The authors present the case of a patient who developed left bundle branch block with asynchrony of left ventricular contraction and, secondarily, a dilated hypokinetic cardiomyopathy. There were no signs of an ischaemic, toxic or inflammatory cause for the cardiomyopathy whereas cardiac resynchronisation by biventricular stimulation rapidly restored a normal left ventricular ejection fraction. This suggests that asynchrony of left ventricular contraction is not necessarily the consequence of a dilated hypokinetic cardiomyopathy but it may also be considered as a possible cause.

We report a case of Williams and Beuren syndrome in which the obstruction of the pulmonary vascular bed, linked with peripheral stenoses of the pulmonary arteries, associated here with an interventricular communication, was aggravated due to the coexistence of in situ thrombotic disease, leading to a progressive hypoxaemia, requiring long-term anticoagulant treatment, and compromising the long-term prognosis. This case report puts into question the so-called favourable prognosis of pulmonary arterial branch stenoses in this malformation syndrome.

We report two cases of celiac disease (CD) presented as an idiopathic dilated cardiomyopathy in association with a complete heart block in one patient, without digestive manifestation. The diagnosis of CD was obtained by both positivity of antiendomysial antibodies (AEA) and identification of the characteristic duodenal endoscopic and histological findings. Gluten-free diet improved the cardiac function in one patient but it had no effect on atrioventricular conduction in this same patient. These cases highlight the possible cardiac involvement in celiac disease and the relevance of antiendomysial and antigliadin antibodies test in case of rhythm disturbances and cardiomyopathies of unknown etiology. The effect of gluten free diet on cardiac performance was described.

The RV is the dominant ventricle during fetal life. Postnatally, the RV rapidly loses its ability to sustain systemic load. In several forms of congenital heart disease, the RV is the dominant or systemic ventricle. Patients with these lesions often develop progressive RV dysfunction over time. This may be related to differences in morphology, genetic profile and hemodynamic exposure between the LV and RV. This review explores the evolutionary and developmental differences between the LV and RV, the molecular basis of these differences and the potential impact of these differences on long term RV adaptation and function in heart disease.

Because of a limited capacity for cell regeneration, the cardiac tissue, when submitted to ischemic stress, may activate endogenous mechanisms of cell survival resulting in physiological conditions of adaptation to ischemia, known as myocardial stunning, ischemic preconditioning and myocardial hibernation. These conditions result from a switch in gene and protein expression, which sustains cardiac cell survival in a context of oxygen deprivation and during the stress of reperfusion. Understanding how the molecular adaptation of the cardiac myocyte during stress sustains its survival in these conditions might help to define novel mechanisms of endogenous myocardial salvage, in order to expand the conditions of maintained cellular viability and functional salvage of the ischemic myocardium. This review summarizes recent progress made in the study of the molecular pathways controlling reversible ischemic dysfunction, and the unraveling of novel genomic paradigms. We also focus on the discovery and characterization of novel genes, which further increase our knowledge of myocardial ischemia and open novel therapeutic possibilities for ischemic heart disease.

Numerous epidemiological studies indicate that a moderate intake of alcohol is associated with a reduced risk of morbidity and mortality secondary to cardiovascular diseases. Alcohol intake from any type of alcoholic beverage appears beneficial, but red wine seems to confer additional health benefits because of the presence of red wine polyphenolic compounds (RWPC). On the basis of clinical and experimental data, the favourable effect of moderate intake of alcohol results to its action on lipid profile, hemostatic parameters, and reduction of inflammation markers. RWPC exert numerous effects including antioxidant and free radical properties, anti-aggregatory platelet and anti-thrombotic activities. Moreover, RWPC are powerful vasodilators and contribute to the preservation of the integrity of the endothelium and inhibition of smooth muscle cell proliferation and migration. All these effects of red wine might interfere with atherosclerotic plaque development and stability, vascular thrombosis and occlusion. Although, red wine might be of therapeutic benefit in cardiovascular diseases, prospective controlled clinical studies are still lacking.

The object of this enquiry was to estimate the number of self monitoring devices for blood pressure measurement in Guadeloupe in 2005 and to determine how they were used. The enquiry included 509 patients aged over 35 years and living in Guadeloupe meeting the inclusion criteria of PRETRAHGUAD: PREvalence et TRAitement de Hypertension en GUADeloupe. The enquiry was made by Qualistat, a survey institute. Designed as a survey, it was based on the two degree quota method. It was carried out by telephone by CATI (Computer Assisted Telephone Inquiry) networked computer programming by ten operators trained by experts of the HTA-GWAD organisation. In addition to questions on socio-demographic background and biometric parameters, the operators also asked about observance of antihypertensive treatment, the ownership of a self monitoring blood pressure device and its usage. A subject who said he took a treatment validated as antihypertensive was considered to be a "treated hypertensive". The results indicate that in 2005, in Guadeloupe, 32% of the population over 35 years of age were treated hypertensives, making a total of 51,230 individuals. Forty three percent of treated hypertensives and 19% of other subjects admitted to having used a self monitoring blood pressure device. Twenty six percent of the study population owned a device. Of the estimated total of 43,220 devices in circulation, nearly half of them were wrist devices. Regular usage (at least once per month) was declared by 73% of hypertensive and 46% of other subjects. Out of the total population, the medical practitioner had spoken of self monitoring of blood pressure to his patients and had incited only 18% to carry it out. The authors conclude that, in 2005, one third of adults over 35 years of age were treated for hypertension and 43% of treated hypertensives owned a self monitoring blood pressure device. The incitation by medical practitioners to use this method of self monitoring remained modest. This technique would seem to be little used by medical practitioners although the patients have started to equip themselves with the device.

The endovascular treatment of aorta diseases with S-Graft is considered as an alternative to surgery, especially interesting in patients with severe comorbidities. Indeed, the mid-term morbidity and mortality are comparable to surgery in relatively large series, and S-Graft implantation appeared as a safe, less invasive and efficient treatment for different affections of the thoracic aorta. This article reviews technical aspects, indications and results of endovascular repairs of thoracic aorta lesions. We will also assess the advantages and limitations of S-Graft therapy.

Low molecular weight heparin (LMWH) are obtained through chemical or enzyme depolymerisation of unfractioned heparins (UFH). LMWHs present several advantages over UFH: they exhibit a smaller interindividual variability of the anticoagulant effect, they have a greater bioavailability, a longer plasma half-life and do not require monitoring of the anticoagulant effect. LMWH have restrictive indications in AF patients, cardioversion (II level C and TEE for ACC/AHA/ESC and 2C for ACCP guidelines) or use as a bridge therapy (IIB, level C for ACC/AHA/ESC). The ACE study (Anticoagulation for cardioversion using enoxaparin), showed a reduction, though not statistically significant, of 42% of the composite end point (embolic event, major bleeding and death) 2.8% under enoxaparin vs. 4.8 % under conventional treatment, relative risk 0.58, CI 95% 0.23-1.46). Other studies, using dalteparin, confirmed that an anticoagulant treatment using LMWH followed by warfarin was at least as good as conventional management. ACUTE II (Assessment of cardioversion using transesophageal echochardiography), a randomized multicenter trial, compared the efficacy and tolerance of enoxaparin (1 mg/kg every 12 hours) and UFH in 155 patients eligible for a TEE-guided cardioversion. These patients were administered LMWH or UFH for 24 hours before TEE or cardioversion. There were no significative differences regarding the incidence of the study end points, in particular stroke and bleeding, and no death occurred. HAEST (Heparin in acute embolic stroke trial), a randomized, placebo-controlled, double blind trial failed to show the LMWH superiority over aspirin in patients with acute ischemic stroke and atrial fibrillation. Finally, LMWH have been proposed as a bridge therapy in patients under chronic VKA prior to surgery or invasive procedures. This strategy resulted in a low rate of thromboembolic events and major bleedings.

Cachexia is related to a malnutrition state related to hypercatabolism. Initially described in cancer, it is also related to several chronic diseases including heart failure. Defined by an unintentional weight loss exceeding 7.5% of body mass during more than 6 months, it is presented by the association of nutritional deficiencies, digestive and/or urinary losses as well as metabolic abnormalities causing fat and lean mass loss and is associated to a poor prognosis. The pathophysiology of cachexia and heart failure presented some similarities associating especially neuro-hormonal activation, a cortisol/DHEA ratio imbalance, as well as pro-inflammatory cytokines activation. Currently the treatment of cachexia is mainly preventive, based on ACE-inhibitors and beta-blockers therapy and physical reconditioning. The benefits of hormonal and nutritional substitutes remains to be evidenced.

The object of this study was to compare the management of uncontrolled hypertensives (BP > 140/90 mmHg) by general practitioners with respect to the presence or absence of overweight (BMI > or =25 Kg/m2). A 2/1 stratification allowed comparison of 4080 patients who were overweight and 1951 patients with a normal body weight (normal BMI < 25 Kg/m2). The BP of patients who were overweight (> or =25 Kg/m2) was slightly higher than those with a normal BMI (161 +/- 12 mmHg vs. 159 +/- 12 mmHg, p < 0.001). The presence of a metabolic syndrome (43% vs. 7%, ATPIII criteria) was, logically, commoner in the patients overweight. However, the practitioners only recognised the presence of a metabolic syndrome in 65% of the overweight patients (28% true positives and 37% true negatives). The practitioners fixed their target value of systolic BP at 136.5 +/- 5.6 mmHg, in accordance with the recent recommendations of the Health Authorities. The targets were judged to be difficult to obtain in 18% of the overweight group and in 5% of patients with normal body weights. This optimism contrasted with the prescriptions, especially in the overweight patients, 46% of whom were treated by monotherapy and who remained for 44% on monotherapy at the end of the consultation. This descriptive study confirms the lack of awareness of the metabolic syndrome in overweight patients and identifies barriers to effective management of the hypertension of these high risk patients.

The posterior mitral leaflet is usually motionless following mitral valve repair. The aim of this study was to assess (1) the geometric changes of the left ventricular base following prosthetic ring annuloplasty and (2) their impact on the anterior mitral leaflet (AML) mobility. Thirty five patients operated upon for mitral valve repair underwent an intraoperative transesophageal echographic study before and after annuloplasty. A posterior leaflet resection was achieved in 29 cases and ring annuloplasty alone in 6 cases. No repair technique was performed on the AML. Four parameters were assessed: the anteroposterior mitral annulus diameter, the aortomitral angle, the opening and closure angles of the AML. Annuloplasty resulted in a drastic reduction of the mitral annulus from 36.8 +/- 5.6 mm to 20.9 +/- 3.8 mm (systole, long axis view) (p < 0.0001). The aortomitral angle decreased following annuloplasty from 115.1 +/- 8.3 to 108.0 +/- 9.60 (systole, long axis view) (p < 0.0001). No difference was observed between systolic and diastolic measurments concerning the mitral annulus or the aortomitral angle. The opening angle of the AML remained unchanged whereas the closure angle increased from 17.8 +/- 6.10 to 26.6 +/- 6.70 (long axis view) (p = 0.0001) resulting in a displacement of the coaptation point towards the apex. Consequently, the excursion of the anterior leaflet throughout the cardiac cycle decreased following annuloplasty from 43 +/- 130 to 32.5 +/- 11 (long axis view) (p < 0.0001).