Archives des maladies du coeur et des vaisseaux
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Arch Mal Coeur Vaiss · Mar 2007
Comparative Study[Early detection of myocardial disease in young patients with Becker's muscular dystrophy asymptomatic from the cardiac point of view: value of myocardial doppler tissue imaging].
Becker's muscular dystrophy is an X-linked hereditary disorder characterised by progressive muscle weakness and possible cardiac disease. Cardiac involvement is assumed to be rare in young patients. Early diagnosis could lead to earlier treatment at an infra-clinical stage of the disease. ⋯ Nevertheless, patients with Becker's disease had lower systolic and diastolic intra-myocardial velocity gradients: 2.2 +/- 1.1 vs. 4.7 +/- 2.4 s(-1), p = 0.006, and 3.6 +/- 2.0 vs. 5.6 +/- 1.3 s(-1), p = 0.048, respectively, compared with the control group. These results show that myocardial disease is possible in patients with Becker's muscular dystrophy under the age of 20. Myocardial Doppler tissue imaging is a sensitive method for detecting these early abnormalities and should be recommended in the young patients.
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Arch Mal Coeur Vaiss · Mar 2007
[Variations of radiation dosage delivered to patients undergoing interventional cardiological procedures. A monocentric study 2002-05].
X-ray exposure of patient during coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) may have some deleterious effects. The dose area product (DAP), related to the effective dose, is a measure of stochastic risk and a potential quality indicator. The aim of our study was to assess radiation exposure of patients in a large series of "real life" interventional cardiac procedures. ⋯ In conclusion, radiation exposure to patients and staff are strongly dependent on operators, time course, and the arterial access, due in part to the learning curve for radial approach. The enhanced knowledge of radiation dose is the first step of a radiation dose-reduction program, likely to minimize patient and operator radiation hazards in interventional cardiology. Definition of national reference values for DAP and fluoroscopy time would be helpful for appropriate comparisons.
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Arch Mal Coeur Vaiss · Feb 2007
Clinical Trial[Usefulness of B-type natriuretic peptide (BNP) for the diagnosis of new-onset heart failure with a preserved left ventricular systolic function in longstanding hypertensive patients with acute dyspnea].
B-type natriuretic peptide (BNP) has been largely validated in the etiologic diagnosis of acute dyspnea. Nevertheless, its reliability in the setting of a preserved left ventricular systolic function (ejection fraction >50%) has not been adequately established. ⋯ BNP is a reliable biomarker of new-onset heart failure with a preserved systolic function in hypertensive patients, in particular older, hospitalized for acute dyspnea and can be safely integrated in the diagnostic strategy.
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In the field of valvular diseases, the year 2006 has been above all marked by the publication of new joint AHA/ACC guidelines. Besides, other publications included severe aortic stenosis, drug therapy in chronic aortic regurgitation, the indications for surgery in asymptomatic mitral regurgitation, as well as valve surgery in the elderly and mismatch severity after aortic valve replacement. In a series of 66 cases of aortic stenosis with poor LV function undergoing stress echocardiography, it has been shown that whether the absence of contractile reserve identifies a high-risk subgroup for aortic valve replacement (33% vs. 6%), this exam does not predict the functional prognosis and the post-operative LV function improvement. ⋯ According to these guidelines, this association not only reduces the risk of thrombo-embolic events in patients with valvular prosthesis, but also decreases the mortality related to other cardiovascular causes (especially coronary artery disease), with the cost of a minimal risk augmentation for hemorrhagic complications. The importance of pejorative prognosis of mismatch (defined as an inadequacy between the aortic orifice size and patient's body surface after aortic valve replacement) has been subject to several publications this year. The substantial increase of post-operative events and poor survival in patients with this mismatch imply adapted preventive strategies in terms of selection of diameters and type of aortic valvular prosthesis and associated aortic surgical techniques (such as annular enlargement or supra-annular position).
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Arch Mal Coeur Vaiss · Jan 2007
[Delays of treatment of acute myocardial infarction with ST elevation admitted to the CCU (coronary care unit) in Alsace].
to determine the time delay from symptom onset to diagnosis and treatment of patients with persistant ST segment elevation myocardial infarction (STEMI). ⋯ our study documents the beneficial effect of a direct call to Emergency Medical Services. Our results also underscore the need for an effort to reduce the time to offer the best appropriate reperfusion techniques in STEMI pts: speed up the admission in the cath-lab, think about pre-hospital thrombolysis followed by coronary angioplasty if necessary.