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C Tribouilloy

Publications and source records attributed to C Tribouilloy.

At least 19 recordsLinked to original sources
PubMed2006

Treatment practices in heart failure with preserved left ventricular ejection fraction: a prospective observational study.

BACKGROUND: Current guidelines for treatment of patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) are empirical. One of the objectives of the ETICS study was to evaluate medical treatment at discharge and after 1 year in patients hospitalised for a first episode of HF in 2000. We report the results concerning treatment of patients with preserved LVEF at discharge and at 1 year. METHODS: Two hundred and sixty three consecutive patients (75+/-10 years, 47 males) with LVEF >50% hospitalised for a first episode of HF were prospectively included. Mean LVEF was 63+/-8%. The main aetiology was hypertension (61%) followed by ischaemic heart disease (29%). Atrial fibrillation and diabetes were present in 34% and 27% of cases, respectively. Medical treatment records were complete at discharge and at 1 year after discharge. RESULTS: At discharge, as at 1 year after discharge, diuretics were the drugs most commonly prescribed (81% and 78%), followed by ACE inhibitors (49% and 46%), amiodarone (32% and 28%), beta-blockers (27% and 29%), nitrates (28% and 27%), calcium channel blockers (27% and 26%), spironolactone (21% and 25%), cardiac glycosides (19% and 24%), and angiotensin II receptor antagonists (4% and 6%). Once prescribed at hospital discharge, drug prescription rates and daily doses did not change significantly over time. Age did not influence drug prescription rates at discharge or at 1 year, except for the spironolactone prescription rate, which decreased at 1 year in patients > or =75 years of age. At discharge, ACE inhibitor and beta-blocker daily doses were lower in older patients, while, at 1 year, no differences in daily doses of these drugs were observed between patients above and below the age of 75 years. CONCLUSION: Loops diuretics are largely prescribed in HF with preserved LVEF, followed by ACE inhibitors. Future large multicentre trials are required to define the background standard treatment in addition to treatment of aetiological factors.

Aged↗
PubMed2006

[The best of echocardiography in 2005].

Echocardiography continues to evolve in several directions: on the technical front, various tools are being developed and real time 3D is starting to find a place in routine practice as much as contrast is used unequally depending on the country. On the diagnostic front, certain aspects have been particularly emphasised this year: The key role of quantification of valvulopathies in order to guide management, both at rest and on effort. The place of echocardiography in asynchronism, even if a more consensual strategy is needed to take into account the different approaches. The very good prognostic series on stress echography in the context of myocardial ischaemia. Advances in the evaluation of filling pressures have allowed a better definition of the limits, and have refined the understanding of so-called 'diastolic' cardiac failure. Finally, the role of echography to guide and also evaluate the results of foramen ovale or interatrial communication closure.

Cardiac Pacing, Artificial↗
PubMed2006

[Prevention of calcific aortic stenosis by statins: myth or reality?].

Degenerative calcific aortic stenosis is the most common valvular disease in the industrialised world. During the last decade, experimental studies have improved our understanding of the physiopathology of this disease. The latest data concerns the demonstration of the mode of installation and progression which resembles that of athrosclerosis. Lipid abnormalities, especially hypercholesterolaemia, are important in the initiation of the valvular lesions and also in the calcification of the aortic orifice. Experimental data and retrospective clinical studies suggest, but without proof, that statins could slow th progression of the aortic stenosis. However, the first prospective trial, recently published, questions this hypothesis. Randomised multicenter trials are currently under way and should provide the answer to the role of stetins in the prevention of aortic stenosis.

Aortic Valve Stenosis↗
PubMed2005

Heart failure due to left ventricular systolic dysfunction: treatment at discharge from hospital and at one year.

BACKGROUND: The treatment of heart failure (HF) due to left ventricular systolic dysfunction has been defined in recent guidelines, but these guidelines are not always applied in routine clinical practice. One of the objectives of the ETICS study was to evaluate medical treatment at discharge and after 1 year in patients hospitalised for a first episode of congestive HF due to left ventricular systolic dysfunction in 2000. METHODS: One hundred and seventy nine patients (63% males, mean age of 69+/-13 years) with an ejection fraction < or = 40% were prospectively included. The main aetiology was ischaemic heart disease (44%). RESULTS: The drugs prescribed at discharge and at one year, respectively, were loop diuretics in 95% and 91% of cases, angiotensin-converting enzyme (ACE) inhibitors in 82% and 75%, spironolactone in 35% and 37%, beta-blockers in 25% and 41%, digitalis glycosides in 34% and 30% of cases, and nitrates in 20% and 16% of cases. ACE inhibitors were prescribed at discharge and at 1 year at dosages reaching 64+/-29% and 72+/-30% of the recommended doses, respectively, and beta-blockers were prescribed at 26+/-16% and 35+/-25% of recommended doses, respectively. CONCLUSION: Diuretics and ACE inhibitors are largely prescribed in HF due to left ventricular systolic dysfunction, followed by spironolactone. Beta-blockers are still underused both in terms of the rate of patients receiving them and the daily doses. These results highlight the value of continuing to widely circulate official practice guidelines in order to improve the management of HF due to left ventricular systolic dysfunction.

Adrenergic beta-Antagonists↗
PubMed2005

Superiority of surgical versus medical treatment in patients with Staphylococcus aureus infective endocarditis.

BACKGROUND: We present here the clinical features and outcome of 54 patients affected by a Staphylococcus aureus infective endocarditis at the Amiens hospital between 1990 and 2000. The patients operated-on, group A (20 patients), were compared to the population of patients treated by exclusive antibiotherapy, group B (34 patients). PATIENTS AND METHOD: The male gender predominated with a sex ratio of 2.6. The mean age of the global population was 58.7+/-1.6 years. Time between onset of endocarditis symptoms and treatment (entire group) ranged from 1 to 120 days (mean 14.4 days). The main portal of entry were, respectively, for group A and group B: cutaneous 55% and 44.1%; intravascular material 5% and 8.8%; and rhinopharynx 5% and 8.8%. Seventy-five percent of the Staphylococcus aureus isolated were Methi-S. The main surgical treatment indication were: hemodynamic failure (HF) (30%), unstable infection with collapse (UI) (30%), UI+HF (10%), voluminous vegetation (20%) and embolism event (10%). RESULTS: The hospital mortality rate were respectively for the entire group, group A and group B: 25%, 35% and to 41% (ns). For group A, the operative mortality was lower(21%) after the first week. The actuarial survival rate (Kaplan-Meier) after 24 months was 54./+/-6.9% for the global population and 74+/-10.6% for group A and 43+/-8.5 for group B (p<0.001). The multivariate analysis finds severe sepsis and index of comorbidity as independent factors related to the global late mortality and, respectively, the age and the severe sepsis for group A, and the cardiac insufficiency for group B. CONCLUSION: The surgical treatment seems to be the best way to improve the results after Staphylococcus aureus endocarditis. The severity of the sepsis remains the most severe prognostic element, whatever the treatment adopted may be.

Anti-Bacterial Agents↗
PubMed2005

[When should one operate for severe asymptomatic aortic stenosis?].

The most common cause of aortic stenosis is degenerative and progression of the disease is slow. Deciding to proceed to aortic valve replacement in an asymptomatic patient is always difficult. Only a minority will require valve replacement after repeated work-ups including stress testing and serial echographic examinations. In the future, stress echocardiography and BNP measurements may prove helpful in decision making.

Aortic Valve Stenosis↗
PubMed2005

Comparison of clinical and morphological characteristics of Staphylococcus aureus endocarditis with endocarditis caused by other pathogens.

OBJECTIVES: To analyse clinical, echocardiographic, and prognostic characteristics of Staphylococcus aureus infective endocarditis (IE) compared with endocarditis caused by other pathogens. DESIGN: Cohort study. METHODS: 194 consecutive patients with definite IE according to the Duke criteria prospectively examined by transthoracic and transoesophageal echocardiography were enrolled. Patients without identified microorganisms were excluded. The S aureus IE group (n = 61) was compared with the group with IE caused by other pathogens (n = 133). RESULTS: Compared with IE caused by other pathogens, S aureus IE was characterised by severe co-morbidity, a shorter duration of symptoms before diagnosis, and a higher prevalence of right sided IE, cutaneous portal of entry, and history of renal failure. Severe sepsis, major neurological events, and multiple organ failure were more frequent during the acute phase in S aureus IE. In-hospital mortality (34% v 10%, p < 0.001) was higher in patients with S aureus IE and the 36 month actuarial survival rate was lower in S aureus IE than in IE caused by other pathogens (47% v 68%, p = 0.002). Multivariate analyses identified S aureus infection as a predictive factor for in-hospital mortality and for overall mortality. CONCLUSIONS: S aureus IE compared with IE caused by other pathogens occurs in a more debilitated clinical setting and is characterised by a higher prevalence of severe sepsis, major neurological events, and multiple organ failure leading to higher mortality.

Cause of Death↗
PubMed2005

Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases.

OBJECTIVES: To identify the prognostic markers of a bad outcome in a large population of 104 patients with prosthetic valve endocarditis (PVE), and to study the influence of medical versus surgical strategy on outcome in PVE and thus to identify patients for whom surgery may be beneficial. DESIGN: Multicentre study. METHODS AND RESULTS: Among 104 patients, 22 (21%) died in hospital. Factors associated with in-hospital death were severe co-morbidity (6% of survivors v 41% of those who died, p = 0.05), renal failure (28% v 45%, p = 0.05), moderate to severe regurgitation (22% v 54%, p = 0.006), staphylococcal infection (16% v 54%, p = 0.001), severe heart failure (22% v 64%, p = 0.001), and occurrence of any complication (60% v 90%, p = 0.05). By multivariate analysis, severe heart failure (odds ratio 5.5) and Staphylococcus aureus infection (odds ratio 6.1) were the only independent predictors of in-hospital death. Among 82 in-hospital survivors, 21 (26%) died during a 32 month follow up. A Cox proportional hazards model identified early PVE, co-morbidity, severe heart failure, staphylococcus infection, and new prosthetic dehiscence as independent predictors of long term mortality. Mortality was not significantly different between surgical and non-surgical patients (17% v 25%, respectively, not significant). However, both in-hospital and long term mortality were reduced by a surgical approach in high risk subgroups of patients with staphylococcal PVE and complicated PVE. CONCLUSIONS: Firstly, PVE not only carries a high in-hospital mortality risk but also is associated with high long term mortality and needs close follow up after the initial episode. Secondly, congestive heart failure, early PVE, staphylococcal infection, and complicated PVE are associated with a bad outcome. Thirdly, subgroups of patients could be identified for whom surgery is associated with a better outcome: patients with staphylococcal and complicated PVE. Early surgery is strongly recommended for these patients.

Aortic Valve↗
PubMed2005

[The best of echocardiography in 2004].

What major trends can we single out from the large amount of literature that appeared in 2004? The role of echography in the investigation of asynchronism has most certainly been better defined. Real time 3D echography, now routinely available, has started to gain respect in different pathologies. The place of filling pressure evaluation in patients' management, as much diagnostic as therapeutic, has again been refined. The prognostic contribution of stress echography has been emphasized in particular this year. Despite a still limited routine role, publications regarding contrast techniques have been quite numerous: not only diagnostic contrast echography, but also contrast and pleiotropic gene transfer in the myocardium. The study of coronary reserve via the transthoracic route, possibly assisted with contrast, should become established as a routine technique.

Contrast Media↗
PubMed2005

[Contrast echocardiography: from diagnosis to treatment].

Contrast echocardiography is widely used in echocardiographic laboratories. When used at rest or with a stress test, it provides complementary information concerning myocardial perfusion not available with conventional imaging. Its applications in the evaluation of left ventricular ejection fraction, the detection of coronary stenosis and the no reflow phenomenon in acute myocardial infarction have been validated. Advances in our understanding of the interaction between the microbubbles and ultrasound have led to considering the microbubble not just as a vascular tracer but also as a vector of active molecules. The detection of angiogenesis, thrombi, or intravascular inflammation are possible with contrast echocardiography. Therefore, new perspectives in myocardial contrast echo are opening up in therapeutics. Preliminary studies in the animal suggest that it may be possible to use microbubbles to deliver drugs or genetic material to the heart of the cardiomyocytes.

Animals↗
PubMed2005

[Value of coronary reserve flow measurement by transthoracic echocardiography].

The measurement of coronary reserve flow by transthoracic echocardiography of the left anterior descending and the posterior interventricular artery is a new non-invasive reproducible and attractive method which can be performed at the bedside with the proviso of a specific learning curve. The potential value is great: detection of significant (> 70%) coronary stenosis, coronary occlusion, post-angioplasty follow-up, evaluation of intermediate stenoses, coupling with stress echo, reperfusion studies, no reflow detection, post-infarction viability, coronary bypass patency and studies of microcirculation.

Coronary Artery Bypass↗
PubMed2004

Impact of inflammation and oxidative stress on vascular calcifications in chronic kidney disease.

Vascular and/or valvular calcifications in patients with chronic kidney disease (CKD) appear to indicate a poor prognosis in terms of overall survival and cardiovascular morbidity and mortality. Inflammation and oxidative stress represent new features of the arterial and/or valvular calcification process. However, only limited observational and epidemiological data are available in these areas. Therefore, the link between inflammation, oxidation and vascular and/or valvular calcifications deserves careful consideration in CKD patients, since they may become targets for the development of new therapeutic strategies.

Calcinosis↗
PubMed2004

Aortic valve replacement with the minimal extracorporeal circulation (Jostra MECC System) versus standard cardiopulmonary bypass: a randomized prospective trial.

BACKGROUND: We prospectively evaluated a newly introduced minimal extracorporeal circulation system (Jostra MECC System; Jostra AG, Hirrlingen, Germany) for aortic valve surgery. METHOD: In a prospective, randomized study, 100 patients underwent aortic valve replacement either with standard cardiopulmonary bypass (n = 50, group B) or with the MECC System (n = 50, group B). The myocardial protection and the left vent were identical for the two groups. The intrapericardial suction device was never used (only the cell salvage device was used) to reduce the air-blood contact area. RESULTS: No significant differences were noted in patient characteristics and operative data between groups. Operative mortality (<30 days) was 2% for group A and 4% for group B (difference not significant). From the preoperative period to the postoperative period, the increase in C-reactive protein was significantly higher for group B (P <.001). The postoperative troponin I level was significantly lower in group A (mean 4.65 +/- 2.9 microg/L at 24 hours) than in group B (8.2 +/- 4.4 microg/L, P <.03). On the other hand, the MECC System was associated with platelet preservation. Renal function was better preserved and the neurologic event rate was significantly lower for the MECC group (P <.02). CONCLUSION: The MECC System is safe and allows aortic valve replacement under the most favorable conditions. The system is more biocompatible than standard cardiopulmonary bypass and provides a good postoperative biologic profile and good clinical results, particularly for high-risk patients.

Aged↗
PubMed2004

[Epidemiology and aetiology of cardiac failure in the Somme].

UNLABELLED: The epidemiology of cardiac failure (CF) is little known in France. Our work, integrated in the prospective ETICS (epidemiology and therapeutics of cardiac insufficiency in the Somme) study, was aimed at determining the incidence of hospitalisation, the epidemiological profile, the causes of CF, as well as the frequency of cardiac failure with preserved systolic function in the Somme. METHOD: Patients hospitalised for a first attack of CF from January 1 to December 31, 2000 in one of the 11 medical establishments in the Somme were included. RESULTS: During this period, 799 patients were included. The male/female ratio was 1.05; the mean age was 75 +/- 12 years, for males it was less than for females (72 +/- 12 and 78 +/- 11 years respectively p < 0.001); 60% of patients were > 75 years. The average length of hospitalisation was 10.8 +/- 7 days. The hospital mortality was 8.4% (N = 67). The standardised hospital incidence was 1.92 percent per thousand of inhabitants per year and varied from 0.06 percent per thousand among those under 40 years to 14.7 percent per thousand in those over 80 years. The left ventricular ejection fraction, evaluated in 82.8% of patients, was greater than 50% in 55% of cases. The 2 principal causes found were: ischaemic (40%) and hypertensive (39%). CONCLUSION: The hospital incidence of CF in the Somme during the year 2000 was 1.92 percent per thousand. The proportions of males and females were equivalent. This disease preferentially affects the elderly. CF with preserved systolic function is common (55% of cases), particularly in elderly subjects.

Adult↗
PubMed2004

[Quantification of mitral regurgitation in 2003].

Doppler echocardiography is the method of choice for quantifying mitral regurgitation. There are methods, especially those based on the study of the zone of convergence or proximal isovelocity which are remarkable advances in this indication. The results are compared with those of other semi-quantitative parameters. The comparison and concordance of these results provides a reliable evaluation of the severity of the regurgitation in over 90% of cases. In this article, the authors review the different approaches to quantification, their indications and limitations.

Diagnostic Techniques, Cardiovascular↗
PubMed2003

[Physiopathology and etiology of mitral insufficiency].

Mitral regurgitation has a complex pathophysiology. It should be assessed from the study of factors influencing regurgitant volume and the evaluation of hemodynamics effects downstream (impact on left ventricular function) and upstream (level of left atrial compliance and pulmonary pressure). The regurgitant volume is larger when the regurgitation time is longer, the regurgitant orifice is bigger and the magnitude of the left ventrico-atrial systolic gradient higher. The study of left ventricular function is difficult, especially in chronic mitral regurgitation where the apparently normal left ventricular systolic function can hide a significant worsening in myocardiacs fibres contractile abilities. With the increase in life expectancy and with the decrease in the incidence of rheumatic fever, aetiologies of mitral regurgitation have changed in the past 30 years. They are now dominated by dystrophic mitral regurgitation and infective endocarditis while rheumatic fever becomes less frequent.

Endocarditis, Bacterial↗
PubMed2003

Bivalvular mechanical mitral-aortic valve replacement in 254 patients: long-term results--a 22-year follow-up.

BACKGROUND: We have retrospectively studied 254 patients who underwent a bivalvular mechanical mitral-aortic replacement in the cardiovascular and thoracic surgery unit of Nantes from 1979 to 1989. The follow-up was 22 years (1979 to 2001). The last patient was operated on 12 years before the end of the follow-up. METHODS: All mitral prostheses were St. Jude Medical (SJM) bileaflet valves, and the aortic prostheses were 124 monodisc Björk-Shiley valves, 3 Sorin prostheses, and 127 St. Jude Medical bileaflet prostheses. The mean age was 56.8 +/- 8.5 years with a sex ratio equal to 1. Rheumatism as the etiology predominated with 79.5%. Ninety-seven percent of the patients were followed for a total of 2,779 patient-years and a mean of 11.7 years. RESULTS: Operative mortality was 7.08%. Freedom from overall mortality and valve-related mortality at 22 years were 45.7% +/- 3.6% and 73.1% +/- 3%, respectively. The linearized rates of thromboembolic and hemorrhagic events were 1.07% and 0.9% per patient-year, respectively. Multivariate analysis showed age (p < 0.002), sex (p < 0.01), and degenerative etiology (p = 0.04) as independent factors of late mortality, and age, sex, degenerative disease, and tricuspid pathology were related to valve-related mortality. CONCLUSIONS: This study shows good results after mechanical mitral-aortic replacement in terms of survival rate and quality of life in surviving patients, and outlines the factors influencing long-term results as compared with isolated mitral valve replacement.

Actuarial Analysis↗