[Evaluation of left ventricular function by systolic time intervals]

Evaluation of left ventricular systolic function, usually based on the assessment of the ejection fraction, is increasingly supplemented by other more sophisticated techniques such as 3D echocardiography and speckle tracking. However these methods require a high technicity and a good echogenicity. As heart failure leads to lengthening of aortic pre-ejectional time [PET] and shortening of left ventricular ejection time [ET], systolic time intervals [STI] were proposed for the evaluation of systolic myocardial performance. To establish a correlation between left ventricular ejection fraction [LVEF] and STI and determine a cut-off value of PET/ET ratio to diagnose a LVEF inferior to 35%. 109 consecutive patients referred to two echocardiographic laboratories had measurements of STI and LVEF estimated by Simpson biplane method. Patients included were in sinus rhythm with a heart rate<100 beats per minute. Patients with atrial fibrillation, pacemaker or prosthetic valves were excluded. Results: Feasibility of STI measurements was 100%. A significant negative correlation between PET and LVEF was found [r=-0.49, p<0.0001]. LVEF was also significantly correlated to ET [r=0.44, p<0.0001]. PET/ET ratio was significantly correlated to LVEF [r=-0.63, p<0.0001]. Receiver operating curve analyses revealed a cut-off value of PET/ET ratio of 0.33 to diagnose a LVEF<35% with a sensitivity of 85% and a specificity of 78%. STI, easy to obtain and useful in case of poor quality echographic window, are an interesting alternative to evaluate systolic left ventricular function and may be used to detect alteration of LVEF

[Cardiac amylodosis]

Amyloidosis is a rare infiltrative disease characterized by multiple clinical features. Various organs are involved and the cardiovascular system is a common target of amyloidosis. Cardiac involvement may occur with or without clinical manifestations and is considered as a major prognostic factor. To analyze the clinical features of cardiac involvement, to review actual knowledgement concerning echocardiographic diagnostic and to evaluate recent advances in treatment of the disease. An electronic search of the relevant literature was carried out using Medline and Pubmed. Keys words used for the final search were amyloidosis, cardiopathy and echocardiography. We considered for analysis reviews, studies and articles between 1990 and 2007. Amyloidosis represents 5 to 10% of non ischemic cardiomyopathies. Cardiac involvement is the first cause of restrictive cardiomyopathy which must be evoked. In front of every unexplained cardiopathy after the age of forty. The amyloid nature of cardiopathy is suggested if some manifestations were associated as a peripheral neuropathy, a carpal tunnel sydrome and proteinuria > 3g/day. Echocardiography shows dilated atria, a granular sparkling appearance of myocardium, diastolic dysfunction and thickened left ventricle contrasting with a low electric voltage. The proof of amyloidosis is brought by an extra-cardiac biopsy, the indications of endomyocardial biopsy are very limited. The identification of the amyloid nature of cardiopathy has a direct therapeutic implication: it indicates the use of digitalis, calcium channel blockers and beta-blockers. Today the treatment of amyloidosis remains very unsatisfactory especially in the cardiac involvement. An early diagnosis before the cardiac damage may facilitate therapy and improve prognosis

[Cardiac failure with normal systolic function]

Cardiac failure with normal systolic function representes 30 to 50% of all the cardiac failures. There is no clinical radiographicaln electro cardio graphical symptorn to characteize this Kind of Cardiac failure. It's diagnosis and its valuation could be done with doppler echocardiography. The etiology is dominated by the ischemic cardopathy, the hypertrophic myocardis fathies and senile heart. It's traiternent isn't codified yet

[Sino atrial block induced by therapeutic doses of diltiazem: about 3 observations]

We report three observations of Diltiazem intoxication at therapeutic doses with occurence of sino auricular block. The situation evolute favorably for two patients while the thind die. The electro systolic stimulate seems to be justified in case of Diltiazem intoxication