Archives des maladies du coeur et des vaisseaux最新文献

Lifestyle changes form the basis of the therapeutic management of dyslipidemia associated with abdominal obesity and other risk factors associated with an excess of visceral adipose tissue. The use of lipid-lowering agents is justified if the therapeutic objectives are not attained by lifestyle changes alone. New therapeutic approaches are aimed directly at the excess visceral adipose tissue, and the CB1 receptor blockers are particularly promising for improving the overall lipid profile for patients with abdominal obesity.

Non-coronary interventional cardiology has for about ten years been undergoing significant development, with the arrival of new percutaneous procedures in various domains. Some of them have already been well validated, notably percutaneous mitral comissurotomy, percutaneous closure of inter-atrial (IA) communications and patent foramen ovale, trans-septal catheterisation, and alcohol septal ablation of hypertrophic obstructive cardiomyopathy. Other interventional techniques are still in the validation phase, such as the techniques for percutaneous occlusion of the left atrium, percutaneous implantation of valvular prostheses, or the new approaches to percutaneous treatment of mitral valvulopathy. The rapid development of these techniques has benefited widely from the use of echocardiography in the catheter suite, providing a very precise clarification of the anatomy and continuous guidance during procedures. This echocardiographic guidance provides optimal results for the interventional procedure and reduces the incidence of complications.

Biventricular resynchronisation is accepted as an effective alternative treatment for patients with refractory dilated cardiomyopathy. Based on the presence of ventricular asynchrony, the objective of this technique is to restore homogenous contraction of the myocardial walls. The electrocardiographic criteria for selecting patients only generates a response rate in the order of 70%. Echocardiography has been suggested as another tool for evaluating asynchrony, but there is much confusion in the application of the different criteria. Here we propose an approach based on an understanding of the complexity of myocardial contraction in order to integrate the different echocardiographic parameters in a logical overall evaluation of asynchrony. However, the role of echography does not end with pre-implantation evaluation alone. The follow up of resynchronised patients can effectively benefit from all the opportunities of functional, morphological and hemodynamic investigation, that ultrasound provides. From confirmation of the efficacy of resynchronisation to optimising the pacemaker, the applications of echographic investigation in this field are widespread.

The dyslipidemia classically associated with abdominal obesity is characterised by a metabolic atherogenic triad including an elevation of triglycerides, a low HDL-cholesterol and an excess of small dense LDL fractions. All of these lipid anomalies contribute to an increased cardio-metabolic risk, and are engendered by an excess of visceral adipose tissue. This excess adipose tissue seems to be the direct origin of the dyslipidemia associated with abdominal obesity, causing more free fatty acids to flow into the liver and contributing to insulin resistance.

The objective of this article is to clarify the advantages and limits of echocardiography, MRI, and CT for the determination of left ventricular (LV) function, emphasising the importance of evaluating global ventricular function. MRI is the reference technique, owing to its precision, reproducibility, and innocuous nature. However, echography is performed much more frequently because it is more widely available and easier to carry out. It is our reference technique in everyday practice. More recently, synchronised multi-slice tomodensitometry has provided dynamic reconstructed images of the left ventricle throughout the cardiac cycle, offering a succession of short axis views covering the entire volume of the ventricle. These acquisitions, in addition to non-invasive coronary angiography, allow the LV ejection fraction to be determined. With MRI, study of the LV function does not require any contrast medium to be injected and makes use of effective semi-automatic segmentation programs.