[Right ventiular function by the tricupid annular motion in inferior myocordial infarction]

Summary To assess the method of tricuspid annular motion and tricuspid annular velocity in the study of the right ventricular function after inferior myocardial infarction. 65 patients with myocardial infarction were studied prospectively. The infarction site was anterior in 30 cases and inferior in 35 cases. 9 patients with inferior infarctus had electrocardiographic signs of right ventricular infarction. 24 healthy individuals served as control patients. The standard echocardiography was completed by the analysis of systolic motion of the tricuspid annulus with the use of M-mode and the recording of tricuspid annular velocity with the use of pulsed-move tissue imaging. The tricuspid annular motion was significantly reduced in inferior myocardial infarction compared with that in healthy individuals [20 and 25 min, p<0.001]. The peak systolic velocity of the tricuspid annulus was significantly reduced in inferior myocardial infarction compared with that in healthy individuals and patients with anterior infarction [11.5; 15; 14 cm/s, p<0.001]. In the group of patients with inferior infarction, the tricuspid annular motion was significantly lower in patients with right ventricular infarction than in patients without right ventricular infarction [16 and 13 mm, p<0.001]. The patients with right ventricular infarction had also a significantly decreased peak systolic tricuspid annular velocity [11 and 1305cm/s, p<0.001], peak early diastolic velocity [9 and 12.5cm/s, p<0.001] and late diastolic velocity [14 and 18 cm/s, p<0.001]. The method of recording the motion and velocity of tricuspid annulus is simple and can be used to assess right ventricular function in patients with inferior myocardial infarction

[Pluse wave doppler tissue imaging in the assessment of regional left ventricular diastolic function in patients with coronary artery disease]

Myocardial ischemia impairs the diastolic left ventricular [LVi function earlier than the systolic function. We evaluated the value of pulse-wave Doppler Tissue Imaging [DTI] in the study of regiona myocardial function of LV in patients with coronary artery disease. We performed a prospective study in 60 patients with coronary artery disease that we compared to 40 healthy individuals in order to assess the value of pulse-wave DTI to study the diastolic LV function. Both groups had a clinical examination, ECG echocardiography and pulse-wave DTI. Only the patients had a coronary angiography. Pulse-wave DTI was applied to the 16 myocardial segments of the LV, we measured the isovolumetric relaxation time [IVRT], early [Ea] and late diastolic [Aa] velocities We have demonstrated that compared with healthy subject patients with coronary artery disease has a significant increase of IVRT [100.2 +/- 20ms vs 62.5 +/- 12.2, p <0.001] and lower Ba [7.6 +/- 1.6 vs. 9.2 +/- 2.6] and report Ea/Aa. These anomalies are more pronounced in akinetic segments compared with hypokinetic segments. Relying on data from the coronary angiography, we found in patients that IVRT had increased, Ea and Ea/Aa lowered in most segments hypoperfused than in normally perfused segments. An IVRT>70ms and Ea <8.3 cm/s emerge as threshold values to identify myocardial ischemia. More coronary lesions are severe mom Ea and Ea/Aa decline and IVRT increase. The culprit coronary artery could be identified by pulse-wave DTI since the DTI parameter anomalies are systemized. The pulsed DTI technique seems to be attractive as a non-invasive evaluation method of ischemic heart disease

Utility of Stress cardiography to identify myocardial ischemia

The dobutamine echocardiography takes more and more an important place in diagnosis, prognosis and therapeutics strategies of the coronary disease. We prospectively enrolled 130 consecutive patients followed for a coronary insufficiency. The aim of determinating the diagnostic value of the dobutamine echocardiography in the myocardial ischemia compared with the classic means as the exercise test and the myocardial scintigraphy. Our results are comparable to the data of the literature, the dobutamine echocardiography is more specific than the exercise test and the myocardial scintigraphy [96%, 61% and 53%], more sensitive than exercise test [75% versus 47%] but less sensitive than the myocardial scintigraphy [75% versus 96%]. The stress echocardiography has the best diagnosis precision 87%, against 72% for the scintigraphy and 56% for the exercise test. The dobutamine echocardiography is a very feasible, tolerated well exam and especially very reliable in term of detection of the coronary disease in the feminine population, with a sensibility at 66,7%, a specificity at 100% and a diagnostic precision at 92%, also in patient with hypertension the stress echocardiography is much more specific and reliable than the exercise test [100% vs 22% and 93% vs 54%, respectively], and it's superior to the exercise test in the presence of electric signs of systolic excess load and to the myocardial scintigraphy in case of left ventricular hypertrophy. The dobutamine echocardiography can be considered as safety and reliable means of investigation of the coronary insufficiency

[Double chamber right ventricle: about 3 cases]

The double chambered right ventricle is a rare congenital abnormality. It creates an obstacle for the right ventricular ejection. The cardiac ultrasonography examination allows the diagnosis in most majority of cases. The angiography is performed in difficult cases. We report 3 cases of infundibular stenosis with normal interventricular septum. The diagnosis was suspected for the 3 cases by the constellation of clinical findings pointing to systolic murmur over the precordium. and the electrocardiography showing right ventricular hypertrophy. It is confirmed by the echocardiogram and the hemodynamic exploration with a trans stenotic gradient evaluated at 72,80 and 80 mmHg. The 3 patients underwent surgery and had all good post operative follow up. These 3 observations allow us to recall the epidemiological. embryological. clinical and echocardiographic particularities of pure infundibular stenosis and to determin the adequate treatment and the prognosis

[Screening and management of coronary artery disease in diabetic patients]

Diabetes represents as independent risk factor for coronary artery disease [CAD] and the prognosis in term of survival rates is worse for diabetic patients who have CAD with report to those with CAD but no diabetes. The coronary artery disease in diabetes has specificities and, in particular, more extensive atherosclerosis. Diabetic patients are also more fre-quently asymptomatic. Due to the extreme complexity of ischemic vascular disease in patients with diabetes, an optimal therapeutic strategy is based on the correction of elevated blood glucose and lipid levels, of blood pressure, of platelet and coagulation abnormalities. Diabetic patients benefit from secondary prevention by drug therapy [aspirin, lipid lowering with statines, beta blocker and ACE inhibitors] to the same extent as, or more than, non-diabetic patients. Both percutaneous and surgical myocardial revascularization have been proved equally effective for CAD treatment in diabetes. A recent randomized trial has shown a significantly improved outcome after surgical revascularization. But, the effects of drug-eluting stents, which dramatically decrease the incidence of re-stenosis, seem promising

[Stress echocardiography and mitral stenosis: what interest?]

The stress echocardiography is used extensively as a diagnostic and prognostic tool and the assessment of ischemic cardiopathies. Its use in valvulopathies is more limited, but is increasing with time. The discrepancies between the functional symptoms and hemodynamics at rest is frequently met in patients with mitral stenosis. By assessing changes of pressures, gradients and surface stress echocardiography helps to identify the real hemodynamic conditions permitting to recommend a more aggressive approach in certain situations

Infarctus du myocarde sur coronaires angiographiquement saines: etude descriptive de 46 cas

This a retrospective study on 46 patients conducted over a 9-year period. These patients had an acute myocardial infarction [AMI] confirmed with changes on the electrocardiogram and raised cardiac enzymes. However, the subsequent coronary angiography was normal in all these patients. The purpose of our study is to assess epidemiologic, clinical, prognostic and therapeutic features of AMI with angiographically normal coronary arteries and compare the results obtained with those of AMI with coronary artery disease. AMI with angiographicalIy normal coronary arteries is a first coronary event in young patients [mean age 47.7 years] having few coronary risk factors [54.3% have only one risk factor] mainly smoking [73.9%]. The anterior location is prevalent. The patients with AMI and angiographically normal coronary arteries have a better prognosis than those with coronary artery stenosis. Indeed, their left ventricular function is unaltered [mean ejection fraction 48.7%]. Hypokinesis is the most frequent abnormality of wall motion noticed. The patients' post infarction course is bengin when the coronary arteries are angiographically normal. The incidence of hemodynamic complications and ischemic recurrences are lower than in AMI with coronary stenosis. The choice treatment remains fibrinolysis

[Introduction of the myocardal dopler tissue imaging]

Introduced in 1989, the myocardial doppler tissue imaging has now many clinical applications. The doppler tissue imaging explores the proper systolic and diastolic regional function of myocardial fibers. We can measure myocardial velocities by recording signals of low v‚locitiy and high magnitude, the strain and the strain rate are then derived from velocities. Specific softwares are therefore necessary. There are many ways of recording and representing myocardial doppler tissue parameters. Diagnostic and prognostic value of myocardial doppler tissue imaging is now proved and this method has many applications in ischemic cardiopathy and in cardiomyopathies. The development of powerful softwares is promising for the applications of the strain in the future

atteinte cardiaque au cours des spondylarthropathies

Cardiac involvement is a real manifestation of spondylarthropathies and include specially aortic reguragitation an conduction troubles. We present a prospective open study of fifty patients with spondylarthropathy [responded to Amor criteria] in order to evaluate the frequency of cardiac involvement, to see its type and if we can evaluate a group of patients able to this complication. We have included forty-four men and six women with a mean age of 38 years. The disease evolue for 8.8 years in mean. Ag HLA B27 was present in 70% of the cases. Thirty patients have ankylosing spondylitis, although twenty have a secondary spodylartropathy: psoriasic rheumatism [12 cases], inflammatory bowel disease: crohn's disease [4 cases], RCH [three cases] and fiessenger le Roy-reiter syndrom in one case. All the patients have had a cardiac check up with research of clinical cardiac manifestation, thoracic chest trans-thoracic echographi, Holter rhythmic done in five cases only. Cardiac involvement is found in five cases [10%]: aortic regurgitation in 3 cases [6%] and mitral regurgitation in 2 cases [4%]. These valvular disease are well tolerated