[Acute heart failure and preserved systolic function: can we explain all only by the diastolic dysfunction? A prospective study on 145 patients hospitalized for acute pulmonary edema]. / Insuffisance cardiaque aiguë et fonction systolique préservée: peut-on tout expliquer par la seule dysfonction diastolique? Etude prospective sur 145 patients hospitalisés pour OAP.

INTRODUCTION: Heart failure with conserved systolic function is frequent and attributed to the diastolic dysfunction. The diagnosis of diastolic heart failure requires the association of clinical signs of heart failure, a conserved left ventricular systolic function and a diastolic dysfunction. OBJECTIVE: To determine the proportion of cases of isolated diastolic heart failure among patients hospitalized for acute pulmonary edema. METHODS: The left ventricular ejection fraction (LVEF), the diastolic function and levels of NT-proBNP have been assessed at admission of 145 patients hospitalized for acute pulmonary edema. RESULTS: 49% of patients included were older than 80 years (mean age 78.6 + 0.9 years). Among the 83 patients with conserved LVEF, 25% had an ischemic heart disease, 24% a severe valvular disease, 22% an atrial fibrillation, 5% a severe bradycardia, 2% a severe hypertrophic obstructive cardiomyopathy. Only 15 patients presented an isolated diastolic heart failure. The level of NT-proBNP was correlated to LVEF but was not able to identify those with isolated diastolic heart failure in the group with "conserved systolic function". CONCLUSION: Among patients hospitalized for acute pulmonary edema, the prevalence of heart failure with conserved systolic function is high, but only 10% of them presented an isolated diastolic heart failure. The NT-proBNP levels do not permit to identify them.

Possible association of thrombotic, nonbacterial vegetations of the mitral ring-mitral annular calcium and stroke.

Although numerous studies have shown an increased risk of stroke associated with mitral annular calcification, a direct link has rarely been demonstrated. We report the occurrence of long, pedunculated thrombi attached to the calcified mitral annulus in 3 patients who suffered from stroke, with resolution after anticoagulant and antithrombotic therapy.

[Study of myocardial viability after myocardial infarction. Value and limits of magnetic resonance imaging compared with myocardial scintigraphy]. / Etude de la viabilité myocardique après infarctus du myocarde. Intérêt et limites de l'imageriepar rsonaanace magnétique comparée àla scintigraphie myoardiaque.

The aim of this study was to compare myocardial thickness measured by magnetic resonance imaging and quantified fixation of thallium. Twenty-one patients 61.2 +/- 11 years were investigated after myocardial infarction of the anterior wall in 8 cases, inferior in 10 cases, lateral in 2 cases and apical in one case. The mean angiographic ejection fraction was 46.5 +/- 19%. Myocardial scintigraphy was performed after an exercise or pharmacological stress test and followed by a study of redistribution. The data was analysed by a quantitative method. Magnetic resonance imaging was performed with vertical and horizontal long axis views in systole and diastole with division of the left ventricle into the same 12 regions. Three groups were defined according to fixation during redistribution. Group I: regions with fixation > 80% (n = 155); group II: 60 to 80% (n = 78); group III: fixation < 60% (n = 19). All measurement of myocardial thickness were correlated (p < 0.01) with the fixation of thallium during redistribution. Systolic thickening, was significantly greater in group I (3.80 +/- 3.1 mm) than in groups II (2.20 +/- 3.8 mm) and III (1.56 +/- 2.4 mm) in which it was comparable. Regions in group III had systolic (8.61 +/- 3.53) and diastolic (6.89 +/- 3.3 mm) thicknesses significantly inferior to those in groups I (13.79 +/- 4.4 mm: 9.95 +/- 2.8 mm) and II (11.59 +/- 5.5 mm: 9.38 +/- 2.9 mm). Ninety per cent of regions with a systolic thickness of over 10 mm had fixation during redistribution of more than 60%. This study shows that myocardial thickness is correlated to scintigraphic data. The systolic thickness over 10 mm would confirm the viability of a given region.