Intérêt du dosage des troponines hypersensibles dans l’amélioration de la précision diagnostique de l’échocardiographie de stress à la dobutamine chez les diabétiques à haut risque

Background and aim

Dobutamine stress echocardiography (DSE) is a well-established noninvasive stress modality for the detection and evaluation of coronary artery disease in diabetic patients. High-sensitivity cardiac troponin T recently emerged as a highly sensitive dosage for the detection of ischemia. The aim of the study was to examine whether high-sensitivity cardiac troponin T may improve the diagnostic accuracy of silent ischemia by DSE in high-risk diabetic patients.

Methods and results

Twenty-one patients with long-standing (> 10 years) and/or complicated type II DM but no established CAD were included. In addition to DSE, venous blood samples for measurement of hs-cTnT were collected prior to DSE, 6 hours and 24 hours after the test. Troponins were deemed positive if > 1.5 upper limit for normality. Patients with positive troponins underwent coronary angiography or CT scan regardless of the result of DSE. Among the 21 patients, 7 had positive troponins measured 6 hours after stress, (mean peak troponin = 44.5). DSE were negative in all of them. Mean age was 64 years significantly higher than patients with negative troponins. No differences were noted between the groups in terms of epidemiological, clinical or echocardiographic characteristics. Patients with positive cardiac troponins were evaluated for the presence of coronary lesions but none of them had significant disease. After an 18-month mean follow-up, no adverse cardiac events were noted in either group.

Conclusion

In high-risk diabetic patients, the measurement of hs-cTnT during DSE does not improve the sensitivity at least in those with negative DSE tests.     

Variations pondérales, risque cardiométabolique et impact des médicaments antidiabétiques chez le diabétique de type 2

In the first part of this review article, the prognostic impact of weight and weight changes in terms of clinical outcomes and metabolic control is reviewed, through the analysis of the results of several large cohorts and prospective studies of diabetic patients followed in “real world” settings. The second part of the review focuses on the impact of antidiabetic medications on weight, emphasising the importance of a comprehensive approach, taking into account weight, in the management of diabetic patients.     

Pénétration de l’approche radiale dans le monde et apprentissage de la technique

The transradial approach has been used for the first non selective coronary angiographies but was quickly replaced by the femoral approach until a new birth in 1989 for coronary angiography in 1989 and coronary angioplasty in 1992. Transradial approach use is extremely heterogeneous in the world, dominated by some countries in Europe, Canada, and eastern Asia (India, Taiwan, China, Japan).Risk factors of failure have been well described, allowing two kinds of learning: systematic attempt in all kind of patients when working with a proctor; patient selection when beginning the technique alone in order to get a high and stable success rate from the beginning. Systematic radial approach for coronary angiography is a must to learn the technique.     

Induction de tolérance orale aux aliments chez l’enfant : aspects pratiques

Specific oral tolerance induction (SOTI) to food is a new topical-therapeutic approach of food allergy. When successful, it improves significantly the patients’ quality of life. SOTI’s practical aspects for child are discussed from our recent experience concerning cow milk, hen’s egg and wheat. Family’s motivation and education are crucial questions to achieve SOTI correctly. A detailed information of possible side effects is essential.