Diamant brut

Ce coup de fil, au petit matin. Le coup de fil porte les ingrédients d’une histoire. Au coeur de l’histoire racontée au téléphone, une enfant. D’Irun, Poitiers et Bruxelles, chacun dans sa chambre ou cuisine du petit déjeuner, nous sommes projetés, par ondes électromagnétiques, au coeur de l’histoire dans laquelle il y a, comme protagoniste principale, une enfant, 15 ans, venue de Conakry. D’Irun on nous dit, au téléphone : un ange, une perle, un diamant, on ajoute : brut. Un diamant brut. Le diamant brut avait quitté son pays pour en remonter d’autres, territoires après territoires, territoires sans nom et sans spécificité sinon du point de vue des plus ou moins grands dangers qu’on y rencontrerait, ici le viol, ici le feu du soleil, là les policiers jetant des pierres, la noyade, les centres, puis le vide total parce qu’il n’y a plus de route. La route, c’est fini, Espagne France Belgique Allemagne et demi-tour. Europe est une terre avant une autre terre, mais il n’y a pas d’autre terre, Europe n’est qu’une étape avant un but mais il n’y a pas d’autre but. On est arrivé à la fin et on tourne dans la fin comme dans une cage

Heart Rate Variability in Idiopathic Dilated Cardiomyopathy: Characteristics and Prognostic Value

AbstractObjectives. This study was designed to evaluate heart rate variability (HRV) in patients with idiopathic dilated cardiomyopathy (IDC), to determine its correlation with hemodynamic variables and ventricular arrhythmias and to evaluate its prognostic value in IDC.Background. Previous studies have shown that HRV could predict arrhythmic events in patients after infarction, but the characteristics of HRV in IDC have not been fully established.Methods. Time domain analysis of HRV on 24-h electrocardiographic (ECG) recording was performed in 93 patients with IDC, and results were compared with those in 63 control subjects.Results. Patients with IDC, even those without congestive heart failure, had significantly lower values for HRV than those of control subjects. HRV was related to left ventricular shortening fraction (R = 0.5, p = 0.0001) and to peak oxygen uptake (R = 0.53, p = 0.01). HRV was not different in patients with runs of ventricular tachycardia or in patients with late potentials on the signal-averaged ECG. During a mean follow-up period (±SD) of 49.5 ± 35.6 months, patients with reduced HRV had an increased risk of cardiac death or heart transplantation (p = 0.006). On multivariate analysis, cardiac events were predicted by increased left ventricular end-diastolic diameter (p = 0.0001), reduced standard deviation of all normal to normal RR intervals (p = 0.02) and increased pulmonary capillary wedge pressure (p = 0.04).Conclusions. Decreased HRV in patients with IDC is related to left ventricular dysfunction and not to ventricular arrhythmias. Analysis of HRV can identify patients with IDC who have an increased risk of cardiac death or heart transplantation

Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy

International audienceThe study evaluated the prognostic value of interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy (IDC)

Ventricular Dyssynchrony and Risk Markers of Ventricular Arrhythmias in Nonischemic Dilated Cardiomyopathy:. A Study with Phase Analysis of Angioscintigraphy

International audienceBiventricular pacing is a new form of treatment for patients with dilated cardiomyopathy and ventricular dyssynchrony. Limited information is available regarding the relationship between ventricular dyssynchrony and risk markers of ventricular arrhythmias in idiopathic dilated cardiomyopathy (IDC). In 103 patients with IDC, Fourier phase analysis of both ventricles was performed from equilibrium radionuclide angiography (ERNA). The difference between the mean phase of the LV and RV was a measure of interventricular dyssynchrony, and the standard deviations of the mean phases in each ventricle measured intraventricular dyssynchrony. There were no significant differences in inter- and intraventricular dyssynchrony between patients with versus without histories of sustained VT or VF, nonsustained VT, abnormal signal-averaged ECG, or induced sustained monomorphic VT. Dyssynchrony was not related to decreased heart rate variability (HRV). LV and interventricular dyssynchrony were weakly related to QT duration and QT dispersion. During a follow-up of 27 +/- 23 months, 21 patients had major adverse cardiac events (MACE), including 7 cardiac deaths, 11 progression of heart failure leading to cardiac transplantation, and 3 sustained VT/VF. The only independent predictors of MACE were an increased standard deviation of LV mean phase (P = 0.003), a decreased HRV (standard deviation of normal-to-normal intervals, P = 0.004), and histories of previous VT/VF (P = 0.03) or nonsustained VT (P = 0.04). In conclusion, left intraventricular dyssynchrony evaluated with ERNA was an independent predictor of MACE in IDC and was not related to usual risk markers of ventricular arrhythmias. This may have implications for resynchronization therapy and/or the use of implantable cardioverter defibrillators in IDC

Lydie Salvayre, maintenant même

Warren Motte, «Dans le vif du vivant» Lydie Salvayre et Warren Motte, «Une conversation avec Lydie Salvayre» Lydie Salvayre, «Deux artistes» Lydie Salvayre, «Projet en cours» Lydie Salvayre, «Quatre photos» Bernard Wallet, «Lydie Salvayre, écrivain baroque’n’roll» David Lopez, «Almuerz» Marie Cosnay, «Diamant brut» Mahir Guven, «À propos de Lydie Salvayre» Stéphane Bikialo, «Éloge de la fuite» «Ouvrages de Lydie Salvayre»https://digitalcommons.unl.edu/zeabook/1103/thumbnail.jp

Reliability of QRS duration and morphology on surface electrocardiogram to identify ventricular dyssynchrony in patients with idiopathic dilated cardiomyopathy

International audienceUsing Fourier phase analysis of equilibrium radionuclide angiography in both ventricles, inter- and intraventricular delays were correlated with QRS morphology and duration in 103 patients with idiopathic dilated cardiomyopathy. We found that left bundle branch block on the left axis may reflect a high intra-left ventricular dyssynchrony. A precise evaluation of the dyssynchrony appears useful because a high proportion of patients with incomplete bundle branch block, left anterior hemiblock, or "normal" QRS exhibit a marked intra-LV dyssynchrony and may respond to cardiac resynchronization therapy

Indications du défibrillateur cardiaque automatique implantable dans le syndrome de Brugada

International audienc

[Arrhythmias of primary hypertrophic cardiomyopathy].

International audiencePrimary hypertrophic cardiomyopathy is a genetic disease causing sarcomere dysfunction. The structural and functional myocardial changes combine to produce cardiac arrhythmias related to reentry phenomena and to triggered automatic activity. The commonest arrhythmias are atrial fibrillation and ventricular arrhythmias; junctional tachycardias via the bundle of Kent are rare. Atrial fibrillation and the Wolff-Parkinson-White syndrome are more commonly associated with certain genetic mutations. Their treatment is mainly based on medication with amiodarone or on radiofrequency ablation in cases of junctional tachycardia. Ventricular arrhythmias are mainly isolated ventricular extrasystoles and non-sustained ventricular tachycardia. The prognostic significance of the latter has been subject of debate for many years but recent studies report a poor prognosis with non-sustained ventricular tachycardia especially in the young patients. Sustained ventricular tachycardia and ventricular fibrillation, though life-threatening complications of hypertrophic cardiomyopathy, are rarely documented and justify implantation of an automatic defibrillator as the risk of recurrence is high. The main objective of the cardiologist in cases of primary hypertrophic cardiomyopathy is to identify the patient at high risk of sudden death. This requires analysis of several parameters: clinical, anatomical, haemodynamic, rhythmic, functional and genetic. The presence of at least two risk factors for sudden death justifies preventive measures. The implantation of an automatic defibrillator is the most reliable form of treatment