[Clinical value of cardiac resynchronization therapy in patients with congestive heart failure]. / Resynchronisation ventriculaire dans la décompensation cardiaque réfractaire.

Besides major progress in the pharmacologic treatment of severe chronic heart failure, cardiac resynchronization therapy (CRT) has developped over the last ten years. We report the follow-up of the 36 first patients with a CRT device implanted from July 2000 to November 2002 at the CHR de la Citadelle Hospital in Liege. After a mean follow up of 6 months, no death was observed. The functional benefit of resynchronization is validated by a significant improvement in the NYHA class, an increase in the walking distance measured by the six minute walk test from 268 +/- 103 to 342 +/- 106 meters (p < 0.004) and by a not significant rise in the VO2 max (from 11.1 +/- 2.8 to 14 +/- 10 ml/kg/min; P=0.1). The quality of life, assessed by the Minnesota-Living-In-CHF score, improves from 49 +/- 20 to 35 +/- 22 after the six month follow-up (P=0.02) The echocardiogram also shows a better left ventricular ejection fraction at six months, from 24 +/- 7% to 31 +/- 7% (P<0.05). Based on a better NYHA functional class, responders (n=24; 71%) and non responders (n=10; 29%) were compared; a correlation between the functional class change and the improvement of the ejection fraction was documented, but not with the reduction in QRS width. Our registry, with the potential pitfalls of a monocentric prospective study, confirms the feasability, safety and efficacy of CRT in severe chrbnic heart failure uncompletely corrected pharmocalogically. It remains however approximately 30% of non responding patients, in whom the current clinical studies should help identify the right criteria to predict and discriminate responders.

[Paroxysmal tachyarrhythmias in pediatrics]. / Les troubles du rythme paroxystiques de l'enfant.

The purpose of this retrospective study was to investigate the clinical characteristics in pediatric patients with supraventricular or ventricular tachycardia. Sixty-nine pediatric patients were included. Age distribution at first episode of tachyarrythmia, most indicative symptoms and signs, associated conditions and long-term prognosis were determined for the different mechanisms of tachyarrythmia. 78% of the children had supraventricular tachycardia and 22% ventricular tachycardia. At diagnosis, 57% of the children with supraventricular tachycardia were younger than 1 year. The majority of infants were detected during routine investigation without having any complaints whereas the majority of children presented with symptoms. Recurrence was rare in cases diagnosed during infancy, but was usual in cases diagnosed beyond infancy.

[Clinical case of the month. Biventricular stimulation, a new adjuvant therapy in the treatment of congestive heart failure]. / Le cas clinique du mois. La stimulation biventriculaire, nouvelle thérapeutique adjuvante dans le traitement de l'insuffisance cardiaque réfractaire.

The pharmacological treatment of congestive heart failure has improved its morbidity and mortality. Nevertheless, many patients remain disabled in spite of optimal treatment. The availability of alternative therapies such as heart transplantation or cardiomyoplasty is limited. Newer devices are awaited. Biventricular pacing is a potential option to improve the homogeneity of contraction and the overall mechanical performance without myocardial oxygen consumption increase. This approach has proved acute hemodynamic and functional benefits but has to demonstrate a favourable influence on long term morbidity and mortality.

Dose-finding clinical assay of triletide in gastric and duodenal ulceration.

Three groups of 15 patients with endoscopically confirmed active gastric or duodenal ulcer were treated over a period of 8 weeks with daily doses of 1, 1.5 or 2 g triletide, an anti-ulcer agent which acts by enhancing the mucosal defence capacity. Intensity of epigastric pain and of heartburn and weekly consumption of standard antacid tablets, as well as possible accessory symptoms, were recorded every other week, endoscopy was repeated at the end of treatment and routine haematology and haematochemistry performed before and after treatment. The proportion of patients found to be endoscopically healed was significantly correlated to the log of the dose used, giving an ED50, under the test conditions, of 1.2 g/day (86.7% healed at 2 g/day). The improvement in each assessed symptom was significantly correlated with time according to an exponential regression. The computed exponent indicated that each higher dose resulted in a significantly faster regression of symptoms than each lower dose (mean time to decrease symptoms by 50%; 4.3 weeks at 2 g/day; 7.4 weeks at 1.5 g/day; and 20.8 weeks at 1 g/day). Moreover, two-ways analysis of variance indicated a significant dose-time interaction (p less than 0.01); thus, the improvement provided at any given time was more than proportional to the used dose. Tolerance was good at all three dose levels and no variations in haematology and haematochemistry could be detected. It is concluded that triletide, at a dose of between 1.5 and 2 g/day according to the patient's condition, appears to be an effective and well-tolerated means of promoting healing and controlling symptoms in peptic ulcer patients.

[Hypothalamoneuropituitary activation during vasodilatator perfusion in normal individuals (author's transl)]. / Activation hypothalamoneurohypophysaire lors de la perfusion d'un vasodilatateur chez l'individu normal.

The hypothalamo-neurohypophyseal function has been tested in 9 normal individuals (age 22 - 50; 2 women and 7 men) in the course of a vasodilatator perfusion (sodium nitroprussiate) in standardized conditions. Vasopressin-neurophysin (hNPI), oxytocin-neurophysin (hNPII) and total immunoreactive neurophysins (IRN) have been assayed. Our preliminary results show a clear-cut increase of hNPI and IRN when the decrease of the mean blood-pressure exceeds 20 +/- 10% (15 - 33). There is only a weak, if any, increase of hNPII. There is a highly significant relationship (r : 0.90, p less than 0.01) between maximal increment of IRN and maximal increment of heart frequency suggesting a similar way of activation. Vasodilatator perfusion could be, in the future, a reliable test for hypothalamo-neuropituitary function although it's reproducibility has still to be deeper investigated.