Incidence and mechanism of silent myocardial ischemia early after coronary angioplasty

Holter monitoring was used to detect myocardial ischemia [MI] before and after successful percutaneous transluminal coronary angioplasty [PTCA] in 31 patients. Angiographic controls were performed 24 hours and 6 months after PTCA. Twelve patients had MI before PTCA [total ischemic period: 743 minutes]. Despite the primary angiographic success [average stenosis defect [n=2]. The evolution of the residual angiographic stenosis after PTCA at 24 hours in the entire group was 25 +/- 17% vs 34 +/- 25% [P <0.005]. it was the same in group 1 [without restenosis at six months], 25 +/- 14% versus 33 +/- 22% as in group 2 [restenosis at 6 months], 25 +/- 22% versus 37 +/- 30% NS. In group 1 the degradation of the result at 24 hours was reversible at 6 months [33 +/- 22% ischemia observed in 20% of cases was frequently silent and not related to restenosis at 6 months which raises the possibility of a reversible micro-thrombotic origin. These results justify anti-aggregant and anticoagulant therapy in the 48 hours period after PTCA

Quantitative assessment of mitral regurgitation by doppler echocardiography: value of multifactorial approach

This study was undertaken to assess the value of Doppler echocardiographic parameters taken singly and in association for the quantification of mitral regurgitation. Fifty-eight patient, with angiographically mild [Group I,n=21], moderate [Group II, n=9] or severe [Group III, n=28] mitral regurgitation, underwent Doppler echocardiographic examination. The following parameters were chosen for the study; maximum color Doppler regurgitant jet area, ratio of maximum regurgitant jet area to left t atrial area, width of the reguritantjet at its origin, maximum regurgitant jet length, peak early velocity of mitral inflow, and intensity of regurgitant signal on continuous wave Doppler [CW] graded 1 to 3. univariate statistical analysis showed that maximum regurgitation jet area >8.1 cm° predicted the presence of severe regurgitation with a sensitivity of 50% and a specificity of 100. peak early velocities of mitral inflow over 1.7 m/s identified Group III patients with sensitivity of 54% and a specificity of 100%.finally, Grade 3 CW signal intensity predicted severe regurgitation with a sensitivity of 86%and a specificity of 97%. A score was elaborated from multivariate analysis based on maximum regurgitant jet area and continuous wave signal intensity. All patients with scores over 3.5 [n=14] had severe regurgitation and patients with a score of0 or less [n=23] had mild to moderate mitral regurgitation. Left ventriculography was required to differentiate patients with intermediate scores [n=21]. Non-invasive Doppler echocardiographic quantification of mitral regurgitation remains difficult even when a multifactorial approach is used. However, severe regurgitation can be reliably diagnosed or excluded in more than 60% of cases by this method

How reliable is digital ambulatory electrocardiography in the detection of ventricular arrhythmias?

The sensitivity of the monitor one star tm Q med solid memory Holter recorder for the detection of ventricular arrhythmias was assessed by simultaneous endocavitary electrophysiological studies including atrial and ventricular stimulation in 11 patients. The min +/- and maximum heart rates were underestimated by the Holter device [43 +/- 10 /mn vs 58 +/- 10 / mn and 154 +/- 21 / mn vs 165 +/- 20 / mn respectively]. The sensitivity of detection of ventricular extrasystoles was only 19% [163 out of 824 ventricular extrasystoles occurring during endocavitary electrophysiological investigations]. The sensitivity of detection of ventricular tachycardia was 31% [32 out of 101 ventricular tachycardia occurring during endocavitary electrophysiological investigations]. These results indicate that this particular solid memory Holter recorder is unsuitable for the study of ventricular arrhythmias. Frequency modulated and amplitude modulated Holter recorders are reliable instruments for diagnosing cardiac arrhythmias and ST segment changes. The usual procedure is visual analysis of the analogical signal recorded on magnetic tape cassettes but this is time-consuming and requires conscientious and well trained personnel. Digitization and stocking the ECG with real-time analysis is an alternative to conventional Holter monitoring and systems using currently available microprocessors that have recently come on the market. The new method dose not have the technical and temporal problems associated with tape recorders and has been shown to provide reliable analysis of ST segment changes [1,2]. The aim of this study was to assess the system's performance in the detection of ventricular arrhythmias arising spontaneously or induced during endocavitary electrophysiological investigation. The digital ambulatory electrocardiography [DAE] used was the monitor One Star tm, Q-med