“Crochetage” (Notch) on R wave in inferior limb leads: A new independent electrocardiographic sign of atrial septal defect

AbstractObjectives. This study sought to determine the clinical significance of a “crochetage” pattern—a notch near the apex of the R wave in electrocardiographic (ECG) inferior limb leads—in secundum atrial septal defect.Background. Atrial septal defect is often overdiagnosed on the basis of classical clinical features. Thus, more specific signs on the ECG for screening are needed.Methods. We searched for a crochetage pattern in 1,560 older children and adults: 532 with secundum atrial septal defect, 266 with ventricular septal defect, 146 with pulmonary stenosis, 110 with mitral stenosis, 47 with cor pulmonale and 459 normal subjects.Results. This pattern was observed respectively in 73.1%, 35.7%, 23.3%, 6.4%, 10.6% and 7.4% of these groups (p < 0.001). In atrial septal defect, its incidence increased with larger anatomic defect (p < 0.0001) or greater left-to-right shunt (p < 0.0001), even in the presence of pulmonary hypertension. By multiple regression analysis, only shunt size (p < 0.0006) and defect location (p < 0.0001) were the determinants of its presence. In all groups, the specificity of this sign for the diagnosis was remarkably high when present in all three inferior limb leads (≥92%), even when comparison was limited to patients with an incomplete right bundle branch block (≥95.2%). Early disappearance of this pattern was observed in 35.1% of the operated-on patients although the right bundle branch block pattern persisted.Conclusions. A crochetage pattern of the R wave in inferior limb leads is frequent in patients with atrial septal defect, correlates with shunt severity and is independent of the right bundle branch block pattern. Sensitivity and specificity of this sign are remarkably high when it is associated with an incomplete right bundle branch block or present in all inferior limb leads

Heart Rate and Risk of Cancer Death in Healthy Men

BACKGROUND: Data from several previous studies examining heart-rate and cardiovascular risk have hinted at a possible relationship between heart-rate and non-cardiac mortality. We thus systematically examined the predictive value of heart-rate variables on the subsequent risk of death from cancer. METHODS: In the Paris Prospective Study I, 6101 asymptomatic French working men aged 42 to 53 years, free of clinically detectable cardiovascular disease and cancer, underwent a standardized graded exercise test between 1967 and 1972. Resting heart-rate, heart-rate increase during exercise, and decrease during recovery were measured. Change in resting heart-rate over 5 years was also available in 5139 men. Mortality including 758 cancer deaths was assessed over the 25 years of follow-up. FINDINGS: There were strong, graded and significant relationships between all heart-rate parameters and subsequent cancer deaths. After adjustment for age and tobacco consumption and, compared with the lowest quartile, those with the highest quartile for resting heart-rate had a relative risk of 2.4 for cancer deaths (95% confidence interval: 1.9-2.9, p<0.0001) This was similar after adjustment for traditional cardiovascular risk factors and was observed for the commonest malignancies (respiratory and gastrointestinal). Similarly, significant relationships with cancer death were observed between poor heart rate increase during exercise, poor decrease during recovery and greater heart-rate increase over time (p<0.0001 for all). INTERPRETATION: Resting and exercise heart rate had consistent, graded and highly significant associations with subsequent cancer mortality in men

Thérapie cellulaire par greffe de myoblastes squelettiques dans l'insuffisance cardiaque ischémique expérimentale

La greffe de myoblastes squelettiques dans le myocarde infarci améliore la fonction globale du ventricule gauche mais un effet contractile direct reste controversé. Matériels et méthodes : Les fonctions globales et régionales du ventriculaire gauche ont été étudiées dans un modèle d'infarctus du myocarde chez la brebis (n=16), avant (T0), à 4 mois (MS) autologues ou de milieu de culture (MC). Le volume télédiastolique (VTD), la fraction d'éjection (FE), le score de cinétique pariétale (SG) et le gradient des vélocité myocardiques (GVM) systolique au sein de la paroi infarci ont été étudiés grâce à l'échocardiogra&phie bidimensionnelle et à l'imagerie Doppler tissulaire myocardique (DTI)...PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Cellular basis of hypocotyl growth in Arabidopsis thaliana

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Postures et savoir-faire pour animer le dialogue territorial

National audienceCet article tente de synthétiser les travaux et les réflexions d'un groupe d'échange de pratiques de Bretagne, constitué dans le cadre du projet "Dialog". Il montre qu'animer le dialogue territorial entre les agriculteurs et les acteurs du territoire nécessite des compétences spécifique

Cellular basis of hypocotyl growth in Arabidopsis thaliana

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