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RESUME But de l’etude Le catheterisme coronaire apres implantation d'une valve aortique par voie percutanee (TAVI) peut poser certaines difficultes, variables suivant le type de valve. L'objectif principal de notre etude est d’evaluer le taux de reussite du catheterisme et/ou de l'angioplastie coronaire. Patients et methode Nous avons analyse retrospectivement les procedures de coronarographie et/ou d'angioplastie percutanee realisees a distance d'un TAVI dans deux centres de cardiologie. Le succes d'intubation de l'ostium coronaire a ete evalue selon la qualite de l'engagement dans l'ostium et l'opacification de l'artere. D'autres indicateurs ont ete recueillis notamment les sondes utilisees, les temps de scopie, PDS et quantites de produit de contraste utilisees. Resultats Parmi 1512 procedures TAVI, 33 patients avec procedure invasive coronaire ont ete inclus. La valve Sapien 3® a ete implantee chez 22 patients et l'Evolut® chez 11 patients (7 Evolut-R® et 4 Evolut Pro®). Une coronarographie avec catheterisme selectif ou partiellement selectif a ete realisee avec succes chez tous les patients porteurs d'une valve Sapien 3®. Dans le groupe Evolut®, nous avons identifie 3 cas de catheterisme non selectif pour la coronaire droite et 1 cas pour la coronaire gauche. Les catheters standard Judkins semblent etre les sondes les plus adaptees pour les deux types de valve. Conclusion Les resultats de notre etude sont rassurants avec un taux de succes de catheterisme coronaire proche de 100 %. On note quelques difficultes en cas de valve supra-annulaire type Evolut®. Une attention particuliere devrait etre portee a la technique d'implantation et l'orientation des cusps de la prothese, permettant de faciliter le catheterisme coronaire ulterieur.

@DrHulot_PARCC Anti-platelet therapy adjustment guided by CYP2C19 genotyping can be done in

Coronary catheterization after transcatheter aortic valve implantation (TAVR) may be challenging. The main objective of the study is to assess the feasibility of coronary catheterization and angioplasty according to each type of valve.We retrospectively studied coronary angiography or percutaneous angioplasty procedures after TAVR in two different centers. The catheterization success of coronary artery was evaluated according to the quality of engagement in ostium and opacification of the artery. Other indicators were collected including catheters used, fluoroscopy and angiography times, DAP and the volume of the contrast agent.Among 1512 TAVR procedures, 33 patients were included. The Sapien 3® valve was implanted in 22 patients and the Evolut® in 11 patients (7 Evolut-R® and 4 Evolut Pro®). Coronary angiography with selective or partially selective catheterization has been successfully performed in all patients with a Sapien 3® valve. In the Evolut® group we identified 3 cases of non-selective catheterization for the right coronary and 1 case for the left coronary. Standard Judkins catheters seem to be the most suitable for both types of valve with very good efficiency.The results of our study is promising for the future of TAVR with a coronary catheterization success rate close to 100% with some difficulties for the Evolut® supra-annular valves. Special attention should be paid to the technique of implantation and orientation of cups in the aortic sinus.

Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.

Introduction Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction (LVEF) in patients with takotsubo cardiomyopathy, recent studies have demonstrated the long-lasting functional impairment in those patients. Purpose We sought to evaluate the predictors of incomplete recovery in chronic phase and its impact on cardiovascular mortality after takotsubo cardiomyopathy. Methods Patients with takotsubo cardiomyopathy between 2008 and 2018 were retrospectively enrolled in three different institutions. Takotsubo cardiomyopathy was diagnosed according to the European Society of Cardiology Heart Failure Association criteria. After exclusion of in-hospital deaths, 407 patients were split into 2 subgroups according whether their LVEF were >50% (recovery group; n=333), or ≤50% (incomplete recovery group; n=74) at follow-up. The primary endpoint was the impact of incomplete recovery on cardiovascular mortality. Results Patients with incomplete recovery were more likely to be male, to have dementia, pacemaker, and supraventricular arrhythmia. C-reactive protein (CRP) levels on admission, at peak, and at discharge were significantly higher in patients with incomplete recovery. By multivariate logistic regression analysis, lower EF at discharge (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.88 to 0.95; p Conclusions We demonstrate that incomplete recovery after takotsubo cardiomyopathy is characterized by a residual systemic inflammation and an increased cardiac mortality at follow-up. Altogether, our findings underline patients with persistent inflammation as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate inflammation. Funding Acknowledgement Type of funding source: None

Background Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo Syndrome (TTS). Objective In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS. Methods Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. 385 patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP>19 mg/L at discharge, on cardiac death or hospitalization for heart failure. Results Follow-up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow-up (61.7 vs. 60.7 vs. 57.9%; p=0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; p=0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.97; 95% confidence interval: 1.11 to 3.49; p=0.02). Conclusions RHIR was associated with impaired LVEF recovery and was evidenced as an independent factor of cardiovascular events. All together these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR. Main results Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): GERCA (Groupe pour l'Enseignement, la prévention et la Recherche Cardiovasculaire en Alsace)

Introduction Post-infarction adverse left ventricular (LV) remodelling is strongly associated with subsequent heart failure events. The conicity index, sphericity index and LV global functional index (LVGFI) are new LV remodelling indexes assessed by cardiac magnetic resonance (CMR). The aim of our study was to assess their predictive value on one-year adverse LV remodelling in patients with anterior myocardial infarction. Methods CMR studies were performed in 129 anterior ST-elevated myocardial infarction (STEMI) patients (58 ± 12 years, 78%men) from the randomized CIRCUS trial (CMR sub-study) treated with the primary percutaneous coronary intervention (PCI) and were followed for the occurrence of major adverse cardiovascular events (MACE) (death or hospitalization for heart failure). The conicity index, sphericity index, LVGFI, infarct size (IS) and microvascular obstruction (MVO) were assessed by CMR performed 5 ± 2 days after coronary reperfusion. Adverse LV remodelling was defined as an increase in LV end-diastolic volume ≥ 15% by transthoracic echocardiography at 1 year. Results Adverse LV remodeling occurred in 27% of patients in one year. IS and MVO were significantly predictive of adverse LV remodelling (OR = 1.03, CI 95% [1.02–1.05], P Fig. 1 ). Conclusion LVGFI was associated with adverse LV remodelling and MACE at one year after anterior STEMI. However, this relationship and its predictive value in on top of infarct size remain hypothesis-generating at this stage. Further studies are needed to explore the relationship of all these remodelling indices with adverse outcomes in larger populations of MI patients.

Vascular complications are frequent in the context of transcatheter aortic valve replacement and may require the implantation of a covered stent graft in the common femforal artery. However, common femoral artery is considered to be at high risk of stent fracture or occlusion due to high mobility of the hip joint.We analyzed medical records of patients with transcatheter aortic valve replacement related vascular complications between 2015 and 2018, treated with commom femoral artery transluminal angioplasty or surgery. Vascular complications or suspect symptoms were followed up by phone calls.Among 552 patients, 43 patients were included. Twelve (11.6 %) were managed by prolonged balloon inflation, 5 (11.6 %) by first line surgery and 26 (60.4 %) by the implantation of a covered stent graft. Among the latter group, the covered stent graft was efficient in 24 patients (92.3 %). The median follow-up was 430 days [3-1499]. The first-line surgery group had a higher risk of red blood cell transfusion and all causes mortality. At follow-up, no patient had suspicious symptoms of vascular covered stent complication. Four patients (9.3 %) had US-doppler or CT vascular imaging at follow-up, showing no evidence of stent fracture or occlusion.In our study, the implantation of a covered stent graft in the common femoral artery was an efficient and safe strategy for the management of transcatheter aortic valve replacement related vascular complications.

We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication.

The objective of this study is to evaluate the effectiveness and the safety of the FemoSeal mechanical closure system in order to obtain hemostasis of the puncture site following angioplasty procedures performed through femoral arterial approach.A single-centre prospective registry was conducted from November 2010 to April 2011, comparing the results of manual compression (n=111 patients), hemostatic bandages compression (n=43 patients) and FemoSeal mechanical closure (n=100 patients). The end points evaluated were the following: successful hemostasis, major and minor complications right after the procedures and major and minor complications at 1 month follow-up. The patients' feedback about their comfort was also collected right after the procedure and after one month.Successful hemostasis with FemoSeal was obtained in 93% of the patients (n=93). Seven patients required additional slight manual compressions or compression bandages. The use of FemoSeal was not associated with any major complications, significantly reducing (P0.05) the number of complications compared to other compression techniques over the studied period. Only one minor complication was observed with FemoSeal (a 1.5-cm-hematoma, which reabsorbed spontaneously without any issue).In our experience, the use of FemoSeal is effective in achieving hemostasis performed through femoral arterial approach up to 7F and is associated with a very low rate of complications.

Resume Introduction La survenue d’une thrombose intraventriculaire est un evenement grave, compliquant le plus souvent un infarctus etendu. Elle necessite une prise en charge medicale adaptee, basee sur les anticoagulants oraux habituels, sans lesquels le risque embolique est eleve. Le diagnostic est le plus souvent realise par l’echocardiographie transthoracique mais avec une sensibilite et une specificite insuffisantes. La place de l’IRM cardiaque dans ce contexte reste a explorer. Patients et methode Nous avons realise un registre retrospectif de toutes les IRM realisees dans notre service depuis 2003, pour bilan d’une masse intracardiaque ou d’un accident vasculaire cerebral. Le but etait de comparer les resultats a ceux de l’echocardiographie et de la ventriculographie de contraste et d’evaluer les performances de ces differentes modalites d’imagerie. Resultats Notre serie comprend 26 cas de thrombus intraventriculaire, confirmes par l’IRM cardiaque. Nos resultats confirment le manque de sensibilite de l’echocardiographie et de la ventriculographie. On retrouve un coefficient de correlation Kappa de l’echographie et de la ventriculographie, vis-a-vis de l’IRM, tres faible, respectivement de –0,08 et 0,16. Conclusion Les performances de l’echocardiographie et de la ventriculographie de contraste pour rechercher une thrombose intraventriculaire semblent limitees. La realisation d’une IRM cardiaque complementaire doit etre preconisee le plus souvent possible en cas de doute diagnostique ou de situation a risque.

X-ray doses (delivered) to the patients during coronary angiography (CA) and percutaneous coronary intervention (PCI) show ability of one certain deterious effects and can be sometimes at very high level. According to the European directives, all the equipments allowing to make diagnostic and interventional procedure integrate a unit of measure of the Dose Area Product. This measure is associated in a linear way with the effective dose and allows to measure the stochastic risk, the indicator also of good practices. Stemming from general vascular rotational acquisition technology, the cardiac rotational angiography is potentially beneficial for the patients and the operators concerning the exposure in ionizing radiations. The purpose of this study is to measure retrospectively the various dominating indicators in the irradiation of the patients on a series of case realized from January, 2009 till May, 2009 further to the implementation of this technique of acquisition. The dose area product, the duration of fluoroscopy as well as the number of acquired images were measured after coronary angiogram at 250 consecutive patients between January, 2009 and May, 2009. The procedures were realized by four operators, using the femoral access. The dose area product, the durations of fluoroscopy as well as the number of images has been respectively of 39,3 Gy cm(2) [4,7-210,65 Gy cm(2)], 8,4 minutes [0,8-38 minutes] and 575 frames [175-1427 frames] in standard coronary angiogram; 33,64 Gy cm(2) [4,95-85,6 Gy cm(2)], 2,8 minutes [1,1-26 minutes], 503 frames [314-836 frames] in single rotational coronary angiogram; 24,26 Gy cm(2) [5,74-51,1 Gy cm(2)], 3,9 minutes [1,3-14 minutes], 272 frames [127-429 frames] in double rotational coronary angiogram. In conclusion, the exposure of the patient to the X-rays, the practitioners and paramedical in interventional cardiology depends on the operator, on the fluoroscopy time and on the number of acquired images. The double rotational angiography is one of the solution to achieve these objectives.

Resume But de l’etude Les anomalies coronaires sont rares et le plus souvent asymptomatiques. Leurs complications potentielles sont pourtant graves, principalement representees par le risque de mort subite. La coronarographie apparait insuffisante pour realiser le bilan complet de ces anomalies et notamment pour etudier le trajet arteriel. Le but de notre serie est d’evaluer l’interet du coroscanner dans cette indication. Patients et methode Nous rapportons les resultats d’une serie retrospective monocentrique de 12 coroscanners 16 barrettes, realises chez des patients presentant des anomalies coronaires diagnostiquees en coronarographie. Resultats Les differents scanners ont permis de confirmer le diagnostic, de preciser les differents trajets coronaires et les rapports avec les vaisseaux de la base, dans 100 % des cas. Conclusion Le scanner multi-coupe apparait comme un examen de choix pour le diagnostic et le bilan prechirurgical des aberrations coronaires, ainsi que pour la distinction des formes benignes et des formes a risque, potentiellement responsables d’ischemie myocardique. Son efficacite et son caractere non invasif pourraient permettre de l’inclure dans le bilan des syncopes a l’effort chez l’adulte jeune, terrain a risque de morts subites en cas d’aberrations coronaires graves.

Resume Le scanner coronaire est une technique prometteuse, qui offre une evaluation anatomique des arteres coronaires de facon non invasive. Nous rapportons dans cet article le bilan des deux premieres annees d'utilisation dans notre centre. Methodes Etude retrospective sur 328 patients nous ayant ete adresses entre janvier 2005 et decembre 2006 pour la realisation d'un scanner coronaire. Comparaison par patient des lesions coronaires observees au scanner et a la coronarographie chez 61 patients. Resultats Sur 328 patients evalues par scanner coronaire, 61 (18,5 %) ont eu une coronarographie. Chez ces patients, on observe respectivement une sensibilite, une specificite, une valeur predictive positive et une valeur predictive negative de 100, 54, 59 et 100 %. Le principal facteur empechant une analyse correcte des vaisseaux etait la presence de calcifications excessives. Conclusion En pratique courante, le scanner coronaire permet d'exclure la presence de stenoses coronariennes significatives de facon non invasive, avec une grande sensibilite, dans une population non preselectionnee.

We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication.

Resume Objectif Evaluer le devenir a long terme des patients traites a la phase aigue d'un infarctus du myocarde par angioplastie primaire, dans un centre hospitalier general du nord de l'Alsace. Patients et methodes Deux cent quatre-vingt-dix-huit patients ayant beneficie d'une coronarographie en urgence a l'hopital de Haguenau, en vue d'une angioplastie immediate, entre le 1 er janvier 1999 et le 31 decembre 2001. Suivi hospitalier et a long terme, retrospectifs. Resultats Deux cent soixante-quatre patients (88,6 %) ont effectivement ete traites par angioplastie en urgence, avec un taux de succes de 87,1 %. La mortalite hospitaliere atteignait 7,7 %, sur une population heterogene comprenant 16,4 % de patients âges de plus de 75 ans, et 11,7 % de patients en classe Killip 3 ou 4 a l'admission. Au terme d'un suivi moyen de 34 mois, le taux de patients perdus de vue etait de 4,7 %, le taux de survie global de 78,9 %, et le taux de survie sans evenement de 41,9 %. Conclusion Ces resultats, comparables aux donnees de la litterature, confirment que l'angioplastie coronaire en urgence est une methode de revascularisation efficace sur une population de la « vraie vie », avec des resultats qui se maintiennent dans le temps.

Drug eluting stent is a new technology aimed to prevent the development of neointimal hyperplasia and restenosis following percutaneous coronary intervention. This review describes the direction for their use at the present time and the future of their utilization with the summary of the principals clinicals trials.

Resume Objectifs A partir d’un registre prospectif multicentrique, nous avons evalue dans 3 centres de cardiologie interventionnelle alsaciens non universitaires la prise en charge et la faisabilite de l’angioplastie coronaire transluminale (ACT) a la phase aigue du syndrome coronaire aigu. Methodes Nous avons inclus tous les malades admis dans un des centres participants du 1er janvier 1999 au 31 decembre 2002 et ayant un infarctus avec sus-decalage du segment ST. Nous avons etudie les caracteristiques cliniques et angiographiques de ces patients en comparant 2 groupes : âges de plus et de moins de 75 ans. Nous avons analyse les taux de revascularisation et les evenements survenus au decours de l’angioplastie. Resultats Sur un total de 1672 patients, 342 (soit 20,5 %) etaient âges de plus de 75 ans. Ces sujets representaient un groupe a haut risque avec une proportion elevee de femmes (50 %), de nombreuses comorbidites (hypertension arterielle et diabete de type 2) et des atteintes tri-tronculaires en nombre plus eleve que chez les sujets de moins de 75 ans. Le taux de mortalite etait eleve chez les plus de 75 ans et toujours plus severe par rapport aux sujets de moins de 75 ans. La mortalite globale des plus de 75 ans etait de 20,5 % mais de 5,4 % en excluant les patients en etat de choc, en Killip III et apres mort subite recuperee. Le succes de reperfusion (exclusivement flux Timi III retenu) de l’angioplastie etait tres eleve chez les plus de 75 ans, meme s’il etait un peu plus faible que chez les patients de moins de 75 ans (93,9 %vs 97,2 %). Conclusion L’ACT est une technique particulierement indiquee chez les sujets âges en Alsace du fait des particularites de la region : geographique d’une part, avec une proximite des Smur pour la quasi totalite de la population alsacienne, et medicale d’autre part, la politique interventionnelle etant acquise dans de nombreuses equipes de cardiologie.

Resume Objectifs. – A partir d'un registre prospectif multicentrique, nous avons evalue dans trois centres de cardiologie interventionnelle alsaciens non universitaires, la prise en charge et la faisabilite de l'angioplastie coronaire transluminale (ACT) a la phase aigue du syndrome coronaire aigu avec sus-decalage persistant du segment ST (SCA ST+) chez les sujets âges de plus de 75 ans. Methodes. – Nous avons etudie les caracteristiques cliniques et angiographiques des patients âges de plus de 75 ans ainsi que les resultats : les taux de revascularisation et les evenements survenus au decours de l'angioplastie ont ete analyses. Ces donnees ont ete comparees a celles des patients plus jeunes et confrontees aux donnees de la litterature. Resultats. – Sur un total de 1672 patients admis pour un SCA ST+, 342 (soit 20,45 %) sont âges de plus de 75 ans. Ces sujets representent un groupe a haut risque avec une proportion elevee de femmes (50 %), de nombreuses comorbidites (HTA et diabete de type 2) et des atteintes tritronculaires en nombre plus eleve que les sujets plus jeunes. Le taux de mortalite est eleve dans ce sous-groupe de patients et toujours plus severe par rapport aux sujets plus jeunes, mais il reste variable en fonction du profil clinique initial. La mortalite globale des plus de 75 ans est de 20,47 % mais chute a 5,41 % si on exclut les patients en etat de choc, en Killip III et apres mort subite. L'angioplastie est la technique de reperfusion coronaire particulierement indiquee dans la prise en charge du SCA ST+ du sujet âge. C'est une technique efficace en termes de revascularisation, le succes de reperfusion (exclusivement flux TIMI III retenu) reste tres eleve dans cette population, meme s'il est un peu plus faible que chez les patients plus jeunes (93,88 vs 97,18 %). C'est une technique rapidement accessible, sous couvert d'une accessibilite des salles de coronarographie, permettant une reperfusion rapide. Dans la prise en charge des patients âges presentant un SCA ST+, c'est sur le delai avant admission qu'il faut axer nos efforts, les patients âges tardant a appeler les secours en cas de symptomatologie coronarienne. Or plus ce delai est court, meilleur est le pronostic du sujet âge. Conclusion. – L'ACT est la technique de reperfusion indiquee chez les sujets âges en Alsace du fait des particularites de la region : geographique d'une part, avec une proximite des SMUR pour la quasi-totalite de la population alsacienne, et medicale d'autre part, la politique interventionnelle etant acquise dans de nombreuses equipes de cardiologie. En Alsace, la part des personnes âges de plus de 75 ans va sensiblement augmenter, et on peut craindre dans les annees a venir une augmentation du nombre de cas de SCA ST+ du sujet âge. Il faut tenir compte de cette evolution, d'autant plus que cette technique de reperfusion allie de nombreux avantages avec tres peu de complications.

Resume Objectif et methode. – Evaluation de la prise en charge par angioplastie primaire du patient en choc cardiogenique en phase aigue d’infarctus du myocarde dans trois centres alsaciens non universitaires ; suivi hospitalier et a moyen terme pour la periode de 1999 a 2002. Resultats. – Cent quatre-vingt-deux patients etaient inclus. La survie hospitaliere est de 43,96 %. Cent quarante-neuf patients ont ete revascularises par angioplastie, le taux de succes d’angioplastie est de 79,12 %. Les facteurs predictifs de deces en phase hospitaliere sont : l’atteinte tritronculaire, l’âge superieur a 75 ans, le TIMI 0 a l’admission. La survie a moyen terme semble bonne avec 91 % de patients vivant a 24 mois (suivi a cette date sur 28,75 % des patients). Conclusion. – L’angioplastie primaire en phase aigue d’infarctus chez les patients en choc cardiogenique primaire semble l’option therapeutique de choix et permet une meilleure survie hospitaliere et a moyen terme par rapport au traitement conventionnel.

OBJECTIVE AND METHOD Evaluation of angioplasty for primary cardiogenic shock in acute myocardial infarction in three non-universitary alsacians centres between 1999 and 2002. RESULTS One hundred and eighty-two patients were included. Hospitalisation survival rate is 43.96% after hospital discharge. One hundred and forty-nine patients were treated by primary angioplasty. Angioplasty is successful in 79.12%. The predictives factors of death are: age > 75, TIMI = 0 at the admission, three vessels disease. Twenty-four months survival is 91% (follow-up data available on 28.75% of the patients alive at hospital discharge). CONCLUSION Angioplasty seems to be the right choice in case of acute myocardial infarction complicated by cardiogenic shock, the results are better than medical treatment at short- and mid-term.

Intraventricular thrombosis is a serious event, generally complicating a wide myocardial infarction. It requires an adapted therapy, based on the oral anticoagulants. The diagnosis is generally carried out by trans-thoracic echocardiography but with an insufficient sensitivity and a specificity. In this context, the place of cardiac MRI remains to be explored.We carried out a retrospective registry of all cardiac MRI done in our hospital since 2003, for assessment of an intracardiac mass or an cerebral stroke. The aim was to compare the results of cardiac MRI with those of echocardiography and contrast ventriculography.Our registry includes 26 cases of intraventricular thrombi, confirmed by cardiac MRI. Our results confirm the lack of sensitivity of echocardiography and the ventriculography. The Kappa correlation coefficient of echocardiography and ventriculography, with respect to the MRI, are very weak, respectively of -0.08 and 0.16.The values of echocardiography and contrast ventriculography seem limited. The realization of a complementary cardiac MRI must be recommended as often as possible in case of doubt or high risk disease.

X-ray doses (delivered) to the patients during coronary angiography (CA) and percutaneous coronary intervention (PCI) show ability of one certain deterious effects and can be sometimes at very high level. According to the European directives, all the equipments allowing to make diagnostic and interventional procedure integrate a unit of measure of the Dose Area Product. This measure is associated in a linear way with the effective dose and allows to measure the stochastic risk, the indicator also of good practices. Stemming from general vascular rotational acquisition technology, the cardiac rotational angiography is potentially beneficial for the patients and the operators concerning the exposure in ionizing radiations. The purpose of this study is to measure retrospectively the various dominating indicators in the irradiation of the patients on a series of case realized from January, 2009 till May, 2009 further to the implementation of this technique of acquisition. The dose area product, the duration of fluoroscopy as well as the number of acquired images were measured after coronary angiogram at 250 consecutive patients between January, 2009 and May, 2009. The procedures were realized by four operators, using the femoral access. The dose area product, the durations of fluoroscopy as well as the number of images has been respectively of 39,3 Gy cm(2) [4,7-210,65 Gy cm(2)], 8,4 minutes [0,8-38 minutes] and 575 frames [175-1427 frames] in standard coronary angiogram; 33,64 Gy cm(2) [4,95-85,6 Gy cm(2)], 2,8 minutes [1,1-26 minutes], 503 frames [314-836 frames] in single rotational coronary angiogram; 24,26 Gy cm(2) [5,74-51,1 Gy cm(2)], 3,9 minutes [1,3-14 minutes], 272 frames [127-429 frames] in double rotational coronary angiogram. In conclusion, the exposure of the patient to the X-rays, the practitioners and paramedical in interventional cardiology depends on the operator, on the fluoroscopy time and on the number of acquired images. The double rotational angiography is one of the solution to achieve these objectives.

The coronary anomalies are generally asymptomatic and rare. However, their potential complications are serious and mainly represented by the risk of sudden death. The coronarography appears insufficient to carry out the complete assessment of these anomalies, and in particular to study the arterial course. The endpoint of our series is to evaluate the interest of the coronary computed tomography (CT) in this indication.We report the results of a 16-slice coronary-CT monocentric retrospective series among 12 patients presenting coronary anomalies diagnosed in coronarography.Coronary-CT has confirmed the diagnosis, specified the coronary course and the relation with the great vessels in 100% of the cases.Multislice coronary-CT seems an examination of choice for the diagnosis and the presurgical assessment of the coronary aberrations, like for the distinction of the benign and malign forms. Its effectiveness and its "non-invasive" character are strong arguments to include it in the assessment of syncopes linked to effort in the young adult.

Multidetector computed tomography coronarography (MDCT) is a promising tool, offering non invasive anatomic evaluation of coronary arteries. We relate in this article our impressions after our first two years experience.Retrospective study of the 328 patients who underwent MDCT examination between January 2005 and December 2006 at our community hospital. Per patient comparative analysis of the anatomical findings versus percutaneous angiography (PCA) in 61 cases.Out of 328 patients 61 (18.5%) underwent PCA. In these patients we found a sensibility, specificity, positive predictive value and negative predictive value of 100%, 54%, 59% and 100% for MDCT. The main factor responsible for inconclusive vessel analysis was excessive calcification.In routine use, MDCT enables one to rule out significant stenosis non invasively, with high sensitivity in an unselected patient population.

Cas clinique Nous rapportons le cas de Monsieur M. âge de 78 ans porteur d’une cardiopathie post-hypertensive avec des antecedents de flutter auriculaire paroxystique. Celui-ci consulte son cardiologue traitant pour palpitations et douleurs thoraciques atypiques. L’ECG inscrit un rythme sinusal regulier, un hemibloc anterieur gauche isole sans trouble de rythme, ni signe d’ischemie. L’echocardiographie transthoracique met en evidence un epanchement pericardique circonferentiel sans tamponnade et une masse ovale hypoechogene au niveau de la paroi inferieure du ventricule gauche et de l’oreillette gauche. L’IRM cardiaque confirme l’existence d’une masse tissulaire bourgeonnante dans le massif auriculaire (38,5 × 28,9 mm) principalement localisee sur la paroi laterale de l’oreillette gauche, mais s’etendant dans la paroi inferieure et paroi posterieure de l’oreillette droite. Un TDM thoraco-abdomino-pelvien ne retrouve pas d’autre anomalie suspecte, ni d’adenopathie. Une thoracotomie gauche avec drainage pericardique et biopsie sont realises. L’analyse histologique est en faveur d’un lymphome B diffus a grande cellule CD 20+; CD 10–. Une chimiotherapie R-COMP (Rituximab; Myocet ® , cyclophosphamide; vincristine; prednisone) est alors initiee. L’IRM cardiaque de controle montre une regression significative de la tumeur par evolution necrotique ou retractile avec persistance de la masse dans le sillon auriculo-ventriculaire gauche.

Introduction La maladie coronarienne represente la premiere cause de morbimortalite chez le diabetique. Son incidence chez les sujets âges augmente avec l’allongement de l’esperance de vie. L’objectif de notre travail est d’evaluer l’utilite et les risques de la strategie coronaire invasive chez les diabetiques et d’en preciser les resultats, les complications et la mortalite hospitaliere. Patients et methodes Il s’agit d’une etude retrospective, comparative menee sur 63 patients âges (> 75 ans) et diabetiques, admis pour SCA au CH Haguenau entre aout 2012 et aout 2013. Resultats Sur un total de 6 patients âges de plus de 75 ans diabetiques. L’âge median etait de 80 ± 4,3 ans, 54 % etaient des hommes. L’indication principale etait un syndrome coronaire aigu, l’atteinte coronaire souvent tritronculaire. Un premier groupe (n = 21) a eu une coronarographie seule conduisant au renforcement du traitement medical (30,2 %) et au pontage dans 3,2 % cas. Le second groupe (n = 42) a eu une coronarographie suivie d’angioplastie percutanee (42), soit 66,7 % des cas. Le taux de succes primaire de l’ICP a ete de 97 % (un seul cas d’echec). La voie radiale a ete utilisee dans 57,1 % des procedures. Les echecs d’abord vasculaire et/ou les difficultes de catheterisme (4,8 %) ont ete assez rares. Les complications locales (1 cas d’hematome) et generales (1 cas d’AVC, 9 insuffisances renales, 7 insuffisances cardiaques congestives, 7 troubles de rythme/conduction, 2 recidives de necrose en intrahospitalier). Aucune mortalite hospitaliere n’a ete notee. Conclusion La coronarographie est realisable chez les diabetiques preferentiellement par voie radiale avec un taux reduit de complications. Elle permet de proposer une angioplastie coronaire dans les deux tiers des cas. L’angioplastie percutanee coronaire est realisable avec un taux eleve de succes, un risque acceptable de complications locales et generales. Declaration d’interet Les auteurs declarent ne pas avoir d’interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

Drug eluting stent is a new technology aimed to prevent the development of neointimal hyperplasia and restenosis following percutaneous coronary intervention. This review describes the direction for their use at the present time and the future of their utilization with the summary of the principals clinicals trials.

This prospective multicenter study assessed the prevalence and feasibility of percutaneous coronary angioplasty (PTCA) in the acute phase of ST-elevation myocardial infarction (STEMI) in 3 nonacademic interventional cardiology centers (Alsace, France).We studied the clinical characteristics, angiographic data, and PCTA results of all STEMI patients and analyzed the revascularization rates and adverse events during hospitalization. We compared patients at least 75 years of age and younger patients for these data and with the literature.Of the 1672 patients admitted for STEMI, 342 (20.45%) were at least 75 years of age. Half the patients in this high-risk subgroup were women. These patients had more co-morbidities (e.g., hypertension and diabetes mellitus) than younger patients, and more of them had three-vessel disease. Mortality rate was high in this subgroup and always higher than for comparable younger subjects, but it varied according to the initial clinical profile. Their global mortality rate was 20.47%, but it fell to 5.41% when we excluded patients with cardiogenic shock or in Killip stage ill, and those who were resuscitated. PTCA is a coronary reperfusion technique especially indicated for elderly patients with STEMI. It is an effective revascularization technique, with a reperfusion rate (exclusively TIMI III flow) reaching 93.88% in the elderly group, only slightly lower than among younger patients (97.18%).PTCA is a technique particularly indicated in the elderly in Alsace because of regional geographic and medical specificities: nearby emergency services are available to virtually the entire population of Alsace, and most interventional cardiology teams apply a strategy of exclusive primary PTCA.

Evaluation of angioplasty for primary cardiogenic shock in acute myocardial infarction in three non-universitary alsacians centres between 1999 and 2002.One hundred and eighty-two patients were included. Hospitalisation survival rate is 43.96% after hospital discharge. One hundred and forty-nine patients were treated by primary angioplasty. Angioplasty is successful in 79.12%. The predictives factors of death are: age75, TIMI = 0 at the admission, three vessels disease. Twenty-four months survival is 91% (follow-up data available on 28.75% of the patients alive at hospital discharge).Angioplasty seems to be the right choice in case of acute myocardial infarction complicated by cardiogenic shock, the results are better than medical treatment at short- and mid-term.

Aim to analyze the treatment outcome for E.P. (i.e. older than 70 yrs) affected by SCLC treated at our institution with the same protocol and entry criteria as younger pts. Results From 1980 to 1988, 286 patients (M/F 262/24) were treated; 254 (88%) were younger than 70 (Y.P.) while 32 (12%) were E.P., Pt. characteristics were similar in both age groups: median PS was 80% vs 80%, increased LDH 46% vs 47%, weight loss 55% vs 53%, limited disease (LD) stage 58% vs 56%. stages I-II 18% vs 18%, IIIA 26% vs 31%, IIIB 17.3% vs 15.6%, IV 38.2% vs 34.4%, operable pts 35% vs 31% respectively in Y.P. and E.P. Surgery, however, was performed in 73 (28.7%) Y.P. and in only 6 (18.8%) E.P. Chemotherapy (CT) consisted of 6 courses of alternating CAV/PE for extensive disease pts. LD pts were treated with 4 cycles of CT plus surgery in operable pts; RT (44 Gy) followed CT in inoperable pts. Two pts had an early death before starting treatment, 3 pts were submitted only to surgery fur refusal of CT, all in Y.P. group. In 44 pts surgery was followed by adjuvant CT. A total of 237 pts were submitted to primary CT, 210 pts were Y.P., 27 E.P.: objective response rates were 72% and 63% respectively, with 26.7% (56 pts.) and 22.2% (6 pts.) CR. Median survival was 11.6 and 12 months and 3 yrs survivals were 18% and 17.8%. Cox proportional hazard survival analysis showed no significant differences by age. Conclusions compliance, responses and survival were similar in Y.P. and E.P. treated for SCLC. Thus an aggressive therapeutical approach seems to be justified in selected patients older than 70 yrs.

Of the more than 100 agricultured digesters built in Italy, starting in 1979, only a few were developed for the digestion of cow dung slurry. A great number of existing digesters treat pig wastes, and they are used for waste water treatment.

Anaerobic digestion of the organic fraction of municipal solid waste mixed with primary municipal sewage sludge was investigated on pilot scale. Preliminary experimental data are presented. Results indicate that gas yield is close to expectation. Though there are still several operating problems that have to be attended to, the process appears technically feasible.