de-France cardiological association. Between January 2001 and December 2005 there were 2001 cardiac arrests (mean age 68 +/- 20 years, 67% male) at home in 80% of cases. The arrest was in front of a witness in 72% of cases, but they performed resuscitation in only 14.3% of cases. The SAMU and SMUR emergency medical services attempted cardio-pulmonary resuscitation in 78% of cases. In 29% of cases, one or more external electric shocks were carried out, using a semi-automatic defibrillator 79% of the time. Only 11.5% of patients arrived at the emergency department alive, the overall hospital survival rate being less than 2%. Only eight patients subsequently underwent automatic defibrillator implantation. The results of this observational study are to a large extent explained by an extremely long delay (12 minutes) before help was called for, the delay between the call and the arrival of medical assistance (9.5 +/- 4 min), the low percentage of active witnesses, and the variability in management (invasive in particular). In conclusion, at the dawn of the third millennium the prognosis of cardiac arrest remains very poor and fully justifies educating the general public about calling for help early and about actions that can save lives, particularly external cardiac massage before the arrival of the emergency services, as well as the benefits of using automated external defibrillators.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"838-44"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Normal values of the peak early diastolic Ea using myocardial tissue Doppler in 100 elite athletes].","authors":"V Griffet,&nbsp;S Guérard,&nbsp;L Galoisy-Guibal,&nbsp;J-R Caignault,&nbsp;F Bernard,&nbsp;R Brion","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Intense physical training can induce morphological and functional changes in the heart, leading to 'Athlete's heart'. This can be responsible for adaptive left ventricular hypertrophy (LVH), which is sometimes difficult to differentiate from hypertrophic cardiomyopathy (HCM) with its inherent threat to life. Echocardiography usually allows the diagnosis to be clarified, but in borderline cases it can be insufficient.</p><p><strong>Objective: </strong>The value of myocardial tissue Doppler (MTD) in the diagnosis of HCM has been highlighted recently. Normal values in athletes have been published, but these series have only studied a small number of athletes in a small number of sporting disciplines.</p><p><strong>Methods: </strong>Using echocardiography with MTD at the lateral mitral annulus, we therefore evaluated 100 elite athletes from a very wide range of disciplines, in order to obtain a mean reference value for early diastolic Ea velocities.</p><p><strong>Results: </strong>The peak early diastolic Ea was measured at 18.2 +/- 2.7 cm/s. The E/A ratio was 1.7 +/- 0.4. We found that 75% of the athletes had a value for Ea=17 cm/s, and for 84% of them the E/Ea ratio was correlated positively with the E/A ratio, and negatively with age.</p><p><strong>Conclusion: </strong>Elite athletes have early diastolic velocities measured with MTD that are higher due to their physical training. This study has allowed a mean reference value to be established for Ea in this specific population, with the potential opportunity to distinguish between LVH and HCM.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"809-15"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27106412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Multiple myxomata: about one case].","authors":"C Jayle,&nbsp;S Franco,&nbsp;Le Bris,&nbsp;G Lefort,&nbsp;P Corbi","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Among the primitive cardiac tumours, myxoma is the most common. This benign tumour is sometimes described in the context of Carney's syndrome, in which cardiac myxoma, cutaneous myxoma, lentigo and pigmentary nevus cutaneous lesions, endocrine disorders, and testicular, thyroid and hypophyseal tumours are associated. The cardiac myxomata observed are multiple, recurrent, and involve the four cardiac chambers, with a peak incidence at 25 years of age. These observations may exist in a familial context, linked to an autosomal dominant genetic factor, localized on the 17q2 chromosome with polymorphism of the PRKAR1a gene. As in the case of sporadic myxoma, rapid surgical treatment with cardio-pulmonary bypass is indicated, bearing in mind the increased risk of thromboembolic phenomena and sudden death from valvular encroachment. We report a case of bi-atrial myxoma observed in the context of Carney's syndrome.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"878-81"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27103408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Brugada syndrome: update 2006.","authors":"T Boussy,&nbsp;A Sarkozy,&nbsp;P Brugada","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over the last 14 years - since the Brugada syndrome was first recognized as a distinct clinical/electrocardiographical entity - a considerable number of papers have been published on its various aspects. It has been defined as the combination of a typical ST-segment elevation in the right precordial leads and a predisposition for malignant ventricular arrhythmias occurring in the absence of structural heart disease. From the outset, controversy arose about the diagnostic criteria to be applied. This issue has been clarified since the announcement of a first (2002) and second (2005) consensus report. Our review will discuss the clinical characteristics and different possible pathophysiological mechanisms underlying the specific ECG-abnormalities and susceptibility for malignant arrhythmias. Nowadays, the main issue of discussion revolves essentially around its prognostic features, especially in asymptomatic patients. This review will compare the results of different follow-up studies and yields a possible explanation for the differences in event rates and in the identification of useful sudden-death predictors. Finally, the most recent data concerning new diagnostic techniques, gene identification and future therapeutic options will also be discussed.</p>","PeriodicalId":8144,"journal":{"name":"Archives des maladies du coeur et des vaisseaux","volume":"100 10","pages":"865-71"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27103406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}