[Optimization of systolic heart failure treatment by general practitioners after hospital discharge: Are guidelines applied?] / Optimisation du traitement de l'insuffisance cardiaque chronique par les médecins généralistes en sortie d'hospitalisation : les recommandations sont-elles appliquées ?

Heart failure is a common and serious disease, with constantly increasing incidence. General practitioners have an essential role in its management. AIM OF THE STUDY: Describe general practitioner's practice in optimizing heart failure treatment after hospital discharge. PATIENTS AND METHOD: All patients admitted for heart failure with altered ejection fraction in Nanterre's hospital cardiology department between February 2014 and January 2015 and having a general practitioner were included. Demographic, clinical, biological, ultrasound data and treatments were collected. A questionnaire was submitted to general practitioners two months after discharge. RESULTS: A total of 82 patients (age 76±12years, left ventricular ejection fraction 36±8%) were included. The target dose of angiotensin-converting-enzyme inhibitors and beta-blockers was reached for 18% of patients during hospitalization. Forty-two general practitioners answered the questionnaire, which concerned 60% of patients (n=49). None of them modified angiotensin-converting-enzyme inhibitors nor beta-blockers. The reasons were the lack of patient consultation (43%), the good tolerance (43%), the absence of habit (24%), and the attribution of this role to the cardiologist (41%). Possible improvements are: more precise hospitalization reports, alternating consultations and educational sessions. CONCLUSION: Patients with heart failure are under-treated at discharge and general practitioners do not optimize the treatment after hospital discharge. The main axis of improvement is to establish a better defined care pathway.

[Reversible left intraventricular obstruction after treatment of pheochromocytoma and hyperthyroidism]. / Obstruction intraventriculaire gauche réversible après traitement d'un phéochromocytome et d'une hyperthyroïdie.

The authors report an original case of the association of three pathologies: pheochromocytoma, hyperthyroidism and cardiomyopathy with left ventricular outflow tract obstruction. This type of cardiac disease has occasionally been described in cases of pheochromocytoma and are usually induced by the endocrine disturbance because they regress with treatment of the pheochromocytoma. The associated hyperthyroidism observed in this case is very rare and may have increased the left ventricular pressure gradient. Medical treatment before surgery of the pheochromocytoma was unusual in that a triple therapy was used including betablockers, classically contra-indicated in pheochromocytoma alone. In this case, it provided excellent control of the blood pressure and decreased the left ventricular obstruction during the perioperative period.

Trophic effect of human pericardial fluid on adult cardiac myocytes. Differential role of fibroblast growth factor-2 and factors related to ventricular hypertrophy.

Pericardial fluid (PF) may contain myocardial growth factors that exert paracrine actions on cardiac myocytes. The aims of this study were (1) to investigate the effects of human PF and serum, collected from patients undergoing cardiac surgery, on the growth of cultured adult rat cardiac myocytes and (2) to relate the growth activity of both fluids to the adaptive changes in overloaded human hearts. Both PF and serum increased the rate of protein synthesis, measured by [14C]phenylalanine incorporation in adult rat cardiomyocytes (PF, +71.9 +/- 8.2% [n = 17]; serum, +14.9 +/- 6.5% [n = 13]; both P < .01 versus control medium). The effects of both PF and serum on cardiomyocyte growth correlated positively with the respective left ventricular (LV) mass. However, the magnitude of change with PF was 3-fold greater than with serum (P < .01). These trophic effects of PF were mimicked by exogenous basic fibroblast growth factor (FGF2) and inhibited by anti-FGF2 antibodies and transforming growth factor-beta (TGF-beta), suggesting a relationship to FGF2. In addition, FGF2 concentration in PF was 20 times greater than in serum. On the other hand, the LV mass-dependent trophic effect, present in both fluids, was independent of FGF2 concentration or other factors, such as angiotensin II, atrial natriuretic factor, and TGF-beta. These data suggest that FGF2 in human PF is a major determining factor in normal myocyte growth, whereas unidentified LV mass-dependent factor(s), present in both PF and serum, participates in the development of ventricular hypertrophy.