Prevalence of left ventricular systolic dysfunction in Duchenne muscular dystrophy: an echocardiographic study.

The prevalence and hemodynamic consequences of regional wall motion abnormalities (RWMA) were evaluated in 84 advanced-stage Duchenne muscular dystrophy (DMD) patients who underwent echocardiographic and systolic time interval (STI) examination. A satisfactory echocardiogram was obtained in 72 patients who were divided into two groups: group I (33 patients) had normal wall motion or minor changes, and group II (39 patients) had akinetic and/or dyskinetic areas. In group II, 15 patients had ventricular dilation; 8 of the 15 had a history of cardiac failure and 4 died during the study. Wall motion index (WMI), end-diastolic volume (EDV), and STI values increased significantly from group I to group II. In the whole group, a strong correlation was found between WMI and STI ratios. This study demonstrates a high prevalence of RWMA and supports the viewpoint that RWMA, consequences of the myopathic process, result in progressive left ventricular dilation, heart failure, and cardiac death.

Ventricular arrhythmia in Duchenne muscular dystrophy: prevalence, significance and prognosis.

The prevalence and prognostic value of ventricular arrhythmias were examined in 45 Duchenne muscular dystrophy patients without congestive heart failure and followed up for 3 yr. Baseline evaluation included 24 h ECG monitoring, systolic time intervals measurement (preejection period/left ventricular ejection time PEP/LVET), echocardiogram and vital capacity tests. Fifteen patients (33%) had ventricular premature beats (VPB > or = 2 h-1). More complex ventricular ectopy (Lown grades 3, 4A, 4B) occurred in 12 patients (27%), who had abnormal ventricular contractility (PEP/LVET > 0.48) and an area of akinesia or dyskinesia. Complex VPB were present on presentation in only 3 of the 30 survivors (10%) but were detected in 6 of the 15 patients (40%) who died. Patients who died suddenly were more likely to have had documented complex ventricular arrhythmias (6 of 9; 66%). It is concluded that: (1) significant arrhythmias frequently coexist with asymptomatic left ventricular dysfunction and wall motion abnormalities; (2) complex VPB as well as left ventricular dysfunction and dilated cardiomyopathy are risk factors for sudden death.

Maintenance of blood pressure control in elderly hypertensives on ketoprofen.

In elderly patients, nonsteroidal anti-inflammatory drugs (NSAIDs) are often used concomitantly with antihypertensive agents. It is therefore important to assess the potential for interactions between NSAIDs and these agents. In a double-blind, placebo-controlled study, 40 elderly hypertensive patients treated with acebutolol or atenolol, together with frusemide, were randomized to receive either ketoprofen, 200 mg/day (50 mg q.i.d.), or matching placebo for 7 days. Arterial blood pressure and heart rate were monitored for a 24-hour period at baseline and at the end of treatment. Standard sphygmomanometric measurements of blood pressure and heart rate were conducted twice a day during the study. No clinically significant side effects or blood pressure or heart rate alterations were observed during the trial. The results indicate that ketoprofen does not interfere with blood pressure control in elderly hypertensive patients being treated with a combination of beta-blockers and diuretics.

["Blue phlebitis" by thrombosis of the inferior vena cava on top of dysplastic stenosis]. / "Phlébite bleue" par thrombose de la veine cave inférieure sur sténose dysplasique.

A case of dysplastic stenosis of the infra-renal segment of inferior vena cava, with acute thrombosis and ischaemia of the left lower limb, is reported. Emergency thrombectomy, with pre- and post-surgery anticoagulant therapy, resulted in perfect recovery. As a comment on this case, various types of vena cava dysplasia, and possible causes of vena cava thrombosis, are briefly reviewed.