Profil pharmaco-doppler pénien des patients coronariens souffrant de dysfonction érectile à l'Institut de Cardiologie d'Abidjan une série de 30 cas / Penile pharmaco doppler profile of coronary patients with erectile dysfunction at the Abidjan Cardiology Institute: a series of 30 cases

Contexte et objectif. La maladie athéromateuse dont la coronaropathie étant une pathologie diffuse peut être prévenue par le contrôle des facteurs de risqué cardiovasculaire. Le but de cette étude était de décrire les caractéristiques pharmaco doppler pénien des patients coronariens souffrant de dysfonction érectile. Méthodes. Il s'agissait d'une série analytique des cas suivie entre juin 2020 et février 2021. Elle concernait des patients ayant des lésions athéromateuses significatives à la coronographie et souffrant de dysfonction érectile. Nous avons évalué les caractéristiques pharmaco doppler pénien. La qualité d'érection était appréciée par le score de rigidité Erectile Hardness Score (EHS). Résultats. Trente-six patients étaient inclus. L'âge moyen était de 56 ± 8,4 ans. le pic de Vitesse systolique au repos (PSVr) moyen des patients était de 13,7 cm/s ± 5,9. Le pic de vitesse systolique post injection (PSV pi) moyen des patients était de 23,9 cm/s ± 5,4. Les causes étaient principalement artérielles de 75%. La qualité d'érection était appréciée selon le score EHS : E1 (83%), E2 (22%), E3 (5%) et E4 (3%). Conclusion. La dysfunction érectile est associée aux facteurs de risque cardiovasculaire selon plusieurs études. L'echodoppler pénien avait occupé une place importante dans le diagnostic étiologique. Les causes retrouvées étaient principalement artérielles avec une baisse de PSVpi<25 cm/s.

Coronarographie et interventions chez des sujets de moins 40 ans au CHU aristide le dantec

Introduction: La coronarographie est une méthode exploratrice et thérapeutique des artères coronaires qui connait depuis quelques années des avancées remarquables, de telle sorte que ses indications peuvent s'étendre à tous les âges en fonction des orientations cliniques. L'objectif de ce travail était de décrire les aspects des artères coronaires chez les patients de moins de 40 ans explorés au CHU Aristide Le Dantec.Patients et Méthodes: Nous avons effectué une étude descriptive qui incluait tous les patients dont l'âge était inférieur ou égal à 40 ans et qui avaient eu une coronarographie suite à un consentement éclairé dans la période du 1er Mai 2014 au 31 Août 2017. Les paramètres étudiés étaient épidémiologiques, cliniques, coronarographique, incluant l'éventuelle angioplastie Résultats: Nous avions inclus 32 patients. L'âge moyen était de 33,84 ± 5,59 ans, avec un minimum de 18 ans. Le genre masculin prédominait avec 27 hommes. Le facteur de risque cardio-vasculaire le plus fréquemment retrouvé était le tabac (28,13%) suivi de la dyslipidémie (25%), de l'hérédité (18,75%) et du surpoids (15,6%). Chez deux patients (6,25%), on a noté une consommation de substance stupéfiante. Les indications de la coronarographie étaient entre autres, le syndrome coronaire aigu (72%) et l'angor d'effort à (19%). La coronarographie était normale chez 11 patients et Pathologique chez les 21 restants, incluant 15 cas (46,87%) avec des lésions serrées. Les atteintes angiographiquement significatives étaient dominées par les atteintes mono-tronculaires dans 50% des cas. L'angioplastie était réalisée avec satisfaction chez 5 patients avec une prédominance de stents nus.Conclusion : Chez le sujet jeune avec syndrome coronarien aigu ou angor d'effort, le facteur de risque le plus fréquent est le tabac et l'atteinte coronaire est le plus souvent mono tronculaire

Comorbidites viscerales associees a la goutte : a propos de 75 patients suivis au CHU de Brazzaville (Congo)

Objectif : Rechercher les comorbidités viscerales observees au cours de la goutte. Patients etMethode : Etude transversale descriptive et analytique, portant sur les patients goutteux Diagnostiques selon les criteres ACR 1977, suivis entre le 1erjanvier 2012 et le 31 janvier 2017 dans le Service de Rhumatologie du CHU de Brazzaville au Congo. Les patients ont ete evalues a la recherche De comorbidites visceralescardiovasculaires, renales et cerebrales. Resultats : 105 patients goutteux Ont ete repertories durant la periode d'etude, dont 75 (71,43%) qui repondaient aux criteres D'inclusion, constituant ainsi la population d'etude. Il s'agissait de 60 hommes et de 15 femmes (sexratioDe 4/1), d'age moyen de 60 +/- 11,47 ans (extremes: 30-82 ans). Les comorbidites viscerales Etaient representees dans 50,67 % des cas. Il s'agissait de l'insuffisance renale (21,33%), la maladie Coronarienne (14,67%), les AVC (12%) et l'insuffisance cardiaque (2,67%). La presence des Comorbidites etait associee a un suivi irregulier dans 86,56% des cas (P=0,025) et une mauvaise Observance therapeutique dans 93,75% des cas (P=0,006). Conclusion : La goutte est une maladie Grave de par la frequence de ses comorbidites viscerales. Le suivi irregulier et l'inobservance Therapeutique en sont les principaux facteurs associes

The integrated effect of moderate exercise on coronary heart disease

Background: Moderate exercise is associated with a lower risk for coronary heart disease (CHD). A suitable integrated model of the CHD pathogenetic pathways relevant to moderate exercise may help to elucidate this association. Such a model is currently not available in the literature.Methods: An integrated model of CHD was developed and used to investigate pathogenetic pathways of importance between exercise and CHD. Using biomarker relative-risk data, the pathogenetic effects are representable as measurable effects based on changes in biomarkers.Results: The integrated model provides insight into higherorder interactions underlying the associations between CHD and moderate exercise. A novel 'connection graph' was developed, which simplifies these interactions. It quantitatively illustrates the relationship between moderate exercise and various serological biomarkers of CHD. The connection graph of moderate exercise elucidates all the possible integrated actions through which risk reduction may occur.Conclusion: An integrated model of CHD provides a summary of the effects of moderate exercise on CHD. It also shows the importance of each CHD pathway that moderate exercise influences. The CHD risk-reducing effects of exercise appear to be primarily driven by decreased inflammation and altered metabolism

Assessment of indirect inflammatory markers in patients with myocardial bridging

Introduction: Myocardial bridging (MB)is a congenital variant of the coronary artery in which a portion of the epicardial coronary artery takes an intramuscular course. Although it is considered a benign anomaly, it may lead to such complications as myocardial ischaemia, acute coronary syndrome, coronary spasm, exercise-induced dysrhythmias or even sudden death. MB may be related to increased inflammatory and atherosclerotic processes. This study was conducted with the aim of evaluating the relationship between neutrophil/lymphocyte ratio (NLR) and MB.Methods: Taking into consideration the inclusion criteria, 86 patients with MB and 88 with normal coronary angiographies (control group) were included in the study. The association between MB and laboratory and other clinical parameters was evaluated.Results: The platelet distribution width (PDW) (17.3 ± 0.40 vs 16.1 ± 0 .5; p < 0.05), NLR (3.2 ± 1.3 vs 2.2 ± 0.9; p < 0.05) and red cell distribution width (RDW) (14.3 ± 1.3 vs 13.1 ± 1.1; p < 0.05) were significantly higher in the MB group than in the control group.Conclusions: This study demonstrated that compared to normal coronary arteries, PDW, NLR and RDW were significantly higher in MB patients. Further studies are needed to clarify the increased inflammatory parameters in patients with MB

Correlation between dyslipidiemia and the severity of coronary artery disease using SYNTAX scoring system

Background: the relationship between hyperlipidiemia and an increased risk of coronary heart disease has been well documented and has served as a motivating factor for research into lipoproteins structure, function and metabolism. Many epidemiological studies have revealed that chronically elevated lipid and cholesterol levels are associated with an increased incidence of atherosclerosis. Dyslipidemia together with hypertension and diabetes is major modifiable risk factors for atherosclerotic disease and the subsequent development of cardiovascular events. Dyslipidemia is known to be an independent predictor for cardiovascular events, other risk factors including family history, hypertension, tobacco use, age, sex and diabetes also have been found to be associated with an increased risk of coronary artery disease (CAD). This cross-sectional study was aimed to investigate the association of Dyslipidemia as an atherosclerosis predictor and its relationship to the severity of CAD using SYNTAX score. Patients and Methods: the current study included 535 patients who presented during 2015 with chest pain to Dar Al Fouad Hospital, experiencing symptoms of CAD or evidence of CAD by noninvasive testing were enrolled, a fasting blood sample was extracted and assessed for lipids profile. Patients underwent coronary angiography either using femoral or radial approach, and the resulting angiographic study was used to calculate the SYNTAX score of each patient. Patients were divided in to two group i.e. CAD and Non-CAD group. The CAD group was further divided into three sub-groups according to the SYNTAX score into low risk, intermediate risk and high risk group. Results: in this study, triglycerides, total cholesterol and LDL-C levels were positively associated with sever CAD and higher number of diseased vessels. Higher HCL-C levels were also found in subjects with normal coronaries. Conclusion: there was no significant proportionate, linear relation between the SYNTAX score and the levels of triglycerides, total cholesterol or LDL-C

Glycaemic Control and Cardiovascular Outcomes in Diabetes : Review

While type 1 diabetes mellitus (DM) is characterised by insulin deficiency due to pancreatic beta-cell destruction; type 2 DM is characterised by a state of longstanding insulin resistance (IR); compensatory hyperinsulinaemia and varying degrees of elevated plasma glucose levels (PG); associated with clustering of cardiovascular (CV) risk and the development of macrovascular disease prior to the diagnosis of DM. Coronary artery disease (CAD) accounts for 70of mortality and morbidity in patients with diabetes. Studies in diabetes care have helped prevent or reduce microvascular complications in type 1 and 2 diabetes. However the same cannot be said about macrovascular disease. Despite all data concerning the association between diabetes and cardiovascular disease (CVD); the exact mechanism by which diabetes is linked to atherosclerosis is incompletely understood; and this is especially true in the case of hyperglycaemia. The positive effect of intensive glucose management in comparison to non-intensive glucose control is far from proven. The DCCT and UKPDS studies have shown that while glycaemic control is important for preventing long-term macrovascular complications; early glucose control is far more rewarding (metabolic memory). Later trials such as ACCORD; ADVANCE and VADT do not advocate tight glycaemic control. In fact; the ACCORD trial has shown increased mortality with tight glucose control. Tight glucose control may be beneficial in selected patients with short disease duration; long life expectancy and no CVD. In critically ill patients; a blood glucose target of 140-180 mg is fairly reasonable and achievable. The ESC/EASD guidelines of October 2013; like those of the ADA; AHA and ACC; continue to endorse a treatment target for glucose control in diabetes of HbAlc level 7; based predominantly on microvascular disease with acknowledged uncertainty regarding the effect of the intensive glucose control on CVD risk. Management of hyperglycaemia in diabetics should not be considered in isolation; diabetics require multifactorial intervention for hypertension; dyslipidaemia and microalbuminuria besides hyperglycaemia. In fact; the combined use of antihypertensives; aspirin and lipid-lowering agents makes it difficult to discern the beneficial effects of antihyperglycaemic therapy

Association between c-reactive protein and coronary calcium score in coronary artery disease : cardiovascular topics

Background : Both high-sensitivity C-reactive protein (hs-CRP) and spiral computed tomography coronary artery calcium score (CCS) are valid markers of cardiovascular risk. It is unknown whether hs-CRP is a marker of atherosclerotic burden or if it reflects a process leading to acute coronary events. Methods and results : We studied the association between hs-CRP and CCS in 143 patients who were candidates for coronary artery bypass grafting (CABG). In our cross-sectional study; we found no significant association between hs-CRP and the CCS in bivariant (p = 0.162) and multivariant (p = 0.062) analyses. However; in patients who did not use statins; this association was significant and positive in the bivariant analysis (p = 0.001); but in the multivariant analysis it was negative and significant (p = 0.008). Conclusion : High-sensitivity CRP was not correlated with CCS. The relationship between CRP and clinical events might not be related to atherosclerotic burden. Measures of inflammation; such as hs-CRP; and indices of atherosclerosis; such as CCS; are likely to provide distinct information regarding cardiovascular risk

Carotid Intima-Media Thickness is a Predictor of Coronary Artery Disease in South African Black Patients : Cardiovascular Topics

Background: Several studies have shown that increased carotid intima-media thickness (CIMT) confers risk of future coronary artery disease (CAD) and stroke. The present study aimed at investigating whether CIMT is a predictor of CAD in South African black patients. Methods and Results: This was a prospective study of 53 patients; 41 men and 12 women; with ages ranging from 30 to 70 years. All patients had undergone coronary angiography for suspected CAD. B-mode ultrasound measurement of the carotid intima-media thickness was carried out in all patients; the operator being blinded to the coronary angiography findings. Twenty-nine of the 38 (76) subjects with established CAD had increased CIMT; with an average mean CIMT of 1.13 mm. Single-vessel disease was present in 12 people; double-vessel disease in 11 and triple-vessel disease in 12. There was a significant positive linear trend between CIMT and the number of involved coronary vessels (p 0.0001; r

Quality of Life-Associated Factors among Patients Undergoing Coronary Artery Bypass Surgery as Measured Using the WHOQOL-BREF : Cardiovascular Topic

This was a study of the pre-operative factors that influence quality of life (QoL) in patients with coronary artery disease and the relationship between pre-operative QoL and early outcome after coronary artery bypass surgery (CABG). Using the WHOQOL-BREF questionnaire; 283 patients who underwent isolated coronary artery bypass surgery were interviewed and scores were obtained for the physical; psychological; social and environmental components. The study found that the independent physical component predictors for higher QoL included male gender and diabetes mellitus; while the independent psychological component predictors were male gender and high ejection fraction. Males; diabetics and patients with low education levels had higher social well-being than others. Among the postoperative complications; only respiratory failure was found to have a relationship with physical and psychological components. Women with coronary artery disease who were candidates for CABG had lower scores than the men in respect of all components of QoL. Furthermore; a lower pre-operative psychological score in patients undergoing CABG can influence postoperative complications; especially respiratory failure

The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery Study: A Surgical Perspective

The SYNTAX (The Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery) study is an important study to indicate the best treatment option for patients who have three vessel coronary artery disease and/or left main stem coronary disease (LMD). CABG (coronary artery bypass grafting) is still the preferred therapy for these patient groups with proven low mortality and excellent long term survival rates. PCI-DES (percutaneous coronary intervention with drug eluting stents) is a relative non-invasive procedure with comparable short and medium term survival; but with a much higher repeat revascularisation rate. The SYNTAX Study enrolled 1800 patients in a randomised arm and 1275 in a registry arm. A SYNTAX Score was developed to assess the lesion morphology. At 12 months follow-up in the randomised group there was an increased death rate (4.3vs 3.5); myocardial infarction rate (4.8vs 3.2) and repeat revascularisation rate (13.7vs 5.9) in the PCI-TAXUS (percutaneous coronary intervention with TAXUS stent) group compared to the CABG group. This trend continues up to 24 months with increased death rate (6.2vs 4.9); myocardial infarction rate (5.9vs 3.3); repeat procedure rate (17.4vs 8.6) and MACCE rate (23.4vs 16.3) in the PCI group compared to the CABG group. The aim of the SYNTAX Study was to prove non-inferiority of PCI (percutaneous coronary intervention) compared to CABG in these patient populations. Non-inferiority of PCITAXUS compared to CABG in this study population could not be shown at 12 or 24 months. The cerebrovascular event rate was higher in the CABG group in both study arms (2.2vs 0.6) in the first year; but a nearly similar CVA rate during the next 12 months. The study will terminate in 2011 and will give much-needed information regarding the optimal treatment option in patients with three vessel disease and/or left main disease

Patients with Coronary Artery Disease : Maintaining Planned Lifestyle Adaptations

The purpose of this study was to describe how patients with coronary artery disease; who have had one or more cardiac interventions; were maintaining their planned lifestyle adaptations at four months after the intervention. Furthermore; the study aimed to develop guidelines to further assist patients in maintaining lifestyle adaptations. A descriptive study was undertaken using the survey method. The population consisted of 65 participants (42 males; 23 females) from five private hospitals in Gauteng. The questions for a questionnaire were derived from a conceptual framework. The participants first completed the questionnaire immediately before they were discharged; and again over the telephone four months after the intervention. Descriptive statistics were used to analyse the data obtained. The results showed that patients suffering from coronary artery disease do adapt their lifestyle after interventions; but most patients find it problematic to stop smoking. It is essential for patients with coronary artery disease to maintain lifestyle adaptations to ensure further health and prevention of recurrence of the same problems. These adaptations should be a lifelong commitment