AP/HP Pôle 6

- Cardiologie Adultes -

Réponses affichées : 40

Lien PubMed [High risk of cardiac dysfunction after treatment of secondary acute myeloid leukemia following chemotherapy and radiotherapy for breast cancer]
WILLEMS L, SUAREZ F, MESSAS E, BAUBION N, DECAUDIN D, FOURQUET A, GHEZ D, DELARUE R, HERMINE O, BUZYN A, VARET B, RUBIO MT
2010 - Bull Cancer 97(2):245-54
Secondary acute myeloid leukaemia (AML) occurring after breast cancer is a rare long-term complication of the chemo- and/or radiation therapy required to treat breast cancer. The usually recognized curative option of these secondary AML includes courses of anthracycline-based chemotherapy followed by haematopoietic stem cell transplantation (HSCT). Cardiac dysfunction during AML treatment of these patients previously treated with anthracyclines for breast cancer has not been reported to date. We evaluated the evolution of cardiac function in seven patients treated with anthracyclines and/or autologous or allogeneic bone marrow transplantation for secondary AML occurring after breast cancer. All of the patients who received a cumulative anthracycline dose above the cardiac toxicity threshold developed cardiac symptoms during AML chemotherapy courses. Moreover, four of the five transplanted patients developed severe heart failure among which two were fatal. Thus, the risk of severe cardiac dysfunction after treatment of secondary AML following breast cancer must be taken in account as part of the therapeutic strategy of those patients. As discussed here, an accurate evaluation of risk factors, the use of sensitive detection tests and of cardioprotective drugs as well as that of non-cardiotoxic chemotherapy might decrease the occurrence and severity of this life-threatening complication.
Unité(s) : Cardiologie Adulte, Hématologie Adulte
 
Lien PubMed High risk of cardiac dysfunction after treatment of secondary acute myeloid leukaemia to breast cancer
WILLEMS L, SUAREZ F, BAUBION N, DECAUDIN D, GHEZ D, HERMINE O, VARET B, RUBIO MT
2009 - Ann Oncol 20(3):597-9
Unité(s) : Cardiologie Adulte, Hématologie Adulte
 
  Treatment perspectives for critical limb ischemia: gene and cell therapy
PASQUALONI E, MESSAS E, FIESSINGER JN, EMMERICH J
2008 - Presse Médicale 37(6 Pt 2):1039-1046
Critical limb ischemia is associated with a high risk of amputation and death.Several medical options have been tested on patients who cannot be revascularized surgically, but none has shown any effect on the amputation rate at 6 months.Gene and cell therapy intended to stimulate angiogenesis have been tested in phase I and II clinical trials.These innovative approaches appear both feasible and safe.Large randomized clinical trials are necessary to demonstrate their benefits and long-term safety.
Unité(s) : Cardiologie Adulte
 
  Bosentan for the treatment of pulmonary arterial hypertension associated with congenital heart defects
SITBON O, BEGHETTI M, PETIT J, ISERIN L, HUMBERT M, GRESSIN V, SIMONNEAU G
2006 - Eur. J. Clin. Invest. 36(Suppl.3):25-31
BACKGROUND: Bosentan is an effective first-line therapy in New York Heart Association (NYHA) III patients with idiopathic pulmonary arterial hypertension (PAH). Pre-clinical data support the rationale for the potential benefit of bosentan in PAH associated with congenital heart disease (CHD). MATERIALS AND METHODS: We performed a retrospective analysis of patients with PAH-associated CHD who were treated with bosentan on top of conventional therapy. Bosentan was started at 62.5 mg bid for 4 weeks, then titrated to 125 mg bid. New York Heart Association (NYHA) functional class, 6-min walking distance (6MWD), Borg dyspnoea index, arterial oxygen saturation and cardiopulmonary haemodynamic data (cardiac output, pulmonary blood flow and systemic and pulmonary vascular resistances) were collected at baseline and at follow up. RESULTS: Twenty-seven patients (23 females, mean 35 +/- 15 years) with NYHA class III-IV PAH-associated CHD (not repaired in 23 cases) were treated with bosentan for a mean 18.3 +/- 9.9 months. Bosentan improved 6MWD from 298 +/- 92 m at baseline to 355 +/- 82 m at 3 months (P = 0.0002) and to 364 +/- 92 m (P = 0.0001) at the last follow up (mean 15.2 +/- 9.7 months). At the last follow up, 13 patients had improved (= 1 NYHA class) and 14 remained stable. A favourable effect was observed in pulmonary blood flow and pulmonary vascular resistance for the 11 available patients. No change in pulse oximetry or liver enzyme elevation was reported. CONCLUSIONS: Bosentan improves exercise capacity, functional class and haemodynamics in most patients with PAH-associated CHD, without serious side-effects, suggesting bosentan may be an important treatment option for these patients.
Unité(s) : Cardiologie Pédiatrique, Cardiologie Adulte
 
  Percutaneous transluminal septal coil embolisation as an alternative to alcohol septal ablation for hypertrophic obstructive cardiomyopathy
LAFONT A, DURAND E, BRASSELET C, MOUSSEAUX E, HAGEGE A, DESNOS M
2005 - Heart 91(1):92
Unité(s) : Cardiologie Adulte, E 0016
 
  Stress myocardial scintigraphy and dobutamine echocardiography in the detection of coronary disease in asymptomatic patients with type 2 diabetes
LE FEUVRE C, BARTHELEMY O, DUBOIS-LAFORGUE D, MAUNOURY C, MOGENET A, BAUBION N, METZGER JP, TIMSIT J
2005 - Diabetes Metab. 31(2):135-142
Objective: The aims of this propective study were: (1) to compare stress thallium-201 single photon emission computed tomography (SPECT) and dobutamine echocardiography (DE) in the detection of silent myocardial ischemia (SMI) in asymptomatic high risk diabetic patients; (2) to analyse long-term outcome after intensive care of SMI in these patients.Methods: SPECT was performed in 100 high risk diabetic patients and DE in the first 75 patients. Coronary angiography was realized in patients with SMI, with revascularization for suitable lesions. Intensive treatment of atherosclerosis risk factors was performed in all patients. Patients were followed 2 +/- 0.5 years for the subsequent occurrence of cardiac death, myocardial infarction and revascularization.Results: SMI was detected by SPECT in 62% and by DE in 10% of the patients (p < 0.0001), whereas significant coronary stenosis at angiography was detected by SPECT in 26% and by DE in 5% of the patients (p < 0.02). Independent predictive factors of significant coronary stenosis were male gender (p < 0.03) and peripheral arterial disease (p < 0.007). Nonfatal acute coronary syndrome occurred during follow-up in 2 patients (2%). Subsequent revascularization procedure was needed in 9 patients. Baseline patients' characteristics, as well as SMI, were not predictive of cardiac event during follow up.Conclusion: SPECT seems more accurate than DE to detect significant coronary stenosis in high risk asymptomatic diabetic patients. In this population, aggressive treatment of SMI with systematic revascularization combined with intensive care of risk factors is associated with a favorable long-term prognosis, similar in diabetic patients with and without initial SMI.
Unité(s) : Biophysique & Médecine Nucléaire, Cardiologie Adulte
 
  Ischaemic mitral insufficiency
MESSAS E
2004 - Arch. Mal. Coeur Vaisseaux 97(6):647-654
Ischaemic mitral insufficiency (IMI) due to regurgitation of an anatomically normal valve, due to dysfunction directly related to myocardial ischaemia, is observed in over 20% of post-infarction patients and is associated with a doubling of the risk of death. The responsibility of ventricular remodelling with displacement of the papillary muscles in the genesis of IMI has been demonstrated experimentally. 3-D echocardiography has improved our understanding of the central role of geometrical changes of the subvalvular apparatus. The inconsistent results of surgery using an undersized mitral annulus have led to the search for alternative techniques. The correction of mitral insufficiency at coronary bypass surgery is a current topic of research. The application of new techniques of mitral valvuloplasty seems more effective and should provide an answer to this problem.
Unité(s) : Cardiologie Adulte
 
  Myocardial viability, coronary flow reserve, and in-hospital predictors of late recovery of contractility following successful primary stenting for acute myocardial infarction
BEYGUI F, LE FEUVRE C, HELFT G, MAUNOURY C, METZGER JP
2003 - Heart 89(2):179-183
OBJECTIVE: To assess the relation between myocardial viability, coronary flow reserve, and recovery of myocardial contractility after stenting for acute myocardial infarction. DESIGN: Consecutive sample prospective study. SETTING: University hospital. PATIENTS: 41 patients with single vessel disease and successful primary stenting for a first acute myocardial infarction. INTERVENTIONS: (201)Tl single photon emission computed tomography, contrast ventriculography, and intracoronary Doppler performed 7 (1) days after primary stenting. MAIN OUTCOME MEASURES: Regional contractility recovery assessed by contrast ventriculography at 6 (1) months' follow up. RESULTS: On univariate analysis, contractility recovery was correlated to prereperfusion anterograde and collateral flow grades (r = 0.41, p = 0.03 and r = 0.55, p = 0.0004), viability index (r = 0.55, p = 0.04), peak creatine kinase concentrations (r = -0.55, p = 0.0005), left ventricular ejection fraction (r = 0.45, p = 0.005), end diastolic pressure (r = -0.62, p < 0.0001), end systolic volume index (r = -0.47, p = 0.01), and the extent of hypokinetic area (r = -0.48, p = 0.003), but not the coronary flow reserve. On multivariate analysis, independent predictors of late contractility recovery were prereperfusion anterograde and collateral flow grades and viability index. Relative coronary flow reserve, reflecting the culprit vessel's microvascular function, was correlated only to the extent of the infarct risk area (r = -0.45, p = 0.003). CONCLUSIONS: Independent predictors of contractility recovery between the seventh day and the sixth month after successful stenting for acute myocardial infarction are prereperfusion anterograde and collateral flows and myocardial viability. The culprit vessel's microvascular dysfunction is independent of myocardial viability and contractility and correlated to the extent of "jeopardised microvasculature".
Unité(s) : Cardiologie Adulte
 
  Viability and differentiation of autologous skeletal myoblast grafts in ischaemic cardiomyopathy
HAGEGE AA, CARRION C, MENASCHE P, VILQUIN JT, DUBOC D, MAROLLEAU JP, DESNOS M, BRUNEVAL P
2003 - Lancet 361(9356):491-492
Autologous skeletal myoblast transplantation might improve postinfarction ventricular function, but graft viability and differentiation (ie, proof of concept) has not been shown. A 72-year-old man had autologous cultured myoblasts from his vastus lateralis injected to an area of transmural inferior myocardial infarction in non-reperfused scar tissue. He showed improvement in symptoms and left-ventricular ejection fraction. When he died 17.5 months after the procedure, the grafted post-infarction scar showed well developed skeletal myotubes with a preserved contractile apparatus. 65% of myotubes expressed the slow myosin isoform and 33% coexpressed the slow and fast isoforms (vs 44% and 0.6%, respectively, in skeletal muscle). Myoblast grafts can survive and show a switch to slow-twitch fibres, which might allow sustained improvement in cardiac function.
Unité(s) : E 0016, Cardiologie Adulte
 
  Safety, efficacy, and cost advantages of combined coronary angiography and angioplasty
LE FEUVRE C, HELFT G, BEYGUI F, ZERAH T, FONSECA E, CATULI D, BATISSE JP, METZGER JP
2003 - J. Interv. Cardiol. 16(3):195-199
AIM: The safety and efficacy of ad hoc PTCA has been previously reported and this approach is performed in many angioplasty centers as a routine procedure. The aim of this study is to examine whether this approach reduces the length, and cost of hospital stay. METHODS AND RESULTS: To determine the hospital costs we studied 2,440 PTCAs over 11 years in our institution (1990-2000). Urgent PTCA for acute coronary syndromes refractory to medical treatment were excluded. In 1809 patients (74%) angioplasty was performed immediately after coronary angiography, while separate procedures were performed in 631 patients. Indication for PTCA was unstable angina in 1342 patients (55%). In the ad hoc PTCA group, 92% of the culprit lesions were successfully treated; complications included myocardial infarction (2%), urgent bypass surgery (0.6%) and death (0.9%). The rate of combined procedure progressively increased from 54% in 1990 to 88% in 2000, with a significant decrease in the rate of complications. After adjusting for clinical and angiographic differences between combined and separate procedures, angiographic success and complication rates were not statistically different in the two groups. Mean length of hospital stay decreased all along the years, and was 45% less in the ad hoc PTCA group (11.4 6.9 vs 18.2 7.7 in 1990, 5.4 4.3 vs 10.8 5.7 in 2000, P < 0.0001). The cost was 40% lower in the ad hoc PTCA group. For patients with stable angina, the savings were 49%, and for those with unstable angina, they were 29%. CONCLUSION: In the era of coronary stenting, ad hoc PTCA can be performed in most of the patients as safely and successfully as a separate procedure. It reduces the length, and the cost of hospital stay in patients with stable or unstable angina.
Unité(s) : Cardiologie Adulte
 
  Heart failure in patients treated with human immunodeficient virus protease inhibitors
BARTHELEMY O, ESCAUT L, VAYRE F, GALLET B, PULIK M, HELOIRE F, VITTECOQ D
2002 - Presse Médicale 31(8):343-348
Introduction Cardiovascular complications occurring in patients infected by the human immunodeficient virus (HIV) have considerably changed since the appearance, in April 1996, of highly active antiretroviral tri-therapy (HAART), associating reverse transcriptase and protease HIV-1 inhibitors. The spectacular efficacy of anti-proteases has led to the almost complete disappearance of these opportunistic complications. However, in May 1998, acute coronary accidents were reported in the literature, thus questioning the possible responsibility of antiprotease treatment in the occurrence of accelerated atheroma.Method We report a series of 8 seropositive patients in whom an acute coronary event had occurred between February 1997 and February 1999.Results The patients were young and all exhibited cardiovascular risk factors (smoking, dyslipidemia) and were treated with HIV-1 protease inhibitors. Six patients presented myocardial infarction, one patient unstable angina and one patient effort angina.Comments A rise in triglycerides was observed principally on ingestion of ritonavir and a rise in cholesterol and LDL-cholesterol with all the antiprotease agents. Glucose intolerance was observed with indinavir. The occurrence of acute coronary events appeared to be related to antiprotease treatment (at the origin of metabolic disorders, endothelial dysfunction...), although it was impossible to say whether the antiprotease agents were responsible for the early atheroma or whether they simply contributed to the event The coronary lesions were characterized by their number (single artery) and their topography (proximal or median). Nelfinavir may carry less cardiovascular risks than the other antiproteases. Mean term prognosis was relatively good, after therapeutic adjustment (change in antiprotease, strategic measures against cardiovascular risk factors, introduction of anti-anginal treatment..).Conclusion Larger and longer studies would help to specify the role of antiproteases in the occurrence of early coronary events. Rigorous monitoring (lipid and glucose measurements, tests to search for myocardial infarction...) together with the development of new antiretroviral molecules would reduce the number of coronary events in this type of patient.
Unité(s) : Cardiologie Adulte
 
  Coronary vasodilator reserve: a clue to the explanation of (201)Tl redistribution patterns early after successful primary stenting for acute myocardial infarction
BEYGUI F, LE FEUVRE C, MAUNOURY C, HELFT G, METZGER J
2002 - J. Amer. Coll. Cardiol. 40(5):877
We sought to assess the mechanism and significance of different (201)Tl redistribution patterns after successful primary stenting following acute myocardial infarction (AMI).The mechanism of (201)Tl reverse redistribution and the impact of different redistribution patterns on the recovery of contractility after successful reperfusion therapy for AMI remain unclear.We studied 41 consecutive patients with successful primary stenting for a first AMI. Patients underwent predischarge and six-month follow-up dipyridamole stress-reinjection single photon emission tomography (SPECT), coronary and left ventricular angiography. Intracoronary Doppler assessment of coronary flow reserve (CFR) was performed before discharge.FOUR PATIENT GROUPS WERE IDENTIFIED ACCORDING TO PREDISCHARGE SPECT: patients with I: nonreversible defects (n = 8), II: redistribution (n = 7), III: reverse redistribution (n = 21), IV: no defect (n = 5). At follow-up contractility recovery increased in a stepwise fashion from groups I to IV (19 +/- 41%, 40 +/- 53%, 70 +/- 28%, 78 +/- 33%, p = 0.01). Compared with patients with redistribution, those with reverse redistribution had lower infarct-related artery (IRA) CFR (2.2 +/- 0.5 vs. 2.8 +/- 0.9, p = 0.03) but higher contractility recovery.Variable (201)Tl redistribution patterns, early after successful stenting for AMI, may predict different degrees of late contractility recovery. The lower IRA CFR and the higher contractility recovery in areas with reverse redistribution suggest more severe microvascular dysfunction and less severe myocardial injury in such areas compared with those with redistribution.
Unité(s) : Cardiologie Adulte
 
  Interet de l'angioplastie coronaire dans le meme temps que la coronarographie
FONSECA E, LE FEUVRE C, HELFT G, BEYGUI F, ZERAH T, DAMBRIN G, BATISSE JP, CATULI D, VACHERON A, METZGER JP
2002 - Arch. Mal. Coeur Vaiss. 95(10):891-896
Combined coronary angioplasty and coronary angiography is performed in most catheter laboratories and has become a routine procedure. The aim of this study was to assess its clinical results and economic value. This was a retrospective monocenter study performed over an 11 year period (1990-2000) which included 2,727 patients requiring coronary angioplasty after coronary angiography. The angioplasty procedure was performed at the same time as angiography (combined, n = 1,809) or after angiography (deferred, n = 631). Patients admitted for acute coronary syndromes not stabilised by pharmacological interventions were excluded from the study. The comparison of these two modes of angioplasty was based on primary success rates, complications, duration of hospital stay and hospital costs. The combined procedure was used progressively more frequently over the study period, increasing from 54% to 88% in 2000. The hospital clinical results (Success and complication rates) were comparable in the two groups. The predictive factors of failure were the year of the angioplasty procedure and occlusive lesions on multivariate analysis. The combined procedure was associated with a shorter hospital stay than deferred angioplasty (8.2 +/- 6.1 days versus 15.0 +/- 8.0 days, p = 0.0001) and with lower costs. The authors conclude that combined coronary angiography-angioplasty is as effective and as safe as deferred angioplasty. It is associated with a shorter hospital stay and lower hospital costs.
Unité(s) : Cardiologie Adulte
 
  Les cardiopathies cyanogènes de l'adulte
ISERIN L
2002 - Arch. Mal. Coeur Vaiss. 95(11):1100-1113
Patients with cyanotic heart disease may have an acceptable quality of life but are exposed to several complications: polycythaemia, often beneficial but with its risks: hyperviscosity, hyperuricaemia, thrombocytopaenia, blood clotting abnormalities; and the other complications of right-to-left shunt: cerebral abscess, cerebral embolism, endocarditis. The hypoxia may be improved by interventional catheterisation or palliative surgery. The Eisenmenger syndrome is life-threatening in pregnancy or during general anaesthesia. These patients are at risk and sometimes have iatrogenic complications, so usual cardiological treatment may be dangerous: diuretics, ACE inhibitors, oral anticoagulants, antiarrhythmics.
Unité(s) : Cardiologie Adulte, Cardiologie Pédiatrique
 
  Surveillance d'un adulte ayant eu une dérivation de type Fontan ou cavopulmonaire
ISERIN L, VOUHE P, ISERIN F, SIDI D
2002 - Arch. Mal. Coeur Vaiss. 95(11):1127-1134
Patients with cyanotic heart disease may have an acceptable quality of life but are exposed to several complications: polycythaemia, often beneficial but with its risks: hyperviscosity, hyperuricaemia, thrombocytopaenia, blood clotting abnormalities; and the other complications of right-to-left shunt: cerebral abscess, cerebral embolism, endocarditis. The hypoxia may be improved by interventional catheterisation or palliative surgery. The Eisenmenger syndrome is life-threatening in pregnancy or during general anaesthesia. These patients are at risk and sometimes have iatrogenic complications, so usual cardiological treatment may be dangerous: diuretics, ACE inhibitors, oral anticoagulants, antiarrhythmics.
Unité(s) : Cardiologie Adulte, Cardiologie Pédiatrique
 
  Cardiologie (Ed.2002)
VACHERON A, LE FEUVRE C, DI MATTÉO J
2002 - Ouvrage 792
Unité(s) : Cardiologie Adulte
 
  Actualités dans l'insuffisance cardiaque
BOUNHOURE JP, VACHERON A
2001 - Ouvrage 188
Unité(s) : Cardiologie Adulte
 
  Defining the optimal activated clotting times during percutaneous coronary intervention: aggregate results from 6 randomized, controlled trials
HELFT G, BEYGUI F, LE FEUVRE C, METZGER JP
2001 - Circulation 104(22):E124
Unité(s) : Cardiologie Adulte
 
  Fibrinolysis or angioplasty in acute myocardial infarction ?
HELFT G, BEYGUI F, WORTHLEY SG
2001 - Chest 120(5):1747
Unité(s) : Cardiologie Adulte
 
  Anti-Thrombotic, anti-platelet and fibrinolytic therapy: Current management of acute myocardial infarction
HELFT G, WORTHLEY SG
2001 - Heart Lung Circ. 10(2):68-74
Significant advances in the treatment of patients with acute myocardial infarction (MI) have been obtained in recent times. In particular, thrombolytic therapy has been shown to preserve ventricular function and improve survival in patients with acute MI. Therapies now include third-generation thrombolytic agents, percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stenting, and new anti-thrombotic therapies including anti-platelet treatment with glycoprotein (GP) IIb/IIIa inhibition and direct anti-thrombin agents. This review will focus on the use of GP IIb/IIIa antagonists and thrombin inhibitors as adjunctive therapies to thrombolytic treatment of patients with acute MI.
Unité(s) : Cardiologie Adulte
 
  Identification of unstable coronary atherosclerotic plaques
HELFT G, WORTHLEY SG, BEYGUI F, ZAMAN AG, LE FEUVRE C, VACHERON A, METZGER JP, BADIMON JJ, FUSTER V
2001 - Arch. Mal. Coeur Vaisseaux 94(6):583-590
The mechanisms of atherogenesis are better understood and the detection of atherosclerosis has improved with the different diagnostic methods currently available. However, it is almost impossible at present to differentiate high risk, unstable or vulnerable plaques from quiescent or stable plaques of atherosclerosis. This is a crucial problem given the banality of atherosclerosis on the one hand, and, on the other hand, the serious consequences (acute coronary syndromes, cerebrovascular accidents) of thrombotic occlusion at the site of an atherosclerotic plaque. It has now been established that the composition of the plaque is more important than the degree of stenosis, a fundamental concept in the risk of plaque rupture, precipitating the cascade of reactions leading to uncontrolled thrombosis. Consequently, new imaging techniques should address the problem of analysing the composition of atheromatous plaques. Endovascular ultrasonography, fast CT, angioscopy, nuclear imaging techniques and MRI are so many promising tools. However, non-invasive techniques should be distinguished from invasive ones. In all probability, it will be the former which will turn out to be the most useful diagnostic aid in pauci or asymptomatic patients. This article reviews the different imaging techniques under evaluation for the identification of risk of plaque rupture.
Unité(s) : Cardiologie Adulte
 
  Management of pregnancy in women with congenital heart disease
ISERIN L
2001 - Heart 85(5):493-494
Unité(s) : Cardiologie Adulte
 
  Clinical outcome following coronary angioplasty in dialysis patients: a case-control study in the era of coronary stenting
LE FEUVRE C, DAMBRIN G, HELFT G, BEYGUI F, TOUAM M, GRUNFELD JP, VACHERON A, METZGER JP
2001 - Heart 85(5):556-560
Background-Balloon coronary angioplasty has been reported to be ineffective in patients treated for end stage renal disease because of a high restenosis rate. Objective-To compare the clinical outcome following coronary angioplasty with provisional stenting in dialysis versus non-dialysis patients. Design-A case-control study. Patients-Of 1428 consecutive patients who underwent coronary angioplasty, 100 (7%) were being treated for end stage renal disease. These were compared with 100 control patients matched for age, sex, coronary lesions, presence of diabetes mellitus, and rate of coronary stenting (40%). Main outcome measures-In-hospital and one year clinical outcome. Results-The rates of procedural success (90% v 93%), in-hospital mortality (1% v 0%), stent thrombosis (0% v 0%), and Q wave myocardial infarction (0% v 1%) were similar in dialysis and non-dialysis patients. One year clinical outcome after coronary angioplasty was similar in the two groups in terms of clinical restenosis (31% v 28%) and myocardial infarction (6% v 2%), but cardiac death was more common in dialysed patients (11% v 2%, p < 0.03). Conclusions-Dialysis does not increase the risk of clinical restenosis after coronary angioplasty with provisional stenting. Coronary angioplasty is a safe and effective therapeutic procedure in selected dialysis patients with culprit lesions accessible to stenting. However, the one year survival is reduced in this high risk population. [References: 29]
Unité(s) : Cardiologie Adulte, Néphrologie Adulte
 
  Talking effect and "white coat" effect in hypertensive patients: physical effort or emotional content ?
LE PAILLEUR C, MONTGERMONT P, FEDER JM, METZGER JP, VACHERON A
2001 - Behav. Med. 26(4):149-157
Talking has been shown to increase blood pressure instantaneously in hyper-tensive patients and to contribute to the white coat effect. The effects of talking were compared with those of counting aloud in 64 patients with essential hypertension who were randomly assigned to a period of stress talking and a period of counting aloud (active periods), alternating with three periods of silence (control). The same monitor was used for office measurements and 24-hour ambulatory blood pressure analysis. Systolic/diastolic blood pressures increased significantly more during talking (163/110 mmHg) than during counting aloud (152/102 mmHg, both p < .0001) in both treated and untreated patients and in sustained and clinical hypertension. Talking had a residual effect on systolic blood pressure that lasted 5.8 +/- 0.1 minutes. The emotional content seemed to be the only cause of the talking effect. Its instantaneous and residual effects on blood pressure and heart rate should be considered when measuring these variables. [References: 30]
Unité(s) : Cardiologie Adulte
 
  Myoblast transplantation for heart failure
MENASCHE P, HAGEGE AA, SCORSIN M, POUZET B, DESNOS M, DUBOC D, SCHWARTZ K, VILQUIN JT, MAROLLEAU JP
2001 - Lancet 357(9252):279-280
Intramyocardial skeletal muscle transplantation has been shown experimentally to improve heart function after infarction. We report success with this procedure in a patient with severe ischaemic heart failure. Wa implanted autologous skeletal myoblasts into the postinfarction scar during coronary artery bypass grafting of remote myocardial areas. 5 months later, there was evidence of contraction and viability in the grafted scar on echocardiography and positron emission tomography. Although this result is encouraging, it requires validation by additional studies. [References: 5]
Unité(s) : Cardiologie Adulte
 
  Cardiovascular abnormalities with normal blood pressure in tissue kallikrein-deficient mice
MENETON P, BLOCH-FAURE M, HAGEGE AA, RUETTEN H, HUANG W, BERGAYA S, CEILER D, GEHRING D, MARTINS I, SALMON G, BOULANGER CM, NUSSBERGER J, CROZATIER B, GASC JM, HEUDES D, BRUNEVAL P, DOETSCHMAN T, MENARD J, ALHENC-GELAS F
2001 - Proc. Nat. Acad. Sci. USA 98(5):2634-2639
Tissue kallikrein is a serine protease thought to be involved in the generation of bioactive peptide kinins in many organs like the kidneys, colon, salivary glands, pancreas, and blood vessels. Low renal synthesis and urinary excretion of tissue kallikrein have been repeatedly linked to hypertension in animals and humans, but the exact role of the protease in cardiovascular function has not been established largely because of the lack of specific inhibitors. This study demonstrates that mice lacking tissue kallikrein are unable to generate significant levels of kinins in most tissues and develop cardiovascular abnormalities early in adulthood despite normal blood pressure. The heart exhibits septum and posterior wall thinning and a tendency to dilatation resulting in reduced left ventricular mass. Cardiac function estimated in vivo and in vitro is decreased both under basal conditions and in response to beta -adrenergic stimulation. Furthermore, flow-induced vasodilatation is impaired in isolated perfused carotid arteries, which express, like the heart, low levels of the protease. These data show that tissue kallikrein is the main kinin-generating enzyme in vivo and that a functional kallikrein-kinin system is necessary for normal cardiac and arterial function in the mouse. They suggest that the kallikrein-kinin system could be involved in the development or progression of cardiovascular diseases. [References: 48]
Unité(s) : Cardiologie Adulte
 
  Lipids, today
VACHERON A
2001 - Ann. Méd. Intern. 152(3):157
Unité(s) : Cardiologie Adulte
 
  Trimetazidine as adjunctive therapy to primary ptca for acute myocardial infarction
BEYGUI F
2000 - Rev. Port. Cardiol. 19(Suppl 5):V31-V34
Acute myocardial infarction remains a complex medical problem despite major advances in its management, especially early myocardial reperfusion by percutaneous transluminal coronary angioplasty (PTCA). Situations such as absence of TIMI 3 flow grade and/or persistence of ST segment elevation despite successful PTCA, no-reflow phenomenon and absence of improvement of myocardial regional contractility despite angiographic TIMI 3 flow, probably involve microvascular injury due to neutrophil and platelet activation, free radical generation and myocardial metabolic disorders. Trimetazidine is a well tolerated and efficient antianginal agent, that experimentally reduces ischemia-reperfusion injuries, neutrophil infiltration, platelet aggregation and has antioxidant effects. The Limitation of Infarct Size by trimetazidine Trial (LIST) randomized 94 patients with acute myocardial infarction undergoing primary PTCA into two groups: placebo versus trimetazidine i.v. infusion started before PTCA and continued for 48 hours. Continuous ST segment monitoring was performed during and after primary PTCA. The major results of the study were a significantly more important and faster reduction of ST segment elevation with a trend to less ST segment exacerbation, in the trimetazidine group after PTCA compared to the placebo group. These results suggest that trimetazidine may efficiently reduce ischemia-reperfusion lesions after primary PTCA for acute myocardial infarction.
Unité(s) : Cardiologie Adulte
 
  Detection of coronary restenosis by exercise electrocardiography thallium-201 perfusion imaging and coronary angiography in asymptomatic patients after percutaneous transluminal coronary angioplasty
BEYGUI F, LE FEUVRE C, MAUNOURY C, HELFT G, ANTONIETTI T, METZGER JP, VACHERON A
2000 - Amer. J. Cardiol. 86(1):35-40
Noninvasive detection of restenosis in patients remaining asymptomatic after percutaneous transluminal coronary angioplasty (PTCA) remains a major clinical problem. The value of exercise electrocardiography (ECG) and exercise-redistribution thallium-201 single-photon emission computed tomography (SPECT) in detecting restenosis in such patients remains uncertain. Discordances between these tests and coronary angiography is a common situation. We studied 179 consecutive patients remaining asymptomatic after successful PTCA (208 vessels), who underwent 6 +/- 2 months of exercise EGG, SPECT, and coronary angiography. We sought to assess the diagnostic value of the noninvasive tests compared with coronary angiography, and identify the determinants of discordances between the tests. Restenosis (diameter stenosis >50%) was detected in 39% of patients and in 37% of vessels. The overall sensitivity, specificity, and accuracy for exercise ECG and SPECT in detecting restenosis in individual vessels were, respectively, 53% versus 63% (p = 0.06), 59% versus 77% (p = 0.0001), and 57% versus 72% (p = 0.0001). On multivariate analysis, positive exercise ECG was associated with higher heart rate response (p = 0.02), incomplete revascularization (p = 0.004), and angiographic restenosis (p = 0.03), whereas positive SPECT was associated with incomplete revascularization (p = 0.02), infarct-related artery PTCA (p = 0.01), and angiographic restenosis (p = 0.0001). Accuracies of the 2 tests were not significantly different in patients with incomplete revascularization or PTCA of an infarct-related vessel. Overall, SPECT is more accurate than exercise ECG in detecting asymptomatic restenosis. Nevertheless, incomplete revascularization and PTCA of on infarct-related artery could cause reversible perfusion defects regardless of restenosis, reducing the diagnostic value of SPECT in such patients. (C) 2000 by Excerpta Medica, Inc. [References: 28]
Unité(s) : Cardiologie Adulte
 
  Factor xii deficiency associated with coronary stent thrombosis
HELFT G, LE FEUVRE C, METZGER JP, VACHERON A, MONSUEZ JJ, LACHURIE ML, AHLENC GELAS M
2000 - Am. J. Hematol. 64(4):322-323
Unité(s) : Cardiologie Adulte
 
  Thrombolysis and adjunctive therapies in acute myocardial infarction
HELFT G, WORTHLEY SG, ZAMAN AG, SAMAMA MM, BADIMON JJ
2000 - Haemostasis 30(4):159-167
Thrombolysis and percutaneous transluminal angioplasty represent the cornerstone of the pharmacologic treatment of and the interventional approach to patients with myocardial infarction (MI). They are very effective. However, they are hampered by some critical limitations. Therefore, alternatives to standard thrombolytic therapy have been developed. Platelet glycoprotein (GP) IIb/IIIa blockade is under investigation and seems very attractive. This review will focus on the use of GP IIb/IIIa antagonists and thrombin inhibitors as adjunctive therapies to the thrombolytic treatment of patients with acute MI. Copyright (C) 2001 S. Karger AG, Basel. [References: 46]
Unité(s) : Cardiologie Adulte
 
  Comparison of clinical outcome following coronary stenting or balloon angioplasty in dialysis versus non-dialysis patients
LE FEUVRE C, DAMBRIN G, HELFT G, TABET S, BEYGUI F, LEGENDRE C, PERALDI MN, VACHERON A, METZGER JP
2000 - Amer. J. Cardiol. 85(11):1365-136+
Unité(s) : Cardiologie Adulte, Néphrologie Adulte
 
  Influence of sin-1 on platelet ca2+ handling in patients with suspected coronary artery disease: ex vivo and in vitro studies
LE-QUAN-SANG KH, LE FEUVRE C, BRUNET A, PHAM TD, METZGER JP, VACHERON A, DEVYNCK MA
2000 - Thromb. Haemost. 83(5):752-758
The 3-morpholinosydnonimine (SIN-1) generates both nitric oxide (NO) and superoxide anion (O-2-). It elicits dose-dependent vasodilation in vivo, in spite of the opposite effects of its breakdown products on vascular tone and platelet aggregation. This study was designed to investigate the influence of intravenous SIN-1 injection on platelet Ca2+ handling in patients undergoing coronary angiography. SIN-1 administration reduced cytosolic [Ca2+] in unstimulated platelets by decreasing Ca2+ influx. It attenuated Ca2+ mobilization from internal stores evoked by thrombin or thapsigargin. In vitro studies were used as an approach to investigate how simultaneous productions of NO and O-2- from SIN-1 modify thrombin- or thapsigargin-induced platelet Ca2+ mobilization. Superoxide dismutase, the O-2- scavenger, enhanced the capacity of SIN-1 to inhibit Ca2+ mobilization but catalase had no effect. This suggests that the effects of SIN-1 on platelet Ca2+ handling resemble those of NO, but are modulated by simultaneous O-2- release, independently of H2O2 formation. [References: 50]
Unité(s) : UMR 8604, Cardiologie Adulte, URC
 
  Angioplasty and stenting in patients with renal disease
LEFEUVRE C
2000 - Heart 83(1):7-8
Unité(s) : Cardiologie Adulte
 
  Coronary angioplasty in haemodialysis patients
TABET S, LE FEUVRE C, DAMBRIN G, HELFT G, BEYGUI F, VACHERON A, METZGER JP
2000 - Arch. Mal. Coeur Vaisseaux 93(7):807-812
The results of balloon coronary angioplasty are very disappointing In haemodialysis patients because of the high restenosis rate. On the other hand, the use of stents in this population had not previously been assessed. This retrospective study compared 63 coronary patients on haemodialysis with a reference group of 63 paired patients with respect to gender, age, and the necessity or not of stent implantation. There was a higher frequency of hypertension (79 vs 39%) and of hypertriglyceridaema (22 vs 8%) in the haemodialysis group than in the controls. However, there was no significant difference with respect to primary success rate of angioplasty (92 and 89% respectively), nor to the development of early cardiovascular complications (4% and 1.9% respectively). After a two-year follow-up, there was no significant difference in the restenosis rate in the haemodialysis patients (33%) compared with the controls (25%). Nevertheless, the mortality rate at 2 years was higher in the dialysis group (15%) compared with the reference group (3.5%, p = 0.03). However, this mortality rate was lower than that reported in the literature in haemodialysis patients after balloon angioplasty. Therefore, haemodialysis does not increase the risk of restenosis when an optimal angiographic result is obtained either by balloon angioplasty or by angioplasty with stenting. Coronary angioplasty is a safe and effective method of revascularisation in coronary haemodialysis patients when the lesions are accessible to stenting. [References: 24]
Unité(s) : Cardiologie Adulte
 
  The heparin management test: a new device for monitoring anticoagulation during coronary intervention
HELFT G, BARTOLOMEO P, ZAMAN AG, WORTHLEY SG, CHOKRON S, LE PAILLEUR C, BEYGUI F, LE FEUVRE C, METZGER JP, VACHERON A, SAMAMA MM
1999 - Thromb. Res. 96(6):481-485
Whole blood coagulation analysers are widely used during percutaneous coronary interventions. The precise degree of anticoagulation in patients is important in this setting. The aim of this investigation was to compare the results obtained with ACT (Hemochron) and HMT, the Heparin Management Test (TAS) in patients undergoing percutaneous coronary interventions. Patients (n = 100) were enrolled prospectively. Each patient received 10,000 units of heparin. At the end of the procedure, the mean ACT was 284+/-31 seconds and the mean HMT was 292+/-33 seconds. The correlation between the two methods was highly significant (r = 0.64, p<0.001). The HMT correlates well with ACT values in patients undergoing percutaneous coronary interventions. Its use in the management of these patients should be considered.
Unité(s) : Cardiologie Adulte
 
  New thrombolytic agents in myocardial infarction
HELFT G, ELALAMY I, BEYGUI F, DAMBRIN G, LECOMPTE T, LE PAILLEUR C, LE FEUVRE C, METZGER JP, VACHERON A, SAMAMA MM
1999 - Arch. Mal. Coeur Vaisseaux 92(4):411-417
Myocardial infarction is the result of thrombotic coronary artery occlusion. Although present-day thrombolytics have major value by increasing the frequency of reopening of arteries responsible for myocardial infarction, by preserving myocardial function and, thereby, significantly reduce mortality. Nevertheless, they are subject to the following limitations: I) excellent arterial partency is only obtained in 50% of cases; 2) reocclusion occurs in 5 to 10% of cases; 3) severe complications such as cerebral haemorrhage are observed in about 0.5% of cases.
Unité(s) : Cardiologie Adulte
 
  Late results with bioprosthetic valves in the elderly
HELFT G, TABONE X, GEORGES JL, LOMAMA E, LEPAILLEUR C, LE FEUVRE C, METZGER JP, HEULIN A, VACHERON A
1999 - J. Cardiac Surg. 14(4):252-258
Aim: We report the long-term outcome of aortic and mitral bioprostheses in patients over 65 years of age at the time of implantation. The aim was to determine actuarial patient survival, causes of death, and the rate of documented primary structural deterioration. Methods: One hundred ten patients greater than or equal to 65 years of age (mean, 73.4; range, 65-82) underwent successful bioprosthetic valve replacement (aortic, n = 71; mitral, n = 32; both, n = 7) from 1979 to 1985. The valve was pericardial in 39 cases and porcine in 78. The mean follow-up was 8.5 years (101.9 months-total; 934 patient-years; range, 2 months to 15 years). Results: Actuarial patient survival was 79.6% (71-86) at 5 years and 62.4% (52-71) at 10 years. Forty-four patients died, 21 from valve-related causes and 23 from other causes. Thirteen patients (11.8%) had reoperation for valve-related complications: 10 structural deteriorations, 2 paravalvular leaks, and 1 case of endocarditis. One surgical death occurred (7.7%). Twenty-six percent of the patients were receiving anticoagulants because of atrial fibrillation, and 6.4% developed severe bleeding (2.9% patient-years). Conclusions: Long-term follow-up of these patients > 65 years of age, undergoing bioprosthetic value replacement surgery revealed a low rate of documented primary structural deterioration (0.95% per patient-year), a low mortality rate on reoperation (7.7%), and a high mortality rate due to non-value-related causes (52.3%). [References: 24]
Unité(s) : Cardiologie Adulte
 
  Bronchial casts in children with cardiopathies: The role of pulmonary lymphatic abnormalities
LANGUEPIN J, SCHEINMANN P, MAHUT B, LE BOURGEOIS M, JAUBERT F, BRUNELLE F, SIDI D, DE BLIC J
1999 - Pediat. Pulm. 28(5):329-336
Expectoration of bronchial casts, a condition also called plastic bronchitis, is very rare in children. Bronchial casts may be associated with bronchopulmonary diseases associated with mucus hypersecretion, bronchopulmonary bacterial infections, congenital and acquired cardiopathies, or pulmonary lymphatic abnormalities. A classification based on anatomy and pathology has been proposed which identifies an "acellular" group associated with congenital cardiopathies and palliative surgery. We report on 3 cases with bronchial casts associated with cardiopathy. Observations suggest that the formation of bronchial casts may result from lymphatic leakage into the bronchi. The 3 cases on which we report were immunodeficient and had pulmonary lymphatic abnormalities. The bronchial casts contained lymphocytes and lipids, as determined by histologic examination. In the absence of congenital pulmonary or diffuse lymphatic dysplasia associated with cardiopathy, the principal factors resulting in the formation of bronchial casts appear to be surgical trauma to the lymphatic channels surrounding the bronchi, pleural adhesions, and high systemic venous blood pressure. The prognosis for these patients is poor, and possibilities for treatment are limited. Copyright 1999 Wiley-Liss, Inc.
Unité(s) : Anatomo-Pathologie, Radiologie Pédiatrique, Cardiologie Adulte, Pneumologie-Allergologie Pédiatrique
 
  A century and a half of cardiology in the Public Teaching Hospital Network in Paris, France
VACHERON A
1999 - Sem. Hôp. Paris 75(5-6):174-177
Unité(s) : Cardiologie Adulte
 
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