094: Contribution of cardiac MRI to early evaluation and impact on the long term follow-up in myocarditis mimicking an acute coronary syndrome. A 43-cases prospective study

BackgroundAcute myocarditis (AM) diagnosis is a challenge to rule out an acute coronary syndrome (ACS). AM is thought to favour the evolution towards dilated cardiomyopathy (DCM) and the occurrence of severe arrhythmias. Three months after the acute episode, re-evaluation including cardiac MRI could help to identify patients at risk for unfavourable evolution. The use of MRI has rarely been investigated in AM prognosis stratification.Method and resultswe report a prospective series of 43 consecutive patients hospitalized for AM mimicking ACS: 36 men and 7 women, 32 years old on average, without sign of heart failure. All patients presented with troponine I elevation. Echocardiography showed moderate global left ventricular dysfunction in 6 cases and segmental wall motion abnormalities in 22. MRI performed early after admission never showed myocardial first-pass perfusion defect after gadolinium injection but subepicardial delayed-enhancement (DE) areas in 39 cases mainly located in lateral segments. Three months after the acute episode, no patient was symptomatic. Echocardiography, Holter monitoring and biological check-up were normal. MRI showed the persistence of DE in 23 cases without wall motion abnormality in the affected segments. The presence of these latter abnormalities led to effect an annually clinical examination with an ECG. One patient was lost at further follow-up. Among the other 22 patients, only one patient dysplayed heart failure revealing DCM with ventricular arrhythmias at 3 - year mean follow-up.Conclusionsat the time of admission, the absence of early perfusion defect at cardiac MRI after gadolinium injection and the subepicardial localization of the DE constitute reliable criteria in favour of AM diagnosis, allowing to rule out ACS. During the follow-up the persistence of a DE does not allow any prognosis stratification. In our series after a mean 3-year follow-up, it is not associated with any clinical and para-clinical disorder except in one case

Diagnostic échographique du souffle systolique de l adulte jeune (à propos de 280 cas)

Le souffle systolique cardiaque, anomalie fréquente de l'auscultation, se définit en souffle systolique "innocent" sans anomalie cardiaque sous-jacente ou en souffle systolique "organique" lié à une cardiopathie. Depuis 2008, la strategie de l HlA Brest était d effectuer une échocardiographie ansthoracique (ETT) sur prescription d un médecin militaire devant un souffle systolique. L objectif de cette étude est d évaluer la prévalence des cardiopathies responsables de souftle systolique chez l'adulte jeune. Il s agit d une étude monocentrique retrospective réalisée de janvier 2008 à juillet 2011 sur les compte-rendus d ETT effectuées a l HIA de Brest. 280 patients âgés de moins de 30 ans, (23+/-3,5 ans) porteurs d un souffle systolique ont été inclus. 81 (28,9%) présentaient un souffle systolique organique révélateur d une cardiopathie et 199 (71%) présentaient un souffle systolique innocent. Parmi les souffles systoliques organique, 51 (62,9%) présentaient une insuffisance mitral (IM), un prolapsus de la valve mitrale et une dystrophie myxoïde de la valve mitrale; 13 (16,0%) un bicuspidie aortique avec et sans fuite; 6 (7,4%) une CIV dont 4 (66%) périmembraneuses et 2 (33%) musculaires; 6 (6,4%) une insuffisance tricuspidienne grade 1 à 2; 3 (3,7%) une communication inter-auriculaire; 1 (1,2%) un rétrécissement aortique sous-valvulaire et 1(1,2%) une sténose pulmonaire. En conclusion, 11 (3,9%) patients étaient déclarés "inapte à l'engagement" ou "apte avec restrictions d'activité". L ETT est donc indispensable dans le diagnostic étiologique du souflle systolique de l adulte jeune. Au vue des pressions exercées sur le médecin d unité pour donner une réponse rapide sur l aptitude, l absence de passage par une consultation specialisee avant l'ETT semblait justifiée.BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Douleur thoracique aiguë en haute mer et évacuation médicale héliportée (expérience du service de santé des armées des missions "SAR" à partir de la base aéronavale de Lanveoc-Poulmic)

Après un rappel sur la réglementation et l'organisation propre au secours en mer, l'auteur présente les résultats d'une étude rétrospective sur l'épidémiologie des douleurs thoraciques prises en charge par moyen héliporté à partir du site de Lanvéoc-Poulmic. La douleur thoracique est la première d'évacuation médicalisée pour étiologie médicale prise en charge par l'équipage SAR de Lanvéoc-Poulmic. Les des patients sont des marins de métier, et présentent d'importants facteurs de risques cardiovasculaires. Si le syndrome coronarien aigu est la pathologie la plus fréquemment rencontrée, le diagnostic d'une douleur thoracique prise en charge en milieu hauturier n'est pas chose aisée. Les conditions météorologiques, aéronautiques et la gravité des patients (56% des patients présentent un pronostic vital engagé) sont à l'origine d'une difficulté diagnostique majeure. Cette réflexion a permis de proposer un organigramme de prise en charge des douleurs thoraciques en milieu hauturier s'articulant autour de l'électrocardiogramme et du monitorage du patient.BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Apport de l'échographie transthoracique, transoesophagienne et du holter ECG à titre systématique dans le bilan étiologique des accidents vasculaires cérébraux ischémiques et des accidents ischémiques transitoires (Etude observationnelle rétrospective à l'HIA de Brest)

L'auteur décrit les connaissances en 2011 sur les cardiopathies potentiellement emboligénes dans le bilan étiologique des accidents vasculaires cérébraux ischémiques (ACVi ) et accidents ischémiques transitoires (AIT). Il réalise une étude rétrospective sur 220 patients de Hôpital d'Instruction des Armées de Brest hospitalisés en neurologie entre le 01 janvier 2007 et le 31 décembre 2010. L'objectif principal est d'estimer l'apport du bilan étiologique systématique à la recherche de cardiopathie emboligène comprenant l'association d'une échographie transthoracique, transoesophagienne et d'un holter ECG. Il montre un gain de sensibilité dans le dépistage des cardiopathies majeures par la réalisation systématique chez tous les patients d'un holter ECG. Il souligne également que le profil à risque cardiovasculaire avant l'évènement neurologique des patients porteurs de cardiopathies emboligènes est le même que les patients indemnes de cardiopathies.Il discute ses résultats par rapport aux études comparables de la littérature. Enfin, il confronte ses résultats aux recommandations partiellement concordantes des sociétés savantes de neurologie, de cardiologie et d'échographie.BREST-BU Médecine-Odontologie (290192102) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Conciliation médicamenteuse à l’admission des patients à l’hôpital : quelle place pour le dossier pharmaceutique ?

International audienc

Cardiovascular disease in patients with spondyloarthropathies.

International audienceSpondyloarthropathies are associated with a greater cardiovascular risk than expected based on the cardiac lesions known to occur in these diseases. The prevalence of several conventional risk factors is high in spondyloarthropathy patients, and chronic inflammation also contributes to premature plaque formation. In addition, susceptibility genes for spondyloarthropathies may be associated with an increased risk of cardiovascular disease. Finally, several drugs used to treat spondyloarthropathies may contribute to the occurrence of cardiovascular events. A careful evaluation of the cardiovascular risk profile is a key component of the management of patients with spondyloarthropathies

Multi-slice computer tomography of left ventricular function with automated analysis software in comparison with conventional ventriculography.

International audiencePURPOSE: To evaluate the accuracy of left ventricular volumetric and functional parameters from multi-slice computed tomography using automated analysis software, and to correlate results with those of invasive left ventriculography. MATERIALS AND METHODS: In 145 consecutive patients (mean age, 61 years+/-12) known or suspected to have coronary artery disease, a 16-channel multi-slice computed tomography (Philips Mx8000 IDT 16) was performed using a standard technique. Using short-axis secondary multi-slice computed tomography reformations, we determined end-diastolic and end-systolic left ventricular volumes and ejection fraction with a commercially available analysis software capable of automated contour detection. Conventional left ventriculography was performed according to standard techniques within the following 24 h. Bland-Altman analysis was performed to calculate the limits of agreement and systematic errors between multi-slice computed tomography and conventional left ventriculography. RESULTS: As determined by computer tomography, mean end-systolic (53+/-29 mL) left ventricular volumes had an acceptable correlation with conventional ventriculography (67+/-50 mL; r=0.74; p<0.001) and mean end-diastolic (119+/-33 mL) left ventricular volumes a poor correlation with conventional ventriculography measurements (154+/-69 mL; r=0.41). Left ventricular ejection fraction (57%+/-14 versus 55%+/-14 for conventional ventriculography; r=0.79) showed a very good correlation (p<0.001). Bland-Altman analysis showed acceptable limits of agreement (+/-9.2% for ejection fraction) without systematic errors. CONCLUSION: The use of a multi-slice computed tomography with an automatic calculation software has a good correlation with conventional ventriculography findings and could accurately assess left ventricular function, but should not be used for ventricular volumes, because of biased estimations

Accuracy of 16-detector multislice spiral computed tomography in the initial evaluation of dilated cardiomyopathy.

International audienceBACKGROUND: Multislice Computed Tomography (MSCT) recently proved its accuracy in the detection of coronary artery disease (CAD). It can also give information about left ventricular function and venous network anatomy. We here sought to validate a MSCT-based strategy in the initial evaluation of patients with dilated cardiomyopathy (DCM). METHODS: 36 patients with DCM underwent cardiac MSCT before conventional coronary angiography with ventriculography. We analysed arterial calcium score (Agatston score equivalent: ASE), coronary stenosis, left ventricular parameters and venous network. RESULTS: The sensitivity of a MSCT-based strategy in detecting significant CAD was 100% and the specificity 80%. The positive and negative predictive values were respectively 67% and 100%. For ASE or =1000, MSCT enabled conventional angiography to be avoided in only 2/9 patients (22.2%). The ventricle was assessable in 83.4% (30 patients) on MSCT. Correlation coefficient Rs with ventriculography were 0.78 (p1.000, conventional coronary angiography is mandatory due to MSCT's poor interest in such cases; when ASE <1.000, a contrast-enhanced MSCT may, when normal, replace coronary angiography

[Systematic implementation of transthoracic echocardiography, transesophageal echocardiography and 24-hour Holter ECG for the detection of cardiac sources of embolism in patients with stroke or transient ischemic attack. A retrospective study of 220 patients.]

International audienceINTRODUCTION: Embolism of cardiac origin accounts for around 20% of ischemic strokes. ECG and transthoracic echocardiography (TTE) are commonly obtained during the evaluation of patient of ischemic stroke but specific indications for the transesophageal (TEE) echocardiography and 24-hour Holter ECG (Holter) remain uncertain. OBJECTIVES: The aim of this study is to report the contribution of TTE, TEE and Holter performed as a routine during the evaluation of patients with ischemic stroke (IS) or transient ischemic attack (TIA). METHODS: This is a retrospective single-center study of 220 patients hospitalized between 1st January 2007 and 31st December 2010 for a first IS or TIA. RESULTS: One hundred and forty-three IS and 77 TIA are identified. The average age of patients was 66 years (18-88 years). TTE/TEE/24-hour Holter allowed the diagnosis of cardiac sources of embolism in 135 patents (61.3%). TTE/TEE identified potential source of cardiogenic embolism in 126 patients (52.2%). Twenty four-hour Holter ECG tracked supraventricular arrhythmia in 15 patients (6.7%), 9 (4%) which had non-contributory ultrasound assessment. CONCLUSION: The systematic implementation of TTE/TEE/Holter is useful for identifying potential sources of cardiogenic embolism. The performance of TEE remains above the TTE. Holter should be recommended because it is a cost effective and non-invasive tool

Evolution of Early Repolarization Patterns after 5 Years in a Military Population at Low Cardiovascular Risk and Practical Implications in Military Medical Expertise

International audienc