[ST elevation myocardial infarction in young adults: Is there an interest for thrombophilia screening?] / Syndrome coronarien aigu avec sus-décalage du segment ST chez les jeunes adultes : le bilan de thrombophilie a-t-il un intérêt ?

BACKGROUND: Coronary lesions characteristics as well as patient thrombogenicity can explain coronary events manifestation. In young patient, local conditions are usually less important and thrombogenicity could play a significant role. Assessing thrombophilia could be justified in young patients and may induce an adapted therapeutic management. PURPOSE: We aimed to assess the prevalence of thrombophilia and therapeutic modification in young adults aged≤55 years admitted in our department for ST elevation myocardial infarction (STEMI). METHODS: From January 2013 to January 2017, data on all patients aged≤55 years with STEMI admitted in emergency were retrospectively retrieved from our database. Thrombophilia investigation was made regarding clinical (with or without cardiovascular risk factors [CVRF]), biological and/or angiographic evaluation. RESULTS: A total of 133 patients aged≤55 years with STEMI were included. Cardiac arrest occurred in 15 patients (11%). One or less CVRF were found in 47 patients (35%). Smoking was reported in 93 patients (70%) and drug addiction (cannabis, cocaine) in 19 patients (14%). A subset of 51 patients (38%) were screened for thrombophilia. Patients with thrombophilia assessment were younger, less active smokers and presented less CVRF than patients without investigation (P<0.001). Single vessel diseased was found in 88 patients (66%). No differences regarding coronary procedural characteristic were found between the two groups. The most frequently encountered aetiology, found in 122 patients (92%), was de novo intra-arterial thrombosis related to atherosclerosis. In patients with thrombophilia assessment (n=51), one or more abnormal biological results was found in 22 patients (43%) and a therapeutic adjustment was made in 6 patients (12%). CONCLUSION: Thrombophilia screening in young STEMI adults showed an abnormality in 43% of cases. Antithrombotic treatment can be modified after its demonstration.

[Clinical characteristics and follow-up of patients with magnetic resonance imaging confirmed myopericarditis: A retrospective study]. / Caractéristiques et suivi clinique d'une cohorte de patients atteints de myopéricardite confirmée en imagerie par résonance magnétique.

INTRODUCTION: Pericarditis are frequently associated with some degree of concomitant myocardial involvement. Predominant pericarditis with limited myocardial involvement are named myopericarditis. Data regarding myopericarditis are scarce. PATIENTS AND METHODS: Retrospective chart review of all patients admitted between 2002 and 2011 with magnetic resonance imaging confirmed myopericarditis. RESULTS: Twenty-seven patients were included. Eighty-one percent were men, with median age of 32 years. Infectious disease preceded hospitalization in 55% of cases. Mean left ventricle ejection fraction at admission was 55% with focal myocardial impairment mainly localized in lateral and inferior walls. Coronary angiogram was performed in 37% of cases to rule out an ischaemic aetiology. We identified 5 cases (19%) of myopericarditis preceded by an episode of streptococcus group A throat infection. Non-sustained ventricular tachycardia was observed in 15% of cases. After a 2-year follow-up period, mortality rate was zero and recurrence rate was 15%. CONCLUSIONS: In our series, myopericarditis was a benign disease affecting mostly young men, and prognosis was good. A significant proportion of cases was preceded by group A streptococcus infection.

[Fractional flow reserve and instantaneous wave-free ratio for the physiological assessment of coronary artery stenosis in the catheterization laboratory: Practical tips]. / Fractional flow reserve (FFR) et instantaneous wave-free ratio (iFR), l'évaluation physiologique d'une sténose coronarienne dans le laboratoire de catéthérisme cardiaque : mise au point et guide pratique.

In recent years, a large body of evidence has revealed the limitations of angiographic evaluation in determining the physiological significance of coronary stenosis, particularly when these are intermediate lesions. Percutaneous coronary interventions (PCI) guided by physiological assessment using fractional flow reserve (FFR) have been shown to reduce cardiovascular events when compared to angiography alone. Recently, another coronary physiologic parameter has been introduced: the "instantaneous wave-free ratio" (iFR). In this review, we will discuss the FFR, the iFR, and their use in the functional assessment of coronary stenosis in the cardiac catheterization laboratory. This review will cover theoretical aspects for non-interventional cardiologists, as well as practice points and common pitfalls related to coronary physiological assessment for interventional cardiologists.

[Contrast-induced nephropathy: An update]. / Néphropathie induite par les produits de contraste : une mise à jour.

Contrast-induced nephropathy (CIN) is common in hospitalized patients. Its occurrence is associated with an increased hospitalization stay and cost, morbidity and mortality. Thus, preventives strategies remain a major issue. Patients that are referred for cardiac catheterization are among the most vulnerable to develop CIN due to their comorbidities. Moreover, in some cases, such preventives measures cannot be introduced due to emergent clinical settings. After a summary regarding the properties of iodinated contrast medium, the aim of this work was to review the definition, pathophysiology, diagnosis and preventive strategies related to CIN.

[Cardiac impairment after hanging attempt: a preliminary descriptive study]. / Anomalies cardiaques après tentative de pendaison : étude descriptive préliminaire.

PURPOSE OF THE STUDY: Cardiomyopathy has sometimes been reported after suicide attempts by hanging. The objective of this retrospective observational study was to describe cardiac dysfunction occurring after hanging and its consequences on prognosis. PATIENTS AND METHODS: Fifteen patients admitted to the intensive care unit for hanging from 1997 to 2011 were included and divided into two groups according to presence or absence of cardiac arrest at initial presentation. Cardiac dysfunction was defined by the presence of clinical, biological, electrocardiographic or echocardiographic abnormalities. RESULTS: Cardiac impairment was diagnosed in nine patients over 15 (60%). Of the six patients with initial cardiac arrest, only one survived without severe neurological sequellae. Among the nine patients without cardiac arrest, eight survived and five patients (56%) had cardiac impairment, including two cases of echocardiographic aspect of Takotsubo complicated by pulmonary edema. Mortality in intensive care was significantly related to the severity of the initial neurological state assessed by the Glasgow Coma Score (OR=1.7; P=0.02), and the occurrence of cardiac arrest (OR=40; P=0.016). The presence of cardiac involvement, reversible after the acute phase in all surviving patients was not associated with increased mortality. CONCLUSION: In the aftermath of hanging, predictors of mortality are the presence of impaired consciousness or initial cardiac arrest, but not the occurrence of cardiac disease.