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G Jondeau

Publications and source records attributed to G Jondeau.

At least 19 recordsLinked to original sources
PubMed2006

[The best of cardiac failure in 2005].

The year 2005 saw the validation of resynchronisation treatment of cardiac failure with improved mortality in certain symptomatic patients under optimal medical therapy with QRS duration >150 msec. The implantable defibrillator has ousted the last antiarrhythmic drug, amiodarone, on which hopes for a reduction in mortality had been based. The positive inotropic agents have thrown their last reserves into the fight against cardiac failure: the anti-endothelins have not yet been shown to have significant benefits. The year 2005 was also the year of recommendations: European in acute and chronic heart failure, and American. The importance of clinical practice has been emphasised by the role given to registers. Finally, the diseases change: cardiomyopathy of stress is recognised in this stressful era; the importance of polypathology is increasingly understood in the elderly; the importance of renal function has been underlined although the method of its evaluation is less clear. As usual, there have been many advances in 2005, difficult to summarise in just a few lines.

Anemia↗
PubMed2006

[Medical management of Marfan's syndrome and ascending aortic aneurysms in France: initial assessment].

Over the last 30 years, there has been considerable progress in the management of aneurysms of the ascending aorta whether isolated or related to Marfan's syndrome which has considerably increased the life expectancy of these patients. The aim of this study was to assess the management protocol proposed in France for this condition in order to establish recommendations. A questionnaire was sent to cardiologists, paediatric cardiologists and cardiac surgeons and also to patients diagnosed with Marfan's syndrome. Most of the 228 physicians who replied prohibited violent sporting activities and less than a quarter advised against all sports. There was a wide dispersion in the prescription of beta blockers in Marfan's syndrome as 57% proposed this treatment only in cases with dilatation of the aorta and 5% prescribed no treatment at all. On the other hand, beta blockers were widely prescribed (93%) after replacement of the ascending aorta. When poorly tolerated in adults, the most commonly prescribed option was a calcium antagonist (60%) followed by angiotensin converting enzyme inhibitors and therapeutic abstention. On the other hand, 60% of paediatric cardiologists preferred to withdraw treatment. These results were confirmed by the replies from patients with Marfan's syndrome: 58.3% were prescribed beta blockers with a higher proportion in children less than 12 years of age. This treatment was introduced late, about 7 years after diagnosis. The authors conclude that there is much disparity in the management of ascending aortic aneurysms whether or not associated with Marfan's syndrome, especially with regards the prescription of beta blockers, justifying the publication of recommendations.

Adolescent↗
PubMed2006

[Type B natriuretic peptide (BNP) versus n-terminal type B natriuretic propeptide in the diagnosis of cardiac failure in the elderly over 75 population].

Type B natriuretic peptide (BNP) versus n-terminal type B natriuretic propeptide in the diagnosis of cardiac failure in the elderly over 75 population The value of BNP is well established in the diagnosis of cardiac failure in cases of dyspnoea in the emergency room in young and, more and more, in elderly subjects. However, there are few studies comparing the diagnostic value of BNP and of the n-terminal pro-BNP in patients over 75 years of age. The aim of this study was to compare the diagnostic value of BNP and NT-pro BNP in dyspnoea of the elderly patient. One hundred and three consecutive patients over 75 years of age admitted to the emergency unit for dyspnoea were included. A blood sample for measuring the BNP (Biosite) and the NT-proBNP (Roche Diagnostic) was taken in the admission unit in addition to the standard blood workup. The final reference diagnosis was established by two independent cardiologists. Of the 103 patients, 61 were women and the average age was 84.9 +/- 6.2 years. The final diagnosis was cardiac failure in 49 patients (48%), pulmonary embolism in 6 patients, an acute exacerbation of chronic obstructive airways disease in 36 patients and an acute bronchitis in 30 patients. In 9 cases, the dyspnoea was considered to result from mixed cardiac and pulmonary disease. Renal function was assessed by calculating the creatinine clearance by Cockcroft and Gault's formula. The average value of the creatinine clearance was 41.7 +/- 16.4 ml/min indicating that mild renal failure was relatively common. The diagnostic value, assessed by the area under the ROC curve, was similar for the BNP (0.79; CI: 0.70-0.88) and NT-proBNP (0.80; CI: 0.71-0.89). A BNP value of 300 pg/ml had the same sensitivity and specificity as an NT-proBNP of less than 1 500 pg/ml. A BNP of less than 200 pg/ml and an NT-proBNP of less than 1 000 pg/ml had excellent negative predictive values for excluding the diagnosis of cardiac failure. The authors conclude that the BNP and NT-proBNP are useful for the diagnosis of cardiac failure in acute dyspnoea of the elderly and seem to have a comparable diagnostic value.

Aged↗
PubMed2005

[Prevalence and management of heart failure in France: national study among general practitioners of the Sentinelles network].

BACKGROUND: Epidemiological data on heart failure's epidemiology in France are scarce and mostly hospital based. The present study's objective is to estimate the prevalence of heart failure (HF) and its management, in subjects aged 60 years and older seen by the French general practitioners (GP). METHODS: A standardised questionnaire was mailed to 900 GPs of the Sentinelles network, requiring answers for any patient aged 60 years and more, seen on a randomly assigned single day of year 2002. National census and health insurance data were used to estimate prevalence. RESULTS: 434 GPs answered, reporting data for 1797 patients aged 60 years and more. The 214 patients with HF, aged 79 years on average, had been seen by a cardiologist in 95% of cases. Results of an echocardiography was available for 58% of HF patients. Compared to non-HF patients, patients with HF were significantly more dependent, more frequently requiring home visit of the GP and more frequently hospitalised (p < 0.001, age adjusted). All the 42% HF patients with a reported left ventricle ejection fraction lower than 40% were treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor inhibitor. The prevalence of HF among patients aged 60 years and older was estimated at 11.9% in general practice (95% confidence interval: 10.5-13.5), and at 2.19% (1.9-2.5) in the general population. The prevalence increased with age, over 20% in persons aged 80 years and more. CONCLUSION: HF in patients aged 60 years and more seen in general practice in France is characterised by a high prevalence and medical consumption in terms of required number of hospitalisation and GP's home visit. For the GP, the diagnosis of HF relies on the cardiologist more than on an echocardiography. The therapeutic management seems to fit the actual recommendations.

Aged↗
PubMed2005

[The best of cardiac failure in 2004].

Regarding cardiac failure, the year 2004 was notable for the dissemination of indications for the use of medical devices in heart failure: indications for cardioversion with the long awaited publication of the COMPANION study, advancement of the concept of intra-ventricular asynchronism, and studies of defibrillators in non-ischaemic cardiac failure (COMPANION, DEFINITE, SCD-HeFT, TOVA). Furthermore, pragmatic clinical studies allowed refinement of the uses of BNP (diagnostic and prognostic), underlining the importance of renal function and its progression during hospitalisation, and the risks of using strong, modern therapy in populations without "ad hoc" surveillance which do not correspond with study populations (aldactone in Canada). Just as in coronary patients, it appears to be important to commence full medical treatment prior to hospital discharge, because treatment is rarely changed thereafter. The management of seriously ill patients is evolving with several therapeutic advances: the methods of selecting patients for heart transplants have changed, with the advancement of opportunities for circulatory assistance. Attention has also been turned to the significant group, still poorly understood, of patients with diastolic heart failure, for whom diagnostic methods have been defined, as well as their clinical characteristics. Lastly the medication studies: new drugs in acute cardiac failure (preliminary results for vasopressin antagonists), wider indications for betablockers in elderly subjects (SENIORS), and advances in cellular cardiomyoplasty (using haemopoietic stem cells especially this year). It has been a fruitful year, difficult to summarise in a few lines, or even several pages....

Cardiac Pacing, Artificial↗
PubMed2005

[Therapeutic education for cardiac failure patients: the I-care programme].

Therapeutic education is becoming increasingly important in the management of chronic diseases including cardiac failure. The I-CARE programme consists of an evaluation of the role of therapeutic education in France, creating standardised tools and setting up training sessions for therapeutic education in the context of cardiac failure. Approximately two thirds of the French centres contacted perform therapeutic education with their available means. The lack of personnel, space, and training tools represent obstacles to the development of therapeutic education. The tools developed in the programme fall into 5 areas: diagnosis education, understanding the illness, diet, physical activity/daily life, and treatment. Training sessions were organised for the teams, consisting of at least one cardiologist and nurse. The I-CARE programme should allow the expansion of therapeutic education for cardiac failure and improve the multidisciplinary management of this disease which increasingly affects often elderly subjects.

Activities of Daily Living↗
PubMed2004

[Skeletal muscle efficiency in heart failure].

Heart failure is associated with modifications of skeletal muscle cells, which could participate in the exercise limitation of the patients. However, the mechanical efficiency of the skeletal muscle has not been fully evaluated in these patients. We therefore measured VO2 during prolonged exercise (15 min) at constant load to obtain stable conditions. Load was chosen after maximal stress test as 35% and 65% of load at anaerobic threshold. VO2 during assisted cycling was subtracted from that during constant load to evaluate the relationship between VO2 and Watt. Twenty CHF patients (peak VO2 17.6 ml/kg/min, LVEF <35%) have been compared to 11 controls (peak VO2 40.2 ml/ml/kg). VO2 was similar in the two groups at rest and during assisted cycling. Ventilation on contrary was higher in CHF patients. The relationship between VO2 and Watt was similar in the two populations, indicating that skeletal muscle mechanical efficiency was not altered in CHF patients. In conclusion, histological modifications present in skeletal muscle of CHF patients do not translate into altered skeletal muscle efficiency.

Adult↗
PubMed2004

[Is there an indication for the association of betablockers and angiotensin II receptor antagonists in cardiac failure?].

ACE inhibitors initially developed as vasodilators are effective by their anti-hormonal action. Antagonists of the receptors of angiotensin II (ARA II) should provide an equivalent or better blockade of the rennin-angiotensin system (absence of tolerance). Clinical trials have shown equivalent haemodynamic effects of the two classes, equal functional tolerance but mortality studies have shown more variable results. None have shown the superiority of ARA II over ACE inhibitors and the demonstration of their equivalence has just been reported with high doses in the post-infarction period. A deleterious effect of ARA II in association with betablockers was reported in two mortality studies but has not been confirmed in the most recent trials. The difficulty is to determine the roles of the association of ARA II-ACE inhibitors, ARA II-antialdosterones or of the association of all three classes of molecules.

Adrenergic beta-Antagonists↗
PubMed2004

[Management of heart failure by French general practitioners in 2003].

The PRINCEPS study (Prise en charge des Insuffisants Cardiaques: Enquête chez les Patients Symptomatiques) was carried out by 1,717 general practitioners who reported their experience with 3,782 patients with cardiac failure treated by an angiotensin converting enzyme (ACE) inhibitor. This is the largest observational study carried out in general practice in France to date. The average age of the patients with cardiac failure was 71 years, with a majority of men (62%), many of whom were hypertensive (76%) and had other cardiovascular risk factors. The diagnosis of cardiac failure was made by the presence of effort dyspnoea (92%) and confirmed by a cardiologist in 81% of cases. Heart failure was rarely chronic (17%>5 years), usually related to hypertension (58%) and had required hospital admission in only 39% of patients. Finally, the patients were not very symptomatic (63% Class II of the NYHA Classification). Treatment included the obligatory ACE inhibitor at a high dosage (maximal dosage according the European Recommendations) in half the patients. The dosage prescribed was considered optimal in 3 out of 4 patients, and usually treated by the consulting cardiologist (81% of patients). It was higher in the young patients, less symptomatic, and in patients with heart failure due to hypertension. A treatment with betablockers (20%), diuretics (74%), digitalis (21%), was often associated with the ACE inhibitor. These results suggest that heart failure patients treated by general practitioners have hypertension as the main cause. The ACE inhibitors seem to be prescribed initially at high dosage for treating the hypertension, and the dosage is progressively decreased with time and aggravation of the cardiac failure.

Adrenergic beta-Antagonists↗
PubMed2004

[Medical histories of patients with Marfan's syndrome].

The life expectancy of patients with Marfan's syndrome has been increased by over 30 years by modern medico-surgical management but the diagnostic problems related to the multiplicity of symptoms and the necessity of collaboration by many specialities complicate the medical history of patients, which is largely unknown. The authors sent a self-administered questionnaire to 1 353 patients with Marfan's syndrome to obtain this information. Of the 430 questionnaires returned, as many by men as by women, the diagnosis of the disease was made in less than half the cases by clinical symptoms (42%): the investigation of an unrelated clinical problem (39%) or a family enquiry (19%) also led to the diagnosis. The delay between the first symptoms of the disease and first medical consultation (usually cardiological or ophthalmic) was long (5.2 years) as was the interval between the first consultation and the diagnosis (2.8 years). However, the population could be divided into two groups. one with rapid access to the physician (< 1 year) and to the diagnosis (< 3 years) and the second group in which the delays are long. When the diagnosis of Marfan's syndrome is made following consultation for an unrelated condition, it is more often delayed and the patient is usually older. The delay in diagnosis observed could be shortened by systematic familial enquiries and better information to physicians who could then suspect the diagnosis before the advent of clinical symptoms.

Adolescent↗
PubMed2003

[Aortic aneurysms excluding Marfan's syndrome].

The causal factors of aneurysm are not the same in the ascending and abdominal aorta. Atheroma is the dominant lesion in the abdominal aorta and genetic abnormalities predisposing to "mediacystic necrosis" are more frequently observed in ascending aortic aneurysms. The causal genetic abnormalities are multiple: abnormalities of fibrillin type I in Marfan's syndrome, collagen abnormalities in the Ehlers-Danlos syndrome, abnormalities of microfibrils, possible metallo-proteases, with many gene candidates. Finally, some ascending aortic aneurysms are associated with bicuspid aortic valves, some of which are familial. Familial factors are less evident in abdominal aortic aneurysms: genes favoring atheroma may be responsible but the factors which predispose to dilatation and non stenosis are not well known: they would seem to be general factors because the tendency to arterial dilatation is diffuse. In all cases, because of the high risk of disease in a close relative, a familial enquiry would seem to be justified with echocardiography for close relatives of affected subjects, especially when young and female.

Aortic Aneurysm↗
PubMed2003

[Marfan syndrome].

Marfan's syndrome is a monogenetic disease with an autosomal dominant transmission generally accompanied by type I fibrillin abnormality. This widely-distributed molecule participates in the structure of connective tissues so that any aberration may result in disease of many systems: skeletal morphology, dislocation of the lens, neurological or cutaneous signs and dilatation of the aorta predisposing to dissection, mitral valve prolapse being a common association. The diagnosis, clinical because of the size of the culprit gene and the multiplicity of the possible mutations, is sometimes difficult, and diagnostic criteria have been proposed. It is important to make the diagnosis because treatment is based on the restriction of violent exercise, betablocker therapy and regular echocardiographic monitoring of the ascending aorta, the region at highest risk of dilatation and dissection. A family enquiry is essential to make the diagnosis before the onset of complications in pauci-symptomatic patients (great intra-familial variability). Pregnancy poses special problems in these patients.

Adult↗
PubMed2003

[Negative D-dimers and peripheral pulmonary embolism].

The measurement of D-dimers is a recent addition to the diagnostic strategy of pulmonary embolism and has been shown to be a valuable tool with excellent sensitivity. However, there have been rare reports of patients with pulmonary embolism but negative D-dimer tests. The object of this study was to study patients with pulmonary embolism but negative D-dimers and to compare them with a population of patients with pulmonary embolism and raised D-dimers. One hundred and fifty consecutive patients admitted for pulmonary embolism were included in this study. All underwent measurement of D-dimers (normal <500 ng/ml) by an ELISA technique. The data of clinical examination and complementary investigations were analysed with respect to the D-dimers result. The sensitivity of raised D-dimers for pulmonary embolism was 96% (6 patients had results <500 ng/ml). The finding of chest pain was statistically greater in the group with negative D-dimers (p=0.01). In these cases, the emboli were all distal (p=0.0003), the average Miller index was significantly lower than in patients with high D-dimers (p=0.04) and the diagnostic value of ultrasound investigations (echocardiography, ultrasonography of lower limb veins) was less (p<0.0001). The authors conclude that measurement of D-dimers by the ELISA method may be non-diagnostic in distal pulmonary embolism and one explanation could be the less extensive thromboembolic process. In cases with negative D-dimers, a strong clinical suspicion of pulmonary embolism should lead to the request for further investigations.

Adult↗
PubMed2002

[Incidence of acute cor pulmonale and deep venous thrombosis in acute pulmonary embolism].

OBJECTIVE: Ultrasounds are a useful tool when looking for indirect evidence in favor of pulmonary embolism. The aim of this study was to determine the incidence of acute cor pulmonale and deep venous thrombosis revealed by ultrasonographic techniques in a population of patients presenting with pulmonary embolism. METHODS: 96 consecutive patients with a mean (+/- SD) age of 65 +/- 15 years, admitted to our hospital for pulmonary embolism were included in this study. The diagnosis of pulmonary embolism was made either by spiral computed tomography or selective pulmonary angiography. Each patient subsequently underwent both trans-thoracic echocardiography and venous ultrasonography. The diagnostic criterion used for defining acute cor pulmonale by echocardiography was the right to left ventricular end-diastolic area ratio over (or equal to) 0.6. Diagnosis of deep venous thrombosis was supported by the visualization of thrombi or vein incompressibility and/or the absence of venous flow or loss of flow variability by venous ultrasonography. RESULTS: Using ultrasounds, an acute cor pulmonale was found in 63% of our patients while 79% were found to have deep venous thrombosis and 92% of the patients had either acute cor pulmonale or deep venous thrombosis or both. All of the patients with proximal pulmonary embolism had acute cor pulmonale and/or deep venous thrombosis. The presence of acute cor pulmonale on echocardiography was significantly higher in patients with proximal pulmonary embolism (p < 0.0001). CONCLUSION: This study emphasizes the potential value of ultrasonographic techniques in the diagnosis of acute pulmonary embolism.

Acute Disease↗
PubMed2002

[Isolated and asymptomatic Brugada syndrome. A case report].

The case report of a 32-year-old man with a Brugada syndrome is presented. He was asymptomatic and without familial history of sudden death or syncope. Diagnosis criteria for Brugada syndrome were 1--a pattern of right bundle branch block and ST-segment elevation in leads V1 and V2 on the ECG, 2--no cardiac structural anomalies. Symptomatic patients with this electrical anomaly are at high risk of sudden death and need an automatic implantable defibrillator. The outcome and the treatment of asymptomatic patients are a matter of debate and are discussed in this report.

Adult↗
PubMed2002

[Endothelin receptor antagonists in heart failure].

Endothelin 1 is a vasoconstrictor and pro-hypertrophic peptide released by the endothelium, whose secretion increases in cardiac insufficiency in proportion to the haemodynamic alteration, notably the systolic pulmonary arterial pressure. It acts by binding to 2 receptors: receptor A, responsible for the vasoconstriction effect, and receptor B, which produces vasodilatation and permits the pulmonary clearance of the molecule present in the plasma. Blocking receptor A appears logical in view of the hormonal hypothesis which prevails in the pathophysiology of cardiac insufficiency, but the significance of blocking receptor B is under discussion. The immediate effect of receptor antagonists is vasodilatation, permitting a haemodynamic improvement in patients, but the benefit on dyspnoea or the evolution of the disease has not been established. Animal models show a beneficial effect of endothelin receptor antagonists on survival, which has not been confirmed by the first studies in humans. The latter are difficult to interpret: the increase in dosage should probably to be very progressive, the optimal dosage is difficult to determine and could be lower than the doses tested. Only the result of studies underway will indicate the place of these drugs in the therapeutic arsenal for cardiac insufficiency.

Animals↗
PubMed2001

Local pulse pressure is a major determinant of large artery remodelling.

1. The aim of the present brief review is to show that the pulsatile component of blood pressure is a stronger determinant of large artery remodelling than the steady component (i.e. mean blood pressure). 2. Pulse pressure, which is a strong determinant of cardiovascular events, including coronary heart disease and stroke, is increased when large arteries stiffen. Local pulse pressure, measured with applanation tonometry in normotensives and patients with essential hypertension, explains a significant part of the variance of intima-media thickness at the site of the carotid artery, a proximal elastic artery, whereas mean blood pressure does not contribute. Local pulse pressure has no influence on intima-media thickness at the site of the radial artery, a distal muscular artery that undergoes very little stroke change in diameter. 3. The decrease in carotid pulse pressure is also a major determinant of the regression of carotid intima-media thickness after antihypertensive treatment. Local pulse pressure can influence not only intima-media thickness, but also internal diameter. Indeed, there is a significant association between the lumen enlargement of the ascending aorta in patients with Marfan syndrome and pulse pressure. In addition, carotid pulse pressure is positively correlated with carotid internal diameter in normotensives and hypertensives, and the decrease in carotid internal diameter during long-term antihypertensive treatment is influenced by the decrease in carotid pulse pressure and not by the reduction in mean blood pressure. 4. We suggest that the effects of pulse pressure on large artery remodelling may explain part of its predictive value on cardiovascular events.

Antihypertensive Agents↗