Hypertensive patients with left ventricular hypertrophy have global left atrial dysfunction and impaired atrio-ventricular coupling.

Objective: The aim of this study was to comprehensively investigate left atrial (LA) reservoir, conduit, and booster pump functions, as well as their predictors in patients with primary systemic arterial hypertension (HTN) and left ventricular (LV) hypertrophy.

Methods: Thirty patients with HTN and LV hypertrophy, but no history of atrial arrhythmia or heart failure, were compared with 29 normotensive controls. Speckle-tracking echocardiography of the LA wall was used to measure systolic and diastolic strains and strain rates.

One-year incidence and clinical impact of bleeding events in patients treated with prasugrel or clopidogrel after ST-segment elevation myocardial infarction.

Background: Little information is available on the long-term incidence of bleeding events after ST-segment elevation myocardial infarction (STEMI) with the current antithrombotic strategy.

Aims: To evaluate the effect of bleedings for up to 12months on clinical events and therapeutic compliance in unselected STEMI patients treated with prasugrel or clopidogrel.

Methods: Patients were treated with clopidogrel or prasugrel according to guidelines.

[What is the place of bioresorbable vascular scaffolds in setting of ST-segment elevation myocardial infarction?].

A 50-year-old woman was admitted for an inferior ST-segment elevation myocardial infarction; immediate coronary angiogram revealed a subocclusive stenosis of the right coronary artery. After optimal antithrombotic treatment, the type of stent could be discussed. The latest generation of drug-eluting stents showed excellent efficacy and safety in the long-term but has limitations such as potential chronic inflammation of the arterial wall and no recovery of vasoactive function.

Exercise response in hypertrophic cardiomyopathy: blunted left ventricular deformational and twisting reserve with altered systolic-diastolic coupling.

Background: Abnormal left ventricular (LV) deformational mechanics have been demonstrated in patients with hypertrophic cardiomyopathy (HCM) at rest, but there is a lack of information on their adaptation to exercise. The aim of this study was to assess the adaptability of LV strains and torsional mechanics during exercise in HCM patients.

Methods And Results: Twenty nonobstructive HCM patients (age, 48.

A case of cardiomyopathy induced by inappropriate sinus tachycardia and cured by ivabradine.

We present the case of a 67-year-old woman with cardiomyopathy induced by inappropriate sinus tachycardia (IST) and a particularly high average heart rate. The patient was resistant and/or intolerant to treatment with conventional rate-slowing medications. We used ivabradine--a specific sinus node I(f) current inhibitor--and successfully lowered the heart rate (33 beats per minute mean heart rate decrease).

Silent cardiac dysfunction and exercise intolerance in HIV+ men receiving combined antiretroviral therapies.

Resting and exercise cardiac function, skeletal muscle oxygenation and whole-body aerobic exercise capacities were evaluated prospectively in cardiac symptom-free HIV men receiving antiretroviral therapies and in healthy controls matched for age, physical activity, smoking and body surface area. HIV patients showed resting cardiac dysfunction, altered cardiac responses to exercise and depressed exercise tolerance. Exercise stroke volume kinetics and muscle oxygenation were impaired in HIV patients, especially in those with resting diastolic dysfunction.

Subclinical cardiac abnormalities in human immunodeficiency virus-infected men receiving antiretroviral therapy.

Although cardiotoxic effects of highly active antiretroviral therapy (HAART) are a growing concern, there is a lack of prospective studies of subclinical involvement of the heart in human immunodeficiency virus (HIV)-infected patients. This study evaluated noninvasively cardiac morphologic characteristics and function in HIV-positive (HIV(+)) men receiving HAART for > or =2 years with no clinical evidence of cardiovascular disease. Echocardiography at rest, including tissue Doppler imaging and exercise testing, were performed in 30 HIV(+) men (age 42.

Reproducibility of automated pulse wave velocity measurement during exercise. Running head: pulse wave velocity during exercise.

Pulse wave velocity measurement is used as an index of arterial stiffness. The purpose was to evaluate the reproducibility of pulse wave velocity measurement at rest, during exercise and recovery from exercise, using an automated device. Twelve healthy young adults (mean age 22.

High versus low training frequency in cardiac rehabilitation using a systems model of training.

No study has reported the long term effects of cardiac rehabilitation, concerning the duration of beneficial effects of training program. The present study analyzed the influence of training session frequency on long-term beneficial effects in patients with coronary artery disease (CAD) undergoing phase 2 cardiac rehabilitation. Four patients with CAD completed 20 training sessions.

A systems model of training for patients in phase 2 cardiac rehabilitation.

Background: The aim of this study was to apply a systems model of training for athletes in patients with coronary artery disease (CAD) undergoing phase 2 cardiac rehabilitation.

Methods: Data from six patients with CAD undergoing 20 conventional training sessions were used to test this model. The method required daily training quantification using heart rate, and regular assessment of real exercise tolerance using a constant-duration test.

Applying a systems model of training to a patient with coronary artery disease.

Purpose: The aim of the present study was to apply a systems model of training for athletes to a patient with coronary artery disease (CAD) undergoing phase 3 rehabilitation.

Methods: A patient with CAD underwent 14 wk of training during which exercise was quantified using intensity and duration. Real exercise tolerance was assessed twice a week during this period using a constant-load test.

[Is it necessary to rehabilitate coronary artery disease patients based on ventilatory threshold?].

Purpose: To compare the efficiency of two programs of exercise-based rehabilitation that are different for heart rate (HR) training in patients with coronary artery disease: heart rate (HR) according to Karvonen formula (HR training =70% (max HR -rest HR) +rest HR) or HR recorded at the gas exchange ventilatory threshold (VT). TYPE: Controlled randomised clinical trial.

Setting: Cardiovascular rehabilitation unit.

Transcranial Doppler detection of cerebral microemboli during left heart catheterization.

The role of transcranial Doppler ultrasonography (TCD) in individual risk assessment of embolic complications and the development of prevention strategies during coronary angiography remains to be determined. The purpose of this study was to assess the prevalence, time of occurrence and potential significance of microembolic signals (MES) detected with TCD during femoral left heart catheterization. TCD monitoring of the right and left middle cerebral artery was performed in 51 consecutive patients (36 men, 15 women) who were referred for coronary angiography.

Postoperative exercise tolerance after aortic valve replacement by small-size prosthesis: functional consequence of small-size aortic prosthesis.

Objectives: The objective of this study was to determine whether a small-size valve prosthesis contributes to exercise intolerance, as assessed by VO2 measurement during an exhaustive cycle ergometer exercise.

Background: The determinants of exercise capacity after mechanical aortic replacement are not well known. The selection of small valve sizes has, however, been described as an independent predictor of exercise intolerance as assessed by exercise duration.

Successful conservative surgery of acute ascending aortic dissection occurring during coronary angiography.

We reported the case of an acute aortic dissection complicating right guiding catheter manipulation during engagement in the right coronary ostium. Despite absence of hemodynamic deterioration, dissection progressed rapidly from the sinus of Valsalva to the ascending aorta along its entire length. At surgery, performed in emergency, the aorta was not dilated and the aortic wall did not appear pathologic.

A "dysautonomic" head-up tilt test pattern in elderly patients with neurocardiogenic syncope.

The characteristics of neurocardiogenic syncope (NCS) in elderly patients remain unclear. We compared the hemodynamic profiles of young and older patients with consecutive and positive head-up tilt tests (HUT). Continuous, noninvasive, and reliable monitoring of arterial pressure (AP) and heart rate (HR) was done throughout 46 consecutive positive HUTs of symptomatic patients.

Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction.

Objective: To evaluate the combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after myocardial infarction.

Design: Myocardial contrast echocardiography was performed in patients with acute myocardial infarction shortly after successful coronary reperfusion (TIMI 3 patency) by direct angioplasty. Collateral flow was assessed before coronary angioplasty, and contrast reflow was evaluated 15 minutes after reperfusion.

[Role and significance of cytokines in the development of cardiac insufficiency].

The hypothesis of immune and inflammatory activation occurring during chronic cardiac failure, capable of maintaining the disease, is supported by many experimental and clinical trials. Plasma cytokines levels, particularly the tumour necrosis factor alpha (TNF alpha), are raised at advanced stages of the disease, especially in cachectic patients. The correlations with other, more traditional markers, especially neurohumoral, are not very close, probably suggesting different mechanisms.

[Low-dose dobutamine echocardiographic assessment of reversible contractile dysfunction (myocardial stunning) after myocardial infarction].

Low dose (5 to 10 micrograms/min) dobutamine echocardiography was used to predict the presence of reversible contractile dysfunction (myocardial stunning) after myocardial infarction successfully revascularised in the acute phase of primary angioplasty. The investigation was undertaken in 40 patients, 4 +/- 1 days after inaugural myocardial infarction. The left ventricle was divided into 16 segments.

Exercise tolerance in heart transplant patients with altered pulmonary diffusion capacity.

To test whether orthotopic heart transplant (OHT) patients with low pulmonary diffusion capacity have a greater limitation to exercise than OHT patients with normal pulmonary diffusion capacity, we investigated cardiorespiratory responses and blood gases in two groups of OHT patients, one with low (LdG) and the other with normal pulmonary diffusion capacity (NdG), during a graded exercise test. The results showed 1) significantly reduced peak power (P < 0.05), peak oxygen uptake (VO2, P < 0.

Myocardial viability assessed by dobutamine echocardiography in acute myocardial infarction after successful primary coronary angioplasty.

Dobutamine echocardiography (5 and 10 microg/kg/ min) was performed in 40 patients 4 +/- 1 days after acute myocardial infarction reperfused by primary coronary angioplasty. The left ventricle was divided into 11 segments. Reversible myocardial dysfunction was indicated by a decrease in at least 2 grades in the total segmental score.

[Cardiopulmonary exercise test in cardiology].

In the cardiopneumologic exercise test, a concomitant analysis of respiratory gas exchange is conducted in addition to the usual cardiologic exercise test: After excluding patients with the habitual contraindications, the test must be conducted with a rigorous methodology, with particular care being given to standardizing the equipment settings before each test and in choosing an individualized protocol allowing a maximal test for a duration of no longer than 10 to 12 minutes. This cardiopneumologic exercise test allows a good assessment of the pneumological pathophysiological factors participating in limited exercise capacity of cardiac origin. It can also help the clinician distinguish cardiac from pulmonary dyspnea, particularly by measuring ventilatory reserves at maximum effort.

[Cardiorespiratory adaptations to exercise].

For the organism, adaptation corresponds to a physiological response to a problem raised by a modification in the internal medium and/or the environment while preserving homeostasis. Adaptations to muscle exercise can involve changes in metabolic, respiratory, or nutritional, or nutritional functions or any other modifications whose endpoint is the production more ATP for further muscle exercise. Adaptations occur at all the levels of the oxygen transport chain.