Philippe Timmermans

Angina pectoris and coronary artery disease in severe aortic regurgitation.

A consecutive series of 198 patients (148 men and 50 women, mean age 51 years, range 18 to 76) with pure, isolated, severe aortic regurgitation was retrospectively studied to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris and coronary risk factors. Significant CAD (coronary diameter stenoses greater than 50%) was found in 28 patients (14%). Typical angina was present in 18% and atypical chest pain in 16%. Angina alone had a sensitivity of 57% to detect significant CAD. The predictive accuracy of a positive history of angina was 46% and that of a negative test 93%. By using multivariate logistic regression, a risk score could be calculated that increased the sensitivity to 74% at equal specificity. Almost 40% of the total population had a risk score of less than -2.9 (only 1 patient in this group had CAD). It is concluded that coronary arteriography can safely be omitted in many patients with severe aortic regurgitation if they have no symptoms of myocardial ischemia or risk factors known to increase its incidence.

Myocarditis Associated With Campylobacter Enteritis: Report of Three Cases

Myocarditis connected with bacterial infection is rare in immunocompentent hosts.1 Campylobacter jejuni infection is a commonly recognized cause of bacterial gastroenteritis. Several case reports have suggested an association between Campylobacter enteritis and the development of myocarditis and pericarditis.2,3 Case 1. Six days after the onset of acute watery diarrhea, a 42-year-old previously healthy man was admitted with abnormal tiredness, dyspnea, and persistent watery diarrhea. Biochemical analysis showed elevated plasma creatine kinase (178 U/L; normal value 170 U/L), troponin I (3.67 μg/L; normal value <0.13), and NT-proBNP levels (1722 ng/L; normal value <115). The ECG was normal on admission. A moderately decreased systolic left ventricular (LV) function with diffuse hypokinesia was seen on echocardiography. Cardiac magnetic resonance imaging (cMR) confirmed a reduced LV systolic function (ejection fraction [EF] 40%; Supplemental Video 1 and 2; see online-only supplement) and showed patchy areas of increased signal intensity on T2-weighted images, suggesting myocardial edema (Figure 1, panel A). After administration of intravenous gadolinium, diffuse and persisting enhancement of the subepicardium and the midwall was seen (Figure 2, panel A). The next day troponin I reached a peak level of 15.6 ng/L, and new repolarization disturbances in the inferolateral leads were noticed. C jejuni , resistant to ofloxacine, …

From therapeutic hypothermia towards targeted temperature management: a decade of evolution

More than a decade after the first randomised controlled trials with targeted temperature management (TTM), it remains the only treatment with proven favourable effect on postanoxemic brain damage after out-of-hospital cardiac arrest. Other well-known indications include neurotrauma, subarachnoidal haemorrhage, and intracranial hypertension. When possible pitfalls are taken into consideration when implementing TTM, the side effects are manageable. After the recent TTM trials, it seems that classic TTM (32-34°C) is as effective and safe as TTM at 36°C. This supports the belief that fever prevention is one of the pivotal mechanisms that account for the success of TTM. Uncertainty remains concerning cooling method, timing, speed of cooling and rewarming. New data indicates that TTM is safe and feasible in cardiogenic shock, one of its classic contra-indications. Moreover, there are limited indications that TTM might be considered as a therapy for cardiogenic shock per se.

The path to surgery in carcinoid heart disease: a retrospective study and a multidisciplinary proposal of a new algorithm

Abstract Background: Development of carcinoid heart disease (CHD) is the major negative prognostic factor in patients with the carcinoid syndrome. The only effective treatment is valve replacement. However, the selection of candidates and determination of optimal timing remain unclear. Considerable variability in local screening and treatment strategies exist. Methods: In this single-centre study, we retrospectively analysed the diagnostic process and outcome of all CHD patients who underwent valve surgery between 2000 and 2016. We propose a new CHD screening and management algorithm. Results: All patients (n = 15), mean age 64 ± 7, underwent tricuspid valve surgery. In 14 of them (93%) an additional valve was replaced. In only a minority of patients (27%) CHD diagnosis was established by screening. Survival after 1, 3, 12 and 24 months was 93%, 80%, 53% and 33%, respectively. Causes of death included infections and critical illness immediately postoperatively, and tumour progression and right heart failure in the longer term. There was a trend (p = .099) towards better preoperative right ventricular function in the patients who survived more than 12 months postoperatively (TAPSE 20 mm ± 4) compared to those who died between 3 to 12 months after surgery (TAPSE 16 mm ± 1). The former group had a shorter mean interval from diagnosis of the carcinoid syndrome to cardiac diagnosis than the latter (13 vs. 105 months, p = .014). Conclusion: Mortality after valve replacement for CHD remains high. A probably underestimated cause is late referral for cardiac surgery. We propose a systematic, multidisciplinary approach to all carcinoid syndrome patients.

Exercise cardiac magnetic resonance imaging with pulmonary artery catheter monitoring in carcinoid heart disease: a shift towards early intervention?: Exercise cardiac magnetic resonance imaging with pulmonary artery catheter monitoring in carcinoid heart disease

Neuroendocrine tumours are a rare malignancy, which can be complicated by a carcinoid syndrome and, in more rare cases, also valve destruction. The correct timing for surgical repair remains unknown. We report the first‐in‐men exercise cardiac magnetic resonance imaging with pulmonary artery catheter measurements in order to better understand the haemodynamic impact of isolated tricuspid valve insufficiency in a low symptomatic patient. Not pressure but volume overload is the key factor in the development of symptoms, as long as the right ventricular function is intact. Based on our findings, we referred the patient for tricuspid valve replacement. This case, together with the review of all carcinoid heart disease cases in our hospital (a large tertiary cardiology and oncology centre) since 2000, indicates a potential benefit for early intervention in carcinoid heart disease.