Changing echocardiographic features of a hydatid cyst of the heart

A 24 year old woman with pulmonary embolism and a past history of echinococcal disease underwent echocardiography which detected two cysts in the right ventricle which became more solid after treatment with mebendazole. The surgical and pathological findings confirmed the presence of the two cysts and the hydatid nature of the lesion.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pulsed Doppler regurgitant flow patterns of normal valves

Although Doppler echocardiography allows recording of regurgitant turbulent flow patterns in normal persons, sparse information is available concerning the incidence, characteristics and mechanism of these flow patterns. Therefore, pulsed Doppler echocardiograms were recorded in 25 normal persons to detect regurgitation. A regurgitant turbulent flow pattern was recorded at the pulmonic valve in 23 subjects (92%), covered up to 81% of the diastole and could never be recorded in early diastole. An early to midsystolic regurgitant flow pattern was recorded at the mitral valve in 10 subjects (40%) and covered up to 60% of systole. A similar regurgitant flow was recorded at the tricuspid valve in 11 subjects (44%) and was holosystolic in 1 subject. An early diastolic regurgitant flow with low maximal velocities and rapid decrease in velocities was recorded at the aortic valve in 8 subjects (33%) and covered up to 26% of the diastole. In no person could those flows be recorded farther than 1 cm proximal to the valve closure. Whatever the still-debated mechanisms of those regurgitant flow patterns in normal subjects, one should be aware of their existence and characteristics when assessing valvular function by Doppler. © 1986.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

A study of the correlation between Doppler and cross-sectional echocardiography in the determination of the mitral valve area

Fifty-five consecutive adult patients with mitral stenosis (MS) were investigated by Doppler echocardiography, to assess the severity of MS. The measurement of mitral valve area (MVA) by cross-sectional echocardiography (CSE) was considered as the reference method, because catheterization data are often inadequate when combined lesions are present. Doppler MVA was calculated from apical mitral flow using the pressure half-time method. Adequate Doppler recordings (52 on 55) were easier to obtain than adequate CSE images. The correlation between both methods was excellent (r = 0.90, SEE: 0.42 cm2) despite systematic underestimation of MVA by Doppler versus CSE. From our data, the following regression equation could be drawn, providing MVA from Doppler measurements: MVA = 250 (pressure half-time)-1 +0.15, where the area is in cm2 and half-time in ms. Both severe and mild MS were identified by Doppler with enough accuracy for clinical use. Reproducibility, inter and intraobserver variability were better for Doppler than for CSE. We conclude that Doppler seems particularly suitable for noninvasive quantification of MS and for patient follow-up.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Lack of cardiovascular side effects of the new tricyclic antidepressant tianeptine. A double-blind, placebo-controlled study in young healthy volunteers.

In a double-blind, placebo-controlled, crossover study, the effects of therapeutic doses of the new tricyclic antidepressant tianeptine on cardiovascular function were closely monitored in 21 healthy volunteers during a 2-week treatment period. Blood pressure measurements, ECG recording, 24-h Holter monitoring, and echocardiography were carried out at 1-week intervals. Isotopic ventriculography was measured twice under each treatment. Tianeptine did not produce orthostatic hypotension or increase heart rate. No ECG changes could be observed and the cardiac conduction time remained unchanged. One subject presented with an increase in frequency of ventricular premature beats that could not be definitely attributed to the drug. Cardiac output assessed at rest and after a bicycle exercise stress test was not altered. The present study suggests that tianeptine is a tricyclic antidepressant endowed with less cardiac toxicity than classical tricyclic antidepressants.Clinical TrialControlled Clinical TrialJournal Articleinfo:eu-repo/semantics/publishe

Is the use of cholesterol-lowering drugs for the prevention of cardiovascular complications in type 2 diabetics evidence-based? A systematic review.

International audienceCholesterol-lowering drugs are often prescribed to patients with type 2 diabetes mellitus despite uncertainty about the benefits of this treatment in the prevention of cardiovascular complications. We here systematically review (PRISMA guidelines) the results of high-quality double blind trials testing whether cholesterol-lowering drugs (statins and fibrates) reduce mortality and cardiovascular complications specifically in type 2 diabetics. Trials with premature termination without pertinent medical justification or using nonrandomized subgroups of diabetics were excluded from the review. Only four trials met our predefined inclusion criteria. Among the 3 statin trials, CARDS was discontinued 2 years before the anticipated end and in the absence of significant effect on both overall and cardiovascular mortality, suggesting that the trial should not have been prematurely stopped. The two other statin trials showed no significant effect on the primary endpoint (relative risk 0.92, 95% CI 0.77 to 1.10 in 4D and 0.90, 95% CI 0.73 to 1.12 in ASPEN) and on both cardiovascular and overall mortality. Finally, the fibrate trial (FIELD) showed no significant benefit on the primary endpoint (relative risk 0.89, 95% CI 0.75 to 1.05) and mortality (relative risk 1.11, 95% CI 0.95 to 1.29). Because of a huge medical heterogeneity between patients in the selected trials, it was consensually decided to stop the analysis at this stage. This review does not support the use of cholesterol-lowering drugs (such as statin and fibrate) to reduce mortality and cardiovascular complications in type 2 diabetics. Official guidelines should be re-examined and reformulated by experts independent from the pharmaceutical industry

Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy: a critical reappraisal.

International audienceBACKGROUND: Among the recently reported cholesterol-lowering drug trials, the JUPITER (Justification for the Use of Statins in Primary Prevention) trial is unique: it reports a substantial decrease in the risk of cardiovascular diseases among patients without coronary heart disease and with normal or low cholesterol levels. METHODS: Careful review of both results and methods used in the trial and comparison with expected data. RESULTS: The trial was flawed. It was discontinued (according to prespecified rules) after fewer than 2 years of follow-up, with no differences between the 2 groups on the most objective criteria. Clinical data showed a major discrepancy between significant reduction of nonfatal stroke and myocardial infarction but no effect on mortality from stroke and myocardial infarction. Cardiovascular mortality was surprisingly low compared with total mortality-between 5% and 18%-whereas the expected rate would have been close to 40%. Finally, there was a very low case-fatality rate of myocardial infarction, far from the expected number of close to 50%. The possibility that bias entered the trial is particularly concerning because of the strong commercial interest in the study. CONCLUSION: The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors