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Recently cardiac peptides have received close attention as cardiovascular markers. Brain (B type) natriuretic peptide is a neurohormone synthesized predominantly in ventricular myocardium. Previous studies have shown that this hormone can provide prognostic information in patients with myocardial infarction. The aim of this review is to evaluate the impact of plasma levels of BNP on prediction of left ventricular ejection fraction and remodelling and major cardiac events after myocardial infarction.

Resume L’aortite syphilitique est une arterite obliterante des vasa-vasorum responsable d’une reponse inflammatoire locale avec developpement de lesions anevrysmales au niveau de la paroi aortique. Cette pathologie, jadis tres frequente, est devenue exceptionnelle de nos jours grâce a la decouverte des antibiotiques. Nous rapportons l’observation d’un patient âge de 65 ans sans antecedents pathologiques notables hospitalise pour dyspnee, toux et gene thoracique. Les differentes explorations radiologiques, echocardiographiques, scanographiques et par resonance magnetique ont montre un anevrysme de l’aorte ascendante etendu jusqu’a la naissance du tronc arteriel brachio-cephalique. L’origine syphilitique a ete retenue devant la positivite des examens serologiques avec un profil de syphilis tertiaire et l’absence d’arguments en faveur d’une autre etiologie. Le patient a beneficie d’un remplacement de l’aorte ascendante par prothese en dacron avec reimplantation du tronc arteriel brachiocephalique, sans incidents. Notre observation a le merite d’attirer l’attention sur cette pathologie devenue exceptionnelle a travers une riche iconographie incluant les outils diagnostiques les plus recents. (J Mal Vasc 2006; 31: 93-97)

Introduction Obstructive sleep apnea (OSA) is associated with several cardio-vascular abnormalities as atrial fibrillation (AF). AF occurrence in OSA increases the risk of stroke which worsens the prognosis of these patients. P wave dispersion (Pd) and maximal P wave duration (P max) are simple electrocardiographic parameters which reflect atrial conduction abnormalities and have been reported to be predictors of atrial fibrillation Aim the aim of this study is to determine the correlation between apnea-hypopnea index (AHI) and P wave dispersion and maximal P wave duration. Methods Forty patients (18 men and 22 women) who were diagnosed with OSA by overnight polysomnography were included in this prospective study. The mean age was 56±10 years old. They were all in sinus rhythm. Before initiating continuous positive airway pressure therapy, we evaluated on a 12 lead ECG P wave duration and P wave dispersion (P max - P min). Results Twenty four patients had severe OSA (AHI >30), 4 had moderate OSA (AHI between 15 and 30) and 12 had a mild OSA (AHI between 5 and 15). Mean P max duration was 119±21 ms. P wave dispersion was 93±6 ms. There was a significant positive correlation between P max and AHI (r= 0.45, p=0.001) and between P wave dispersion and AHI (r=0.42, p=0.001) Conclusion The severity of OSA seems to be correlated with the importance of atrial conduction abnormalities. These results suggest the higher is the AHI the higher is the risk of AF occurrence in OSA. Further studies are needed to validate these results.

Aim Cardiac resynchronization therapy (CRT) is recommended for selected patients with advanced heart failure (HF) despite optimal medical treatment. However, the doses of pharmaceuticals in this population are often limited by adverse effects. We compared the drug regimens of 21 patients before and 6 months after they underwent the implantation CRT systems. Methods We studied 17 men and four women (mean age = 63.4 ± 11 years) presenting in New York Heart Association HF classes III-IV, and with a left ventricular ejection fraction (LVEF) ≤ 35% and cardiac dyssynchrony, who underwent implantation of CRT systems. Results At baseline, 52% of patients were treated with β-adrenergic blockers (β-B), though in optimal doses in only 19%. The introduction of (β-B) was complicated by cardiogenic shock in three patients. At baseline, all patients were treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB), of whom 76% received optimal doses. After 6 months of CRT, β-B were administered to 76% of patients, in optimaklon ACE or ARB but 75% of them were receiving maximal doses. After 6 months of CRT, β blockers have been introduced in 72% of patients and maximal doses have been achieved in 60% of them. Maximal doses of ACE or ARB were reached in 95% of the study population. We noticed that systolic blood pressure was higher after implantation. There was also a significant improvement in functional status and left ventricular ejection fraction compared to baseline. Conclusion CRT is an efficacious adjunctive device therapy to standard medical therapy for patients with heart failure and cardiac dyssynchrony. Its benefits are in addition to those afforded by standard pharmacological therapy. Achieving maximal doses of medical treatment and the possibility of introducing β blockers after CRT prove that CRT and pharmacological treatment are complementary strategies and should not be considered as competitive.

Hydatic pulmonary embolism: complication of a cardiac hydatic cyst:a case report hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% of all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardiography and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up. This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur.

Heart failure is a major problem of public health, it represents a frequent status among patients with heart disease, and its implications in term of mortality and cost are high. Non Pharmacological treatment of heart failure most commonly designed as cardiac resynchronization therapy (CRT) has demonstrate efficacy to improve functional class, exertion capacity, left ventricular ejection fraction, reduction of mitral regurgitation, and probably mortality at midterm. The most recent studies emphasize on the role of implantable cardioverter defibrillate or (ICD) combined with CRT to reduce mortality. More trials are needed to valid this concept.

Introduction Several studies proved that obstructive sleep apnea (OSA) is associated with cardio-vascular diseases such as cardiac arrhythmia. QT duration and dispersion reflect the heterogeinity of ventricular repolarization and are considered as precursors of ventricular arrhythmia Aim The aim of this study is to assess the relation between the severity of OSA parameters as apnea hypopnea index and QT intervals. Methods Forty patients (18 men and 22 women) who were diagnosed with OSA by overnight polysomnography were included in this prospective study. The mean age was 56±10 years old. They were all in sinus rhythm. Before initiating continuous positive airway pressure therapy, we calculated on a 12 lead ECG : QT duration (QTend) corrected to Bazett formula and QT dispersion (QT end max -QT end min). Results Twenty four patients had severe OSA (AHI >30), 4 had moderate OSA (AHI between 15 and 30) and 12 had a mild OSA (AHI between 5 and 15). There was a significant positive correlation between QT dispersion and AHI (r=0.48, p=0.001) Conclusion The severity of OSA seems to be correlated with ventricular repolarization heterogeinity These results suggest that the higher is the AHI the higher is the risk of ventricular arrhythmia occurence. Further studies are needed to validate these results.

Inflammation has been shown to play an important role in the pathogenesis of unstable angina. CRP has been demonstrated to be a reliable marker of prognosis is unstable angina. The aim of this study was to investigate the prognostic value of CRP in assessing short outcome of unstable angina. Our study is a prospective double blinded one. We measured CRP in 33 consecutive patients admitted for unstable angina at the 24th and 48th hour. The mean age is 60 years (30 to 84 years). There were 22 men and 11 women. 8 patients were included in class I of Braunwald classification, 5 were in class II and 20 in class III. 14 patients presented cardiac events. The CRP mean value was significantly higher among these patients (12 mg/l vs 5 mg/l, p10.4). Patients having a CRPor = 3 mg/l have a higher risk of developing complications (66% vs 13%, p = 0.002). Elevation of CRP predicted poor outcome of intrahospital evolution with a sensitivity of 86%, a specificity 68%, a positive and negative predictive values of 66% and 86%. The CRP in our preliminary study is an independent risk factor of early outcome of unstable angina. In association with clinical scores and other cardiac markers will lead to a better identification of high risk patients.