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Hézard N, Metz D, Potron G, Nazeyrollas P, Maes D, Droulle C, Mulpas MC, Elaerts J, Nguyen P. Monitoring the Effect of Heparin Bolus during Percutaneous Coronary Angioplasty (PTCA): Assessment of Three Bedside Coagulation Monitors. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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2
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Nazeyrollas P, Frances C, Prevost A, Costa B, Lorenzato M, Kantelip JP, Elaerts J, Millart H. Efficiency of amifostine as a protection against doxorubicin toxicity in rats during a 12-day treatment. Anticancer Res 2003; 23:405-9. [PMID: 12680240] [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: 03/01/2023]
Abstract
BACKGROUND Our purpose was to determine the effects of amifostine, a cytoprotective agent, on doxorubicin tolerance and cardiotoxicity in rats. MATERIALS AND METHODS Male Wistar rats were treated every other day with an intraperitoneal injection of amifostine or saline 30 minutes before intraperitoneal injection of doxorubicin or saline. Weight change was recorded, and contractile function was evaluated after 11 injections by means of the isolated heart. RESULTS Weight evolution and cardiac function were significantly improved by 7 and 20 mg/kg amifostine (p < 0.001) but not by 50 mg/kg. The final weight were: controls 349 +/- 16 g; doxorubicin alone 258 +/- 54 g; with amifostine: 7 mg/kg 314 + 28 g; 20 mg/kg 312 +/- 32 g; 50 mg/kg 250 +/- 34 g. Left ventricular developed pressure were: controls 137 +/- 15 mmHg; doxorubicin alone 119 +/- 20 mmHg; with amifostine: 7 mg/kg 140 +/- 20 mmHg; 20 mg/kg 137 +/- 25 mmHg; 50 mg/kg 124 +/- 20 mmHg. CONCLUSION Seven and 20 mg/kg amifostine protected rats from the toxicity of doxorubicin at the cumulative dose of 18 mg/kg during a 12-day treatment, with regard to weight loss and heart contraction.
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Affiliation(s)
- P Nazeyrollas
- Laboratoire de Pharmacologie, Faculté de Médecine, Service de Cardiologie, CHU de Reims, 51092 Reims, France.
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3
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Brasselet C, Tassan-Mangina S, Durand E, Perotin S, Garnotel R, Metz D, Desnos M, Elaerts J, Lafont A. [Biochemical markers of myocardial ischemia and necrosis]. Arch Mal Coeur Vaiss 2002; 95:775-80. [PMID: 12407791] [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: 02/27/2023]
Abstract
The biochemical markers of myocardial ischaemia have to be interpreted according to their kinetics; their interests depend on the clinical presentation. They are helpful to orient to a myocardial ischaemia in front of undefined chest pain, to stratify the outcome of acute coronary syndrome without ST segment elevation, to evaluate the amount of myocardial damage following infarction, to detect the failure of thrombolysis therapy and probably to stratify the post percutaneous coronary intervention outcome.
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Affiliation(s)
- C Brasselet
- Département de cardiologie, CHU Robert-Debré, avenue du Général-Koenig, 51092 Reims
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4
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Tassan-Mangina S, Brasselet C, Nazeyrollas P, Collot-Bigot M, Costa B, Blaise AM, Laury P, Bonfils L, Metz D, Elaerts J. [Value of pulsed Doppler tissue imaging for early detection of myocardial dysfunction with anthracyclines]. Arch Mal Coeur Vaiss 2002; 95:263-8. [PMID: 12055764] [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: 02/25/2023]
Abstract
The cumulative and definitive nature of chronic cardiotoxicity of anthracyclines requires a preventive strategy of early diagnosis. The authors undertook a prospective study of the association of echocardiography, mitral Doppler and pulsed Doppler tissue imaging of the left ventricular lateral and posterior walls in the context of this problem in 20 patients without cardiac disease undergoing cancer chemotherapy including anthracyclines. Doppler echocardiography was performed before the first session of chemotherapy and at the end of treatment, 6 +/- 4 months later. After a total cumulative dose of 227 +/- 91 mg/m2 of doxorubicine, there were no changes in left ventricular ejection fraction but a significant decrease in mitral E wave velocity (p = 0.04) and in E/A ratio (p = 0.01), suggesting early changes in left ventricular relaxation. The Doppler tissue examination confirmed the presence of radial and longitudinal abnormalities in myocardial relaxation (decreases in myocardial E wave velocities of the posterior and lateral walls of the left ventricle, p = 0.02 and p = 0.01, respectively). The peak velocity of the myocardial systolic wave (Sm) was significantly decreased in the lateral wall (p = 0.02) and approached statistical significance in the posterior wall (p = 0.07). These results suggest concomitant changes in myocardial systolic and diastolic function with moderate doses of anthracyclines. Therefore, pulsed Doppler tissue examination enables earlier detection of left ventricular cardiotoxicity with anthracyclines than classical echocardiographic parameters.
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Affiliation(s)
- S Tassan-Mangina
- Département de cardiologie et pathologie vasculaire, CHU de Reims.
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5
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Brasselet C, Metz D, Perotin S, Maillier B, Tassan-Mangina S, Deschildre A, Bonfils L, Jennessaux C, Blaise C, Elaerts J. [One center's experience of coronary angioplasty with a 5 French catheter guide by a femoral approach at the same time as coronary angiography]. Arch Mal Coeur Vaiss 2002; 95:269-74. [PMID: 12055765] [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: 02/25/2023]
Abstract
The object of this study was to assess the feasibility of so-called ad hoc 5 F percutaneous transluminal coronary angioplasty (PTCA). This monocentric register included 200 consecutive procedures (233 lesions) of 5F PTCA by a femoral approach after a bolus of standard heparin (50 to 70 IU/kg). The population included 15.4% of stable angina, 29.4% of unstable angina, 11% acute phase, 13.5% post-revascularisation angina and 30.7% post-infarction cases. A successful procedure was defined as a good angiographic result without ischaemic complications. A failed 5F procedure was defined by the need to fall back on a 6F PTCA. The peripheral vascular complications were recorded. The lesions were stented in 77.4% of cases including 13.4% of direct stenting. There were 200 successful procedures (87%). The failures (N = 26) were mainly explained by the inability to cross chronic obstruction (N = 11). The ischaemic complications included 2 coronary bypasses (2 retrograde dissections of the left anterior descending artery) and 7 enzymatic increases without ECG changes. Fall back to 6F PTCA was required in 4 cases (1.7%) always because of the instability of the 5F catheter guide before the procedure. The quality of coronary contrast was estimated to be good. The vascular complication rate was low with 2% of communicating haematomas (N = 4). Therefore, 5F PTCA is feasible with failure and complication rates comparable to those reported with catheters of larger dimensions. One of its principal advantages is "ad hoc" angioplasty after 5F coronary angiography.
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Affiliation(s)
- C Brasselet
- Département de cardiologie, CHU Robert-Debré, 51092 Reims.
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6
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Laury P, Chabert JP, Blaise C, Pérotin S, Brasselet C, Schlick C, Tassan-Mangina S, Metz D, Elaerts J. [A rare cause of stroke in a patient with a cardiac pacemaker]. Arch Mal Coeur Vaiss 2002; 95:219-22. [PMID: 11998338] [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: 02/24/2023]
Abstract
The authors report the case of a 78 year old woman admitted to hospital for recurrent cerebrovascular accidents, the initial investigation of which was normal. This pacemaker patient had a displacement of the definitive ventricular pacing catheter which was positioned in the left ventricle through a patent foramen ovale. The diagnosis was suspected on clinical and echocardiographic examination and confirmed by transthoracic and transoesophageal echocardiography. In view of the risk of systemic embolism, the pacing catheter was repositioned by an endovascular approach in the right ventricle.
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Affiliation(s)
- P Laury
- Département de cardiologie, hôpital Robert Debré, 51092 Reims.
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7
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Lozé O, Tassan-Mangina S, Nazeyrollas P, Brasselet C, Laury P, Bonfils L, Jamet B, Deschildre A, Metz D, Elaerts J. [Prediction of improvement of left ventricular systolic function by dobutamine echocardiography after recent myocardial infarction]. Arch Mal Coeur Vaiss 2001; 94:1038-44. [PMID: 11725708] [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: 02/22/2023]
Abstract
Left ventricular ejection fraction is a major prognostic factor of ischaemic heart disease. In the early phase of myocardial infarction, part of the myocardium may be stunned and responsible for marked segmental wall dysfunction which is potentially reversible. The authors studied the potential of low dose dobutamine echocardiography to predict secondary improvement of left ventricular systolic function in 21 patients with recent inaugural myocardial infarction without primary angioplasty. All patients were treated and the investigation was carried out up to 20 micrograms/Kg/min of dobutamine without unwanted side-effects or myocardial ischaemia. The detection of viability by this method was associated with improved wall motion of the affected segments in 74% of cases, most of which had benefited from myocardial revascularisation at control echocardiography performed 8 weeks later. If 4 or more segments were estimated to be viable initially, the left ventricular ejection fraction improved to a value comparable to that obtained at a dosage of 20 micrograms/Kg/min of dobutamine. On the other hand, there was no secondary improvement in 76% of segments estimated to be non-viable whether or not they had been revascularised. The sensitivity, specificity, positive and negative predictive values of low dose dobutamine echocardiography for prediction of myocardial recovery after recent infarction were respectively 71, 79, 74 and 76%. The results of this investigation show prognostic value and could be an aid to the decision concerning revascularisation of patients not having undergone primary angioplasty.
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Affiliation(s)
- O Lozé
- Département de cardiologie et pathologie vasculaire, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims
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8
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Méchiche H, Koroglu A, Elaerts J, Devillier P. [Vascular effects of neurokinins in humans]. Therapie 2001; 56:205-11. [PMID: 11475796] [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: 02/20/2023]
Abstract
Neurokinins (mainly substance P and neurokinin A) are released by sensitive nerve fibres. These fibres have been found in the vascular wall of arteries and veins of many vascular regions, particularly in nasal mucosa vessels, temporal and coronary arteries and saphenous veins. Substance P causes vascular relaxation by stimulating NK1 endothelial receptors. This relaxant effect is mediated, according to the vessels, by nitric oxide (NO), prostanoids or endothelium-dependent hyperpolarizing factor (EDHF). Capsaïcin, which induces the release of neurokinins, and neurokinin A can cause contractions of some vascular preparations, suggesting the existence of smooth muscle NK2 receptor associated with contraction. The vasodilatation induced by substance P injection appears reduced in patients with cardiovascular risk factors. The clinical development of specific neurokinin receptor antagonists may give the opportunity to specify the role of neurokinins in systemic vascular diseases. The results already obtained after repeated local applications of capsaïcin (to reduce local levels of neurokinins) in vasomotor rhinitis and urticaria suggest that the vascular effects of neurokinins may participate in the clinical expression of these diseases.
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Affiliation(s)
- H Méchiche
- Laboratoire de Pharmacologie, IFR 53, EA 2070, Faculté de Médecine, 1 rue du Maréchal Juin, 51095 Reims, France
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9
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Jamet B, Laury P, el Hallak A, Loze O, Bonfils L, Elaerts J. [Early postoperative constrictive pericarditis: value of echocardiography. Report of 4 cases]. Ann Cardiol Angeiol (Paris) 2000; 49:455-63. [PMID: 12555433] [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: 02/28/2023]
Abstract
In the present study, four cases of early postoperative constrictive pericarditis have been described which serve as a basis for recalling the current main echographic features of this disorder: pericardial thickening, abnormal septal movement with inspiratory expansion of the right ventricle, respiratory variations in ventricular filling, characteristic modifications in the supra-hepatic pulmonary venous flow, and pulmonary insufficiency. Some hypotheses have also been presented on the possible etiology of this disease. The necessity of making a precise and rapid diagnosis, which should also be confirmed by catheterization to ensure the appropriateness of therapy, has been emphasized. Pericardectomy can determine the long-term prognosis.
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Affiliation(s)
- B Jamet
- Département de cardiologie et pathologie vasculaire, hôpital Robert-Debré, rue du Général-Koenig, 51092 Reims, France
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10
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Jamet B, Metz D, Brasselet C, Chabert JP, Blaise C, Tassan-Mangina S, Deschildre A, Nazeyrollas P, Elaerts J. [Comparative evaluation of hydrophilic and standard guide wires for retrograde catheterization of severe aortic stenosis]. Arch Mal Coeur Vaiss 2000; 93:1291-5. [PMID: 11190457] [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: 02/19/2023]
Abstract
The feasibility and safety of using hydrophilic guide wires were compared with those of standard guide wires for retrograde catheterization of aortic stenosis in a prospective randomised study. The performances of the guide wires were assessed by the time taken to catheterize the aortic valve (minutes) and the duration of radioscopy (minutes: grays). The success of the procedure was defined as presence of the guide in the left ventricle in less than 8 minutes. The two patient groups were comparable with respect to the severity of the aortic stenosis. Two failures of catheterisation were observed in the "standard guide wire" group compared with three failures with the hydrophilic guide wire. The mean catheterisation time of the "standard" group was 2.56 minutes compared with 3.12 minutes with the hydrophilic guide wire (p = 0.35 NS). This result was correlated with the duration of radioscopy and number of groups (respectively p = 0.18 NS and p = 0.5 NS). One case of tamponade and a transient ischaemic cerebral attack were observed in the "standard" group. This study does not show the hydrophilic guide wire to be superior to the standard guide wire for catheterisation of aortic stenosis. However, the hydrophilic guide wires were perfectly innocuous for this procedure.
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Affiliation(s)
- B Jamet
- Département de cardiologie, CHR Reims, rue du Général-Koenig, 51092 Reims
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11
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Jamet B, Saade YA, Torossian F, Bonfils L, Elaerts J. [Cardiac lymphoma disclosed by ischemic accident. A case report]. Ann Cardiol Angeiol (Paris) 2000; 49:343-6. [PMID: 12555345] [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: 02/28/2023]
Abstract
We report on the detection of a primitive cardiac lymphoma revealed by a cerebral vascular accident in a context of deterioration of the general state with fever. The diagnosis of the cerebral vascular accident was verified by the brain scan. The echocardiography, in particular the transesophageal ultrasound, suggested the diagnosis of cardiac lymphoma due to the existence of an inhomogeneous multilobar mass invading the right ventricle and largely encompassing the right auricle. The histologic diagnosis of a malignant non-Hodgkin's lymphoma of type B malignancy was confirmed by anatomopathology. The evolution was, unfortunately, rapidly unfavorable, with the patient dying in a state of cerebral suffering despite a combination treatment of chemotherapy and radiotherapy.
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Affiliation(s)
- B Jamet
- Département de cardiologie et pathologie vasculaire, centre hospitalier universitaire de Reims, rue du Général Koenig, 51092 Reims, France
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12
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Jamet B, Chabert JP, Metz D, Elaerts J. [Acute aortic insufficiency]. Ann Cardiol Angeiol (Paris) 2000; 49:183-6. [PMID: 12555479] [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: 02/28/2023]
Abstract
Acute aortic insufficiency can now be diagnosed rapidly and accurately thanks to Doppler echocardiography. The etiologies include infectious endocarditis, aortic dissection, bioprosthesis degeneration and thoracic injury. The clinical diagnosis is substantiated by the particular etiological context, dyspnea and pulmonary edema being the main factors involved. Examination includes finding out whether there is a reduction in the first sound, S1 a generally brief apical diastolic murmur. Echocardiography detects the presence of aortic leakage, the acute character of which is confirmed by the findings of a premature closure of the mitral valve, the existence of telediastolic mitral leakage, a restriction in the transmitral flow, and finally, the absence of left ventricular dilatation. An emergency operation is recommended by most authors in the case of acute aortic leakage due to the major risk or mortality resulting from pulmonary edema, ventricular arrhythmias, electromechanical dissociation or cardiogenic shock.
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Affiliation(s)
- B Jamet
- Département de cardiologie, hôpital Robert-Debré, CHU, avenue du Général-Koenig, 51092 Reims, France
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13
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Brasselet C, Tassan-Mangina S, Mauran P, Raynaud-Brasselet C, Elaerts J, Metz D. [Pulmonary embolism in the child: diagnostic and therapeutic particularities]. Presse Med 2000; 29:955-9. [PMID: 10855249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Pulmonary embolism in children is an overlooked pathology. Yet the first description dates back to the end of the 19th century and this specific pathology is not seldom observed. The main risk factors are trauma, surgery, and foreign bodies. DIAGNOSIS Thrombophilia can be diagnosed when a thromboembolic event occurs. The initial thrombosis may be found anywhere in the venous network. Venous sonography usually gives the diagnosis. Pulmonary embolism usually has a poor clinical expression. An unexplained situation can be the first manifestation. Echocardiography guides diagnosis confirmed by ventilation-perfusion scintigraphy. TREATMENT Prophylaxis is achieved with small doses of heparin. Treatment is based on the use of hypocoagulant doses of heparin, potentially after systemic thrombolysis and followed by oral anticoagulation.
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Affiliation(s)
- C Brasselet
- Département de Cardiologie, Hôpital Robert Debré, Reims
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Hézard N, Metz D, Nazeyrollas P, Droulle C, Elaerts J, Potron G, Nguyen P. Use of the PFA-100 apparatus to assess platelet function in patients undergoing PTCA during and after infusion of c7E3 Fab in the presence of other antiplatelet agents. Thromb Haemost 2000; 83:540-4. [PMID: 10780313] [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: 02/16/2023]
Abstract
The PFA-100 (Dade) is a new functional whole blood analyzer, the accuracy and reliability of which have been evaluated in von Willebrand disease and during acetyl salicylate acid therapy. This new test has the advantages of rapidity and simplicity. It may be useful to monitor new antiplatelet agents, such as GPIIb/IIIa receptor antagonists. The objective of this study was to assess the PFA-100 in comparison with aggregometry and with the percentage of blockaded receptors GPIIb/IIIa during and after c7E3 Fab infusion in fifteen patients undergoing PTCA. Our results showed a change of closure time values from normal to abnormal within a small margin of flow cytometric values (60-75% of blockaded receptors), and moreover a variable platelet response to long-term low dose aspirin treatment in agreement with aggregometry. No influence with heparin was observed. In conclusion, this study shows that PFA-100 may be helpful in the decision making for additional antiaggregant therapy before PTCA or in monitoring long-term GPIIb/IIIa receptor antagonist treatment.
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Affiliation(s)
- N Hézard
- Laboratoire Central d'Hématologie, CHU Robert Debré, Reims, France
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Pop C, Metz D, Tassan-Mangina S, Nazeyrollas P, Jamet B, Maes D, Jennesseaux C, Chapoutot L, Baehrel B, Elaerts J. [Dobutamine doppler echocardiography in severe aortic stenosis with left ventricular dysfunction. Comparison with postoperative examination]. Arch Mal Coeur Vaiss 1999; 92:1487-93. [PMID: 10598228] [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: 04/14/2023]
Abstract
The association of left ventricular dysfunction with aortic stenosis worsens the spontaneous prognosis and increases operative mortality. The aim of this prospective study was to assess the predictive value of dobutamine Doppler echocardiography on the indices of left ventricular contractile function in patients with aortic stenosis and left ventricular dysfunction (LVEF < 0.45) undergoing aortic valve replacement. Eighteen patients, including 9 with coronary artery disease, were included in a protocol consisting of analysis of left ventricular function and of the severity of aortic stenosis before, during dobutamine infusion, and after valvular replacement. The dobutamine was given in progressive increments of 5 micrograms/Kg up to a maximum of 20 micrograms/Kg. During pharmacological stress, the functional aortic valve area increased from 0.46 +/- 0.15 to 0.56 +/- 0.23 cm2. Tolerance of the procedure was good. All but 2 patients improved their postoperative ejection fraction with values equivalent to those observed during the last increment of dobutamine (r = 0.73; p < 0.003). The patients with initial mean pressure gradients > 50 mmHg normalised their LVEF after valve replacement. The authors conclude that dobutamine echocardiography is useful for predicting the values of postoperative left ventricular contractile indices when severe aortic stenosis is associated with systolic dysfunction. It allows evaluation of the expected short term benefits to these indices after aortic valve replacement.
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Affiliation(s)
- C Pop
- Département de cardiologie, hôpital Robert-Debré, Reims
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16
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Brasselet C, Maes D, Tassan S, Beguinot I, Jamet B, Nazeyrollas P, Metz D, Elaerts J. [Extensive mycotic coronary aneurysm detected by echocardiography. Apropos of a case]. Arch Mal Coeur Vaiss 1999; 92:1229-33. [PMID: 10533672] [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: 02/14/2023]
Abstract
The authors report the case of a large mycotic right coronary aneurysm detected at echocardiography in a 45 year old patient with AIDS. Although emergency surgery was planned, the patient died of rupture of the aneurysm with cardiogenic shock and sudden pericardial tamponade. This case underlines the diagnostic value of echocardiography, by the transthoracic approach for para-cardiac masses and with the transoesophageal probe for accurate localisation and demonstration of the coronary origin. In this case, the CT scan was less useful than transthoracic echocardiography. Coronary angiography confirmed the strongly suggestive echocardiographic diagnosis and helped decide management strategy. Atheromatous coronary aneurysms may be treated by stenting but mycotic aneurysms require surgical management.
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Affiliation(s)
- C Brasselet
- Service de cardiologie, hôpital Robert-Debré, Reims
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17
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Metz D, Brasselet C, Tabet E, Nazeyrollas P, Tassan-Mangina S, Deschildre A, Elaerts J, Blaise C. Immediate femoral sheath removal after 6 French routine coronary angioplasty with a weight-adjusted low-dose heparin: results of a prospective registry. J Invasive Cardiol 1999; 11:416-20. [PMID: 10745564] [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: 02/16/2023]
Abstract
This study assesses the feasibility and safety of immediate sheath removal after coronary angioplasty with the use of 6 French (Fr) guiding catheters by the femoral route and weight-adjusted low-dose heparin (100 IU/kg). We prospectively evaluated such a strategy among a single-center cohort of 261 consecutive patients undergoing routine percutaneous transluminal coronary angioplasty (PTCA). Immediate sheath withdrawal was performed in cases when post-PTCA residual coronary stenosis was less than 30%, with or without stenting. One hundred eighty-two (70%) of the enrolled patients were eligible for immediate sheath removal. When compared with non-eligible patients (sheath removal 4 hours or more post-PTCA), we observed a reduction of hematoma occurrence (15% vs. 30%; p < 0.01), time to manual hemostasis of the puncture site (13.8 +/- 7 vs. 19.7 +/- 12 minutes; p < 0.0001), and time to hospital discharge (2.2 +/- 1.9 vs. 2.8 +/- 1.8 days; p < 0.02), while ischemic event rate was similar (1 vs. 2 non-Q wave myocardial infarction; 2 vs. 1 repeat PTCA for out-of-lab acute vessel closure). In conclusion, a good angiographic result at completion of PTCA using a 6 Fr sheath, even without stenting, makes an immediate sheath removal feasible at no increased risk and with a potential reduction in minor bleeding complications.
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Affiliation(s)
- D Metz
- Cardiology Department, Hopital Robert Debré, Avenue du Général Koenig, 51092 Reims Cedex, France.
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18
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Hézard N, Metz D, Nazeyrollas P, Nguyen P, Simon G, Daliphard S, Droullé C, Elaerts J, Potron G. Free and total platelet glycoprotein IIb/IIIa measurement in whole blood by quantitative flow cytometry during and after infusion of c7E3 Fab in patients undergoing PTCA. Thromb Haemost 1999; 81:869-73. [PMID: 10404759] [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: 02/13/2023]
Abstract
A quantitative flow cytometry assay was used to evaluate the ex vivo kinetics of c7E3 Fab platelet effect in 16 patients undergoing PTCA treated with abciximab and compared with aggregometry assay. Immunolabeling of platelets was directly assessed on whole blood, using in parallel two monoclonal antibodies (Mabs) raised against GPIIIa, Mab1, the binding of which is inhibited by c7E3 Fab, and Mab2, the binding of which is not affected by c7E3 Fab. We found a severe and sustained inhibition of both GPIIb/IIIa receptors and platelet functions. The inter-individual variation in response to abciximab was low. A significant transient increase at H24 and H48 in the binding of Mab2 was found as an unexpected result, and confirmed in vitro. Results demonstrate that flow cytometry is a reliable method in agreement with aggregation. In addition, our results show that it is a standardized tool and a time-saving technique.
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Affiliation(s)
- N Hézard
- Laboratoire Central d'H'ematologie and Service de Cardiologie, CHU Robert Debré, Reims, France
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19
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Jamet B, Wagner E, Tassan Mangina S, Chabert JP, Elaerts J. [Werner's disease presenting as ischemic mitral incompetence]. Ann Cardiol Angeiol (Paris) 1999; 48:205-8. [PMID: 12555382] [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: 02/28/2023]
Abstract
Werner's syndrome or progeria, described for the first time in 1886, is a rare disease with autosomal recessive transmission, characterized by premature ageing of connective tissues. About 200 cases have since been reported in the literature. Most patients die young, generally from heart failure due to early coronary atherosclerosis [1]. The authors report the case of a 46-year-old woman presenting with cardiovascular abnormalities, unusual for her age, associated with a particular morphotype belonging to Werner's syndrome.
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Affiliation(s)
- B Jamet
- CHU Reims, Hôpital Robert Debré, Département de Cardiologie et Pathologie Vasculaire, Rue du Général Koenig, 51092 Reims
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Tassan-Mangina S, Metz D, Torossian F, Nazeyrollas P, Chapoutot L, Tassigny C, Wagner E, Heuls S, Jamet B, Elaerts J. [Incidence and predictive factors of mitral insufficiency in surgically treated aortic stenosis. Transthoracic and transesophageal ultrasonographic evaluation]. Arch Mal Coeur Vaiss 1999; 92:11-7. [PMID: 10065277] [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: 02/11/2023]
Abstract
Mitral regurgitation is common in adults with aortic stenosis. When severe, it may aggravate the clinical condition and pose an additional therapeutic problem. The authors studied 40 consecutive patients with severe surgical aortic stenosis prospectively by transthoracic echocardiography and pre-operative transoesophageal echocardiography to determine the incidence, mechanism and degree of mitral regurgitation and its eventual relationship to the aortic stenosis. Mitral regurgitation was detected in all cases when both investigations were taken into consideration. It was usually mild, evaluated grade 2 by measuring the surface of the colour Doppler regurgitant jet, or mild to minimal of transoesophageal echocardiography in 35/40 patients (87.5% of cases). Rarely, a case of significant, autonomous mitral regurgitation (2 cases of valvular dystrophy, 1 pure severe mitral stenosis). On the other hand, calcification of the mitral annulus is common (14/40 patients, 35% of cases). The severity of the regurgitation in univariate analysis was significantly correlated mainly to the age of the patients (p = 0.027). The severity of the aortic stenosis (p = 0.0082) and the parameters related to the effects of stenosis, such as ventricular wall thickness and left atrial size. In multivariate analysis, the severity of the aortic stenosis and of its consequences were confirmed to play a role in the genesis of mitral regurgitation, the severity of which was correlated on transthoracic echocardiography to the aortic valve surface area and the left ventricular ejection fraction and, on transoesophageal echocardiography, to the transvalvular pressure gradient.
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21
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Pop C, Tassan S, Arav E, Metz D, Baehrel B, Pluot M, Elaerts J. [Incidental discovery of asymptomatic Loeffler fibroplastic endocarditis. Report of a case]. Ann Cardiol Angeiol (Paris) 1998; 47:728-31. [PMID: 9922850] [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: 02/10/2023]
Abstract
The authors report a case of fibroplastic endocarditis discovered during echocardiography in an asymptomatic patient in the context of assessment of systematized electrocardiographic modifications. The diagnosis, strongly suspected on the basis of the cardiac MRI findings, was finally confirmed by endocardial biopsy.
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Affiliation(s)
- C Pop
- Service de Cardiologie, CHU de Reims, Hôpital Robert Debré
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22
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Hézard N, Metz D, Potron G, Nazeyrollas P, Maes D, Droulle C, Mulpas MC, Elaerts J, Nguyen P. Monitoring the effect of heparin bolus during percutaneous coronary angioplasty (PTCA): assessment of three bedside coagulation monitors. Thromb Haemost 1998; 80:865-6. [PMID: 9843190] [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: 02/09/2023]
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23
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Pop C, Metz D, Matei M, Wagner E, Tassan S, Elaerts J. [Postpartum myocardial infarction induced by Parlodel]. Arch Mal Coeur Vaiss 1998; 91:1171-4. [PMID: 9805577] [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: 02/09/2023]
Abstract
The authors report the case of a 28 year old woman who developed antero-septoapical myocardial infarction in the post-partum period. This was detected by surface ECG and echocardiography performed after a systemic embolism. The infarction followed treatment with Parlodel for inhibition of lactation. Coronary angiography, performed one month post-partum, was normal and the methergin test was negative. The physiopathological mechanism of myocardial infarction resulted from the association of an iatrogenic spastic phenomenon favourised by the patient restarting to smoke and the physiological arterial hyperactivity of the post-partum period. This mechanism raises the question of preventive measures in cases of inhibition of lactation in the post-partum period, notably stopping smoking.
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Affiliation(s)
- C Pop
- Service de cardiologie, hôpital Robert-Debré, Reims
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24
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Meneveau N, Schiele F, Metz D, Valette B, Attali P, Vuillemenot A, Grollier G, Elaerts J, Mossard JM, Viel JF, Bassand JP. Comparative efficacy of a two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and one-year follow-up. J Am Coll Cardiol 1998; 31:1057-63. [PMID: 9562007 DOI: 10.1016/s0735-1097(98)00068-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 4.8] [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: 02/07/2023]
Abstract
OBJECTIVES This study sought to compare the efficacy of 2-h regimens of alteplase and streptokinase in acute massive pulmonary embolism. The primary end point was immediate hemodynamic improvement, and secondary end points included early clinical efficacy and safety, as well as 1-year clinical outcome. BACKGROUND Several thrombolytic regimens have been compared for the past 10 years in randomized studies, showing that 2-h infusion regimens of alteplase or urokinase lead to faster hemodynamic improvement than former 12- to 24-h administration protocols in acute massive pulmonary embolism. Many trials have focused on immediate hemodynamic and angiographic outcomes, but none has addressed long-term follow-up after thrombolysis. METHODS Sixty-six patients with acute massive pulmonary embolism (Miller score > 17 and mean pulmonary artery pressure >20 mm Hg) were randomly assigned to receive either a 100-mg 2-h infusion of alteplase (n = 23) or 1.5 million IU of streptokinase over 2 h (n = 43). In both groups, heparin infusion was started at the end of thrombolytic infusion and adapted thereafter. Total pulmonary resistance was monitored over a 12-h period. Pulmonary vascular obstruction was assessed 36 to 48 h after thrombolytic therapy. One-year follow-up information included death, cause of death, recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension, stroke and bleeding. RESULTS Both groups had similar baseline angiographic and hemodynamic characteristics of severity, with maintained cardiac output in 64 (97%) of 66 patients. The results (mean +/- SD) demonstrated that despite a faster total pulmonary resistance improvement observed at 1 h in the alteplase group compared with the streptokinase group (33+/-16% vs. 19 16%, p = 0.006), a similar hemodynamic efficacy was obtained at 2 h when both thrombolytic regimens were completed (38+/-18% vs. 31+/-19%). There was no significant difference in either pulmonary vascular obstruction at 36 to 48 h or bleeding complication rates. One-year event-free survival was similar in both groups, as most events were related to concomitant diseases. CONCLUSIONS These results suggest that a 2-h regimen of streptokinase can be routinely used in patients with massive pulmonary embolism and maintained cardiac output without obviously compromising efficacy or safety.
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Affiliation(s)
- N Meneveau
- Département de Cardiologie, Hôpital Universitaire Saint-Jacques, Besançon, France
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25
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Jennesseaux C, Metz D, Maes D, Nazeyrollas P, Tassan-Mangina S, Heuls S, Jamet B, Liehn JC, Elaerts J. [Acoustic quantification of right ventricular dimensions and systolic function]. Arch Mal Coeur Vaiss 1998; 91:231-8. [PMID: 9749250] [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: 04/11/2023]
Abstract
In view of the important prognostic significance of right ventricular systolic function, there have been many non-invasive studies of this subject. The majority of these studies have been limited by difficulties in modelisation of this geometrically complex cardiac chamber. Automatic border detection by acoustic quantification based on the back scatter of ultrasound provides a "direct" method of analysing right ventricular dimensions and functions. The authors undertook a prospective study of 34 patients to evaluate the reliability of this technique in measuring the surfaces and fractional shortening of the right ventricle. The feasibility was 92%. The correlation coefficients between the manual two-dimensional technique and automatic border detection were 0.81 for the end diastolic surface areas, 0.85 for the end systolic surface areas and 0.74 for the fractional shortening. Compared with the isotopic ejection fraction, the correlation coefficient was 0.73. The authors conclude that acoustic quantification is a feasible and reliable technique of measuring right ventricular dimensions and its contractile function.
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26
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Tassan S, Chabert JP, Tassigny C, Jamet B, Ribere R, Deslee G, Metz D, Elaerts J. [Peripheral embolic arterial accident due to pulmonary vein thrombosis revealing bronchial carcinoma]. Ann Cardiol Angeiol (Paris) 1998; 47:11-3. [PMID: 9772926] [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: 02/09/2023]
Abstract
The authors report a case of left superior pulmonary vein thrombosis discovered on transoesophageal ultrasonography in the context of aetiological assessment of a systemic vascular accident. This unusual site of a thrombus on an anatomically perfectly normal left atrium led the authors to perform a more detailed assessment, revealing a previously undiagnosed lung cancer on thoracic CT scan.
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Affiliation(s)
- S Tassan
- Service de Cardiologie, CHU Reims, Hôpital Robert Debré
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27
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Metz D, Meyer P, Touati C, Coste P, Petiteau PY, Durand P, Faivre R, Lefevre T, Elaerts J. Comparison of 6F with 7F and 8F guiding catheters for elective coronary angioplasty: results of a prospective, multicenter, randomized trial. Am Heart J 1997; 134:131-7. [PMID: 9266794 DOI: 10.1016/s0002-8703(97)70117-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [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: 02/05/2023]
Abstract
A group of 460 patients was considered in our prospective study of assessment of the efficiency and safety of 6F (internal diameter 0.062 inches) guiding catheters to perform elective percutaneous coronary angioplasty by the femoral approach by using conventional balloon systems. The patients were randomly assigned either a 6F guiding catheter (first group, n = 231; 247 coronary lesions), or a 7F or 8F guiding catheter (second group, n = 229; 252 coronary lesions). The exclusion criteria were the ongoing myocardial infarction, the marked reduction of left ventricular function, and the decision to treat the lesion with a device not fitting the 6F guiding catheter. The angioplasty success rates (87% in the 6F group vs 88% in the 7F or 8F group) and the stent implantation rates (21% vs 25%) were similar in both groups. The ischemic complication rates (death, 2 vs 1 ) were also similar. The incidence of the femoral complications was significantly less important in the 6F group than in the 7/8F group (13.8% vs 23.5%; p < 0.01). Significant differences also were noted for the procedural time (36 +/- 22 vs 41 +/- 28 min; p < 0.01), the fluoroscopy time (11 +/- 10 vs 14 +/- 4 min; p < 0.05), the volume of contrast injected (136 +/- 68 ml vs 168 +/- 95 ml; p < 0.0001), and the time of femoral compression after the introducer sheath removal (11.7 +/- 9 vs 14.1 +/- 12 min; p < 0.01). Our data suggest that 6F guiding catheters for elective coronary angioplasty are more effective than are the larger diameter catheters. Besides a significant decrease of vascular complications, angioplasty with a 6F guiding catheter reduces the procedural time and the amount of contrast.
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Affiliation(s)
- D Metz
- Section of Interventional Cardiology, Hospital Robert Debré, Reims, France
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28
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Nazeyrollas P, Metz D, Maillier B, Jennesseaux C, Maes D, Tassan S, Jolly D, Chabert JP, Chapoutot L, Elaerts J. [Transthoracic echocardiography and diagnosis of acute pulmonary embolism. Change in the diagnostic valve with respect to thresholds of classification]. Arch Mal Coeur Vaiss 1997; 90:463-9. [PMID: 9238463] [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: 02/04/2023]
Abstract
The diagnostic value of transthoracic echocardiography in acute pulmonary embolism is not well established. Although many parameters are abnormal, the thresholds used vary according to the authors, limiting the contribution of the investigation to the diagnosis. In a prospective study of 70 patients with suspected acute pulmonary embolism without previous cardio-respiratory disease, the authors tried to determine the diagnostic thresholds using discriminating linear analysis and ROC curves. Parameters easily recorded in an emergency were analysed: end diastolic ventricular dimensions, ratio of these diameters and maximal velocity of tricuspid regurgitant flow. Thirty-one patients had pulmonary embolism quantified by the Miller index (average: 16 +/- 7, range 2 to 28). Measurements of left ventricular dimension were disappointing (sensitivity: 0.52, specificity: 0.73 for a threshold value of 45 mm). The right ventricular dimension was a better predictive parameter (sensitivity: 0.70, specificity: 0.86 for a threshold value of 25 mm). However, the ratio of right to left ventricular dimension had a better diagnostic value (sensitivity: 0.85, specificity: 0.78 for a threshold value of 0.5). The best diagnostic parameter was the maximal velocity of tricuspid regurgitation (sensitivity: 0.93, specificity: 0.82 for a threshold value of 2.5 m/s). The authors conclude that the maximal velocity of tricuspid regurgitation with a threshold of 2.5 m/s and the ratio of the ventricular dimensions with a threshold value of 0.5 are valuable diagnostic indicators for acute pulmonary embolism.
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Affiliation(s)
- P Nazeyrollas
- Service de cardiologie, Centre hospitalier universitaire de Reims
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29
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Maillier B, Metz D, Nazeyrollas P, Prevost A, Maes D, Elaerts J. [Late ventricular potentials in patients with sleep apnea syndrome]. Presse Med 1997; 26:369. [PMID: 9113054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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30
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Maillier B, Metz D, Nazeyrollas P, Prevost A, Boudjedien S, Maes D, Chapoutot L, Chabert JP, Elaerts J. [Ventricular late potentials and sleep apnea syndromes]. Ann Cardiol Angeiol (Paris) 1996; 45:561-6. [PMID: 9033692] [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: 02/03/2023]
Abstract
This prospective study in 37 patients evaluated the prevalence of ventricular late potentials in sleep apnea syndrome, a condition associated with an increased risk of ventricular rhythm disorders and sudden death. A comparative analysis was conducted among a group of patients considered free of coronary heart disease and admitted for suspected sleep apnea syndrome based on clinical symptoms and simple blood gas measurements. The prevalence of ventricular late potentials was 56% in the subgroup with and 14% in the subgroup without polygraphy evidence of apnea (F < 0.01). The analysis of clinical, respiratory, and echocardiographic findings in the apneic subgroup failed to detect any factors associated with the presence of ventricular late potentials. Only long-term follow-up studies involving invasive heart rhythm testing could define the prognostic significance of ventricular late potentials in sleep apnea syndrome. However, our data demonstrate that there is an association between ventricular late potentials and sleep apnea syndrome.
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Affiliation(s)
- B Maillier
- Service de Cardiologie et de Pneumologie, CHU Robert Debré, REIMS
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31
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Jennesseaux C, Metz D, Maillier B, Nazeyrollas P, Maes D, Tassan S, Chabert JP, Elaerts J. [Estimation of left ventricular volumes and ejection fraction with acoustic quantification in myocardial infarction. Comparison with echocardiographic, angiographic and scintigraphic data]. Arch Mal Coeur Vaiss 1996; 89:843-9. [PMID: 8869245] [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: 02/02/2023]
Abstract
The object of this study was to assess the reliability of measurements of left ventricular volumes and ejection fraction by acoustic quantification by the method of summation of discs in acute myocardial infarction. Thirty-two patients with an average age of 55.9 +/- 12 years were studied prospectively on average 6 +/- 2 days after the onset of myocardial infarction. Within 48 hours, the patients underwent TM echocardiography (Teichholz's method) two-dimensional echocardiography (Simpson's method on freeze frames and acoustic quantification) before left ventricular angiography and isotopic ventriculography, considered as the reference methods for comparing left ventricular volumes and ejection fractions. The data displayed in real time by acoustic quantification correlated well with the results of left ventricular angiography (r = 0.77; p = 0.0001) and moderately underestimated (+4.1 +/- 11.9%) the ejection fraction, but were relatively disappointing for estimating volumes. When compared with isotopic ejection fraction, the correlation coefficient was r = 0.71 (p = 0.0004) and the values were overestimated. In this study, acoustic quantification was the most reliable echocardiographic method of assessing the left ventricular ejection fraction with reference to contrast angiography (Teichholz: r = 0.56; p = 0.0014; Simpson: r = 0.76; p = 0.001). The authors conclude that assessing the left ventricular ejection fraction with acoustic quantification is reliable in acute myocardial infarction. However, the method is not very accurate in measuring end systolic and end diastolic volumes.
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Maillier B, Metz D, Nazeyrollas P, Maes D, Chapoutot L, Jennesseaux C, Torossian PF, Tassan S, Chabert JP, Elaerts J. [Value of transesophageal echocardiography in post-infarction septal ruptures]. Arch Mal Coeur Vaiss 1996; 89:695-702. [PMID: 8760654] [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: 02/02/2023]
Abstract
The role of transoesophageal echocardiography in the diagnosis of ventricular septal defect in the acute stage of myocardial infarction, was evaluated in 15 consecutive patients (10 men and 5 women) with a mean age of 72 years in the period between June 1991 and April 1995. The patients had 11 anterior infarcts and 4 inferior infarcts with extension to the right ventricle. One patient was in Killips class I,7 patients in class II, 2 in class III and 5 in class IV. Only 8 of the 15 septal ruptures could be visualised directly by conventional transthoracic echocardiography, though all 15 were suspected from continuous Doppler and colour Doppler analysis. Transoesophageal echocardiography was successfully performed in 14 of the 15 patients with a monoplane probe in 11 cases and a multiplane probe in 3 cases. The average duration of the procedure was 12 minutes and clinical and haemodynamic tolerance was good. Ventricular septal defect was directly visualised in all cases in the short axis transgastric view and in 7 cases in transoesophageal views. Transoesophageal echocardiography was concordant with peroperative findings with regards to the site of ventricular septal defect (8 apical, 5 postero-basal and 1 median), their type (6 punched-out defects, 5 fissures, and 3 perforated aneurysms), their size (average 9.3 mm), their number with 5 multiple defects, and associated lesions (4 right ventricular extensions, 4 hemopericardiums and 1 free wall fissure). Transoesophageal echocardiography completes traditional transthoracic echocardiographic examination in the diagnosis of post-infarction ventricular septal defect. It is well tolerated and, in the authors' experience, allows limitation of invasive procedures to coronary angiography alone.
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Affiliation(s)
- B Maillier
- Service de cardiologie, Hôpital Robert-Debŕe, Reims
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Metz D, Nazeyrollas P, Mailier B, Jennesseaux C, Tasson S, Maes D, Elaerts J. Regression of right ventricular hypokinesis after thrombolysis in acute pulmonary embolism. Am J Cardiol 1996; 77:1252-4. [PMID: 8651110 DOI: 10.1016/s0002-9149(96)00177-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 02/01/2023]
Abstract
We found a significant ABD-assisted right ventricular hypokinetic regression after thrombolytic therapy in acute pulmonary embolism but could not demonstrate a linear relation between improvement in early right ventricular function and angiography.
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Affiliation(s)
- D Metz
- Department of Cardiology, Hôpital Robert Debré, Reims, France
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34
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Nazeyrollas P, Metz D, Jolly D, Maillier B, Jennesseaux C, Maes D, Chabert JP, Chapoutot L, Elaerts J. Use of transthoracic Doppler echocardiography combined with clinical and electrocardiographic data to predict acute pulmonary embolism. Eur Heart J 1996; 17:779-86. [PMID: 8737110 DOI: 10.1093/oxfordjournals.eurheartj.a014946] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [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: 02/01/2023] Open
Abstract
Transthoracic echocardiography and continuous wave Doppler were prospectively performed in 132 out-patients with suspicion of pulmonary embolism, and who had no previous history of severe cardiac or pulmonary disease. Bedside echocardiography determined diagnosis other than pulmonary embolism in 55 patients. Further study was completed in 70 patients; pulmonary embolism was found in 31 and excluded in 39. Significant differences were found as regards right ventricular diameter (27 +/- 8 vs 22 +/- 5 mm, P < 0.001), left ventricular diameter (41 +/- 9 vs 49 +/- 7 mm, P < 0.001), right over left ventricular diameter ratio (0.67 +/- 0.23 vs 0.43 +/- 0.15, P < 0.0001), tricuspid regurgitant flow peak velocity (2.9 +/- 0.4 vs 2.4 +/- 0.7 m.s-1, P < 0.0001), and abnormal septum motion (12 vs 4, P < 0.01). Multivariate analysis of echocardiographic data included a tricuspid regurgitant flow peak velocity greater than 2.5 m.s-1 and a right over left ventricular diameter ratio greater than 0.5 in a logistic model (sensitivity 93%, specificity 81%). The combination of echocardiographic and non-echocardiographic data included the two previous echocardiographic variables, together with signs of deep vein thrombosis, a deep S wave in lead D1, and a Q wave in lead D3 on the electrocardiogram in a logistic model (sensitivity 96%, specificity 83%). It can be concluded that emergency echocardiography, alone or combined with clinical examination and electrocardiogram, satisfactorily predicts acute pulmonary embolism.
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Affiliation(s)
- P Nazeyrollas
- Service de cardiologie, Centre hospitalier universitaire, Reims, France
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35
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Chapoutot L, Nazeyrollas P, Metz D, Maes D, Maillier B, Jennesseaux C, Elaerts J. Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management. Cardiology 1996; 87:169-74. [PMID: 8653735 DOI: 10.1159/000177081] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.3] [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: 02/01/2023]
Abstract
The aim of this study was to analyze clinical and echographic findings and to assess therapeutic management in 14 floating right atrial thrombi diagnosed with systematic echocardiography in 200 consecutive patients with proven pulmonary embolism. Auscultatory findings were abnormal in 7 cases, 4 of them showing signs of tricuspid obstruction. Echocardiography displayed a mobile ovoid, polycyclic or worm-like right atrial mass, always associated with signs of cor pulmonale. Four patients (29%) died, 2 of them before any treatment could be started. Regarding the remaining 10 patients with favorable outcome, surgical embolectomy was carried out in 7. Our data suggest that echocardiographic examination is necessary in all suspected pulmonary embolisms and has to be done quickly for emergency treatment in patients with floating right atrial thrombus.
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Affiliation(s)
- L Chapoutot
- Department of Cardiology, University Hospital, Reims, France
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36
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Chapoutot L, Tassigny C, Nazeyrollas P, Poismans P, Maillier B, Maes D, Metz D, Elaerts J. [Pulmonary embolism and thrombi of the right heart]. Arch Mal Coeur Vaiss 1995; 88:1723-8. [PMID: 8815832] [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: 02/02/2023]
Abstract
In general, there are two types of right heart thrombi diagnosed by echocardiography: mobile and non-mobile thrombi, more often located in the atrium than in the ventricle and a potential source of pulmonary embolism. However, they differ in several points: clinical context, clinical and echocardiographic presentations, embolic potential, prognosis and treatment. The result of peripheral venous thrombosis, mobile thrombus it is usually diagnosed during echocardiographic investigation of pulmonary embolism. The appearances are often that of serpentine thrombus floating in the right heart chambers associated with signs of acute cor pulmonale. It is a marker of imminent and often fatal embolism as it completes a previous and usually severe pulmonary embolism; the mortality is over 40%. It is a contra-indication for pulmonary angiography because of the risk of embolism and a therapeutic emergency. Some groups advocate surgical embolectomy and others thrombolysis. Its precise frequency in the acute stage of pulmonary embolism and its treatment remain to be determined by a prospective, multicentre clinical trial. The adherent non-mobile thrombus is usually implanted on the free wall of the right atrium or the interatrial septum. Its formation, in situ, is due to stasis secondary to decompensated congenital or acquired cardiac disease or to the presence of an intracardiac foreign body such as a pacing wire. It is less likely to cause pulmonary embolism. It decreases or disappears with anticoagulant therapy and the outcome is usually good. The differential diagnosis between a mobile thrombus and a Chiari network, or between an adherent thrombus and a vegetation on a intracardiac pacing wire may be difficult and requires transoesophageal echocardiography. The investigation of pulmonary embolism requires systematic echocardiography, one of the objectives of which is to search for right sided thrombi.
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Affiliation(s)
- L Chapoutot
- Service de cardiologie A, CH de Charleville, Charleville-Mézières
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37
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Metz D, Maillier B, Nazeyrollas P, Maes D, Blaise C, Deschildre A, Elaerts J. [Evaluation of the systematic use of wide lumen 6 French guiding catheters in conventional coronary angioplasty]. Arch Mal Coeur Vaiss 1995; 88:1291-1299. [PMID: 8526709] [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: 05/22/2023]
Abstract
The aim of this study was to evaluate the results of systematic use of 6 French guiding catheters in conventional balloon coronary angioplasty without any restriction of indications apart from coronary lesions necessitating other techniques such as atherectomy. Therefore, after a learning period, 200 consecutive procedures performed between November 1993 and June 1994 for the treatment of 234 lesions were analysed prospectively. Fifty-one patients had stable and 70 unstable angina. In 79 cases, the angioplasty was performed on the culprit lesion of a myocardial infarction. An angiographic success was obtained for 206 lesions or 88% of cases which increased to 95% after exclusion of attempted recanalisation. There were 3 cases of damage to the ostium and 7 patients underwent implantation of a stent with the same catheter for occlusive or threatening dissection. There were 10 ischaemic complications (5%) (7 non-Q wave infarctions, 2 Q wave infarctions, 1 aorto-coronary bypass, no deaths) and 8 local complications at the site of arterial catheterisation during the hospital period. These results demonstrate the feasibility of coronary angioplasty with wide lumen 6 French guiding catheters and show that they amy be used in first intention for all conventional balloon angioplasty procedures.
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Affiliation(s)
- D Metz
- Service de cardiologie, hôpital Robert-Debré, Reims
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38
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Metz D, Nazeyrollas P, Maillier B, Maes D, Blaise C, Deschildre A, Elaerts J. Coronary angioplasty of bifurcational lesions with the protecting branch technique using 6 French guiding catheter. Cathet Cardiovasc Diagn 1995; 35:343-7; discussion 348-9. [PMID: 7497508 DOI: 10.1002/ccd.1810350413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The use of 6 French guiding catheters is still usually limited to elective percutaneous transluminal coronary angioplasty. We describe our preliminary experience with this guiding size to perform a double guide wire procedure for angioplasty or coronary bifurcation lesions, to protect (n = 5) and/or to sequentially dilate (n = 9) a major side branch. Technical success was 12/14 (86%), angiographic success 13/14 (93%), and in-hospital outcome was event free in all patients. Thus, 6 French guiding size is both safe and effective for the majority of coronary bifurcation angioplasty.
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39
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Maes D, Chapoutot L, Maillier B, Metz D, Chabert JP, Nazeyrollas P, Torossian F, Baehrel B, Elaerts J. [Transesophageal echocardiographic diagnosis of left ventricular parietal rupture, a complication of myocardial infarction]. Arch Mal Coeur Vaiss 1995; 88:271-3. [PMID: 7487278] [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 authors report the case of postero-lateral myocardial infarction complicated by free wall rupture at the 48th hour. The diagnosis was suspected clinically and transoesophageal echocardiography showed the appearance of pericardial effusion in a patient difficult to examine by conventional echocardiography. Transoesophageal echocardiography was performed and well tolerated. The transgastric view showed a thrombus adjacent to a thinned and lacerated postero-lateral wall. The clinical outcome was favourable after surgical repair.
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Affiliation(s)
- D Maes
- Service de cardiologie, hôpital Robert-Debré, Reims
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40
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Abstract
We studied prospective recording of clinical, electrocardiographic, Doppler and echographic parameters in 32 patients with proven pulmonary embolism, matched with 32 patients with clinically suspected pulmonary embolism and normal perfusion scan or angiography. Thirty-seven per cent of cases and 16% of control subjects had clinical signs of right ventricular overload; S1-Q3-T3 ECG pattern was found in 11 cases and one control. Other clinical and ECG parameters did not reach significant difference. Echographic septum motion was abnormal in 42% of cases and 9% of controls (P < 0.05), end-diastolic right ventricular diameter was > 25 mm in 67% of cases and 11% of controls, ratio of end-diastolic right over left ventricular diameters increased over 0.6 in 67% of cases and 11% of controls, while Doppler examination found tricuspid regurgitant peak flow velocity > 2.5 m/s in 84% of cases vs. 10% of controls. According to these parameters, Doppler-echocardiography was normal in 6% of cases and 87% of control subjects (P < 0.001 for each). In suspected pulmonary embolism, our study shows that Doppler-echocardiography may be both sensitive and specific in emergency conditions and help the decision making for further invasive investigations.
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Affiliation(s)
- P Nazeyrollas
- Department of Cardiology, University Hospital, Reims, France
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41
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Metz D, Jolly D, Graciet-Richard J, Pennaforte JL, Nazeyrollas P, Chabert JP, Elaerts J, Etienne JC. [Cardiac anomalies in disseminated lupus erythematosus diagnosed by Doppler ultrasonography. Prevalence and association with antiphospholipid syndrome]. Presse Med 1994; 23:1797-802. [PMID: 7899300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are widely associated with thrombosis, recurrent abortions and a thrombocytopenia. The purpose of this study was first to evaluate the prevalence of cardiac abnormalities in patients with SLE and secondly to establish the relationship between the findings and the presence of an antiphospholipid syndrome. SUBJECTS AND METHODS First of all, a total of 52 consecutive patients with SLE and 52 healthy sex-and-age-matched control subjects were evaluated in a cross sectional study. All underwent M mode and two dimensional echocardiography, color flow imaging, pulsed and continuous wave Doppler. Secondly, in the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to the control subjects. RESULTS Compared with the control group, patients with SLE had significantly more pericardial abnormalities [(p = 0.0006) RR [3.36-infinity], mitral regurgitation [(p = 0.032) RR 2.48 [1.25-5.6]], tricuspid regurgitation [(p = 0.0016) RR 2.41 [1.58-8.85]. There was no significant difference between both groups for the left ventricular mass (p = 0.07), posterior wall (p = 0.25) and interventricular septum dimension (p = 0.16), and mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased left ventricular mass (p = 0.0054), posterior wall (p = 0.022) and interventricular septum dimension (p = 0.026). The relative risk increased for tricuspid and pulmonary regurgitation in SLE patients who had the antiphospholipid syndrome. CONCLUSION The prevalence of left ventricular hypertrophy and right heart valvular regurgitation is significantly raised in SLE patients who have the antiphospholipid syndrome. However, antiphospholipid syndrome does not modify the prevalence of pericardial abnormalities which seems to be due to SLE alone.
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Affiliation(s)
- D Metz
- Service de Cardiologie, Hôpital Robert Debré, Reims
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Ouzan J, Wilson D, Pèrualt C, Metz D, Torossian F, Gibold C, Loboguerrero A, Carre E, Liehn JC, Elaerts J. Visualization of myocardial infarction six hours after injection of 111 In-antimyosin antibodies using an image subtraction technique. Int J Card Imaging 1994; 10:187-93. [PMID: 7876658 DOI: 10.1007/bf01137900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
111 In-antimyosin antibodies are capable of visualizing acute myocardial infarction (MI). Because of slow blood clearance, images are usually recorded 24 or 48 h postinjection. This pilot study was aimed at validating a blood pool subtraction technique, which makes it possible to visualize MI 6 h postinjection. Twenty-five patients with proven MI (16 anterior, 9 inferior) were imaged 10 minutes, 6 and 24 h after an injection of 110 MBq 111 In-labelled antimyosin antibodies, with a mean delay of two weeks after infarction. Three planar views were obtained each time. Using software which performs geometric registration, grey level normalization and subtraction of images, the blood pool image (obtained 10 minutes postinjection) was subtracted from the 6 hour image. The resulting image was the blood pool corrected 6 h image. The 24 h images and the blood pool corrected 6 h images were interpreted blindly and the number of correct, incorrect and indeterminate MI localizations were tabulated. The number of correct localizations was 19/25 for the standard 24 h images and 22/25 for the blood pool corrected 6 h images. With this blood pool subtraction method it was possible to visualize MI 6 h postinjection. Theoretically, this method could be applied six hours after myocardial infarction.
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Affiliation(s)
- J Ouzan
- Robert Debré Hospital, C.H.U, Reims, France
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43
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Metz D, Jolly D, Graciet-Richard J, Nazeyrollas P, Chabert JP, Maillier B, Pennaforte JL, Elaerts J. Prevalence of valvular involvement in systemic lupus erythematosus and association with antiphospholipid syndrome: a matched echocardiographic study. Cardiology 1994; 85:129-36. [PMID: 7954564 DOI: 10.1159/000176663] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [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: 01/28/2023]
Abstract
Antiphospholipid antibodies in patients with systemic lupus erythematosus (SLE) are often associated with thrombosis, recurrent abortions and thrombocytopenia. The purpose of this study was to evaluate the prevalence of cardiac valvular abnormalities in patients with SLE and to establish the relationship between the echographic findings and the presence of an antiphospholipid syndrome. A total of 52 consecutive patients with SLE and 52 healthy sex- and age-matched controls were therefore evaluated in a cross-sectional study. All underwent M-mode and two-dimensional echocardiography, color-flow imaging, pulsed and continuous-wave Doppler. In the SLE group, subjects exposed to antiphospholipid syndrome (n = 20) were compared to controls. Patients with SLE had significantly more mitral (p = 0.032; RR 2.48; 1.25-5.6) and tricuspid regurgitations (p = 0.0016; RR 2.41; 1.58-8.85). There was no significant difference between either group for mitral valve thickness (p = 0.66). The antiphospholipid syndrome was significantly associated with increased relative risk for tricuspid.
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Affiliation(s)
- D Metz
- Département de Cardiologie, Hôpital Robert-Debré, Reims, France
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44
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Maillier B, Ouzan J, Chapoutot L, Nazeyrollas P, Torossian F, Soyer H, Maes D, Metz D, Baehrel B, Elaerts J. [Value of transesophageal echography in the detection of left intraventricular masses. Apropos of a case of apical thrombus]. Ann Cardiol Angeiol (Paris) 1993; 42:427-430. [PMID: 8122851] [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: 05/22/2023]
Abstract
The authors report a case of left intraventricular thrombus investigated by two-dimensional transesophageal echocardiography (TEE). Three longitudinal views obtained by rotation, left lateral inclination and by advancing the probe, enabled the precise evaluation of a mass situated at the apex of the left ventricle, together with ventricular morphology and kinetics. Two-dimensional TEE is electively indicated for confirmation of the diagnosis of left intraventricular apical masses, in particular in hypoechogenic patients and to guide possible surgery. The two-plane probe provides a certain number of sections which remain relatively limited but this problem is resolved with the development of multidimensional probes.
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45
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Maillier B, Metz D, Chapoutot L, Laudinat JM, Hecart J, Elaerts J. [Cardiogenic shock caused by occlusive thrombosis of a mitral valve prosthesis treated by fibrinolysis]. Presse Med 1993; 22:1193. [PMID: 8415492] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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46
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Metz D, Pommier JL, Nazeyrollas P, Chapoutot L, Graciet J, Chabert JP, Elaerts J, Bajolet A. [Doppler echocardiography under dipyridamole after thrombolyzed early myocardial infarction. Comparison with coronarographic data]. Ann Cardiol Angeiol (Paris) 1993; 42:339-44. [PMID: 8285561] [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: 01/29/2023]
Abstract
The reliability and safety of Doppler echocardiography with dipyridamole (0.84 mg/kg in 10 min) were evaluated in 63 patients an average of 7 days after a thrombolysed early lateral infarct and 24 hours before follow-up coronary arteriography. The aims of the test were the detection of tight stenoses (diameter reduced by more than 75%) affecting the artery responsible for the infarct as well as the other coronary vessels, using the vasodilator action of dipyridamole. The echocardiographic manifestation of induced coronary steal consisted of transitory asynergism in the territory of the artery involved. Clinical tolerability of the test was good. The brief onset of anginal pain was nevertheless seen in 6 patients. Analysis of the zone corresponding to the necrosed area was possible in only 43 cases. Sensitivity of the test for detection of a post-infarction residual stenosis was 64% (39-89) and specificity 90% (79-100). Study of other territories was possible in 59 cases. Sensitivity of the test for the diagnosis of multiple vessel disease was 70% (42-98) and specificity 94% (88-100). In the population as a whole, Doppler study of variations in anterograde mitral flow revealed a sensitivity of 40% (27-53) and specificity of 87% (78-96). Variations in sub-aortic flow were analysed only in the final 27 patients, with a sensitivity and specificity of 100%. The specificity of dipyridamole echocardiography after infarction is good, both for the detection of residual stenosis and that of multiple vessel disease, the chief limiting factor being the impossibility of analysis of the infarcted region in the presence of initial akinesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Metz
- Service de Cardiologie, Hôpital R. Debré, Reims
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Abstract
The intensity of indium-111 antimyosin monoclonal antibody uptake for visualization of myocardial infarction seems partially dependent on the state of the infarct related coronary artery. The aim of this study is to determine the factors which could account for the monoclonal antibody uptake variability. For this purpose, we investigated 27 patients (mean age 52.7 +/- 9.6 years) with a first proven myocardial infarction, by monoclonal antibody scintigraphy and coronary arteriography within the same period of time (7.12 +/- 6 days). The monoclonal antibody uptake was quantified by the heart/lung ratio on images recorded 24 h after injection. The infarct size was quantitatively estimated on wall motion analysis of twelve segments in 30 degree right anterior-oblique view with a radial method. The infarct related coronary artery state was assessed by the Thrombosis in Myocardial Infarction grade and the functional characteristics of collateral vessels by Rentrop's classification. These three variables as well as location of myocardial infarction, left ventricular ejection fraction, administration of a thrombolytic therapy, delay between myocardial infarction and monoclonal antibody scintigraphy were studied using non parametric test, or by linear regression method in order to determine whether these factors would influence the heart/lung ratio. None of these parameters except infarct size was related to heart/lung ratio. Consequently, monoclonal antibody uptake is only dependent on the extent of infarcted myocardium and the intensity of uptake cannot predict the patency of an infarct related coronary artery.
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Affiliation(s)
- J Ouzan
- Robert Debré Hospital, C.H.U., Reims, France
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48
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Chapoutot L, Metz D, Canivet E, Maillier B, Torossian F, Pommier JL, Nazeyrollas P, Sal R, Baehrel B, Elaerts J. [Mobile thrombus of the right heart and pulmonary embolism: diagnostic and therapeutic problems. Apropos of 12 cases]. Arch Mal Coeur Vaiss 1993; 86:1039-1045. [PMID: 8291939] [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: 05/22/2023]
Abstract
The objectives of this report were to analyse clinical presentation, echocardiographic features and diagnostic and therapeutic problems posed by an unusual form of thrombo-embolic disease: mobile right heart thrombosis. Systematic echocardiography in 170 cases of severe pulmonary embolism identified mobile right thrombi in 12 cases. The auscultatory findings were abnormal in 6 cases, 3 showing signs of tricuspid obstruction. Two-dimensional echocardiography showed an extremely mobile right atrial mass, sometimes prolapsing across the tricuspid valve, which was variously spheric, ovoid or worm-like; dilatation of the right heart chambers and echocardiographic signs of cor pulmonale were observed in all cases. The differential diagnosis with other embolic masses of the right atrium and, above all, with well-developed Chiari networks, may be difficult and requires transoesophageal echocardiography. Pulmonary angiography is contra-indicated because of the risk of embolism. Embolectomy under cardiopulmonary bypass was carried out in 8 patients, immediately after echocardiography in 6 cases. The thrombus was recovered from the right atrium in 6 cases and from the pulmonary artery in 2 cases: there was one operative death. Medical treatment was administered to 3 inoperable patients. The clinical and echocardiographic outcome was good in 2 of these but the third patient died; autopsy revealed thrombi in the right atrium and pulmonary artery. One patient died before any treatment could be given and autopsy showed the thrombus in the pulmonary artery. These results confirm the extreme instability of this type of thrombus and the risk of death due to its embolism.(ABSTRACT TRUNCATED AT 250 WORDS)
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49
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Maillier B, Chapoutot L, Metz D, Reksa A, Bailly L, Jeanpierre M, Sal R, Elaerts J. [Late complication of blunt injuries of the thorax: acute pericarditis. Apropos of a case]. Ann Cardiol Angeiol (Paris) 1993; 42:253-255. [PMID: 8368798] [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: 05/22/2023]
Abstract
The authors report a case of closed trauma of the thorax, complicated after a symptom-free period by acute pericarditis, combined with pleural effusion. The clinical outcome was favorable and the pericardial effusion, which was considerable at the first ultrasound scan, spontaneously recovered fully. The incidence of this delayed complication of closed trauma of the thorax is unknown. Its mechanism, related to that of the Dresler syndrome and post-pericardiotomy syndrome differs from that of initial hemopericardium which is of mechanical origin. This case highlights the capital importance of ultrasound in the diagnosis and assessment of cardiac complications of thoracic trauma.
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Affiliation(s)
- B Maillier
- Service de Cardiologie, Hôpital R. Debré, CHU de Reims
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50
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Ouzan J, Pommier JL, Carré E, Elaerts J, Bajolet A. [Chronic constrictive pericarditis after heart surgery. Apropos of a case]. Ann Cardiol Angeiol (Paris) 1993; 42:205-208. [PMID: 8517598] [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: 05/22/2023]
Abstract
A case of pericarditis in a 52-year old patient following aorto-coronary shunt surgery is reported which gradually developed into chronic constrictive pericarditis. In this context, the diagnostic criteria of chronic constrictive pericarditis are recalled. The clinical criteria show little specificity; Doppler ultrasound provides good diagnostic information; CT scans and nuclear magnetic imaging can confirm the diagnostic. The post-heart surgery etiology has increased in recent years. The only real treatment is surgical and consists of pericardial decortication.
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Affiliation(s)
- J Ouzan
- Service de Cardiologie, CHU, Reims
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