The increased histamine release in ischaemic heart disease patients undergoing coronaroangiography is not mediated by specific IgE.

BACKGROUND: The release of histamine by iodinated contrast media (ICM) is higher in coronary artery disease patients than in noncoronary patients during coronary angiogram. METHODS: Eighty-eight patients who underwent a coronary angiography were classified either as having coronary artery disease or as noncoronary patients. Histamine concentration was higher than the 6.8 nM upper limit in 7 cases (group 1), of whom six were coronary artery disease patients. We compared the IgE and complement fractions in plasma of these patients to two control groups with normal histamine blood level, one (group 2) with and the other (group 3) without coronary artery disease. RESULTS: No difference of total IgE and C(3c) and C(4) complement fractions was found among the three groups. Anti-ioxaglate IgE-RIA was positive in only one patient from group 1. The affinity of drug-IgE binding in the serum of this patient was very low (Kd: 18.7 mM). The level of anti-ICM IgE detected by ioxitalamate- and iomeprol-Sepharose RIA was significantly higher in groups 2 and 3 than in group 1. CONCLUSIONS: The higher histamine release in ischaemic heart disease patients undergoing coronaroangiography is not mediated by IgE or complement activation. Further studies are needed to investigate the implication of histamine release factors.

[Coronary stents in patients with severe left ventricular dysfunction. Hospital and long-term results]. / Endoprothèses coronaires chez les patients à dysfonction ventriculaire gauche sévère. Résultats hospitaliers et à long-terme.

The aim of this study was to evaluate the risks and benefits, immediate and at long term, of coronary angioplasty associated with stent implantation in patients with severe left ventricular dysfunction. It was a retrospective study in which all patients with left ventricular ejection fractions 35% who underwent angioplasty between December 1994 and January 1998 were included. Seventy eight patients with an average ejection fraction of 29 +/- 6% who were haemodynamically stable were retained, excluding acute myocardial infarctions and cases of cardiogenic shock. The population was mainly masculine (6(men and 13 women) with a mean age of 65 +/- 11 years. The primary success rate was 97%. The loss of a collateral branch during the procedure, causing a non-Q wave infarction and the impossibility of implanting the stent at the desired site in another patient, were the only two failures. Hospital mortality was nil. The mean follow-up period was 450 +/- 290 days; long-term mortality was 17%. All deaths were of cardiovascular origin. The probability of survival at 6 months, 1 year and 800 days, was 88, 85 and 75% respectively. The good initial results were not maintained at long-term, but this could not be attributed to restenosis or to the pre-existing left ventricular dysfunction.

[Influence of the severity of coronary stenosis on the course of left ventricular function in case of subsequent coronary occlusion. Longitudinal coronarographic study]. / Influence de la sévérité d'une sténose coronaire sur l'évolution de la fonction ventriculaire gauche en cas d'occlusion coronaire ultérieure. Etude coronarographique longitudinale.

In order to evaluate the consequences concerning left ventricular function of the spontaneous occlusion of coronary stenoses, the authors studied the clinical and angiographic characteristics of 30 consecutive patients (25 men, 5 women, mean age: 54) undergoing successive coronary arteriograms showing progression to complete occlusion of the anterior interventricular or right coronary between the two investigations. Two groups of patients were identified: Group I (n = 19) with occlusion of a previously moderate (< or = 50%) stenosis; Group II (n = 11) with occlusion of an initially tight stenosis (> 50%). At the time of the first angiogram, left ventricular ejection fraction (LVEF) was 60 +/- 13% in Group I and 58 +/- 9% in Group II (NS). Times between the two investigations were similar in the two groups (58 +/- 43 months and 54 +/- 57 months, NS). Between the two coronary arteriograms, 7 patients of Group I sustained an infarction as against 3 in Group II (NS). Impairment of LVEF developed in 16 patients of Group I (84%) as against 5 of Group II (45%) (p < 0.005). Global LVEF varied on average by -10.4 +/- 13.3% (p < 0.005) in Group I and -0.1 +/- 9.5% (NS) in Group II. This difference in variation in LVEF between the two groups was significant (p < 0.04). Spontaneous occlusion of moderate coronary stenoses results in certain cases in greater impairment of left ventricular function than the occlusion of tight stenoses. The development of a collateral circulation probably plays a protective role in the second group.

[Outcome of Doppler parameters of left ventricular systolic function during atrial stimulation as a function of coronary disease]. / Evolution des paramètres Doppler de fonction systolique ventriculaire gauche lors de la stimulation atriale en fonction de l'atteinte coronarienne.

The authors studied the effects of transoesophageal atrial pacing on Doppler parameters derived from flow in the left ventricular out flow tract (maximal velocity (V max), velocity-time integral (VTI), mean acceleration of aortic flow (Acc), acceleration force (AF) of the left ventricle). These parameters were recorded in patients with normal left ventricular wall motion at rest, with and without coronary disease. Eight patients had angiographically normal coronary arteries (Group 1) and 21 had coronary disease (Group 2) including 10 with an isolated stenosis of the left anterior descending artery (Group 2a) and 11 with multivessel disease (Group 2b). The heart rate was increased by increments of 20 beats per minute from 90 to 130 each minute. In coronary patients, atrial pacing resulted in a fall in V max from 0.99 +/- 0.15 to 0.90 +/- 0.12 m/s, p < 0.0005 and in AF from 23.1 +/- 6.3 to 19.6 +/- 4.8 Kdynes, p < 0.0005, whereas the Acc remained stable (13.51 +/- 3.27 and 13.53 +/- 2.47 m/s/s, NS). Conversely, V max (1.04 +/- 0.11 and 1.04 +/- 0.11, NS) and AF (25.2 +/- 5.7 and 26.3 +/- 6.7, NS) were unchanged in normal controls and the Acc improved from 13.87 +/- 3.61 to 17.04 +/- 3.49, (p < 0.05). The VTI fell significantly in both groups. The percentage variations of V max, Acc and AF were significantly different in coronary patients compared with normal controls. There were no differences between the two coronary subgroups.(ABSTRACT TRUNCATED AT 250 WORDS)