Maladies cardiovasculaires et diagnostic

Background: Type 2 diabetics are at high risk of atherosclerosis and Cardiovascular (CV) events due to their associated dyslipidemic profile. Adverse levels of the lipid triad: Low-Density Lipoprotein Cholesterol (LDL-C), High- Density Lipoprotein Cholesterol (HDL-C) and Triglycerides (TGs), have been shown to be major contributing factors. Statins (HMG-CoA reductase inhibitors) are recommended as first-line lipid therapy as evidence has shown their effectiveness in primary and secondary prevention of CV events. However, there is limited evidence specifically focused on primary prevention in Type 2 Diabetes Mellitus (T2DM) and dyslipidemia. The main purpose of this review was to assess the efficacy of statins in type 2 diabetics with dyslipidemia for the primary prevention of CV events.

Methods: A systematic review was carried out to determine the effectiveness of statins in T2DM and dyslipidemia. A comprehensive literature search identified Randomised Control Trials (RCTs) specific to participants with T2DM and dyslipidemia without prior CV events, which investigated the effects of statins on the lipid triad. Bias and quality of the studies were assessed and data extracted was critically analysed. Meta-analyses were carried out to determine the significance of statin effects. PRISMA guidelines were adhered to throughout.

Results: 10 RCTs were included investigating the effects of six statins. Statins were shown to improve the lipid triad by lowering LDL-C and TGs and increasing HDL-C, in agreement with previous research. Atorvastatin and rosuvastatin were shown to be most potent in reducing LDL-C and TGs and simvastatin showed the greatest increases in HDL-C. Meta-analyses demonstrated significance favouring statins for LDL-C and TG reductions but less evidence of significant effect of HDL-C improvement with all statins. Statins were well tolerated and adverse effects were minimal.

Conclusion: Primary prevention in this high risk population is very important. Statins are effective at reducing CV event risk, and clinicians should have knowledge of most appropriate statin treatments for patients based on individual lipid levels.

Acute myocardial infarction induced by left main coronary artery (LMCA) stenosis is the infrequent but fatal disease. LMCA stenosis occurs in 4-10% whereas lethal total occusion of LMCA occurs in 0.04-0.42% of angiograms. We report the case of 52 years diabetic obese male with central chest pain for one week; electrocardiogram (ECG) shows ST elevation in leads aVR, V1-V4, and coronary angiography displays stenosis of LMCA (>80% occlusion).The high risk primary angioplasty with drug eluting stent was performed in the unprotected LMCA without any complications.

Objectives: The aim of the study was to assess the role of ST segment elevation in the Posterior leads V7,
V8, and V9 for the diagnosis of acute posterior wall infarction and the identification of infarct related artery (IRA) in patients with acute inferior wall MI.

Background: The posterior wall infarction is difficult to diagnose through standard 12 lead ECG alone, especially in the acute setting.

Methods: In our retrospective study, 121 patients (101 male, 20 female) with an inferior acute MI, were included. They were divided into two groups according to the presence (Group A: mean age 60.00±10.05 years) or absence (Group B: mean age 57.65 ± 12.86 years) of ST segment elevation in leads V7, V8, V9. Complete demographic data were recorded in all subjects, the infarct size was estimated by CPK MB, left ventricular function was assessed by echocardiographically and infarct related artery patency was evaluated by coronary angiography.

Results: Group A patients had a higher frequency of Left cirucumflex occlusion than group B patients (n=33,
27.3% vs. n=4, 3.3%, p=0.0001). Group A had a more extensive infarction, as is shown by CPK MB values (90.12 ± 33.42 vs 45 ± 38.28, P= 0.0001) but with no difference in left ventricular ejection fraction.

Conclusion: ST segment elevation in posterior leads helps to diagnose left circumflex artery as a culprit IRA in an acute inferior wall MI with extensive infarct area involving posterolateral walls.

The PediBooster external cardiac compression device is a minimally invasive, non-blood contacting Biventricular Assist Device (BiVAD) intended for pediatric use. It is being developed as a palliative therapy for acute Postcardiotomy Shock (PCS). The PediBooster extracardiac wrap is pneumatically actuated to circumferentially compress the heart, providing co-pulsation support. Attachment is via a novel hydrogel coating. Early versions of the wrap were tested in vivo using a single ventricle congenital heart disease model with postcardiotomy shock, which proved unstable and demonstrated high peri-operative mortality. The final wrap design was tested in 4 acute studies with piglets (5.1 ± 0.3 kg), where the combination of ASD and PA banding induced acute right ventricular dysfunction. Data collected included routine hemodynamic values, TEE, video of the exposed heart, and cardiac histology. The model proved stable for support durations ranging from 2 to 16 hours. The wrap restricted the heart in 3 of the 4 animals, as evidenced by increased diastolic LVP during support compared to the baseline failure condition. TEE and video data showed good attachment and function of the wrap, particularly during the final 16 hr study. This model of congenital heart disease shows promise for chronic (24-72 hr) studies. Ventricular filling during support may be improved by adjusting wrap dimensions to eliminate end diastolic restriction.