Operating characteristics of the Finapress system to predict elevated left ventricular filling pressure.

BACKGROUND: Dyspnea is a common symptom and can be caused by many different conditions. The detection of congestive heart failure (CHF) is sometimes difficult. HYPOTHESIS: The pulse amplitude ratio (PAR) measured by the Finapress procedure during a Valsalva maneuver can detect elevated left ventricular end-diastolic pressure (LVEDP) accurately over a wide range of values. METHODS: Comparison of the estimated LVEDP by PAR with the invasively measured LVEDP before and after ventriculography during coronography was made in 101 consecutive stable patients referred for chest pain and/or chronic dyspnea. RESULTS: A significant correlation was found between the catheter-measured LVEDP (range 3-40 mmHg) and the PAR (R2 = 0.70, p < 0.001). The receiver operator characteristics (ROC) of the PAR to detect an LVEDP > 15 mmHg can be considered to be excellent, with an area under the ROC curve achieving 0.92 (95% confidence interval [CI] 0.87-0.96; p < 0.001). A PAR of > 0.675 predicted the presence of an LVEDP > 15 mmHg with a sensitivity of 0.865 (95% CI 0.780-0.926) and a specificity of 0.847 (95% CI 0.730-0.928). The positive and negative LRs were 5.70 and 0.16, respectively. CONCLUSIONS: The observed likelihood ratios confirm that the PAR determined by the Finapress procedure may be a useful bedside diagnostic tool in patients with cardiac conditions.

[Reliability of scintigraphic methods in the diagnosis of coronary insufficiency]. / Fiabilité des méthodes scintigraphiques dans le diagnostic de l'insuffisance coronaire.

Some conceptual problems arise when applying the probability analysis to the scintigraphic diagnosis of coronary artery disease. Analysis with Bayes' rule considers disease to be present or absent, radionuclide test response to be positive or negative, sensitivity and specificity to be the same in all patients. In fact, disease can be graded in severity; test results can be analysed as continuous variables; sensitivity and specificity of our diagnostic procedures are not constants but depend of the population features. Moreover, the accuracy of the radionuclide tests refers to the coronary arteriogram, which is not the appropriate standard of coronary artery disease.

Prolonged catheterization. A rare cause of pulmonary atheroma.

At post-mortem examination of a 75-year-old man, a fragment of polyethylene catheter placed several years previously was discovered in the right pulmonary artery. It was embedded in a vessel wall and caused an atheromatous plaque, a rare complication in human pathology.

High-output right ventricular failure secondary to hepatic arteriovenous microfistulae. Selective arterial embolization treatment.

A patient with diffuse hepatic arteriovenous microfistulae suffered from secondary high-output right ventricular failure, pulmonary hypertension, and ascites, all of which could be managed by selective embolization of the hepatic artery. The vascular lesion of the liver seems to be essential, although hemorrhagic hereditary telangiectasia , perhaps aggravated by administration of oral contraceptives, may be considered contributory factors in this case.

[Treatment of acute left cardiac insufficiency: a labyrinth without the thread of Ariane?]. / Traitement de l'insuffisance cardiaque aiguë d'origine gauche: un labyrinthe sans fil d'Ariane?

The final picture of left ventricular failure depends at least as much upon its four mechanisms of compensation (increase in preload, in afterload, in heart rate and, as an attempt, in myocardial contractility) as upon its primary factor (decrease in contractility). The complexity of all possible combinations between those various factors has good chances to bring about confusion in therapeutics if one doesn't dispose of a method, a kind of Ariane's thread, making it possible (1) to define some wide orientations to start with, and thereafter (2) to state precisely the way out of that labyrinth. This method must be founded on an accurate physiological basis and therefore requires cardiac catheterization. In all cases the purpose is to get an adequate cardiac output with comfort to the patient and at a low cost to his myocardium. Further adjustment of that treatment essentially founded on hemodynamics, must however take into account its uncertain physiological results in various organs, estimated from clinical and biological information.

[Two-dimensional echocardiography. Principles, techniques, and anatomical comparisons]. / L'échocardiographie bidimensionnelle. Principles, technique et comparaisons anatomiques.

This article introduces bidimensional echocardiography. The main sections are reviewed. A brief comparison between M-mode and 2 D echocardiography is proposed showing that the two techniques are really complementary to one another. Judging by the many applications of M-mode echocardiography in recent years, one may safely expect considerable developments for the bidimensional echocardiography which, in its very first steps, already appears irreplaceable.