Clopidogrel 150 mg/day to overcome low responsiveness in patients undergoing elective percutaneous coronary intervention: results from the VASP-02 (Vasodilator-Stimulated Phosphoprotein-02) randomized study.

Objectives: We investigated whether maintenance therapy with clopidogrel 150 mg/day produces greater platelet inhibition than the standard 75-mg/day dose and whether the higher maintenance dose increases platelet inhibition in low responders to clopidogrel 75 mg/day.

Background: Patients show interindividual variability in their platelet response to clopidogrel. Low responders could potentially obtain greater clinical benefit from greater doses of clopidogrel.

[Drug eluting stents in 2005: have the initial expectations been met?].

Drug eluting stent is a new technology aimed to prevent the development of neointimal hyperplasia and restenosis following percutaneous coronary intervention. This review describes the direction for their use at the present time and the future of their utilization with the summary of the principals clinicals trials.

[Spontaneous idiopathic pneumopericardium in young patients. Review of the literature. Apropos of a new case].

Spontaneous idiopathic pneumopericardium (SIPP) in young subjects is a rare disorder since, apart from the case described here, only 28 cases have been reported in the literature. It occurs mainly in young adults. The physiopathology of the disorder involves alveolar rupture, as described by Macklin.

[Spontaneous pneumopericardium. Review of the literature apropos of 2 cases in the young adult].

Pneumopericardium is defined as the presence of air in the pericardial cavity. It is a rare condition in adults, usually due to trauma; it is commoner in the more exposed neonate and usually iatrogenic. The clinical presentation of chest pain and shortness of breath is associated with the pathognomonic auscultatory sign described by Bricheteau: a water-mill bruit.

Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurements, echocardiography and myocardial scintigraphy.

The respective value of four non-invasive methods for the diagnosis of pulmonary arterial hypertension (PAH) was investigated in 63 COPD patients, using right heart catheterization as the reference method: 22 patients had no resting PAH (pulmonary artery mean pressure (PAP) less than or equal to 20 mmHg); 26 patients had mild PAH (PAP = 21-30 mmHg); and 15 patients had moderate to severe PAH (PAP greater than 30 mmHg). The specificity of ECG was 86% and the sensitivity 51% (only 38% in mild PAH). The specificity of radiological measurements was 63% and the sensitivity 46% (38% in mild PAH).

[M-mode echocardiography in the diagnosis of pulmonary arterial hypertension in chronic respiratory disorders].

Right heart catheterisation (reference method) and M-mode echocardiography were performed in 90 patients with chronic respiratory failure (73 BPCO-chronic airflow obstruction and 17 non-BPCO). The aim of this study was to assess the place of echo-cardiography in the diagnosis and assessment of pulmonary arterial hypertension (HTAP) and/or right ventricular hypertrophy (HVD). The results are somewhat deceptive; first as reliable measurements were impossible in 20% of cases (due to airways distension), then because the sensibility of the method is only 75% (only 62.

[Ultra-sensitive TSH levels: an aid in the screening for amiodarone-induced thyroid dysfunction].

Amiodarone modifies thyroid hormone secretion and hypothyroidism occurs in some cases. The latter diagnosis is often difficult and is of particular importance in these patients as it may have serious consequences for the heart. Early diagnosis is therefore essential but difficult because of the induced hyperthyroxinemia with maintenance of euthyroidism and a hypotriiodothyronemia.

[Dispersion of auricular refractory periods. Role of the intensity of the stimulation current].

In a series of 12 patients, the right atrial effective and functional refractory periods (ERP and FRP) were determined at 3 different sites and at 3 different intensities (threshold intensity and double and triple the threshold intensity). The mean of the range of the ERP in the same atrium was 43.4 ms and that of the FRP was 53.

[Reduction of auricular fibrillation with fenoxedil: the probable role of the autonomic nervous system].

It is still very difficult to study the mechanisms of action of anti-arrhythmic drugs in human clinical studies. The use of continuous electrocardiographic monitoring offers a number of advantages in this field. In this study, the authors evaluate the mechanisms of action of fenoxedil hydrochloride on atrial fibrillation.

Echocardiographic aspects of pulmonary arterial hypertension in chronic lung disease.

An echocardiographic M-mode study has been performed on 58 patients with pulmonary arterial hypertension at rest or on exercise, with chronic lung disease, either obstructive (41 cases of COLD) or restrictive (17 cases of interstitial lung disease, ILD) in nature. The average Ppa was practically the same (i.e.

Detection of right ventricular pressure overloading by thallium-201 myocardial scintigraphy. Results in 57 patients with chronic respiratory diseases.

The diagnostic value of thallium 201 (201Tl) myocardial imaging was studied in 57 patients with chronic respiratory diseases, most with COPD (n = 46), by comparing the results to hemodynamic findings. In healthy subjects, the right ventricle (RV) is not visualized; therefore, any recorded activity of the RV was considered as indicating RV hypertrophy due to RV pressure overloading (RVPO). RV activity was graded from 0 (no activity) to 3 (activity greater than or equal to that of the left ventricle).

[Electrocardiographic criteria of left ventricular hypertrophy and unipolar aVR lead].

The introduction of data processing techniques into the interpretation of electrocardiograms and the rapid progress towards automatization require a multiplication of the criteria of decision and an exact evaluation of their performance. The ECG diagnosis of left ventricular hypertrophy depends on a large number of parameters. Only the aVR lead has not been fully exploited to date.