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Thibaud P, Chow-Chine L, Gonzalez F, Bisbal M, Servan L, Sannini A, Tezier M, Tourret M, Cambon S, Pouliquen C, Ettori F, de Guibert JM, Faucher M, Caillol F, Mokart D. Septic shock and biliary sepsis: 90-day mortality and associated risk factors. HPB (Oxford) 2024; 26:270-281. [PMID: 37940408 DOI: 10.1016/j.hpb.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Biliary sepsis is common in patients with digestive cancer. Recommendations call for antibiotic de-escalation (ADE) as a strategy for antibiotic treatment of sepsis or septic shock. The aim of this study was to identify factors influencing 90-day mortality and to evaluate the impact of ADE. METHODS This retrospective study was conducted between November 2008 and December 2019 in a referral cancer center. Adults with biliary sepsis or septic shock admitted to the ICU were included. Variables associated with 90-day mortality were identified using univariate and multivariate Cox proportional hazards models. RESULTS 122 patients were included. The 90-day mortality was 30.3% (n = 37). After multivariate analysis, the factors independently associated 90-day mortality were metastatic stage (p = 0.004), biliary tract tumour compression (p = 0.001), multi drug resistant (MDR) bacteria carriage on intensive care unit (ICU)admission (p = 0.048), serum lactate on ICU admission (p < 0.001), the use of extra-renal replacement (p = 0.008), factor V < 50% (p = 0.009) and performance status (ECOG-PS) > 2 (p < 0.001). ADE of the pivotal antibiotic (p = 0.041) and recent cancer surgery (p < 0.001) appeared to be associated with survival. CONCLUSION The 90-day mortality of biliary sepsis seems to be favourable. The 90-day mortality is associated with organ dysfunctions, but also with ECOG-PS, cancer stage, MDR bacteria colonisation. ADE seems to be safe.
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Affiliation(s)
- Pierre Thibaud
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | | | - Magali Bisbal
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Luca Servan
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Antoine Sannini
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Marie Tezier
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Maxime Tourret
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Sylvie Cambon
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | - Florence Ettori
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | - Marion Faucher
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Fabrice Caillol
- Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
| | - Djamel Mokart
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France.
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Canac J, Faucher M, Depeyre F, Tourret M, Tezier M, Cambon S, Ettori F, Servan L, Alisauskaite J, Pouliquen C, Gonzalez F, Bisbal M, Sannini A, de Guibert JM, Lambaudie E, Turrini O, Chow-Chine L, Mokart D. ASO Visual Abstract: Factors Associated with 1-Year Mortality of Elderly Patients (Age 80 Years and Older) with Cancer Undergoing Major Abdominal Surgery: A Retrospective Cohort Study. Ann Surg Oncol 2024; 31:67-68. [PMID: 37907697 DOI: 10.1245/s10434-023-14481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Julie Canac
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Marion Faucher
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Fanny Depeyre
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Maxime Tourret
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Marie Tezier
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Sylvie Cambon
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Florence Ettori
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Luca Servan
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Jurgita Alisauskaite
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Camille Pouliquen
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Frédéric Gonzalez
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Magali Bisbal
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Antoine Sannini
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Jean Manuel de Guibert
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Eric Lambaudie
- Département de Chirurgie, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Olivier Turrini
- Département de Chirurgie, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Laurent Chow-Chine
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France
| | - Djamel Mokart
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille Cedex 09, France.
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Canac J, Faucher M, Depeyre F, Tourret M, Tezier M, Cambon S, Ettori F, Servan L, Alisauskaite J, Pouliquen C, Gonzalez F, Bisbal M, Sannini A, de Guibert JM, Lambaudie E, Turrini O, Chow-Chine L, Mokart D. Factors Associated with 1-Year Mortality in Elderly Patients (Age ≥ 80 Years) with Cancer Undergoing Major Abdominal Surgery: A Retrospective Cohort Study. Ann Surg Oncol 2023; 30:8083-8093. [PMID: 37814178 DOI: 10.1245/s10434-023-14365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND The number of elderly patients undergoing major abdominal surgery is increasing, but the factors affecting their postoperative outcomes remain unclear. This study aimed to identify the factors associated with 1-year mortality among elderly patients (age ≥ 80 years) with cancer undergoing major abdominal surgery. METHODS This retrospective cohort study was conducted from March 2009 to December 2020. The study enrolled 378 patients 80 years old or older who underwent major abdominal surgery. The main outcome was 1-year mortality, and the factors associated with mortality were analyzed. RESULTS Of the 378 patients, 92 died at 1 year (24.3%), whereas the 30-day mortality rate was 4% (n = 15). In the multivariate analysis, the factors independently associated with 1-year mortality were preoperative Eastern Cooperative Oncology Group (ECOG) performance status (PS) score higher than 1 (odds ratio [OR], 3.189; 95% confidence interval [CI], 1.595-6.377; p = 0.001), preoperative weight loss greater than 3 kg (OR, 2.145; 95% CI, 1.044-4.404; p = 0.038), use of an intraoperative vasopressor (OR, 3.090; 95% CI, 1.188-8.042; p = 0.021), and postoperative red blood cell units (OR, 1.212; 95% CI, 1.045-1.405; p = 0.011). Survival was associated with perioperative management according to an enhanced recovery after surgery (ERAS) protocol (OR, 0.370; 95% CI, 0.160-0.854; p = 0.006) and supramesocolic surgery (OR, 0.371; 95% CI, 0.158-0.871; p = 0.023). CONCLUSION The study identified several factors associated with an encouraging 1-year mortality rate in this setting. These results highlight the need for identification of suitable targets to optimize pre-, intra-, and postoperative management in order to improve outcomes for this vulnerable population.
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Affiliation(s)
- Julie Canac
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Marion Faucher
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Fanny Depeyre
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Maxime Tourret
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Marie Tezier
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Sylvie Cambon
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Florence Ettori
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Luca Servan
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Jurgita Alisauskaite
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Camille Pouliquen
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Frédéric Gonzalez
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Magali Bisbal
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Antoine Sannini
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | | | - Eric Lambaudie
- Département de Chirurgie, Institut Paoli Calmette, Marseille, France
| | - Olivier Turrini
- Département de Chirurgie, Institut Paoli Calmette, Marseille, France
| | - Laurent Chow-Chine
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Djamel Mokart
- Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
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Jacquemin M, Mokart D, Faucher M, Ewald J, Tourret M, Brun C, Tezier M, Mallet D, Nguyen Duong L, Cambon S, Pouliquen C, Ettori F, Sannini A, Gonzalez F, Bisbal M, Chow-Chine L, Servan L, de Guibert JM, Boher JM, Turrini O, Garnier J. LATE POSTPANCREATICODUODENECTOMY HEMORRHAGE: INCIDENCE, RISK FACTORS, MANAGEMENT AND OUTCOME. Shock 2022; 58:374-383. [PMID: 36445230 DOI: 10.1097/shk.0000000000001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ABSTRACT Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P < 0.001), and C-reactive protein (CRP) concentration (P < 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.
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Affiliation(s)
- Mathieu Jacquemin
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Djamel Mokart
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Marion Faucher
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Jacques Ewald
- Département de Chirurgie Oncologique, Institut Paoli Calmette, France
| | - Maxime Tourret
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Clément Brun
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Marie Tezier
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Damien Mallet
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Lam Nguyen Duong
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Sylvie Cambon
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Camille Pouliquen
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Florence Ettori
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Antoine Sannini
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Frédéric Gonzalez
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | - Magali Bisbal
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | | | - Luca Servan
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, France
| | | | - Jean Marie Boher
- Unité de Biostatistique et de Méthodologie, Institut Paoli Calmette, France
| | - Olivier Turrini
- Département de Chirurgie Oncologique, Institut Paoli Calmette, France
| | - Jonathan Garnier
- Département de Chirurgie Oncologique, Institut Paoli Calmette, France
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Seitz JF, Lapalus D, Arlotto S, Gentile S, Ettori F, Rinaldi Y, Grandval P, Delasalle P. Colorectal cancer screening by fecal immunochemical test or colonoscopy in France: how many people are actually covered? Focus on the Provence-Alpes-Côte d'Azur region. Eur J Gastroenterol Hepatol 2022; 34:405-410. [PMID: 34882643 PMCID: PMC8876435 DOI: 10.1097/meg.0000000000002338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening with fecal immunochemical test (FIT) remains low in France, particularly in the Provence-Alpes-Côte-d'Azur (PACA) region. The aim of this study was to compare insured persons (50-74 years) who had FIT and/or colonoscopy in PACA with the general French population. METHODS FIT and colonoscopy rates were calculated according to SP-France and National Health Data System data. RESULTS The rate of FIT in 2016-2017 was lower in PACA than in France (25.6 vs. 29.1%, P < 0.001). Conversely, in 2013-2017, the rate of colonoscopy in the past 5 years was higher in PACA than in France (23.1 vs. 20.1%, P < 0.001). Total rate for FIT within 2 years and/or colonoscopy within 5 years was 46.0% in PACA vs. 46.5% in France (P < 0.001). Overuse was higher for diagnostic (1.21) than therapeutic colonoscopies (1.05). Therapeutic colonoscopy occurred more with FIT than without (47.88 vs. 38.7%, P < 0.001). According to USA criteria, persons with FIT within 2 years and/or sigmoidoscopy and/or colonoscopy within 10 years was 59.4% in PACA vs. 54.7% in France (P < 0.001). CONCLUSION Low participation in FIT in France must be improved to increase the rate of therapeutic colonoscopies and reduce the incidence of CRC. The higher colonoscopy rate in PACA could explain the lower CRC mortality. Efforts should be focused on the more than 40% of French insured who are not screened by either FIT or colonoscopy.
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Affiliation(s)
- Jean-François Seitz
- Service Oncologie Digestive & Hépato-Gastroentérologie, CHU Timone, Assistance Publique-Hôpitaux de Marseille (APHM) & Aix-Marseille-Univ. (AMU), Marseille
- Centre Régional de Coordination du Dépistage des Cancers – SUD – Provence-Alpes-Côte d’Azur (CRCDC-Sud-PACA), Marseille
| | - David Lapalus
- Agence Régionale de Santé – Provence-Alpes-Côte d’Azur (ARS-PACA), Marseille
| | - Sylvie Arlotto
- Service d’Evaluation Médicale, APHM & AMU, Marseille
- EA 3279 Self-Perceived Health Assessment Research Unit, AMU, Marseille, France
| | - Stéphanie Gentile
- Service d’Evaluation Médicale, APHM & AMU, Marseille
- EA 3279 Self-Perceived Health Assessment Research Unit, AMU, Marseille, France
| | - Florence Ettori
- Agence Régionale de Santé – Provence-Alpes-Côte d’Azur (ARS-PACA), Marseille
| | - Yves Rinaldi
- Centre Régional de Coordination du Dépistage des Cancers – SUD – Provence-Alpes-Côte d’Azur (CRCDC-Sud-PACA), Marseille
| | - Philippe Grandval
- Service Oncologie Digestive & Hépato-Gastroentérologie, CHU Timone, Assistance Publique-Hôpitaux de Marseille (APHM) & Aix-Marseille-Univ. (AMU), Marseille
| | - Patrick Delasalle
- Centre Régional de Coordination du Dépistage des Cancers – SUD – Provence-Alpes-Côte d’Azur (CRCDC-Sud-PACA), Marseille
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Ettori F, Henin A, Zemmour C, Chow-Chine L, Sannini A, Bisbal M, Gonzalez F, Servan L, de Guibert JM, Faucher M, Boher JM, Mokart D. Impact of a computer-assisted decision support system (CDSS) on nutrition management in critically ill hematology patients: the NUTCHOCO study (nutritional care in hematology oncologic patients and critical outcome). Ann Intensive Care 2019; 9:53. [PMID: 31065880 PMCID: PMC6505002 DOI: 10.1186/s13613-019-0527-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/27/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mortality of critically ill hematology (HM) patients has improved over time. Thus, those patients require an extensive diagnostic workup and the optimal use of available treatments. There are no data regarding nutrition strategy for critically ill HM patients, while nutritional support is crucial for both HM and critically ill patients. We hypothesized that the implementation of a computer-assisted decision support system (CDSS), designed to supervise a nutritional intervention by a multidisciplinary team, would be able to increase guidelines adherence and outcomes. RESULTS In this before/after study, 275 critically ill hematology patients admitted to the ICU over 5-year period were included. Energy and protein intakes were delivered using standard protocol in the 147 patients (53%) of the 'before group' and using a CDSS in order to reach every day predefined caloric and protein targets accordingly to the catabolic or anabolic status in the 128 patients (47%) of the 'after group.' Using a Poisson regression, we showed that the use of CDSS allowed to reach a relative increase in the rate of days in compliance with caloric (1.57; 95% confidence interval (CI), [1.17-2.10], p = 0.0025) and protein targets (3.86 [2.21-6.73], p < 0.0001) in the 'after group' by more than 50% as compared with the 'before group.' Interestingly, compliance rates were low and only reached 30% after intervention. Hospital mortality, ICU-acquired infection, and hospital, and ICU length of stay were similar in the two groups of patients. Importantly, exploratory analysis showed that hospital mortality was lower in the 'after group' for neutropenic and severely ill patients. CONCLUSION For critically ill hematology patients, the use of a nutritional CDSS allowed to increase the days in compliance with caloric and protein targets as compared with no CDSS use. In this context, overall hospital mortality was not affected.
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Affiliation(s)
- Florence Ettori
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Aurélia Henin
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Christophe Zemmour
- Unité de Biostatistique et de Méthodologie, Institut Paoli-Calmettes, Marseille, France.,INSERM, IRD, SESSTIM, Aix Marseille Université, Marseille, France
| | - Laurent Chow-Chine
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Antoine Sannini
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Magali Bisbal
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Frédéric Gonzalez
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Luca Servan
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Jean Manuel de Guibert
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Marion Faucher
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France
| | - Jean Marie Boher
- Unité de Biostatistique et de Méthodologie, Institut Paoli-Calmettes, Marseille, France.,INSERM, IRD, SESSTIM, Aix Marseille Université, Marseille, France
| | - Djamel Mokart
- Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille Cedex 09, France.
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Scotti A, Adamo M, Beneduce A, Pivato C, Arrigoni L, Salerno A, Cappelletti A, Stella S, Fragasso G, Montorfano M, Agricola E, Ettori F, Margonato A, Colombo A, Godino C. 3863Two-year outcomes after mitraclip treatment of functional mitral regurgitation in ischemic and non-ischemic dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.3863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vizzardi E, Sciatti E, Bonadei I, Rovetta R, D'Aloia A, Gelsomino S, Lorusso R, Ettori F, Metra M. Effects of transcatheter aortic valve implantation on left ventricular mass and global longitudinal strain: tissue Doppler and strain evaluation. Heart Lung Vessel 2014; 6:253-61. [PMID: 25436207 PMCID: PMC4246844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation is the option of choice for high surgical risk patients suffering from symptomatic aortic stenosis. We aimed to evaluate the influence of baseline global longitudinal strain on left ventricular mass regression after the procedure. METHODS We enrolled 23 patients with pure symptomatic severe aortic stenosis who underwent CoreValve prosthesis (Medtronic, Minneapolis, MN) implantation. Everyone had echocardiography registration before the procedure and after six months in order to analyze two-, three-, and four-chamber peak longitudinal strain and global longitudinal strain. RESULTS After the procedure New York Heart Association class, peak and mean aortic valve gradients (p<0.001 for all) improved. Interventricular septum and posterior wall thicknesses decreased (p<0.001 for both). Moreover, left ventricular mass index for body surface area changed from 190±44 to 143±30 g/m(2), (p<0.001). Finally, global longitudinal strain significantly increased (from 9.4±0.9 to 11.5±0.8%; p<0.001), as well as its components. Baseline global longitudinal strain correlated with left ventricular mass regression (r=0.560; p=0.005; 2-sided) and predicted it at linear regression analysis (B=23.707; p=0.005; adjusted R(2)=0.281). CONCLUSIONS Global longitudinal strain and its components improved six months after the procedure. Moreover, baseline global longitudinal strain seemed to predict left ventricular mass regression in patients with pure aortic stenosis undergoing transcatheter aortic valve implantation. This finding could be related to the extent of myocardial fibrosis which is also responsible for lack of left ventricular mass regression and poorer prognosis.
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Affiliation(s)
- E Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
| | - E Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
| | - I Bonadei
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
| | - R Rovetta
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
| | - A D'Aloia
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
| | - S Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, The Netherlands
| | - R Lorusso
- Cardiac Surgery Unit, Spedali Civili of Brescia, Italy
| | - F Ettori
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
| | - M Metra
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Italy
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9
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Mokart D, van Craenenbroeck T, Lambert J, Textoris J, Brun JP, Sannini A, Chow-Chine L, Hamouda S, Fouché L, Ettori F, Faucher M, Blache JL. Prognosis of acute respiratory distress syndrome in neutropenic cancer patients. Eur Respir J 2011; 40:169-76. [PMID: 22135281 DOI: 10.1183/09031936.00150611] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To date, no study has been specifically designed to identify determinants of death in neutropenic cancer patients presenting with acute respiratory distress syndrome (ARDS). The aim of this study was to identify early predictive factors of 28-day mortality in these patients. Factors associated with 28-day mortality during intensive care unit (ICU) stay were also described. 70 consecutive cancer patients with ARDS and neutropenia were prospectively analysed over a 6-yr period. Mortality at 28 days was 63%. Factors independently associated with good prognosis were: lobar ARDS (OR 0.10, 95% CI 0.02-0.48), use of initial antibiotic treatment active on difficult to treat bacteria (ticarcillin-resistant Pseudomonas aeruginosa, Stenotrophomonas maltophilia or extended-spectrum β-lactamase-producing strains) (OR 0.08, 95% CI 0.02-0.33) and first-line chemotherapy (OR 0.08, 95% CI 0.02-0.37). During the ICU stay, mortality was associated with the markers of organ dysfunctions, the absence of neutropenia recovery and the use of vasopressors. During the first 3 weeks, the conditional probability of discharge alive from ICU did not decrease. At ICU admission, first-line chemotherapy, lobar ARDS and antibiotic treatment active on difficult-to-treat bacteria were associated with survival. During ICU stay, mortality was associated with organ dysfunctions and use of vasopressors. Most survivors have an ICU stay of >3 weeks.
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Affiliation(s)
- Djamel Mokart
- Intensive Care Unit, Paoli-Calmette Institute, 232 bd Sainte Marguerite, 13273 Marseille Cedex 9, France.
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10
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Colle IO, Moreau R, Godinho E, Belghiti J, Ettori F, Cohen-Solal A, Mal H, Bernuau J, Marty J, Lebrec D, Valla D, Durand F. Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study. Hepatology 2003; 37:401-9. [PMID: 12540791 DOI: 10.1053/jhep.2003.50060] [Citation(s) in RCA: 247] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Portopulmonary hypertension represents a major risk factor for transplantation; therefore, preoperative detection is crucial. The aims of this study were to determine (1) whether Doppler echocardiography performed at evaluation is a reliable tool for detecting portopulmonary hypertension and (2) the incidence of acquired portopulmonary hypertension profile after evaluation. One hundred sixty-five patients had Doppler echocardiography and right heart catheterization at evaluation over a 9-year period. All patients had a prospective follow-up, and the results of catheterization at evaluation were compared with those obtained at the time of transplantation. Seventeen of 165 patients met the criteria for portopulmonary hypertension on Doppler echocardiography. Portopulmonary hypertension was confirmed by catheterization in 10 patients and ruled out in 7. There were no false negatives for echocardiography. Mean pulmonary artery pressure was significantly higher during the initial phase of transplantation than at evaluation (17.8 +/- 4.3 vs. 20.3 +/- 5.5 mm Hg, respectively, P <.0001), and there was no significant correlation between values obtained at these 2 time points. Three patients showed to have acquired portopulmonary hypertension profile while waiting for a graft within time intervals ranging from 2.5 to 5 months. In conclusion, Doppler echocardiography is a highly sensitive tool for detecting portopulmonary hypertension. However, because this technique has a poor positive predictive value, right heart catheterization is recommended for confirming portopulmonary hypertension. In addition, the absence of portopulmonary hypertension at evaluation does not exclude the occasional occurrence of acquired portopulmonary hypertension profile after listing.
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Affiliation(s)
- Isabelle O Colle
- Service d'Hépatologie and INSERM U481, Hôpital Beaujon, Clichy, France
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11
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Assanelli D, Ferrari R, Bollani G, Ettori F, Bonetti P, Bersatti F, Archetti S, Ruggeri G, Bonanome A, Martini G. Factor V G1691A, apo E4 allele, hyperhomocysteinemia and MTHFR C677T in a young patient with myocardial infarction. Thromb Haemost 1999; 82:1196. [PMID: 10494787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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12
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Ettori F. [Angioplasty versus bypass in multiple-vessel coronary obstruction pathology]. G Ital Cardiol 1997; 27:1055-9. [PMID: 9410776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- F Ettori
- Divisione di Cardiologia, Università degli Studi, Spedali Civili, Brescia
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13
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Steffenino G, Dellavalle A, Chierchia S, Vicedomini G, Fontanelli A, Bernardi G, Niccoli L, Ettori F, Repetto S, Castiglioni B, Risica G, Giommi L. [The Registry for Angioplasty in Infarction (RAI): brief preliminary report on the main indicators and process of acute outcome]. G Ital Cardiol 1997; 27:563-8. [PMID: 9280725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Emergency coronary angioplasty can be the treatment of choice in selected patients with acute myocardial infarction in centers with adequate facilities and organization. METHODS A multicenter observational study in patients with high-risk acute myocardial infarction was conducted to evaluate the quality of emergency angioplasty treatment according to process, acute and long-term outcome, and use of resources. RESULTS The RAI registry included 345 patients with high-risk acute myocardial infarction who were admitted to six participating centers over a thirteen-month period. Emergency coronary angiography was performed in 261 patients (76%) and was followed by immediate angioplasty in 236 of them (68%). Mean door-to-procedure time was 58 +/- 47 min. Severe left ventricular failure was present at admission in 35 (13%) of the 261 patients with emergency coronary angiography; and 29 of them were in cardiogenic shock (11%). Overall, in-hospital mortality for patients with angioplasty was 7.6%; i.e., 43% and 3.7% for patients with and without shock, respectively. CONCLUSIONS Despite logistical limitation, in centers with emergency angioplasty programs this treatment can be performed with favorable process and acute outcome characteristics in patients with high-risk myocardial infarction.
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Affiliation(s)
- G Steffenino
- Divisioni di Cardiologia di Ospedale Santa Croce, Cuneo
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14
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Milan E, Zoccarato O, Terzi A, Ettori F, Leonzi O, Niccoli L, Giubbini R. Technetium-99m-sestamibi SPECT to detect restenosis after successful percutaneous coronary angioplasty. J Nucl Med 1996; 37:1300-5. [PMID: 8708760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED This study evaluated the accuracy of 99mTc SPECT in predicting restenosis after primary successful PTCA. METHODS Thirty-seven patients with equivocal symptom-limited exercise stress testing were evaluated. All patients underwent separate day exercise-rest 99mTc-sestamibi SPECT. The perfusion studies were evaluated using three different methods of analysis: visual inspection, semiquantitative and quantitative polar map analysis. The perfusion studies were interpreted in absence of a pre-PTCA scan. All patients underwent a control coronary angiography within 1 mo. RESULTS Sensitivity and specificity of 99mTc-sestamibi SPECT in predicting restenosis were 87.5-78%, 50-65% and 75-74% for visual inspection, semiquantitative and quantitative polar map analysis, respectively. Sensitivity and specificity related to the vascular territories were: LAD territory 93-73% (qualitative analysis), 53-60% (semiquantitative analysis), 80-67% (quantitative analysis); LCX territory 83-100% (qualitative analysis); and 33-100% (semiquantitative analysis), 67-100% (quantitative analysis); and RCA territory 67-80% (qualitative analysis), 67-60% (semiquantitative analysis), 67-80% (quantitative analysis). CONCLUSION These data suggest that 99mTc-sestamibi SPECT is a useful noninvasive tool in the follow-up evaluation of patients who have undergone angiographically successful coronary angioplasty even in the absence of a pre-PTCA perfusion study.
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Affiliation(s)
- E Milan
- Nuclear Medicine and Cardiology Departments, Civic Hospital and University of Brescia, Italy
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15
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Leonzi O, Ettori F, Lettieri C, Metra M, Maggi A, Niccoli L. [Coronary angioplasty in chronic total occlusion: angiography results, complications, and predictive factors]. G Ital Cardiol 1995; 25:807-14. [PMID: 7557030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The results of coronary angioplasty of chronic total occlusions are still controversial. We examined baseline clinical and angiographic parameters and the success and complication rates of 142 consecutive procedures of coronary angioplasty of chronic occlusions selected among 1084 total procedures performed between January 1989 and May 1993. Procedural success was obtained in 109 procedures (77%) with 4 major cardiac complications (2.8%) consisting in one cardiac death caused by left main artery occlusion following an attempt of dilatation of an occluded left anterior descending artery, two non Q wave myocardial infarctions caused by distal embolization and one cardiac tamponade following artery perforation, successfully treated by pericardiocentesis. Extensive coronary dissection occurred in 24 procedures (17%): 5 caused vessel reocclusion and 19 were successfully treated by prolonged balloon inflation and/or use of long balloons or stent implantation. Among 15 baseline clinical and angiographic variables, none was predictive of cardiac complications or coronary artery dissection. In contrast, procedural success was significantly related with absence of bridging collaterals, duration of occlusion < 3 months and a tapered or thrombotic morphology of occlusion. Presence or absence of collaterals was the most significant variable selected by multivariate discriminant analysis. When patients with bridging collaterals were excluded from the analysis, occlusion morphology was the most important determinant. Success rates were 95% and 82% in patients with a tapered morphology lesion with < 3 months and > 3 months duration, respectively (ns); in contrast, success rates were 79% and 36% in patients with abrupt occlusion morphology of < and > 3 months duration (p = 0.001).
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Affiliation(s)
- O Leonzi
- Divisione E Cattedra Di Cardiologia Spedali Civili e Università Di Brescia
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16
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Ettori F, Leonzi O, Niccoli L, Lettieri C, Dalla Valle F, Visioli O. [Stable angina: long-term results]. Cardiologia 1994; 39:415-20. [PMID: 7634307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We report on 345 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) for stable angina in a 5-year period, with an average follow-up of 34 months (range 12-72). The primary success rate was 94.5%. The late mortality and incidence of myocardial infarction were 1.5% and 2.1% respectively. The rate of recurrence of angina was 34.5% and required PTCA (28.5%) and/or coronary artery bypass grafting (7%). At the end of follow-up 79.5% of patients were free from angina and a further 10% had improved. Our data confirm the importance of PTCA in stable angina.
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Affiliation(s)
- F Ettori
- Cattedra di Cardiologia, Università degli Studi, Brescia
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17
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Maggi A, Metra M, Niccoli L, Ettori F, Leonzi O, Lettieri C, Zanini R, Dei Cas L. [Prognosis in patients with myocardial infarction and angiographically normal coronaries]. Cardiologia 1994; 39:235-41. [PMID: 8062293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
From a survey on 8,000 coronary angiographic studies performed in our Institute between January 1980 and June 1990, 105 patients were identified as having angiographically normal coronary arteries and myocardial infarction (MI). Coronary arteries considered as normal were subdivided in completely normal (Group I), or slightly abnormal, with minimal lesions resulting in less than 30% narrowing of a major artery, defined as mild coronarosclerosis (Group II). Thirty-five patients were excluded from the study, because of the lack of complete follow-up data; the remaining 70 patients represent the study group we examined. The following parameters were examined: sex, age at the time of acute MI, family of ischemic heart disease, hypertension, dyslipidemia, diabetes, smoking, stable or unstable angina before MI, location of the MI, ejection fraction (EF), presence of completely normal coronary arteries or mild coronarosclerosis. Follow-up was obtained by contacting the patients or their families; post infarction angina, reinfarction, sudden death or cardiac death were noted. The subjects were divided in 2 groups, according to the coronary anatomy; Group I consisted of 41 patients with completely normal coronary arteries and Group II consisted of 29 patients with mild coronarosclerosis. No significant statistical difference was noted between the 2 groups regarding age, sex and coronary risk factors (except for dyslipidemia which was significantly more prevalent in the subjects with mild coronarosclerosis). Prevalence of left ventricular impairment (EF < 45%) and coronary events (angina, reinfarction and death) were significantly higher in Group II. There was no significant difference in age or clinical risk factor prevalence between patients with complicated and non complicated clinical course.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Maggi
- Cattedra e Divisione di Cardiologia, Università degli Studi, Spedali Civili, Brescia
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18
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Bonandi L, Metra M, Niccoli L, Ettori F, Nodari S, Dei Cas L, Visioli O. Combined invasive and noninvasive study of left ventricular systolic and diastolic function following acute administration of cicloprolol to subjects with normal cardiac function. Cardiovasc Drugs Ther 1992; 6:513-7. [PMID: 1360256 DOI: 10.1007/bf00055610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Cicloprolol is a new beta-blocking agent with high selectivity for beta 1 receptors and high intrinsic sympathomimetic activity. We studied the acute hemodynamic effects of cicloprolol in nine subjects with no evidence of left ventricular dysfunction who underwent cardiac catheterization for the evaluation of chest pain. All patients had normal coronary angiography and left ventriculography. Left ventricular pressure was determined throughout the cardiac cycle using a Millar 8Fr Minotip catheter; an echocardiogram, phonocardiogram, and ECG were simultaneously recorded to obtain left ventricular pressure-diameter loops. All the measurements were repeated before and after the intravenous administration of cicloprolol. Cicloprolol was administered at increasing doses of 0.05, 0.10, and 0.25 mg/kg until a cardiac output increase of at least 15% over basal values was achieved. A decrease of mean arterial pressure or cardiac output after cicloprolol was not observed in any patient. Cicloprolol administration significantly increased cardiac output (24%), stroke volume (22%), and peak positive dP/dt (25%); no significant changes in heart rate, systemic blood pressure, right atrial pressure, or pulmonary artery pressures were observed. No significant change in the echocardiographic parameters occurred. Among the indices of left ventricular diastolic function, the time constant of isovolumetric relaxation was significantly decreased (-43%) after cicloprolol; moreover, the left ventricular pressure-diameter loop in the protodiastolic phase was shifted to the left following cicloprolol infusion. This study confirms that in subjects with normal left ventricular function cicloprolol can improve resting left ventricular systolic function, and it shows that this action can also be attended by a more rapid isovolumetric relaxation, similar to what has been observed with other sympathomimetic amines.
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Affiliation(s)
- L Bonandi
- Cattedra di Cardiologia, University of Brescia, Italy
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19
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Assanelli D, Marconi M, Gei P, Zappa C, Facchinetti AI, Ettori F, Niccoli L. [Echocardiographic and cardioangiographic evaluation of non-Q infarction with isolated stenosis of the anterior descending artery]. Cardiologia 1991; 36:31-7. [PMID: 1878900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We studied with two-dimensional echocardiography and coronary angiography 2 groups of patients with one-vessel stenosis located on anterior descending (IVA) and previous acute myocardial infarction (AMI; means 19 days): 23 patients with spontaneous non-Q infarction (Group I), and 23 patients with Q infarction (Group II). Left ventricular function was better in Group I (echo score: 2.04 +/- 2.64, angiographic ejection fraction: 65.65 +/- 9.7 in Group I, echo score: 4.78 +/- 3.14, angiographic ejection fraction: 49.47 +/- 9.1 in Group II, p less than 0.001). Percent occlusion of IVA was lower in Group I and angiographic IVA caliper was significantly higher (p less than 0.05). Differences between groups were much more evident in subgroups with proximal stenosis of IVA: patients of non-Q subgroup had very good left ventricular function but frequently had post-IMA unstable angina (78%). Our results underline usefulness of aggressive diagnostic and therapeutic approach in non-Q AMI, because of higher amount of myocardial a risk.
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Affiliation(s)
- D Assanelli
- Cattedra e Divisione di Cardiologia, Università degli Studi, Spedali Civili, Brescia
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20
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Gei P, Cuccia C, Bonaldi E, Pagnoni N, Volpini M, Berra P, Ettori F, Niccoli L, Riva S. [Coronary angiographic study of patients with non-Q myocardial infarct: correlations with the initial electrocardiographic aspect and prognosis]. G Ital Cardiol 1988; 18:90-6. [PMID: 3410207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The purpose of our study was to evaluate, during the early phase, the coronary anatomy of the patients who suffered from an acute non-Q myocardial infarction (non-Q MI) and to correlate it with the ECG findings and with clinical evolution. We studied 76 patients (pts.), mean age 56 +/- 9 years, who had their a first non-Q MI (reinfarctions non included). They all underwent angiographic examination within an average period of 18 days (range 5-30 days). In the whole group of patients it is worthwhile noting: A) the elevated occurrence of left main lesions (11% of pts.) and multivessel disease (60%); B) the great percentage (41%) of patients with open infarct-related vessel but with very critical residual stenosis (above 90% of total lumen); C) the presence of collateral vessels in almost all the pts. (91%) with totally occluded infarct-related artery. During the 12 month follow-up, in all groups was a high occurrence (above 70%) of coronary events (postinfarction angina, reinfarction, aortocoronary by pass or PTCA). Furthermore, it is possible to identify a subgroup of patients presenting ST-segment depression with very unfavourable coronary anatomy (80% had multivessel disease, 30% of which had a left main critical stenosis) and high prognostic risk (90% occurrence of coronary events). In the subgroup with ST-segment elevation there was an elevated percentage (65%) of open infarct-related vessel, but with an important residual stenosis. Considering the advantages of revascularization interventions in these high risk patients with extensive residual jeopardized myocardium, we conclude that it is important that all patients with non-Q MI undergo early coronary angiography.
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Affiliation(s)
- P Gei
- Cattedra e Divisione di Cardiologia, Università degli Studi e Spedali Civili di Brescia
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21
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Bonandi L, Niccoli L, Ettori F, Leonzi O, Visioli O, Meli M, Brugger JP, Odermatt R, Hahn C. [Evaluation of the volume and ejection fraction of the right ventricle by a theory of measurement applied to thermodilution]. Cardiologia 1986; 31:571-8. [PMID: 3815432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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22
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Niccoli L, Bellandi M, Benedini G, Cucchini F, Ettori F, Leonzi O, Visioli O. Iopamidol a new contrast agent in angiocardiography. Experimental and clinical experience in comparison with a commonly used contrast medium. Radiol Med 1986; 72:32-6. [PMID: 3726197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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23
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Leonzi O, Cuccia C, Ettori F, Bellandi M, Niccoli L. [Lower myocardial infarct with depression of the ST segment in anterior precordial leads. Correlation of the electrocardiogram, coronarography and ventriculography performed in the acute phase]. G Ital Cardiol 1985; 15:1062-5. [PMID: 3830760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We report on 11 pts affected by acute inferior myocardial infarction (group A: 4 pts without precordial ST-segment depression; group B: 7 pts with ST precordial ST-segment depression). These pts underwent left and right coronarography and left ventriculography in the course of intracoronary thrombolysis. We did not observe, in the group B pts, an involvement of the LAD branch of the left coronary, neither contractility abnormalities of the left ventricular anterior wall. ST depression in the precordial leads was associated with severe and extensive abnormalities of left ventricular inferior wall contractility.
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24
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Bissoli GS, La Canna G, Zanini R, Caobelli A, Berra P, Ettori F, Arosio G. [M-mode echocardiographic evaluation of antihypertensive efficacy and the mechanism of action of pindolol]. Minerva Cardioangiol 1985; 33:337-43. [PMID: 4047421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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25
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Krayenbühl HP, Turina J, Hess O, Ettori F. [Echocardiography in the evaluation of ventricular function]. Schweiz Med Wochenschr 1977; 107:1317-24. [PMID: 918587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The ultrasonic beam used for quantitative assessment of left ventricular (LV) function traverses the heart in a projection similar to the familiar angiographic left anterior oblique projection. It crosses the anterior wall of the right ventricle, the right ventricular cavity, the interventricular septum, the LV cavity and the posterior wall of the left ventricle. Whereas the cyclic changes of the right ventricular diameter are rarely clearly determined by echocardiography, the easily assessed cyclic changes of the LV endocardial transverse diameter are useful measure of LV FUNCTION. Of practical importance are the percentage of systolic shortening of the LV diameter (%Sh) and the mean velocity of circumferential fiber shortening (VCF). There are several factors, such as placing of the ultrasonic transducer, the shape and size of the LV cavity and rotational movements of the heart as a whole, that influence echocardiographic determination of the transverse LV diameter. In patients with asynergic contraction, %Sh and VCF cannot be used as measures of overall LV performance, but localized contraction disturbances of the septum and the posterior wall may be detected from the reduced extent of wall motion in a given LV segment during a full sweep from the base to the apex. The most important indications for echocardiographic assessment of LV function are valvar diseases with chronic LV pressure or volume overload, and congestive cardiomyopathy. Echocardiography has proved useful in serial evaluation of LV function in patients undergoing valvar heart surgery. Assessment of LV volume by standard echocardiography using the cubic formula is not satisfactory. More accurate determination of volumes is provided by formulas that include the actual ratio of the LV long axis to the minor axis.
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