[Echocardiography: Why not the gold standard of left ventricular systolic function assessment?]

Left ventricle [LV] systolic function is a corner stone in diagnostic and therapeutic decision makings and is a potent predictor of patient's outcome. A lot of investigational techniques help to assess the systolic performance of LV but in practice echocardiography and LV angiography are still the most used methods. Because, in the last decade echocardiographic techniques have tremendously evolved, accuracy and limitations of LV systolic function assessment by echo has to be revisited. 100 successive patients scheduled for LV angiography, got estimations of LV stroke volume [SV] and ejection fraction [LVEF] echographically by Simpsom's methods and by pulsed Doppler at the level of aortic annulus in the second harmonic mode and invasively by a 30° RAO LV angiography. Echocardiography has been performed by two operators prior to the angio study. Statistics were done using linear regression methods with determination of the correlation coefficient [r] and the standard error estimation [SEE] when the variables are normally distributed or the spearmn's coefficient [rs] when not. Echocardiographic assessment was technically feasible in all patients by both operators. Echocardiographic methods had excellent correlation to angiography and correlation coefficients of biplane Simpson and pulsed Doppler at the level of the aortic annulus were respectively r = 0.9 and r = 0.85. These coefficients were r = 0.85 and r = 0.69 in the subset of patients with LV wall motion dyssynergie. The intra and inter observer variabilities were below 7% for all methods. Echocardiographic LV systolic function assessment is nowadays technically possible in almost all patients with an excellent correlation to LV angiography and a good inter observer reproducibility whether there is or not LV remodeling or wail motion abnormities

[Endo arterial investigation: warning for the cholesterol crystal embolism disease]

Cholesterol crystal embolism [CCE] is a rare disorder which can complicate cardiac catheterization, angiographic studies and cardiovascular surgery. The CCE exposes to a great risk of renal failure and it can even threaten life by means of a multi visceral failing syndrome. Report a new case of CCE following cardiac catheterization. We report the observation of a 63-year-old patient who had a coronary angiography via the right femoral artery after a myocardial infarction. This examination has showed a multi-vessel coronary disease. 15 days later, the patient presented purplish and painful discoloration of his toes. The laboratory findings showed a mild inflammatory syndrome and eosinophilia at 700/micro L. There wasn't a renal dysfunction nor proteinury nor hematury. We performed a skin biopsy and made the diagnosis of CCE. Trans oesophageal echography objectified an irregular atherosclerotic plaque in the isthmic aorta, The CT scan revealed a spindle-shaped aneurysm in the end of the abdominal aorta. This aneurysm contains a marginal surrounding thrombosis with high embolic risk. The patient was put under clopidogrel, enoxaparine, simvastatine, colchicine and atenolol and operated successfully. The two particularities of this observation are, on one hand, the absence of a renal involvment, which represents the main prognostic factor of the CCE. On the other hand, the CCE has revealed a very unstable aneurysm of the aorta which could be complicated during the cardiac catheterisation. The CCE is a difficult diagnosis that must be remembered before any cardiac catheterisation, because it often reflects unstable aortic atherosclerotic lesions