[Cardiac amyloidosis†: a rare disease†?] / Amyloïdose cardiaque: une maladie rare†?

Cardiac amyloidosis is an infiltrative cardiomyopathy, typically conducting to heart failure with preserved ejection fraction. There are several causes for the disease, from which two can already be seen in the young patient and are due to either genetic mutation or neoplasia. A third, non genetic cause, typically affects older patients (previously called senile amyloidosis) and appears to be much more prevalent than initially reported. A careful initial work-up and a high index of suspicion are important to detect as early as possible the disease, as it is associated with a poor prognosis in the late stage. A standardized diagnostic approach has been proposed with the use of bone scintigraphy, recently recognized as a sensitive diagnostic tool for this type of amyloidosis. With new disease modifying therapies recently becoming available, a more active diagnostic strategy is justified.

L'amyloïdose cardiaque est une cardiomyopathie infiltrative qui mène typiquement à une insuffisance cardiaque à fraction d'éjection préservée. Il existe différentes causes à cette maladie, avec des formes génétiques ou néoplasiques qui peuvent toucher le sujet jeune. Une troisième forme d'amyloïdose cardiaque, non génétique, touche essentiellement le sujet âgé (anciennement appelée amyloïdose sénile) et s'avère nettement plus prévalente qu'initialement suspectée. Un bilan initial systématique par imagerie et un haut index de suspicion sont indispensables pour détecter le plus précocement possible cette maladie au pronostic réservé. L'apport récent de la scintigraphie au DPD (dicarboxypropane disphosphonate) a été essentiel à cet égard. L'arrivée sur le marché de nouveaux médicaments pouvant ralentir la progression de la maladie justifie la mise en place d'une stratégie diagnostique plus active.

Prehospital emergency physician activation of interventional cardiology team reduces door-to-balloon time in ST-elevation myocardial infarction.

QUESTION UNDER STUDY: To explore whether early activation of an interventional cardiology team, by prehospital emergency physicians, reduces door-to-balloon time (DTBT) in patients with ST-elevation myocardial infarction (STEMI) diagnosed with prehospital ECG. DESIGN: before-after comparison. SETTING: emergency department (ED) of an urban teaching hospital with a catheterisation laboratory open continuously. STUDY SUBJECTS: patients with STEMI diagnosed in the prehospital setting or in the ED within 12 hours of symptoms. INTERVENTION: a paging system or "STEMI alarm", activated by prehospital physicians, which simultaneously notified both the catherisation laboratory and cardiology teams before the patient's arrival to the ED. OUTCOME MEASURES: DTBT and the proportion of patients with DTBT <90 minutes. RESULTS: A total of 196 patients were included; 77 before and 119 after implementation of the "STEMI alarm". Between the two periods, median DTBT decreased from 109 to 76 minutes (p <0.001) and the proportion of patients treated within 90 minutes increased from 36% to 66% (p <0.001). During intervention, the STEMI alarm was activated in 67 patients (56%). In these cases the median DTBT was 50 minutes, with 96% within 90 minutes. The alarm was inappropriately activated in 9 cases (11%). CONCLUSIONS: Catheterisation laboratory activation by a prehospital emergency physician markedly reduces DTBT in STEMI patients.