[Late stent thrombosis in a young patient who had ulcerative colitis]

Arterial and venous thrombosis are well recognized systemic complications of inflammatory bowel disease predominantly in patients with Crohn's colitis and in those with ulcerative colitis [UC]. report a new case We describe the case of a 35 years old man presenting previously an anterior infarct with a tighten stenosis in the middle part of the left anterior descending artery [LAD]. The stenosis was treated percutaneously with a bare stent deployment. During an acute exacerbation of UC, the patient developed an acute coronary syndrome with ST elevation secondary to a late stent thrombosis, needing a primary coronary angioplasty. Following course is favorable. Based on this case, we'll discuss the relationship between UC and thrombosis, and therapeutic considerations inherent to thrombotic and bleeding risks

[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

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

[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