[Survival in acute myocardial infarction in a group of 369 patients consecutively admitted between 1988 and 1992. Analysis of risk factors and medical procedure].

A retrospective analysis without exclusion of 369 consecutive cases of myocardial infarction admitted between January 1988 and March 1992 studied the risk factors, previous medical history and treatment in this period during which medical practice seemed to be standardised with acknowledged benefits of thrombolysis, beta-blockade and aspirin therapy. The population observed is divided in three age groups (< 65, > 65 < 75 and > 75). A Cox model multivariate analysis for age, sex, diabetes, hypertension, hypercholesterolaemia, tobacco smoking, previous infarction, coronary artery disease and cardiac failure underlined the risk related to age which was 3.

[Aneurysm of the interatrial septum. Apropos of a retrospective study of 41 cases].

The authors undertook a retrospective study of 41 patients in whom an atrial septal aneurysm (ASA) had been diagnosed at transoesophageal echocardiography performed for ischaemic cerebrovascular events in 26 cases. No significant differences in this size, thickness or mobility of the ASA or the associated cardiac abnormalities were demonstrated in this context. However, patients presenting with cerebrovascular accidents were older, had several cardiovascular risk factors and more cardiac arrhythmias.

A case of recurrent benign pericarditis treated by colchicine.

After five recurrences of idiopathic pericarditis over a period of 8 months on steroidal anti-inflammatory therapy, a splenectomized patient aged 31 years benefited from treatment with colchicine. He was treated for one year without any recurrence. A relapse occurred 6, 7 and 17 months after having stopped the drug.

[Left ventricular diastolic function in hypertensive heart diseases. Comparison of results obtained by echocardiography and mechanocardiography].

Usefulness of computerized mechanocardiography and echocardiography in the bedside diagnosis of impaired left ventricular diastolic function is established in a study comparing 17 hypertensive cardiomyopathy patients and 17 hypertrophic obstructive patients to 20 control. The echocardiographic study involves the ratio A/E obtained from the diastolic motion of the mitral valve and max DD/dtN, the peak rate of maximal diastolic dimension change. Both measurements allow statistical differentiation between pathological conditions and the control.

Mechanocardiographic evaluation of left ventricular diastolic function in hypertrophic cardiomyopathy and hypertensive cardiomyopathy.

Usefulness of computerized mechanocardiography and echocardiography in the diagnosis of impaired left ventricular diastolic function is shown in a study comparing 17 hypertrophic obstructive cardiomyopathy and 17 hypertensive cardiomyopathy patients to 20 normal subjects. Mechanocardiography allows the evaluation of three different parameters of diastolic function: isovolumic relaxation evaluated by S2a-O or better by t-dr/dt and dr/dt/A2 ratio, left ventricular compliance by the A/H ratio and time of rapid filling. All the parameters are impaired in both pathological populations.

[Hypertrophic obstructive cardiomyopathy in elderly patients. Retrospective study of 23 cases].

This retrospective study was based on data obtained from 23 patients over 65 years old (72 +/- 1.04 years) with hypertrophic obstructive cardiomyopathy followed up for 3 years (37.2 +/- 5.

[Importance of magnetic resonance imaging in myocardial infarct].

Imagery by magnetic resonance (IMR) represents a new modality of medical imagery based on the interaction between the magnetic fields produced by radio-frequency waves and living substance. IMR finds an interesting application in the study of different stages of myocardial infarction. In 30 cases of myocardial infarction IMR was compared with thallium tomoscintigraphy and echocardiography.

Acute hemodynamic effects of piroximone (MDL 19,205) in patients with moderate congestive heart failure: comparison with sodium nitroprusside.

Piroximone (MDL 19,205), a new imidazolone derivative, was given intravenously to 14 patients with congestive heart failure (NYHA class II-III), while under constant daily doses of digitalis and diuretics. In the first 3 patients, we determined the dose safely eliciting a favorable hemodynamic response. The subsequent 11 patients received 1 mg/kg of piroximone intravenously, and the hemodynamic effects were compared with those of sodium nitroprusside (SN) at a dose-lowering mean blood pressure by 10-20 mm Hg.

[Obstructive myocardiopathy in the elderly. A retrospective study of 18 cases].

From a retrospective study of 18 cases of obstructive cardiomyopathy in elderly people collected over a 5-year period, it appears that the incidence of the disease is probably underestimated. It seems to vary in severity, but only one-third of the patients present suggestive clinical symptoms associated with an obvious obstructive syndrome. The best diagnostic method is phonomechanography, which is easy to perform, systematically completed by a pharmaco-dynamic test.

[Left intraventricular thrombosis. From diagnosis to treatment].

Left ventricular thrombi are the source of much concern in numerous conditions affecting the ventricles. Refinement in echocardiographic and isotopic techniques is enabling earlier diagnosis and a more rational approach to therapy. These thrombi occur very frequently, and are most often asymptomatic (more than 2 to 3 times out of 4), and their natural course is not well known.

Mechanocardiography in evaluation of left ventricular function. Relevance of combined study of apex cardiogram and systolic time intervals in diagnosis of cardiomyopathies.

The study of left ventricular performance by means of systolic time intervals, especially represented by the PEP/LVET ratio and indices drawn from the first derivative of the apex cardiogram, makes possible a good approach to the functional anomalies of patients suffering from hypokinetic cardiomyopathies or hyperkinetic conditions of obstructive or unobstructive hypertrophic cardiomyopathies and of patients with hyperthyroid conditions. In hypokinetic states, the sensitivity and the specificity of the PEP/LVET ratio proved to be good, as was the case for indices taken from the first derivative of the apex cardiogram. However, the sensitivity and the specificity of the cardiogram were much better in the detection and evaluation of hyperkinetic conditions, hypertrophic cardiopathies or hyperthyroiditis.

[Phonomechanographic evaluation of left ventricular function in hyperthyroid states].

Hyperthyroidism is associated with a hyperkinetic syndrome, the mechanisms of which are not fully understood but which include an increase in heart rate, a reduction in systemic arterial resistance and a debatable increase in myocardial contractility. The limitations of radioimmunological assay of the hormonal mediators underline the diagnostic value of an atraumatic method of quantifying left ventricular systolic function. In view of the variable sensitivity of phonomechanographic and echocardiographic indices with respect to changes in heart rate, pre- and after load, we studied apex cardiographic indices during the phase of isovolumetric contraction.

[Semi-automatic acquisition and processing of mechanocardiograms].

Like echocardiography and radio-isotope techniques, mechanocardiography has a special place in the evaluation of left ventricular function in heart disease. This recognized technique can be easily performed by clinicians or pharmacologists or in aerospace medicine. A programme has been developed from micro-processor material (HP 9845 S - SP 9835 - HP 6940 B multi-programmer) already in use in the department.

[Evaluation of left ventricular function and regional kinetics following myocardial infarction. Comparative study of angiocardiography, echography and radionuclide angiography].

Left ventricular function and regional wall motion were studied three weeks after a myocardial infarction in 25 patients who had undergone L.V. monoplane cineangiography.

Hemodynamic effects of MDL 17,043, a new cardiotonic agent, in patients with congestive heart failure: comparison with sodium nitroprusside.

MDL 17,043 (MDL), a new cardiotonic agent, was given intravenously at a single dose of 0.5 mg/kg to 14 patients with congestive heart failure (stages II-III). The mean half-life of plasma elimination of the parent compound determined in eight subjects was 81 min.

[Phonomechanography: a premature requiem].

The value of phonomechanographic recordings has been contested in recent years. This seems to be the result of the upsurge in other non-invasive methods of investigating cardiac diseases and left ventricular function such as those based on ultrasound, pulsed Doppler or radioisotopes. Far from opposing these techniques, phonocardiography has benefited from their comparison and association which have validated the systolic time and amplitude indices previously used empirically.

[Bacterial endocarditis and mitral valve prolapse].

The suspected diagnosis of bacterial endocarditis is based on a presumption. Over the last few years, ultrasound, which can identify valvular lesions and their repercussions, has established itself as a supplementary diagnostic tool in the early stages of this disease. The existence of false negatives should not be underestimated, but one must also be aware of the possibility of false positives.

[Valvular or muscular cause of heart sounds?].

During the last twenty years, the genesis of the high frequency heart sounds could be outlined in the opposition between "valvular" and "muscular" theories challengers. The latter argued with haemodynamic results and the former with echographic results. The improving investigation methods permitted recently the understanding of valvular closure and authorize conciliation.

[Cardiac sarcoidosis. Mechanisms of valvular dysfunctions].

The sudden onset of massive tricuspid insufficiency in a patient with ocular and pulmonary sarcoïdosis diagnosed fifteen years earlier exemplifies the possible occurrence of sarcoid heart disease, an entity often misdiagnosed or overlooked. After excluding pericardial effusion and rhythm disturbances we point out the specific characteristics of endomyocardial involvement and discuss the mechanisms of valvular dysfunction. In this particular localization, the possibly deleterious effect of steroid therapy is mentioned.