暂无摘要。

Assessment of left ventricular diastolic function by transthoracic Doppler echocardiography is based on a multiparametric approach which includes the spectral tissue Doppler-derived E/e\'. Recently, a new Doppler index, E/(e\'xs\'), which combines E/e\' with a spectral tissue Doppler-derived marker of systolic function, s\', has been proposed in noninvasive assessment of left ventricular myocardial dysfunction. Current literature provides evidence that E/(e\'xs\') has good correlation with NT proBNP levels and invasive left ventricular end-diastolic pressure, both used as markers of left ventricular myocardial dysfunction, irrespective of left ventricular ejection fraction and wall motion abnormalities. More specifically, E/(e\'xs\') has good diagnostic accuracy in patients with intermediate values for E/e\' (8 to 15). Average E/(e\'xs\')>1.6 is reported to predict invasive left ventricular end-diastolic pressure>15mmHg with a sensitivity of 86% and a specificity of 85%. Current literature provides evidence that E/(e\'xs\') could offer better prognostic information than E/e\' in patients with systolic heart failure and heart failure with normal ejection fraction, as well as in patients with asymptomatic heart disease. A few clinical studies also suggest that E/(e\'xs\') could predict recurrence of atrial fibrillation after cardioversion and left ventricular remodeling after acute myocardial infarction. Further experimental and clinical investigation is critically needed to determine the role of this under-recognized tissue Doppler index in noninvasive assessment of cardiovascular diseases, in particular heart failure with normal ejection fraction.

The development of structural interventional catheterization for acquired or congenital heart disease was made possible through concomitant advances in catheterization techniques/tools and imaging techniques (fluoroscopy, ultrasound, magnetic resonance imaging and computed tomography). Imaging should provide an accurate view of the lesions and the surrounding cardiac structures, as well as the medical devices and catheters used. Here, we address the subject of image fusion. The principle of image fusion is based on the superposition of several imaging techniques: real-time fluoroscopy and multislice imaging performed offline or ultrasound imaging performed simultaneously. The goals are to improve the overall visualization of the organ and the surrounding structures, and to help the interventional cardiologist to interpret fluoroscopy images.

BACKGROUND: Bevacizumab is an antibody directed against VEGF-A. It is approved for the treatment of many cancer diseases. Its side effects are currently not well known by physicians.
METHODS: A 70-year-old female with metastatic colonic adenocarcinoma was admitted in the intensive care unit because of a coma, four days after having received a combined monthly chemotherapy containing bevacizumab, oxaliplatine, 5 fluorouracil, and folinic acid for the fourth time. On clinical examination, she presented with lower limbs spasticity and hypertension. Etiologic investigations, including cerebral tomodensitometry, cerebrospinal fluid examination, psychotropic drugs urinary testing, and electroencephalogram, were negative. Consciousness improved without any other treatment than nicardipine and urapidil, but the patient was initially confused. Cerebral magnetic resonance imaging showed changes suggestive of posterior reversible encephalopathy syndrome, but also involving frontal lobes. There were additional biological and echocardiographic changes suggestive of cardiac involvement. The patient recovered completely of both cardiac and neurologic manifestations 10 days later.
CONCLUSIONS: Physicians should be aware of cardiovascular adverse effects of bevacizumab. High blood pressure must be treated to avoid more severe complications. When a posterior reversible encephalopathy syndrome occurs, cardiac involvement should be investigated.