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Despite clinical importance of ventricular repolarisation, it remains difficult to analyse. Conventionally, quantification of the electrocardiographic ventricular repolarization is usually performed with reference to axis of the T wave and QT interval duration. A variety of factors can prolong the QT interval, such as drug effects, electrolyte imbalances, and myocardial ischemia. The biggest risk with prolongation of the QT interval is the development of torsades de pointes. Commonly accepted reference ranges for the electrocardiogram (ECG) have been in use, with little change, for many years. Populations throughout the world present several differences: age, ethnic compositions, and are exposed to different environmental factors. Recent studies have reported reference data for QT interval in healthy population and have evaluated the influence of age, gender, QRS duration and heart rate on this interval. In this review, we address several issues relative to the measurement, and interpretation of QT interval and its adjustment for rate, age, gender and QRS duration.

The introduction of multislice computed tomography angiography (MSCT) has provided new information for percutaneous coronary intervention (PCI), especially in complex lesions. It provides valuable adjustments about coronary lesions, which are predictors of procedural success, for example, in chronic total occlusions, in bifurcations and recently in aorto-ostial lesion PCI. In multiple fields, tomographic coronary analysis facilitates decision making by providing data that is unobtainable from conventional coronary angiography. The aim of this article is to assess the contribution of MSCT in PCI.

Resume Objectif du travail Etudier la correlation du score TIMI avec l’etendue et la severite de l’atteinte coronaire chez des patients explores par coronarographie a la suite d’un syndrome coronarien aigu sans sus-decalage de ST. Patients et methode Etude retrospective des dossiers de 239 patients explores par coronarographie entre 2002 et 2006 a la suite d’un syndrome coronarien aigu sans sus-decalage de ST. Les patients ont ete classes en trois groupes selon la valeur du score TIMI : score TIMI de 0 a 2 (groupe 1 : n = 121), score TIMI de 3 a 4 (groupe 2 : n = 100) et score TIMI de 5 a 7 (groupe 3 : n = 18). Nous avons compare les donnees angiographiques des trois groupes. Resultats Les patients du groupe 1 ont presente plus frequemment des coronaires angiographiquement normales ou une atteinte coronaire non significative que les patients du groupe 2 (36,3 % vs 13 %, p Conclusion Le score TIMI est parfaitement correle a l’etendue et la severite de l’atteinte coronaire chez les patients victimes d’un syndrome coronarien aigu sans sus-decalage de ST.

Resume Objectif de l’etude Analyser le pronostic a court et a moyen terme des syndromes coronariens aigus sans sus decalage de ST chez les diabetiques type 2. Patients et methode Etude retrospective des dossiers de 308 patients hospitalises entre janvier 2002 et decembre 2006 dans le service de cardiologie de l’hopital Sahloul en Tunisie pour un syndrome coronarien aigu sans sus decalage de ST. Il s’agit de 152 patients diabetiques (groupe 1) et 156 patients non diabetiques (groupe 2). Nous avons compare les donnees epidemiologiques, cliniques, angiographiques et therapeutiques des deux groupes. Nous avons analyse le pronostic des deux groupes a court terme (30 j) et a moyen terme (moyenne : 28 mois ; extremes : 12 mois, 72 mois). Resultats La moyenne d’âge a ete comparable entre les deux groupes (60,8 ans). Les patients diabetiques sont plus frequemment de sexe feminin (42,1 % versus 23,1 %) et presentent plus de co-morbidites avec une frequence plus elevee d’hypertension arterielle, de dyslipidemie et d’heredite coronaire. Au contraire, le tabagisme est plus frequent dans le groupe des non diabetiques. Les taux de coronarographie, d’angioplastie coronaire et de pontage aorto-coronaire etaient comparables entre les deux groupes. A court terme, les diabetiques ont ete a plus haut risque de developper une insuffisance ventriculaire gauche (19,1 % versus 6,4 %). Le taux d’evenements cardiaques majeurs etait aussi significativement plus eleve chez les diabetiques (12,5 % versus 5,7 %). Un pronostic plus severe etait retrouve aussi a moyen terme dans la population diabetique avec un taux plus eleve de recidive du syndrome coronarien aigu sans sus decalage de ST (42 % versus 25 %), d’evenements cardiaques majeurs (49,3 % versus 31,6 %) et de nouvelles revascularisations (17,3 % versus 7,2 %). En analyse multivariee par le modele de Cox, le diabete persiste un facteur independamment predictif d’evenements cardiaques majeurs a moyen terme. Conclusion Notre etude confirme le pronostic pejoratif a court et a moyen terme des syndromes coronariens aigus sans sus decalage de ST dans la population des diabetiques type 2.

Aims: To assess whether a strategy of invasive management without stents in selected acute coronary syndrome (ACS) patients with a large thrombus burden (LTB) might be feasible and safe.\ud \ud Methods and results: We performed a prospective non-randomised observational cohort study of invasive treatment decisions guided by optical coherence tomography (OCT) in selected ACS patients with LTB. Among 852 ACS patients who had undergone invasive coronary angiography, 101 (11.8%) patients with large thrombus burden on initial angiography underwent thrombectomy to restore TIMI 3 flow without stenting. All of these patients then had repeat angiography with OCT (days 0-2 [Group 1], days 3-6 [Group 2] or days 7-30 [Group 3]). No adverse events occurred between the initial and second angiograms. Residual thrombus was detected in 68% of patients with OCT (respectively, 94%, 79% and 32% in Group 1, Group 2 and Group 3), and 20% of cases with angiography. Plaque rupture was detected by OCT in 65% of cases. Minimal lumen area was 2.81 mm2, 3.40 mm2 and 4.89 mm2 in Group 1, Group 2 and Group 3, respectively. Sixty-two percent of patients were stented (respectively, 76%, 61% and 50%). During a minimum follow-up period of 12 months in all patients, one non-fatal MI occurred and one PCI was performed for angina.\ud \ud Conclusions: Medical management without stents is safe and feasible in selected ACS patients with LTB. OCT revealed culprit lesion characteristics that were not disclosed by angiography and facilitated treatment decisions.

La cardiomyopathie hypertrophique neonatale est une entite rare, heterogene regroupant plusieurs formes cliniques et donc de diagnostic etiologique difficile. Nous rapportons l�observation d�un nouveau ne issu d�une grossesse gemellaire, ayant presente a la naissance un tableau d�insuffisance cardiaque, l�echocardiographie avait conclut a une cardiomyopathie hypertrophique obstructive. Le bilan etiologique etait negatif notamment une mere non diabetique. L�evolution etait favorable avec regression de l�hypertrophie 2 semaines apres la naissance. L�etiologie finalement suggeree etait une cardiomyopathie secondaire a l�injection antenatale de corticoides dans le but d�accelerer la maturation pulmonaire. L�etablissement par les societes savantes d�un consensus de bilan etiologique minimal standard selon une chronologie bien determinee serait d�un grand apport dans la prise en charge de cette anomalie.

Background Despite successful repair of aortic coarctation (AoC), changes in the left ventricular (LV) regional myocardial function are reported. The aim of this study was to assess the left ventricular systolic function in patients after the successful repair of aortic coarctation using tissue Doppler imaging (TDI) according to the age of aortic coarctation repair. Methods 31 patients (mean age, 12.0 +/− 4.2 years) followed up after a successful chirurgical repair of aortic coarctation (mean follow up, 8,6 ± 7,6 years) were studied by echocardiography. The study population was divided in two groups: patients repaired at age 2 years (Group 1, n = 17) and patients repaired at age > 2 years (group 2, n = 14). The TDI parameters and the conventional echocardiographic indices of the left ventricular systolic function were analyzed and compared between the two groups. Results Standard echocardiographic studies revealed normal global left ventricular (LV) function. The LV dimensions, LV ejection fraction, LV shortening fraction, indexed LV mass did not differ between the examined groups. Among the studied LV filling parameters, peak early (E wave) transmitral flow velocity, as well as deceleration time DT, was similar between the two groups. The Tei index was also not affected by the age at repair of aortic coarctation. Regarding TDI measures, the early diastolic and the systolic velocities on the lateral side of the mitral annulus were significantly higher in group 1 than in group 2 (Sa: 12,7 ± 2,59 cm/s vs 10,6 ± 1,8 cm/s, p = 0,025; Ea : 20,7 ± 3,4 cm/s vs 17,3 ± 4,7 cm/s, p = 0,03). TDI velocities on the septal side of the mitral annulus and on the right ventricle (RV) free wall side of the tricuspid annulus were not different between early (before 2 years) and late (after 2 years) repair of the aortic coarctation. There were no differences of the TDI or conventional parameters between hypertensive and normotensive patients. Conclusion Left ventricular systolic performance in patients after the surgical repair of aortic coarctation reveals tendency to decrease at follow-up in patients repaired at age > 2 years despite a satisfactory results after surgery.

IntroductionCoarctation of the aorta (CoA) is a stenosis usually located in the isthmus of the descending aorta. Treatment consists of surgical or percutaneous removal of the obstruction and may present excellent immediate results. However, despite immediate good results, significant residual problems often persist. The aim of the study is to describe the presentation, treatment and long-term evolution of a population of 48 unselected consecutive patients with CoA in a single pediatric cardiology center.MethodsThis was a retrospective study of all patients with isolated CoA associated or not to either atrial or ventricular septal defects. RESULTS: The patients (n = 48, 56,3% male) were diagnosed at a mean age of 84 ± 109 months. The clinical presentation differed between patients aged less or more than two years, the former presenting with heart failure and the latter being asymptomatic with evidence of hypertension (p < 0.01). Treatment was surgical in all cases (32 end-to-end anastomosis). The mean age of patients was 94 ± 109 months. There was two late deaths, in a mean follow-up of 8,6 ± 7,7 years. Recoarctation occurred in 12 patients (25%). There are patients who currently have hypertension (17 at rest, 2 with effort), their mean age at diagnosis being older than the others (128 vs. 76 months; p < 0.05). Aortic aneurysms occurred in five patients (10,4%). Aneurysm was associated to bicuspid aortic valve in 3 cases.Conclusionsrepaired CoA has a significant incidence of long-term complications, and should thus no longer be seen as a simple obstruction in the descending aorta, but rather as a complex pathology that requires careful follow-up after treatment.

Dual-chamber pacing is believed to have an advantage over single-chamber ventricular pacing. The aim of the study was to determine whether elderly patients with implanted pacemaker for complete atrioventricular block gain significant benefit from dual-chamber (DDD) compared with single-chamber ventricular demand (VVIR).The study was designed as a double-blind randomized two-period crossover study-each pacing mode was maintained for 3 months. Thirty patients (eight men, mean age 76.5 +/- 4.3 years) with implanted PM were submitted to a standard protocol, which included an interview, functional class assessment, quality of life (QoL) questionnaires, 6-minute walk test, and transthoracic echocardiographic examinations. QoL was measured by the SF-36. All these parameters were obtained on DDD mode pacing and VVIR mode pacing. Paired data were compared.QoL was significantly different between the two groups and showed the best values in DDD. Overall, no patient preferred VVIR mode, 18 preferred DDD mode, and 12 expressed no preference. No differences in mean walking distances were observed between patients with single-chamber and dual-chamber pacing. VVI pacing elicited marked decrease in left ventricle ejection fraction and significant enlargement of the left atrium. DDD pacing resulted in significant increase of the peak systolic velocities in lateral mitral annulus and septal mitral annulus. Early diastolic velocities on both sides of mitral annulus did not change.In active elderly patients with complete heart block, DDD pacing is associated with improved quality of life and systolic ventricular function compared with VVI pacing.

Background Time-domain optical coherence tomography (TD-OCT) allows assessment of the anatomy and features of unstable coronary artery lesions, including discrimination between the thrombotic and atherosclerotic plaque components. We sought to investigate the feasibility of thrombus quantification and its monitoring in patients with high thrombotic burden acute coronary syndromes. Methods Patients with successfully revascularized acute coronary syndromes and a large thrombus burden on initial coronary angiography who beneficiated from repeated TD-OCT examinations in our institution were suitable for inclusion. Coronary lesion stenosis degree was determined by quantitative coronary angiography (QCA) methods. Thrombus volume, maximal surface and minimal luminal area (MLA) were quantified by serial area measurement within the athero-thrombotic culprit lesion in 1 mm intervals before any stenting. Results Eleven patients underwent 2 consecutive TD-OCT examinations. The OCT image quality was suitable for thrombus quantification in n=9 subjects (89% men/ age=62.4±5.7y/ 89% STEMI). All patients were under anticoagulant and dual antiplatelet therapy between the two procedures (mean delay: 4.1±0.4 days). No adverse events were observed following OCT analysis. We measured a progressive reduction of thrombus burden between the two analysis, as assessed by the decrease of thrombus volume (5.3±1.7 vs.11.0±3.4 mm3, p=0.004), length (7.4±1.0 vs. 10.9±1.8 mm, p=0.02) and increase of MLA (2.5±0.6 mm2 vs. 1.8±0.3 mm2, p=0.02). However, the degree of stenosis analyzed by QCA didn’t significantly decrease over time (49.7±4.6% vs. 55.7±6.6%, p= 0.15). The thrombus volume reduction was time dependent, as witnessed by the high correlation between the percentage of thrombus volume decrease and the delay between analysis (R=0.87, p=0.002). The observed thrombus volume reduction rate was evaluated to 12% of the initial volume per day under medical therapy. Conclusion TD-OCT assessment of thrombus volume in patients with ACS is feasible, safe and could allow in vivo clot regression monitoring.