Rémy Pillière

Usefulness of Two-Dimensional Speckle Tracking Echocardiography for Assessment of Tako-Tsubo Cardiomyopathy

The aim of this study was to characterize left ventricular (LV) systolic function using 2-dimensional strain in Tako-Tsubo cardiomyopathy (TTC). Forty-two women were prospectively studied using 2-dimensional speckle-tracking echocardiography, divided into 3 groups: 14 patients with TTC (group 1), 14 patients with coronary artery disease (group 2), and 14 healthy patients (group 3). In patients with TTC, mean values of systolic peak velocity, strain, and strain rate were significantly lower than those in group 3 (p <0.04), but these values were similar between the basal septum and lateral wall, between the middle septum and lateral wall, and between the apical septum and lateral wall. LV ejection fractions were significantly improved during follow-up (p <0.0001). All values of velocities were significantly increased at day 7 compared with the acute phase (p < or =0.01). This improvement differed between the middle septum and lateral wall (p <0.0001), and values for the middle septum and lateral wall in patients with TTC were not significantly different from those observed in patients with coronary artery disease (p = NS). At 1-month follow-up, no significant difference was noted between patients in groups 1 and 3. In conclusion, 2-dimensional speckle-tracking echocardiography is a reliable tool for assessing circular dysfunction in patients with TTC. Once the acute phase has passed, TTC may mimic the LV systematized dysfunction observed in patients with coronary artery disease and so lead to misdiagnosis. This novel echocardiographic technique can also be used in the follow-up of LV functional recovery.

Prevalence of Patent Foramen Ovale and Usefulness of Percutaneous Closure Device in Carcinoid Heart Disease

The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. All patients underwent conventional and contrast echocardiography. Patients with clinical signs of dyspnea (New York Heart Association class > or =III), cyanosis, carcinoid heart disease (CHD), and severe PFO were referred for the percutaneous closure of PFO. The prevalence of PFO was 41% in patients with CS and 22% in the control group (p = 0.03) and was significantly higher in patients with CHD (59%, p = 0.009). Four patients (14% of those with CHD) were referred for the percutaneous closure of PFO, and 3 patients ultimately underwent PFO closure (using Amplatzer septal occluders). At 6-month follow-up, New York Heart Association class was improved in all patients, as well as arterial blood gas results (p = 0.04) and 6-minute walking distance (p = 0.03), but all patients presented residual right-to-left shunts. In conclusion, this prospective study demonstrates that in patients with CHD, the prevalence of PFO is high and that percutaneous closure of PFO is feasible, with a reduction in symptoms but with residual shunting.

Brain magnetic resonance imaging before and after percutaneous mitral balloon commissurotomy

Abstract Brain embolism is not rare during PMBC and appears related to the procedure itself. In this group of patients, brain embolisms were not accompanied by symptoms, were not more frequent in patients with atrial fibrillation or without previous anticoagulation treatment, and were not related to balloon type. Hypersignals in brain magnetic resonance images had a diameter

Optimizing the management of acute coronary syndromes in sub-Saharan Africa: A statement from the AFRICARDIO 2015 Consensus Team.

BACKGROUND Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities. RESULTS The outcome of patients with ACS is affected by clearly identified factors, including: delay to reaching first medical contact, achieving effective hospital transportation, increased time from symptom onset to reperfusion therapy, limited primary emergency facilities (especially in rural areas) and emergency medical service (EMS) prehospital management, and hence limited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/or percutaneous coronary intervention [PCI]). With only five catheterization laboratories in the 10 participating countries, PCI rates are very low. However, in recent years, catheterization laboratories have been built in referral cardiology departments in large African towns (Abidjan and Dakar). Improvements in patient care and outcomes should target limited but selected objectives: increasing awareness and recognition of ACS symptoms; education of rural-based healthcare professionals; and developing and managing a network between first-line healthcare facilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-based cardiology departments and catheterization laboratories. CONCLUSION Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcare policies should be developed to overcome the multiple shortcomings blunting optimal management. European and/or North American management guidelines should be adapted to African specificities. Our consensus statement aims to optimize patient management on the basis of realistic considerations, given the healthcare facilities, organizations and few cardiology teams that are available.

Syndrome d’apnées obstructives du sommeil et risques coronariens

Resume Les donnees recentes et convergentes d’etudes epidemiologiques, experimentales et therapeutiques sont en faveur de liens de causalite entre troubles respiratoires du sommeil et maladie coronaire. Les mecanismes impliques sont multiples. L’hyperactivite sympathique diurne et nocturne et l’alternance hypoxie - reoxygenation associees aux apnees entrainent des perturbations hemodynamiques et une cascade de perturbations neuro - humorales aigues et chroniques. Il semble exister des interactions complexes et bi - directionnelles entre syndrome d’apnees obstructives du sommeil (SAOS) et syndrome metabolique. Le stress oxydatif est responsable d’une peroxydation lipidique anormale et de reactions inflammatoires et immunitaires qui induisent une dysfonction endotheliale et favorisent l’atherogenese ; il augmenterait egalement la sensibilite des myocytes a l’ischemie - reperfusion. Le traitement efficace des apnees reduit la morbidite et la mortalite cardiovasculaire. Ces donnees doivent inciter a diagnostiquer et a traiter precocement les troubles respiratoires du sommeil et si possible a les prevenir.

Stimuli éveillants endogenes et variations de la pression arterielle

tion de l’effort respiratoire. Les variations EEG concomitantes ont CtC classees en grade 11 = &veil ; grade I = microeveil ; grade 0 = pas de microeveil selon 1’Asda (grade Oa = alpha ou frequences rapides inferieures a 3 secondes ; grade (lb = allegement en ondea lentes ou complexe K ; grade Oc = pas de modification EEG). La PA et la FC ont augmente significativement avec I’intensite de l’eveil cortical. II n’y a pas eu de difference signiticative entre les 3 aous-classes du grade 0. La FC est significativement plus elevee dans le grade 2 que darts le grade 0. Les variations de preasions cesophagiennes ne different pas selon les grades EEG. Ainsi l’augmentation de l’effort inspiratoire chez le ronfleur entraine un Cveil souscortical dont temoigne I’augmentation de la PA. Cet Cveil sous-cortical peut &tre detectable en I’absence d’eveil cortical. Mais I’intensite des eveils sous-corticaux et corticaux sont likes. L’amplitude des pits de PA est significativement plus faible pour les MP saris ME que pour les MP avec ME : 16,8 f 7,6 vs 28,3 + IO,3 mmHg ce qui confirme les r&mats de Bourgin. Elle est similaire dans les cas 2 et 3 et (28,3 f IO,3 vs 27,X f 8,5 vs 22,4 f 7 mmHg ; n = 7). Elle est significativement plus ClevCe lorsqu’un micro&veil est associe a une apnee avec mouvement periodique (37,5 f 15.5 mmHg) ou sans (35,l f 1 I ,3 mmHg). Ces deux types d’association, frequents chez les hypertendus, pourraient marquer l’intensite du stimulus endogbne et celle de la reponse sympathique, potentiellement deletere pour le systeme cardiovasculaire.