[Doppler tissue imaging contribution in the study of diastolic dysfunction in hemodialysis patients]

Doppler echocardiography is currently the main tool permitting the diagnosis and the characterization of the stages of diastolic dysfunction. The purpose of this study is to precise the contribution of Doppler tissue imaging in the study of diastolic function and to identify the parameters having the most discriminating power of diastolic dysfunction in hemodialysis patients. Conventional Doppler echocardiography study implies left ventricular diastolic function from: - Doppler transmitral flow [E/A, isovolumic relaxation time [TRIV], deceleration of mitral E-wave time [TDE], duration of A wave], color M-mode flow propagation velocity [Vp], - the study of pulmonary venous flow [S/D, Systolic fraction [FS] and duration of pulmonary venous A wave], - the annulus Doppler Tissue Imaging [Ea/Aa, E and A waves durations, VTI of E and A] - and finally combined indexes [ratio of peak E-wave velocity to Vp [E/Vp], difference in duration between pulmonary venous and mitral flow A wave [Ap-Am] and ratio of peak mitral and annulus E-wave velocities [E/Ea]. Left ventricular diastolic dysfunction is found in 88% of the 50 haemodialysis patients: abnormal relaxation pattern 56%, pseudo-normal pattern 28% and restrictive pattern 4%. The parameter Vp discriminates normal patterns. The parameters TRIV, S/D and FS characterise abnormal relaxation. Ea/Aa ratio characterises pseudo-normal pattern and E/A ratio restrictive pattern. Discriminating analysis allows a correct classification of 100% of pseudo-normal pattern patients with 3 variables: Ea/Aa, FS and Vp or E/Vp. Doppler parameters which discriminating power is significant [p<0.0001] are, in decreasing order: E/A, Ea/Aa, TRIV, Vp, FS, S/D, E/Vp and TDE. DTI contributes mainly in the characterization of stage II diastolic dysfunction patients and allows in association with pulmonary venous flow parameters [Ap-Am] and combined indexes [E/Vp et E/Ea] an accurate appreciation of left ventricular filling pressures

[Meadows syndrome: Pathogeny and therapeutic perspectives]

Meadows syndrome or peripartum cardiomyopathy [PPCM], is a rare affection characterized with a heart failure on an apparently primitive, dilated cardiomyopathy [DCM], arising during the last month of the pregnancy or in the six months following the delivery, at women with healthy known heart. The incidence of PPCM seems rare. The literature indicate the infections and the auto-immune origin, but without a formal proof of it. The purpose of the treatment is to reduce the preload, to decrease vascular resistances and to increase myocardic contractility. The measures of secondary prevention require a rigorous contraception. We report a retrospective analysis concerning aetiopathogenesis hypothesis, risk factors and therapeutic modalities of this affection

[Bidirectional tachycardia: aetiology, mechanism and treatment-a case report]

Unusual tachyarrhythmia is characterized by a beat-to-beat alternation of the axis of the QRS complexes, the bidirectional tachycardia have multiple mechanisms and aetiologies. We report the observation of a 75-year-old man having a hypertensive dilated cardiomyopathy with chronic atrial fibrillation and treated by diuretics, digitalis and platelets antiaggregants. He presented with a global congestive cardiac failure. The electrocardiogram revealed a bidirectional tachycardia with a regular alternation of the QRS axis within the frontal plane. Laboratory results showed especially a hypokaliemia at 2.1 mEq/1. Digitalics withdrawal and kaliemia correction allowed the resolution of the tachycardia. The patient was treated with diuretics, Amiodarone and platelets antiaggregants. No further episodes of bidirectional tachycardia were observed

Risk factors of accelerated atherosclerosis in uraemic patients

The cardiovascular mortality is more important in patients with chronic renal disease than mortality in general population. These events are linked to specific risk factors in relation with the kidney insufficiency and also to the same factors of atherosclerosis met in the general population. In fact, more than 50% of cardiovascular disease in prolonged hemodialysis are directly related to the formation of an "acceleratcd atherosclerosis", term proposed to describe an atheroma more frequent, extended more calcifying and inflammatory at equal ages in comparison with general population. Thus, the accelerated atheroslerosis is responsible of a heavier mortality at the kidney insufficiency comparatively with the general population. These factors are often noted precociously at the stage of chronic kidney insufficiency and don't disappear with the dialysis. Two groups of factors exist: some are due to kidney insufficiency, others are secondary to the substitutive therapeutic of the renal insufficiency

Endocardite bacterienne sur valves tricuspides au cours des CIV

We report two cases of tricuspid valve endocarditis in congenital heart diseases. The presentation was an isolated fever in the first case, and a prolonged fever associated with skin lesions in the other. Blood cultures had isolated a staphylococcus aureus in one case. Echocardiography confirmed the diagnosis showing the interventricular defect and the tricuspid valve vegetations. Antibiotherapy was unsuccessful, and a bioprothese tricuspid valve was indicated in association with cure of the interventricular defect