Philippe Beaufils

Clinical Assessment of Drug-induced QT Prolongation in Association with Heart Rate Changes

The formulas for heart rate (HR) correction of QT interval have been shown to overcorrect or undercorrect this interval with changes in HR. A Holter‐monitoring method avoiding the need for any correction formulas is proposed as a means to assess drug‐induced QT interval changes.

New report of severe coronary artery disease in an eighteen-year-old girl with pseudoxanthoma elasticum. Case report and review of the literature.

An eighteen-year-old woman with pseudoxanthoma elasticum (PXE) suffered from mild angina pectoris over a ten-year period. Severe triple-vessel disease with mild left ventric ular dysfunction was demonstrated on angiography. No revascularization was feasible. Despite a reported high frequency of angina pectoris among patients with PXE, only 10 convincing reports have appeared in the literature. Careful coronary artery evaluation is required in young patients with PXE, even though asymptomatic, because coronary artery disease (CAD) seems to be frequent and because no precise feature can be distinguished between types with or without severe vascular disease. Through very rare reports, surgical revascularization appears feasible and beneficial in a less severe form of CAD in patients with PXE. The risk of premature and severe diffuse CAD in PXE does not seem to be explained only by the combination of increased Lp [a] (or any other risk factor) and PXE.

Multivariate statistical evaluation of intraaortic counterpulsation in pump failure complicating acute myocardial infarction

Abstract Clinical and hemodynamic data from 189 patients sustaining an acute myocardial infarction complicated by pump failure were analyzed with a multivariate analysis method using correspondence analysis. A graphic decision-making system based on survival at 1 month was derived from a set of 101 patients. According to the scatter of patient data points on the factorial plane resulting from analysis, survival and nonsurvival zones were defined, and the position of a given patient within these zones was considered a reliable estimate of likelihood of survival. Then, the decision-making rule was applied to a set of 88 patients. Every new patient whose data fell within the nonsurvival zone was referred for consideration of intraaortic Counterpulsation. Thus, 43 patients were predicted to be nonsurvivors; 26 of these (group I) underwent balloon counterpulsation; the remaining 17 formed group II. The two groups were considered comparable. Seven patients in group I and none in group II survived for more than 1 month (probability [p] = 0.02); it was concluded that counterpulsation improves short-term survival. The analysis of baseline measurements demonstrated that a good prediction of short-term survival was feasible in the patients undergoing circulatory assistance. Thus, patients who are salvaged in these circumstances are probably in a less severe condition than others and mechanical assistance may not be of value in every patient predicted to be a nonsurvivor. Of the seven shortterm survivors, only three survived for more than 1 year. This low long-term survival rate (11 percent) was related to extensive myocardial and coronary arterial lesions found on angiography in survivors as well as in counterpulsation-dependent patients.

A rare localization in right-sided endocarditis diagnosed by echocardiography: A case report

BackgroundRight-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve.Case presentationA case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle.ConclusionsOur case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.

Ventricular function and arterial compliance in patients with congestive cardiomyopathy

In order to study the interrelationship between left ventricular afterload, estimated from the mean left ventricular wall stress, and the mechanical properties of the aorta, we have simultaneously measured systemic arterial compliance and left ventricular wall stress in 19 patients with congestive cardiomyopathy. The strong linear relationship between the ejection fraction of the left ventricle and systemic arterial compliance, and between left ventricular wall stress and systemic arterial compliance, suggests that systemic arterial compliance is an important determinant of left ventricular afterload and thus of left ventricular function.

Veine cave supérieure gauche : un diagnostic simple par échocardiographie transthoracique. À propos d’un cas

Resume La persistance de la veine cave superieure gauche est une anomalie du retour veineux systemique rencontree chez 0,5 % de la population generale. Nous rapportons le cas d’un patient pour lequel le diagnostic est pose de facon fortuite a l’occasion d’une dyspnee sur cœur pulmonaire chronique. Le diagnostic evoque grâce a l’echocardiographie transthoracique devant une dilatation du sinus coronaire est confirme par une simple injection de microbulles dans une veine du bras gauche. L’echocardiographie transœsophagienne et une resonance magnetique nucleaire cardiaque confirment l’existence de 2 veines caves superieures avec abouchement de la veine cave superieure gauche dans le sinus coronaire. Cette anomalie congenitale est sans consequence hemodynamique si elle est isolee. Sa reconnaissance est importante en cas de manœuvres de catheterisme veineux central par voie superieure gauche.

Improvement of digital coronary angiography: high resolution processing coupled with a real time functional synchronization procedure

The use of Digital Subtracton Angiography in coronary applications is restricted by the difficulty in: 1. obtaining a good resolution of the distal branches. 2. avoiding, for the purpose of subtraction, the motion artifacts induced by artery and background displacement during the cardiac and respiratory cycles. 3. preserving the dynamic vascular motion. 4. and storing the digital dynamic information on a permanent support. We used for this study an angiography system, based upon a high resolution 45 MIPS-32 Mbyte image processor, interfaced with a 2.75 Gbyte Winchester drive allowing the real time storage of either 30 frames/s in the 512*512*8 bits matrix or of 7.5 f/s in the 1024*1024*8 bits matrix. To preserve the most important dynamic informations on the basis of the 7.5 f/s maximal storage rate, we developed a synchronization device able to recognize in real time, from chronologic delays derived by using both ECG and Aortic Pressure curves, the functional End-Diastolic (ED) and the End-Systolic (ES) positions, even in the case of heart rates varying during the procedure. The ED and the ES images are stored together with the Mid-Systolic (MS), the 1—Diastolic (1/3D) and 2/3-Diastolic (2/3D) images. To establish the validity of this sampling method, which uses a reduced number of frames per cardiac cycle, 7200 coronary injections performed during 450 routine coronary angiographics were compared by two independent observers (A and B), using: first a Digital (D) 5 frames/cycle sequence, and secondly a cine Film (F) 50 frames/s sequence acquired immediately after the corresponding D injection. The D technique resulted in the best image and diagnostic quality, particularly when the F quality was estimated ‘fair’ or ‘poor’ by both observers, and in an important reduction on X-Ray doses.The visualisation of the sequential ED, MS, ES, 1/3D and 2/3D frames gives the possibility: 1. of saving the dynamic information, as a regular sample offunctional images, can be displayed with a cine loop technique. 2. of facilitating cardiac synchronized subtractions. 3. of reducing the amount of frames per cycle, thus allowing an important reduction of X-ray doses and the digital and permanent storage of the most important cardiac cycles.