[Gamma-angiography in the diagnosis of akinesia and dyskinesia after myocardial infarction]. / Apport de la gamma-angiographie au diagnostic des akinésies et des dyskinésies après infarctus du myocarde.

A one year prospective double blind trial included all patients with myocardial infarction and clinical, electrocardiographic or radiographic signs of left ventricular aneurysm. All 36 patients underwent ventriculography and radionuclide angiocardiography in the same projections: right anterior oblique, antero-posterior, left anterior oblique and left lateral. The angiographic diagnosis of left ventricular aneurysm was based on the finding of a deformation of the ventricular contour persisting in diastole; 22 patients were classified as having a left ventricular aneurysm and the 14 others had akinesia alone. The radionuclide diagnosis of left ventricular dyskinesia was based on the finding of the following 3 criteria in at least one projection: crossing of the systolic and diastolic isocontours; over 4 p. 100 of LV pixels having a negative ejection fraction; the dephased infarcted region having a movement separate from that of the remaining healthy myocardium. None of the clinical criteria of inclusion allowed diagnosis of LV aneurysm when compared with the results of ventriculography. The results of radionuclide and conventional ventriculography correlated 100 p. 100 in the diagnosis of severe contractile abnormalities. When compared with ventriculography, radionuclide angiocardiography had a specificity of 95 p. 100 and a sensitivity of 86 p. 100 for the diagnosis of aneurysm. The only false negative was a non-surgical septal aneurysm. The multiplication of the incidences of examination increases the sensitivity of the results of radionuclide angiography.

[Treatment of hypertrophic cardiomyopathy]. / Traitement de la myocardiopathie hypertrophique.

The treatment of hypertrophic cardiomyopathy is first and foremost symptomatic, its aim being to counteract dyspnea, angina pectoris, syncopes and lipothymias, palpitations. In therapy, use is made of beta-blockers, propranolol in particular at moderate or high doses, which are often efficacious but readily cause muscular asthenia. Calcium antagonists, especially verapamil, are a therapeutic alternative, often more efficacious but exposing the patient to the risks of iatrogenic effects which are sometimes serious and may even be fatal. Surgical myomectomy is another alternative, the functional results of which are remarkable, more often than not, but the mortality at surgery, although declining progressively, is not negligible and leads to this approach being used only in cases not responding to medical treatment as when infra-aortic septal hypertrophy is accompanied by an "obstruction". The second type of therapeutic approach is the treatment and prevention of rhythmic disorders which are an integral part of the risk of sudden death. Reduction of auricular fibrillation must play a role in the prevention of thrombo-embolic disease. Ventricular arrhythmias, especially sustained attacks of ventricular tachycardia systematically detected by ambulant ECG, ought to be prevented by anti-arrhythmics: beta-blockers, in combination or not with anti-arrhythmics of class I, amiodarone, propafenone, etc.