Biomedical subjects

A Sacrez

Publications and source records attributed to A Sacrez.

At least 19 recordsLinked to original sources

PubMed1992

Inter-study variability in left ventricular mass measurement. Comparison between M-mode echography and MRI.

In order to compare variability in M-mode echography and MRI in the assessment of left ventricular mass, 20 echogenic patients without evidence of coronary artery disease were investigated. Two MR and two M-echo examinations were performed within 4 days by different trained operators, each unaware of the other's results. M-mode echo was carried out according to Devereux's method, using the 'Penn-Cube' formula. MR protocol included multislice (8 to 12) true, short-axis spin-echo imaging (10 mm thick with a 1 to 3 mm gap) encompassing the entire left ventricle. Planimetry was manually traced with standardized window settings. Correlations between both echographic and both MR measurements showed r = 0.89, SEE = 22.7 g and r = 0.96, SEE = 11.2 g, respectively. Mean inter-study variability was 11 +/- 6.4% and 6.75 +/- 3.8% (P = 0.0021). The threshold value corresponding to the 95th percentile of the variability data was 21.5% for echography and 13.5% for MR. In conclusion, MR appeared to be a significantly more reproducible examination tool, when compared with M-mode echo, for the evaluation of left ventricular mass (variability, 63% higher with echo than with MR). The main practical consequence of this result lies in the reduced number of patients required to demonstrate a significant change in the LVM with MR as compared with echography.

Adult↗

PubMed1992

Increase in radionuclide left ventricular ejection fraction after cardioversion of chronic atrial fibrillation in idiopathic dilated cardiomyopathy.

To assess the potential improvement in left ventricular ejection fraction after cardioversion of chronic atrial fibrillation to sinus rhythm in idiopathic dilated cardiomyopathy, we studied prospectively 17 patients, aged 58 +/- 6 years, by radionuclide angiocardiography at rest. Left ventricular ejection fraction was determined before treatment and at a mean delay of 4.7 months after cardioversion. Return to sinus rhythm was obtained in 12 patients, pharmacologically or by electrical cardioversion. Five patients remained in atrial fibrillation. No clinical, echocardiographic or haemodynamic finding could predict the success of cardioversion. In chronic atrial fibrillation, the ejection fraction did not change significantly: 30.0 +/- 9.1% (19 to 44%) at the first evaluation and 29.5 +/- 8.3% (22 to 41%) after 4.7 months. After successful cardioversion, left ventricular ejection fraction improved from 32.1 +/- 5.3% (24 to 41%) to 52.9 +/- 9.7% (37 to 71%) (P less than 0.001). The difference was 20.8 +/- 11.3% and left ventricular ejection fraction was normalized in 50% (6/12) of the patients. There was a significant reduction in the cardiothoracic ratio on chest X-rays and of the left ventricular end-diastolic diameter on echocardiography; fractional shortening increased (27.7 +/- 4.3% vs 20.3 +/- 2.7%, P less than 0.01). A third evaluation was realized after a mean delay of 11.7 months in the patients with successful cardioversion. Sinus rhythm was present in 83% (10/12) of the patients: seven patients were reevaluated by radionuclide angiography. The improvement in left ventricular function observed at the 4.7 months evaluation was still present. In two patients with recurrence of atrial fibrillation, there was a severe deterioration of left ventricular systolic function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1992

Exclusion of cardiac myosin heavy chain and actin gene involvement in hypertrophic cardiomyopathy of several French families.

Familial hypertrophic cardiomyopathy (FHC) is characterized by idiopathic myocardial hypertrophy, which often and predominantly involves the interventricular septum. The disease is transmitted as an autosomal dominant trait, and its major risk is sudden death. It was recently demonstrated that this disease is genetically heterogeneous and that in 13 of 18 unrelated families the morbid locus, termed FHC-1, maps to chromosome 14q11-12 in and/or very near the cardiac beta-myosin heavy chain gene. We have performed linkage analysis with five chromosomal markers detecting polymorphisms in either the cardiac beta-myosin heavy chain gene or the cardiac actin gene (located on chromosome 15q) on eight families from different regions of France. We show that 1) it is possible to analyze medium-sized families by using highly informative microsatellite markers located in these genes and 2) the disease is not linked to the two contractile protein genes in any of these families. Moreover, 10-20% of chromosome 14 and 20-40% of chromosome 15 in the vicinity of the respective markers were excluded as possible locations for the morbid locus. These results provide new insights into the identification of the genes responsible for FHC.

Actins↗

PubMed1992

[Familial polymorph ventricular extrasystole associated with Pierre Robin syndrome].

In a family of 9 persons over 3 generations, 6 had incessant polymorphic ventricular extrasystoles, often in salves, resembling unsustained bidirectional ventricular tachycardia. Ventricular repolarisation was abnormal with giant U waves. Five persons had suffered syncopes. All had a facial abnormality: one woman had a complete Pierre Robin syndrome with mandibular hypoplasia, glossoptos and cleft palate; in the other cases, minor forms were observed, with micrognathia and ogival palate. Two patients had bone abnormalities of the feet with total agenesis of the last 2 phalanges of several toes. This familial polymorphic ventricular extrasystole with repolarisation abnormalities has many features in common with the congenital long QT syndrome; associated with the Pierre Robin syndrome and bone abnormalities of the extremities it would seem to be a new multiple congenital abnormalities syndrome.

Adolescent↗

PubMed1992

[Drug therapy of acute myocardial infarction without cardiogenic shock and thrombolytic therapy excluded].

Myocardial infarction is responsible for 25,000 deaths per year in France and is a real problem of public health. The management of patients victims of this condition is an important feature of medical practice. Thrombolytic therapy has resulted in significant improvements in the reduction of the size of the infarct, in the conservation of left ventricular function and in the reduction of mortality. Treatment of the acute phase of myocardial infarction, especially when there are contra-indications to thrombolysis, comprises other approaches, some of which are old, which are reviewed in the light of the results of the latest large scale therapeutic trials.

Adrenergic beta-Antagonists↗

PubMed1992

[Variations of plasma Willebrand factor and fibrinogen in coronary pathology].

In order to determine a marker of prethrombotic states, reliable and easy to measure, we studied 200 patients under 60 years of age admitted to hospital for a precordial chest pain. Four groups were established: transmural myocardial infarction, acute infarction without Q wave, unstable angina and atypical chest pain. Fibrinogen, von Willebrand factor, cholesterol, and triglyceride levels were measured as well as the white cell and platelet counts. There was a statistically significant correlation between transmural myocardial infarction and increased levels of fibrinogen, von Willebrand factor and white blood cells. Von Willebrand factor was already increased in the acute phase of transmural infarction, reached a maximum on the fifth day and then decreased slowly during the following ten days. This study suggests that plasma von Willebrand factor could be a reliable marker of transmural myocardial infarction in the acute phase or during the two weeks following the thrombotic event.

Angina Pectoris↗

PubMed1991

Invasive reperfusion study. II. Multicentre European randomized trial of anistreplase vs streptokinase in acute myocardial infarction.

IRS II (Invasive reperfusion study II) was a multicentre randomized trial comparing the efficacy of a 2-5-min 30 U anistreplase intravenous injection with a 1,500,000 U 60-min streptokinase (SK) intravenous infusion in acute myocardial infarction. 116 patients were randomized within 6 h of onset of symptoms. Early coronary patency was assessable in 107 patients by coronary angiogram performed 102 min after thrombolytic treatment (range: 30-297 min) in the anistreplase group and 93 min (range: 22-330 min) in the SK group. The early coronary patency rate was significantly higher in the anistreplase group than in the SK group: respectively, 70% (38/54) and 51% (27/53), P less than 0.05). Fifty patients had assessable coronary angiograms at 90 min and 24 h. The 24-h patency rate was 92.3% (24/26) in the anistreplase group vs 87.5% (21/24) in the SK group. No early reocclusion occurred in the anistreplase group vs 15.4% (2/13) in the SK group (NS). Fibrinogen fell to 13.2 +/- 19.8% on anistreplase vs 9.4 +/- 10.3% on SK (NS). Bleeding complications occurred in 12% (7/58) of treated patients in the anistreplase group vs 20.7% (13/58) in the SK group (NS). Two cerebrovascular accidents occurred after thrombolytic treatment with anistreplase (3.4%) vs one after SK (1.7%) (NS). Thus, anistreplase is more effective than intravenous SK and easier to administer.

Adult↗

PubMed1991

[Induction of ventricular tachycardia by esophageal stimulation. Apropos of 2 cases].

The utility of transesophageal atrial pacing in sustained left ventricular tachycardia is reported in two cases. A 46 year old man without any apparent cardiac disease presented with invalidating but undocumented palpitations. Transesophageal atrial pacing with isoproterenol infusion induced wide complex tachycardia with a right bundle branch block morphology and left axis deviation. Atrio-ventricular dissociation was observed and it was possible to reduce the ventricular complex width by rapid transesophageal atrial pacing: the tachycardia was terminated by an injection of verapamil. It was not possible to reinduce the tachycardia after treatment with atenolol 100 mg/day, introduced because of the catecholinergic nature of the arrhythmia. The patient is symptom free after 2 years of treatment with this drug. Regular wide complex tachycardia with right bundle branch block and left axis deviation without any detectable atrial activity was recorded in a 50 year old man without known cardiac disease. Transesophageal atrial pacing with isoproterenol infusion induced an identical tachycardia. The tachycardia started after a normally conducted atrial extrastimulus followed by ventriculo-atrial dissociation and it was possible to overdrive with atrial pacing. The tachycardia could not be reinduced after treatment with atenolol and the patient is asymptomatic 12 months later. These reports show that it is possible to study certain ventricular tachycardias by transesophageal atrial pacing. The efficacy of antiarrhythmic therapy can be controlled simply by this non-invasive technique.

Anti-Arrhythmia Agents↗

PubMed1991

[Isolated ST segment depression from V2 to V4 leads, an early electrocardiographic sign of posterior myocardial infarction].

ST segment depression in leads V2 to V4 in a clinical and biochemical context of myocardial infarction is usually interpreted as a sign of non-Q wave anterior walls infarction. In order to determine if this clinical electric entity could indicate transmural posterior or posterolateral infarction, as recently suggested, we undertook a prospective study of 328 primary myocardial infarctions. Isolated ST depression in leads V2 to V4 was observed in 28 patients (8.5%). It was maximal in V3 (1.8 +/- 0.7 mm) or V4 (2 +/- 1 mm). The T wave was always positive. All these case had segmental wall motion abnormalities of the left ventricular posterolateral wall on 2D echocardiography. The Q wave confirming the transmural character of the infarct was observed in leads V7, V8 and V9 on average 33 hours after the onset of pain (10-56 hours) as did the increase in the R/S ratio in leads V1 and V2. Coronary angiography performed in 26 patients showed significant disease of the left circumflex artery in all cases. This was isolated (39%) or associated with left anterior descending (15%), right coronary artery disease (19%) or both (27%). In conclusion, isolated ST segment depression in leads V2-V4 in the clinical context of acute myocardial infarction indicates a transmural posterior localisation of the necrosis. It corresponds to reciprocal subepicardial posterior ischaemia. In cases of inferior infarction, it reflects postero-lateral extension rather than associated anterior wall ischemia.

Aged↗

PubMed1991

[Congestive heart failure with intact systolic function].

A retrospective study was undertaken of the cases of patients admitted for congestive cardiac failure over a 4 year period, and investigated by radionuclide angiography to determine the prevalence of cardiac failure with normal left ventricular systolic function, to document the underlying mechanisms of this condition and to assess whether the clinical data could predict the presence or absence of left ventricular systolic dysfunction. After excluding patients with significant valvular disease, severe renal failure, or myocardial infarction in the previous 2 months, the study population comprised 152 patients divided into 2 groups: Group I (N = 112) with abnormal systolic function (radionuclide ejection fraction less than 45%) and Group II (N = 40) with normal systolic function (radionuclide ejection fraction greater than or equal to 45%). The clinical, echocardiographic and radionuclide angiographic data was analysed (global ejection fraction in both groups and peak filling rate in Group II). The patients in Group II (26% of the total study population) were older (66.5 +/- 12.4 vs 61.3 +/- 12.3 years, p less than or equal to 0.02), were more often female (35% vs 17.9%, p less than or equal to 0.02), had acute cardiac failure (75% vs 37%, p less than 0.00001), and were frequently hypertensive (65% vs 39%, p less than or equal to 0.005). Univariate analysis of clinical and radiological signs did not show any significant difference between the two groups except for increased jugular venous pressure and cardiomegaly which were more common in Group I (56% vs 25%, p less than 0.00001 and 93% vs 68%, p less than or equal to 0.00001, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

[Acute myocardial infarction: immediate coronary angioplasty for failure or contra-indications of thrombolytic therapy. Apropos of a series of 100 cases].

One hundred patients admitted to a centre of interventional cardiology with acute myocardial infarction of less than 6 hours, underwent coronary angioplasty of first intention because of contra-indications to thrombolytic therapy (n = 20) or after thrombolytic therapy with streptokinase (n = 54), acylenzymes (n = 12) or tissue type plasminogen activator (n = 14). The indication of angioplasty were those of the TIMI (Thrombolysis in Myocardial Infarction) classification (occluded artery, TIMI grade 0) (n = 60) (suboccluded artery, TIMI grade 1) (n = 40). The criterion of success of angioplasty was an increase greater than 1 of TIMI grade. Reperfusion of the coronary artery was obtained by angioplasty in 95% of failures of thrombolysis and in 90% of patients with contra-indications to thrombolytic therapy. The early reocclusion rate at D1 was 2%. Repeat angioplasty at D1 was successful in both these cases and the arteries were still patent at D21. The reocclusion rate at the third week in 75 patients who underwent control coronary angiography was 5.3%. In patients with arterial occlusion, immediate angioplasty attained two objectives in the same procedure: a high rate of emergency myocardial reperfusion and a low rate of reocclusion. The average left ventricular ejection fraction (all arteries) significantly improved (+9.2% in absolute values) when the artery remained patent (p less than 0.001), especially when the initial ejection fraction was low. In the patients who had occluded arteries at control angiography at 3 weeks, the ejection fraction decreased (-4% in absolute values) (NS). The following complications were observed: 4 coronary artery dissections and haematomas at the site of femoral puncture in patients who had received thrombolytic therapy (10 drained surgically). The hospital mortality was 3% and global mortality after an average follow-up period of 19.6 months was 5%. Coronary angioplasty in acute myocardial infarction carries a low risk and seems to be beneficial in patients with contra-indications to or failure of thrombolysis.

Adult↗

PubMed1991

[Effects of heart rate increase by transesophageal stimulation on the left ventricular filling in the normal subject. A pulsed echo-Doppler study].

The effects of increasing the heart rate on left ventricular filling were studied by Doppler echocardiography in 12 mildly sedated normal subjects. The heart rate was increased by 10, 20 and 30 bpm with respect to the basal rhythm by transoesophageal pacing. Four stages were thereby defined: S0, S1, S2 and S3. The principal results were: absence of variation of the isovolumic relaxation period in absolute values (92 +/- 14, 86 +/- 16, 87 +/- 16, 78 +/- 11 ms); absence of variation of the duration of the rapid filling period (246 +/- 36 at 50 vs 220 +/- 28 ms at 53); no change in peak filling velocity (72 +/- 11 at 50 vs 61 +/- 11 ms at 53) or in the timing of peak velocity (77 +/- 12 at 50 vs 72 +/- 13 ms at 53); increased contribution of atrial systole during tachycardia (Vmax 43 +/- 7 at 50 vs 76 +/- 17 cm/s at 53). Therefore, of these Doppler echo parameters, only atrial systole changed during the range of tachycardia rates which were studied. Its increase compensated the loss of diastolic diastasis. These changes should be born in mind in Doppler echocardiographic studies of left ventricular diastolic function.

Adult↗

PubMed1991

[Embolization of the foramen ovale in metastatic course of abdominal liposarcoma].

The authors report a case of embolization of the foramen ovale by a liposarcoma metastasis in a young woman of 28 years of age. Cardiac impact due to the progress of this rare tumor type remains unusual. The various clinical situations resulting from secondary cardiac locations are recalled. The diagnostic role of ultrasonography and the information which can be provided by nuclear magnetic resonance imaging in this context are also recalled.

Abdominal Neoplasms↗

PubMed1990

[Cardiomyopathy in the peripartum period: current aspects. A multicenter study. 11 cases].

Eleven of 17 case histories recensed after an inquiry addressed to all the French university hospital cardiological departments were attributed to peripartum cardiomyopathy. Three patients (27%) needed cardiac transplantation. Predisposing factors were multiparity and twin pregnancies. Forty five per cent of patients were under 25 years of age. Hypoproteinemia was present in all serious forms of the condition. Hypoproteinemia, a cardio-thoracic ratio of over 0.60, echocardiographic left ventricular fractional shortening of under 15 per cent and presistance of symptoms after one month of medical treatment were poor prognostic factors. The relatively high incidence of myocarditis (1 out of 11 cases) justifies endomyocardial biopsy.

Adolescent↗

PubMed1990

[Effect of cardioversion of atrial fibrillation on left ventricular function in dilated cardiomyopathy. A multicenter study].

A group of 73 patients with idiopathic dilated cardiomyopathy were followed up for an average of 22 +/- 7 months to assess the medium term evolution of echocardiographic parameters of left ventricular function and, in particular, the consequences of cardioversion of atrial fibrillation. Seventy nine per cent of patients presented with cardiac failure. Left bundle branch block was observed in 20% and ventricular arrhythmias were frequent in 31%, complex in 62% with episodes of non-sustained ventricular tachycardia in 10% of cases. Left ventricular dilatation was greater in patients with complete left bundle branch block (p less than 0.003). Atrial fibrillation was present in 14 patients (19%) who were generally older than the rest of the study population (p less than 0.02) and was associated with less severe left ventricular dysfunction (p less than 0.01). Return to sinus rhythm was obtained in 9 patients. Echocardiographic data was obtained in 64 patients after an average of 6.2 +/- 1.7 months. Left ventricular function improved during the follow-up period and returned to normal in 12% of cases. Reduction of atrial fibrillation to sinus rhythm was the only predictive factor of normalisation of left ventricular function (p less than 0.02). The changes in left ventricular end diastolic dimension and fractional shortening was less marked in the group of 56 patients in sinus rhythm or chronic atrial fibrillation (normalisation of left ventricular function in 8% of cases) than in the group of 8 patients in which atrial fibrillation was converted to sinus rhythm (normalisation of left ventricular function in 50% of cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

[Left ventricular filling in treated essential hypertension. A study using Doppler echocardiography].

The first stigmata of left ventricular involvement in hypertension are changes in diastolic filling. Early detection of these abnormalities is important as some antihypertensive agents may have beneficial effects on left ventricular distensibility and filling, in addition to lowering the blood pressure. This study compares parameters of left ventricular filling recorded by pulsed Doppler echocardiography in 44 treated hypertensives (average blood pressure: 157 +/- 20/93 +/- 12 mmHg) without any other coronary risk factors with 33 age-matched (52 +/- 13 years and 48 +/- 13 years) control normotensive subjects (average blood pressure: 130 +/- 11/80 +/- 7 mmHg). The main findings were an increase of the peak. A wave velocity after atrial contraction and of the A/E ratio in the hypertensive group (66 +/- 16 cm/s vs 53 +/- 14 cm/s, p less than 0.05 and 0.99 +/- 0.34 vs 0.78 +/- 0.24, p less than 0.05, respectively). These changes were more pronounced in patients with left ventricular hypertrophy. The rapid filling phase was unchanged (maximum E wave velocity = 68 +/- 18 cm/s vs 70 +/- 14 cm/s). The influence of age on peak A wave velocity and A/E ratio was obvious in control subjects and hypertensives without left ventricular hypertrophy r = 0.80; p less than 0.05). The age factor was not significant in the presence of left ventricular hypertrophy (r = 0.18). A weak linear correlation was observed between the peak A wave velocity, diastolic septal thickness (r = 0.44; p = 0.04) and left ventricular mass (r = 0.44; p = 0.05) in hypertensive patients with left ventricular hypertrophy.

Adult↗

PubMed1990

[Ventricular arrhythmia in moderate essential arterial hypertension. Review of the literature apropos of 2 cases].

The authors report two observations of severe ventricular arrhythmias is two hypertensive patients without coronary disease. In the light of these observations and of a literature review, they recall the frequency of these arrhythmias, their possible role in the event of the sudden death of the hypertensive subject without coronary disease and their physiopathology, where the left ventricular hypertrophy is predominant. They also try to draw the practical guidelines for the management of the hypertensive patient.

Aged↗

PubMed1990

Acute coronary care and treatment of myocardial infarction in the three French MONICA registers.

The study evaluates and compares among the three French MONICA centres the access to emergency care, and the treatment administered to 1444 patients aged 25-64 years hospitalized for an acute coronary event. It was carried out in 1985 in Bas-Rhin (BR) on 596 subjects, in 1986 in Haute-Garonne (HG) on 450 subjects, and from October 1986 to July 1987 in the Urban Community of Lille (UCL) on 395 subjects. The time before receiving initial medical care could be analysed only in BR and HG: it is shorter in HG (p less than 0.001). Patients with a history of coronary disease are inclined to consult more quickly than patients with a first event (p less than 0.001). According to the three centres, 68.5 to 72.5% of the patients consult first a private practitioner, while 9 to 10.5% contact first a mobile team (mobile emergency care unit), and 6 to 15% go directly to hospital. Patients with a previous history tend more to call a mobile team directly, or to go to hospital directly than patients without a history (p less than 0.001). The analysis of the treatment was made only on patients classified in MONICA diagnostic category 1: the therapeutic schemes are similar in the three centres, although differences are noted in the frequency of prescription. The use of new medications and procedures seems to be best established in HG and in UCL than in BR, with the reservation that the three studies were not conducted at the same time.

Adult↗