Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation.

Objectives: The purpose of this study was to evaluate the relationship between dyssynchrony involving the mitral valve apparatus and the acute improvement in mitral regurgitation (MR) after cardiac resynchronization therapy (CRT). The effect of interruption of CRT at 6 months' follow-up on dyssynchrony and MR was also evaluated.

Background: Mitral regurgitation may improve acutely after CRT, but the precise mechanism is not fully understood.

[Update in the management of left valvular disease].

In the last years, the management of left valvular disease has considerably evolved. The American guidelines of 1998 were recently reviewed. Since this year, we have European guidelines which are different in some points.

[Beriberi].

We discuss the case of a 49 year old man who was admitted to the emergency department with acute heart failure. He suffered from severe alcoholism and malnutrition. His heart failure was of the high output type and the diagnosis beriberi, a disease caused by thiamine (vitamin B1) deficiency.

Diagnostic accuracy of computed tomography coronary angiography in routine practice.

Objectives: The recent newer advances in computed tomography have dramatically changed our approach to imaging cardiac disease. This study sought to compare the diagnostic value of 16-multi-detector spiral computed tomography (MSCT) for detecting coronary artery stenosis.

Methods: A total of 88 consecutive patients (52 men, mean age 68 +/- 8 years) with atypical chest pain, stable angina or suspicion of ischaemia at stress test were studied by MSCT and invasive coronary angiography (ICA).

[New therapeutic guidelines in lower limb arteriopathy].

This article describes the recent therapeutic options for lower limb arteriopathy and, as much as possible, analyzes the medical and surgical treatments according to the recommendations and levels of evidence.

[New therapeutic guidelines in cardiology].

Cardiovascular diseases are the leading cause of mortality in the so-called industrial countries. An appropriate management is mandatory and its modalities should be known and applied by physicians. European and American recommendations are regularly published and updated.

Determinants of an abnormal response to exercise in patients with asymptomatic valvular aortic stenosis.

Aim: Patients with asymptomatic aortic stenosis (AS) and abnormal haemodynamic responses to exercise testing are at increased risk of cardiac events. This study assesses the Doppler echocardiographic determinants of a positive exercise test in a cohort of asymptomatic patients with AS.

Methods And Results: One hundred and twenty-eight patients with AS underwent quantitative Doppler echocardiographic measurements at rest and during exercise test.

[How I investigate... The coronary arteries in 2007: contributions of CT coronary angiography].

Cardiac imaging has always been a challenge because of the continuous movement of the heart. Cardiac computed tomography (CT) has undergone an accelerated progression over the past decade, due to the combination of the high-speed rotation of the X-ray tube, the ECG-gating technique and the infra-millimeter spatial resolution. Multidetector CT allows visualisation of the coronary artery lumen and the detection of coronary stenosis after intravenous injection of contrast medium.

[Treatment of recurrent pericarditis: case report and review of literature].

Benign acute pericarditis is a common disorder. Recurrence is probably the most troublesome complication, characterized by a return of pericardial pain after recovery from an episode of typical acute pericarditis. Treatment of recurrence is often difficult and the guidelines issued by scientific societies remain vague.

Effects of surgery on ischaemic mitral regurgitation: a prospective multicentre registry (SIMRAM registry).

Aims: Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventricular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively affects prognosis, the additional benefit of valve repair is debated, particularly with mild IMR at rest. Exercise echocardiography may help identify a subset of patients at higher risk of cardiovascular events by revealing the dynamic component of IMR.

Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure.

Aims: Pulmonary hypertension, a marker of poor prognosis in heart failure, may develop or increase during exercise. We sought to examine the determinants of pulmonary hypertension at rest and during exercise in heart failure patients.

Methods And Results: Forty-six patients with left ventricular (LV) dysfunction (ejection fraction: 30 +/- 6%) underwent a semi-recumbent, incremental bicycle exercise Doppler echocardiography.

Spontaneous coronary artery dissection in an antilles man with acute inferior myocardial infarction.

Spontaneous coronary artery dissection is a rare cause of myocardial infarction. It has been reported mainly in young women during or after pregnancy. The diagnosis is usually confirmed at autopsy.

Long-term prognostic significance of high-sensitivity C-reactive protein before and after coronary angioplasty in patients with stable angina pectoris.

We examined whether an increase in high-sensitivity C-reactive protein (hs-CRP) after percutaneous coronary intervention (PCI) predicts long-term prognosis in patients with stable angina pectoris. hs-CRP is an inflammatory marker that predicts future cardiovascular events in healthy subjects and patients with unstable and stable coronary syndromes. Long-term evaluation of pre- and postprocedural inflammatory markers has not been widely reported.

Exercise ventilation inefficiency in heart failure: pathophysiological and clinical significance.

Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and prognostic value. The pathophysiology determining exercise ventilatory inefficiency is complex and not definitively clarified.

[Arrhythmogenic right ventricular dysplasia].

Arrhythmogenic right ventricular dysplasia is an unfrequent disease that associates ventricular tachycardia with left bundle branch block morphology and right ventricular fibro-fatty degeneration. The etiology, pathogenesis, criteria for diagnosis and treatment are discussed.

[Secondary prevention after a myocardial infarction].

Patients after a myocardial infarction are at increased risk of adverse cardiovascular outcomes. They require aggressive secondary preventive measures to control cardiovascular risk factors, and prescription of some pharmacological agents. Compelling data derived from randomized controlled trials have shown the benefits of aspirin (or clopidogrel), statins, beta-blockers and angiotensin-converting enzyme inhibitors, in preventing recurrent events and improving survival.