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Biomedical subjects

Daniel Herpin

Publications and source records attributed to Daniel Herpin.

10 recordsLinked to original sources
PubMed2006

Blunt renal trauma-induced hypertension: prevalence, presentation, and outcome.

BACKGROUND: Blunt renal trauma (RT) may cause hypertension. We assessed the frequency and mechanisms of RT, and blood pressure (BP) outcome after treatment. METHODS: We searched the records of all patients referred to our hypertension unit and included those of previously normotensive patients who developed hypertension within 6 months of RT. RESULTS: Ten of the 17,410 referred patients, with a median age of 26 years, developed hypertension 0 to 3 months after a well-documented RT. Median BP at referral was 170/107 mm Hg. Median glomerular filtration rate was 89 mL/min. Five patients had hematuria. Median kidney length was 107 mm on the damaged side and 114 mm on the opposite side. Renal artery lesions were present in six cases. A pattern of unilateral renin hypersecretion and contralateral suppression was present in five of eight cases with unilateral RT. Six patients underwent surgery. Seven months after referral, median BP was 128/79 mm Hg. The BP was <140/90 mm Hg without medication in one patient who did not undergo surgery and in three patients who did. CONCLUSIONS: Renal trauma is a rare cause of hypertension, mostly in young men. Hypertension is usually renin dependent and associated with parenchymal injury. The RT-induced hypertension may resolve spontaneously and is amenable to surgery.

Abdominal Injuries↗
PubMed2006

[Management of hypertension in patients with diabetes].

Cardiovascular risk is generally high in patients with both hypertension and diabetes and should be specifically assessed for each individual. The blood pressure target is<130/80 mm Hg. Two or even three different drugs are often necessary to reach this rather difficult goal. Angiotensin-converting enzyme (ACE) inhibitors are preferred for patients with renal damage. Proteinuria should be reduced to less than 0.5 g/day. Associated risk factors should be treated with equal effectiveness. In particular, LDL cholesterol should be lowered to less than 1 g/L when additional risk factors are present. Aspirin (0.75 mg a day) should be given routinely as soon as blood pressure is controlled.

Adrenergic beta-Antagonists↗
PubMed2005

Tissue Doppler echocardiographic quantification. Comparison to coronary angiography results in Acute Coronary Syndrome patients.

BACKGROUND: Multiples indices have been described using tissue Doppler imaging (DTI) capabilities. The aim of this study was to assess the capability of one or several regional DTI parameters in separating control from ischemic myocardium. METHODS: Twenty-eight patients with acute myocardial infarction were imaged within 24-hour following an emergent coronary angioplasty. Seventeen controls without any coronary artery or myocardial disease were also explored. Global and regional left ventricular functions were assessed. High frame rate color DTI cineloop recordings were made in apical 4 and 2-chamber for subsequent analysis. Peak velocity during isovolumic contraction time (IVC), ejection time, isovolumic relaxation (IVR) and filling time were measured at the mitral annulus and the basal, mid and apical segments of each of the walls studied as well as peak systolic displacement and peak of strain. RESULTS: DTI-analysis enabled us to discriminate between the 3 populations (controls, inferior and anterior AMI). Even in non-ischemic segments, velocities and displacements were reduced in the 2 AMI populations. Peak systolic displacement was the best parameter to discriminate controls from AMI groups (wall by wall, p was systematically < 0.01). The combination IVC + and IVR< 1 discriminated ischemic from non-ischemic segments with 82% sensitivity and 85% specificity. CONCLUSION: DTI-analysis appears to be valuable in ischemic heart disease assessment. Its clinical impact remains to be established. However this simple index might really help in intensive care unit routine practice.

Acute Disease↗
PubMed2005

Home blood pressure during normal pregnancy.

To determine values for home blood pressure (HBP) during pregnancy, nurses taught 45 healthy pregnant women to use a HBP method for 1 week before 15 weeks of gestation, between weeks 15 and 27, and after 28 weeks for the last 3 months of gestation. HBP values were significantly lower during the second trimester and higher during the last trimester (102 +/- 8/59 +/- 7*, 101 +/- 8/57 +/- 8*, 105 +/- 8*/62 +/- 9* mm Hg;*P< 0.05) than during other trimesters. Heart rate increased significantly during the pregnancy. The present study suggests upper limits for HBP: 118/73, 117/73, and 121/80 mm Hg, respectively during the 3-month gestational periods. These findings may be helpful in providing clinicians with comparative values so as begin to establish reference values for HBP during pregnancy.

Adult↗
PubMed2005

Quantitative regional analysis of left atrial function by Doppler tissue imaging-derived parameters discriminates patients with posterior and anterior myocardial infarction.

BACKGROUND: Doppler tissue imaging can now be used for the assessment of left atrial (LA) function. LA function was evaluated by this technique in a group of patients hospitalized for acute myocardial infarction and in a control population. METHODS: Patients were all prospectively imaged with a scanner. To study the LA, a region of interest was located in the proximal part of the lateral and septal LA walls. Doppler tissue imaging, tissue tracking, strain, and delays were recorded. RESULTS: In all, 12 patients with posterior (age 54 +/- 9 years) and 13 with anterior (age 64 +/- 16 years) acute myocardial infarction, along with 16 control patients (age 54 +/- 9 years), were analyzed. Early diastolic septal velocity was found to be the best parameter for discriminating among the 3 groups. Peak strain was also relevant and did not correlate with left ventricular function. CONCLUSIONS: LA is accessible to Doppler tissue imaging analysis. Strain can quantify LA function relatively independently of left ventricular function, and may provide new insights on LA function.

Aged↗
PubMed2005

The left atrial appendage, a small, blind-ended structure: a review of its echocardiographic evaluation and its clinical role.

The increasing prevalence of stroke and atrial fibrillation is a stimulus for new therapeutic strategies and also warrants a review of imaging modalities of the most important source of cardiac systemic embolic events: the left atrial appendage (LAA). This blind-ended, complex structure is embryologically distinct from the body of the left atrium and is sometimes regarded as just a minor extension of the atrium. However, it should routinely be analyzed as part of a transesophageal echocardiographic (TEE) examination. A pulsed Doppler TEE analysis of LAA emptying flow should supplement a two-dimensional (2-D) analysis; these examinations have proven to be highly reproducible and to help assess thromboembolic risk. In 2-D imaging, potential thrombus and spontaneous echo contrast should be sought. In addition, LAA plays a hemodynamic role that participates in atrial function and is influenced by various hemodynamic conditions. In view of the embolic risks from a dysfunctional appendage, the LAA is often ligated during cardiac valve surgery. New devices are under evaluation for percutaneous closure of the LAA, and further studies should improve the definition, understanding, and treatment of LAA dysfunction.

Age Factors↗
PubMed2004

[Initial management of arterial hypertension].

Systemic arterial hypertension is currently defined by a systolic BP or a diastolic BP higher than 140/90 mmHg. There are about 8 million hypertensives in France. The diagnosis of arterial hypertension can be made in some cases using ambulatory BP recording or home self BP measurement. The associated risk factors have to be identified, as well as target organs damage (heart, brain, kidney, great vessels). Arterial hypertension is most often mild or moderate. A specific etiology is found in less than 5% of the patients. The goal of therapy is usually a clinic BP lower than 140/90 mmHg (130/80 in patients with diabetes or renal failure). Monotherapy results in a well-controlled BP in 50% of the cases, only. Then, hypertensive patients should be often given 2 or 3 drugs.

Antihypertensive Agents↗
PubMed2004

Anatomic M-mode, a pertinent tool for the daily practice of transthoracic echocardiography.

OBJECTIVES: We sought to compare anatomic M-mode (AMM), a new echocardiographic postprocessing option, and conventional M-mode (CMM) using fundamental imaging and tissue harmonic imaging. METHODS: Transthoracic echocardiography was performed in 15 selected patients to analyze the reproducibility of AMM and in 47 patients to assess its clinical value versus CMM. Acquisitions were performed successively: CMM fundamental imaging; CMM tissue harmonic imaging; tissue harmonic imaging cineloops for AMM; and fundamental imaging cineloops for AMM. Quantitative analysis was performed offline. The angle alpha between the CMM line and the septal endocardial interface was calculated and the expected percentage of error in measuring left ventricular diameter was derived. RESULTS: AMM analysis was reproducible. Optimal AMM full echocardiographic definition was obtainable in 77% of the population, whereas CMM was optimal for 49% because of scan line misalignment, causing a measurement overestimation exceeding 5%. CONCLUSION: The ability with AMM to reduce the alpha angle to 0 degrees and, thus, avoid overestimation of left ventricular dimensions might improve follow-up in several pathologic conditions.

Adolescent↗
PubMed2004

Automated office and home phone-transmitted blood pressure recordings in uncontrolled hypertension treated with valsartan and hydrochlorothiazide.

The study objective was to evaluate, by means of automated office and phone-transmitted home blood pressure (OBP and HBP) recordings, the effects of a fixed combination of valsartan 160 mg and hydrochlorothiazide (HCTZ) 25 mg in hypertensive patients previously uncontrolled with the combination of an angiotensin receptor antagonist and HCTZ. From 241 selected patients, 171 (71%) had uncontrolled hypertension OBP and HBP [mean baseline OBP and HBP systolic and diastolic (SBP/DBP): 157/91 and 152/87 mmHg]. In this open-design study, patients were directly switched from other angiotensin receptor blocker combination products to valsartan/HCTZ for 6 weeks. The same validated automated device was used for OBP and HBP recordings. At baseline, mean HBP was 152 +/- 15/87 +/- 10 mmHg and mean OBP was 157 +/- 12/91 +/- 9 mmHg. After 6 weeks of treatment with valsartan 160 mg and HCTZ 25 mg, a significant decrease in BP was observed both at home (146 +/- 17/83 +/- 12 mmHg) and at the office (151 +/- 18/87 +/- 11 mmHg), with a difference from baseline of -4 mmHg, p < 0.001 for DBP and of -6 mmHg for SBP, p < 0.001. The percentage of patients with office and home control was 24% and 23% respectively, with a kappa index at 0.459. Elevated OBP only (office hypertension) was observed in 3.6% and elevated HBP only (masked hypertension) in 10% of patients. In conclusion, treatment with valsartan and HCTZ 25 mg in patients with confirmed uncontrolled hypertension induced a clinically relevant decrease in BP with approximately 23% of additional patients strictly controlled with a single tablet. The use of an automated oscillometric device at the office and at home allowed the detection of controlled subjects with good agreement.

Adult↗