Freedom in the chest.

Pericardial agenesis is a rarely seen congenital defect characterised by the partial or, more rarely complete, absence of the pericardium. Most often asymptomatic, it is usually incidentally discovered following the demonstration of heart's laevorotation on imaging, in the operating room or at autopsy. In this article, we report the case of an 80-year-old patient with asymptomatic complete pericardial agenesis fortuitous discovered. Pericardial agenesis observations are extremely uncommon reported in the literature, which substantiate its original epidemiological character. In addition, this observation brings some clinical, electrical as well as iconographic elements to better understand the pathology and raises clinical suspicions. Finally, this case report confirms the exceptionally symptomatic nature of the pathology, illustrating the irrelevance of treatment or specific follow-up

LES DEFIS ACTUELS ET A VENIR POUR REDUIRE LA MORTALITE CARDIOVASCULAIRE

peer reviewe

Left ventricular non-compaction : diagnosis and management

peer reviewedIsolated left ventricular non-compaction (LVNC) is a congenital disorder characterized by prominent myocardial trabeculations and deep intertrabecular recesses. Although LVNC is diagnosed by echocardiography and cardiac magnetic resonance, there is no evidence-based imaging diagnostic criteria. Affected individuals are at risk of left ventricular failure, life-threatening arrhythmias and cardio-embolism. The diagnosis may be difficult in the atypical forms. The management remains controversial and depends on the clinical manifestations. Familial forms exist, ordering for genetic counseling. The aim of this article is to optimize the knowledge and the management of LVNC by reminding the diagnostic criteria used

Cardiovascular effects of alcohol consumption

peer reviewedAlcohol consumption is a serious problem in terms of public health because it remains a major cause of illness and premature death. The effects of alcohol on cardiovascular system are particularly complex. Current data report both favourable and adverse effects depending on the level of consumption, the type of alcohol consumed and the pathology considered. The goal of this review is to describe the spectrum of cardiovascular events associated with alcohol consumption

Cardiogenic shock : etiology and management

peer reviewedCardiogenic shock is one of the four types of circulatory shock (cardiogenic, distributive, hypovolemic and obstructive). It is a serious complication associated with a hypoperfusion state of terminal organs and possible multivisceral failures, with a high mortality rate of nearly 50 %. It is secondary to an acute myocardial infarction in 8 out of 10 cases but only complicates it in 5 to 10 %. It is more frequently encountered in pluri-troncular coronary diseases. Coronary revascularization and supportive care are the main treatments

The PARAGON-HF trial

peer reviewedThe > (PARAGON HF) trial is a multicenter, randomized, double-blind study comparing the incidence of heart failure hospitalization and cardiovascular mortality in patients with heart failure with preserved ejection fraction (HFpEF) treated with sacubitril/valsartan (Entresto(R)) versus valsartan alone. After a median follow-up of 35 months, the primary endpoint was reduced by 13 % in the sacubitril/valsartan group compared to the valsartan group (relative risk: 0.87, 95 % IC: 0.753-1.005, p = 0.058). Despite this lack of significance, the incidence of hospitalizations for heart failure was reduced (RR 0.85, 95 % CI: 0.72-1.00), whereas no benefit was observed on cardiovascular mortality. A subgroup analysis suggested that women and patients with an intermediate ejection fraction could get more benefit from the treatment. Concerning secondary criteria, a significant improvement in quality of life and in heart failure symptoms was observed in the group sacubitril/valsartan. There was a greater incidence of arterial hypotension and angioneurotic edema, but a lower incidence of hyperkalemia in the group sacubitril/valsartan

Serial heart rate measurement and mortality after acute heart failure.

AIM: Heart failure (HF) poses a unique medical burden of high morbidity and mortality. Elevated resting heart rate (HR) is associated with worse outcomes in chronic HF, but little is known about the prognostic impact of serial HR measurement during hospital stay after acute HF. We examined the association between HR obtained at admission at Day 4 and at discharge and long-term mortality in a cohort of 672 patients discharge from hospital after management of acute HF. METHODS AND RESULTS: All patients examined were in sinus rhythm. HR was derived from electrocardiogram and was defined as the first reported HR in the medical record. At 1 year follow up, 60 patients died. Median HR was 86 +/- 17 b.p.m. (first tertile: 75 b.p.m., third tertile: 97 b.p.m.) at admission, 76 +/- 14 b.p.m. (first tertile: 67 b.p.m., third tertile 85 b.p.m.) at Day 4, and 72 +/- 11 b.p.m. (first tertile: 64 b.p.m., third tertile 80 b.p.m.) at discharge. Patients who died were significantly older (75 +/- 11 vs. 71 +/- 12 years; P = 0.027), had more frequently a history of ischemic cardiomyopathy (n = 34/60, P = 0.012) and of chronic obstructive pulmonary disease (n = 26/60, P = 0.027), had higher admission N terminal pro brain natriuretic peptide (14 572 +/- 21 600 vs. 7647 +/- 7964 pg/ml; P = 0.027), had lower systolic and diastolic blood pressures (P 85 b.p.m. at Day 4 (P 80 b.p.m. at discharge (P < 0.0001). In the multivariable model that included the third tertile at Day 4 and discharge HR and adjusted for all other significant covariates, haemoglobin (P = 0.019), and HR at Day 4 (P = 0.023) were independently associated with 1 year mortality. When only discharge HR was included haemoglobin (P = 0.0004) and HR at discharge (P = 0.00053) remained independently associated with 1 year mortality. CONCLUSIONS: In patients surviving the acute HF phase, a high HR at Day 4, and at a lesser degree at discharge, but not at admission, is a strong predictor of 1 year mortality

Natriuretic peptides in heart failure

peer reviewedThe diagnosis of heart failure can sometimes be challenging for the clinician because presentation circumstances and heart failure phenotypes are varied. The identification and validation of sensitive and specific biomarkers for this condition are still a subject of intensive research. Among them, natriuretic peptides (ANP, BNP, NTproBNP) are widely used and validated as markers of heart failure. Their appropriate use and correct interpretation, however, require knowledge of their indications, specificities and limitations. The European Society of Cardiology has recently issued recommendations in this regard. This article summarizes them in order to facilitate the understanding and the use of natriuretic peptides in clinical practice. It also discusses their use in the etiological diagnosis of pleural effusions caused by heart failure