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Biomedical subjects

J M Gilgenkrantz

Publications and source records attributed to J M Gilgenkrantz.

At least 19 recordsLinked to original sources
PubMed1992

[Rehabilitation centers: for whom? Why and how long?].

The clinical profile of coronary patients admitted to cardiac rehabilitation centres after myocardial infarction has changed considerably in the last 15 years. Complementary investigations (coronary angiography, studies of left ventricular function) provide accurate information which improves the process of rehabilitation. Global management of the coronary patient requires and justifies, especially in young adults, taking into consideration the physical, psychological and socio-professional consequences of a myocardial infarction. The indications of rehabilitation are much more comprehensive nowadays. Even patients with significant haemodynamic impairment can benefit from a stay in a specialised centre. Contraindications are usually only temporary. Finally, an enquiry performed in 33 French cardiac rehabilitation centres shows large variations in methods, personnel and organisation. However, as a general rule, a 3 week stay seems to be adequate but it is logical to continue rehabilitation when the patients goes home to pursue and maintain at long term the results obtained on discharge from a specialised centre.

France↗
PubMed1990

Improved subtraction technique in intravenous digital left ventriculography: comparison with radionuclide studies.

Adequate processing of left ventricular angiograms depends on the visualisation of all segments of the ventricular wall. At the same time, subtraction of different images can enhance different heart segments but commercially available methods do not allow simultaneous viewing of several images masked by different processes. Using our software, for each studied frame, a four quadrant display permits the simultaneous visualisation of a mask mode image, a diastolic-systolic difference image, an image obtained by subtraction of a frame at the same cycle time and a composite mask subtracted image. The composite mask image is obtained by weighting three images according to videodensitometric measurements by reference to previously acquired data. This method facilitates contour delineation and computation of the ejection fraction by area-length method. Correlation with radionuclide estimates of left ventricular ejection fraction is higher (n = 60, r = 0.90, SEE = 8%) than using the classical mask mode display (n = 60, r = 0.82, SEE = 11%). In a subgroup of 30 patients the contrast medium was injected in an antecubital vein and the correlation coefficient remained satisfactory (n = 30, r = 0.89, SEE = 7%) when compared with the classical subtraction technique (n = 30, r = 0.70, SEE = 12%). We therefore conclude that the composite mask method gives comparatively similar values for left ventricular ejection fraction to those acquired by radionuclide angiography.

Angiography, Digital Subtraction↗
PubMed1990

Skeletal muscle metabolism in the leg during exercise in patients with congestive heart failure.

1. Using 31P nuclear magnetic resonance, it has previously been demonstrated that patients with congestive heart failure exhibit a greater than normal phosphocreatine (PCr) depletion in the working skeletal muscles of the arm. We have studied the importance of the work necessary to reach a similar PCr depletion ([PCr]/([PCr] + [Pi]) = 0.5) in calf muscle. Our results show significantly lower values for patients with congestive heart failure in both aerobic and ischaemic conditions (respectively: 0.009 +/- 0.007 vs 0.026 +/- 0.013 W/kg body weight, P less than 0.01; 0.29 +/- 0.16 vs 0.90 +/- 0.25 J/kg body weight, P less than 0.01). 2. This original model of skeletal muscle exercise facilitates a comparison of PCr recovery rate due to a similarity in the PCr depletion and intracellular pH in the two series at the start of recovery. However, the PCr recovery rate is similar after both normoxic and ischaemic exercise, i.e. respective percentages of PCr increase in the first 25 s recovery spectrum were: (a) aerobic exercise, congestive heart failure 133 +/- 18%, control series 138 +/- 18%; (b) ischaemic exercise, congestive heart failure 114 +/- 13%, control series 118 +/- 12%. The absence of a difference in PCr recovery rate and the greater PCr depletion by ischaemic work in patients with congestive heart failure suggest modifications that cannot be explained by a reduced blood flow to the muscle. 3. When comparing the two series, intracellular pH evolved similarly in normoxia and ischaemia during both work and recovery. Thus, no increase in anaerobic glycolytic activity appears when equivalent PCr depletion has occurred.

Adult↗
PubMed1989

[Effect of conventional medical treatment on the course of unstable angina].

In spite of the frequency of unstable angina, the number of clinical trials which permit to evaluate the value of conventional medical treatments, remains limited, especially because of the difficulties in finding a "specific tracer" of the efficacy of the standard drugs used. The common form of unstable angina is different from the spastic form, in that inducement tests permit, in Prinzmetal angina, better codified selection and monitoring of the patients. The literature is reviewed for each therapeutic family (calcium inhibitors, amiodarone, nitro-compounds, molsidomine, etc.). On a short term basis, the conventional treatment permits, most of the time to perform a coronary angiography under good conditions. On a long term basis, medical treatment and surgical procedure give similar results, except for patients with three-vessels disease in whom surgical revascularization provides a more comfortable life.

Angina Pectoris↗
PubMed1989

[Survival in primary dilated cardiomyopathy as a function of tobacco smoking. A retrospective study].

In order to determine the influence of tobacco smoking on the course and long-term prognosis of idiopathic dilated cardiomyopathy, we conducted a retrospective study of 111 patients (95 men and 16 women, mean age 45.5 +/- 8.1 years) who had undergone cardiac catheterization between January 1970 and December 1979 and had been followed up for 6 to 16 years. The criteria of inclusion was diffuse hypokinesia of the left ventricle with an ejection fraction of 50 per cent or less, normal coronary arteriography and cardiomyopathy of unknown origin. The overall mortality rates at 1, 5 and 10 years were 10, 50 and 66 per cent respectively, and the main predictive factor was the left ventricular ejection fraction. Forty-six per cent of these patients were smokers, 19 per cent were non-smokers and 35 per cent had undetermined smoking habits. A univariate analysis showed a favourable predictive effect of smoking on survival (P less than 0.01), and this was confirmed by the statistical hypothesis of maximum bias for patients with undetermined smoking habits. On multivariate analysis, this predictive effect was superseded by the left ventricular ejection fraction, but after stratification of the sample according to the mean value of ejection fraction (30 per cent), the predictive value of smoking reappeared clearly in the group with a less than 30 per cent ejection fraction (P less than 0.003).

Adult↗
PubMed1989

Return to work after percutaneous transluminal coronary angioplasty: a continuing problem.

Earlier studies have shown that return to work following PTCA is frequent; however PTCA is now performed in patients with more extensive coronary artery disease. The present study was designed to compare the vocational outcome of patients who underwent PTCA in 1980-1982 with that of patients who underwent the procedure in 1985. From 1980 to 1982, 53 of 73 consecutive patients who were employed before PTCA returned to work (73%). Return to work was related to primary success of the procedure (85% vs 40%, P less than 0.01) age (46.1 +/- 7.9 vs 49.3 +/- 6.6 years, P less than 0.05) and clinical status at follow-up (72% feeling well or very well vs 30%, P less than 0.01). In 1985, although the primary success rate had increased to 89%, the overall rate of return to work in the 91 patients employed before PTCA was 64%. The decrease was particularly striking for patients with primary success of the procedure (64% vs 85%, P less than 0.01). The patients in the 1985 group had greater incidences of previous myocardial infarction (40% vs 11%, P less than 0.01) and multivessel coronary disease (43% vs 8%, P less than 0.01); however, these factors were not related to subsequent return to work. In contrast, the age of the patients, which was an important determinant of work resumption, was significantly higher in the 1985 patients (49.9 +/- 7.3 vs 46.4 +/- 9.1 years, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

ACE inhibitors in hypertension: a European viewpoint.

The introduction of angiotensin-converting enzyme (ACE) inhibitors has had an appreciable impact upon the treatment of hypertension in Europe, although acceptance of these new agents has not been uniform in all countries. In order to arrive at an understanding of the place of ACE inhibitors in the management of the hypertensive patient, the attitudes of four parties must be considered: the prescriber, the patient, the manufacturer, and the regulatory agency. Physicians in Britain, Germany, and Scandinavia have lagged behind their counterparts in France and Italy in prescribing ACE inhibitors, due to restrictions placed by national regulatory agencies on the first-line use of these agents in hypertension therapy.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1989

[Hemolytic anemia and cardiac heterografts. Apropos of 2 cases].

Two cases of severe haemolytic anaemia developed after heterograft valve replacement are reported. In one case haemolysis was caused by prosthetic degeneration; in the other case the heterograft was not altered, but a ventricular septal defect had created a high turbulence around the valve which was in pulmonary position. In both cases anaemia subsided after surgical correction of the abnormalities responsible for periprosthetic turbulence. Haemodialysis can only develop in patients with heterograft valve replacement if a change in blood flow rate occurs around the valve, due to its alteration or to an associated cardiac disease.

Adult↗
PubMed1989

[Evaluation of the dose-effect relationship of perindopril in the treatment of arterial hypertension].

To evaluate the dose-effect relationship of antihypertensive drugs is essential to a rational determination of their effective dosage. Two double-blind and strictly controlled trials have demonstrated the effectiveness of perindopril 4 mg orally in the treatment of mild to moderate arterial hypertension (100 less than DAP less than 120 mmHg). The drug remained effective 24 hours after the last dose. The 2 mg dose proved insufficient to obtain a significant reduction of blood pressure. In case where the 4 mg dose was not sufficiently active, a better antihypertensive effect could be achieved with an 8 mg dose without major untoward reactions. The antihypertensive activity of perindopril was parallel to the percentage of angiotensin-converting enzyme inhibition induced by the compound. This study also illustrates clearly the value of semi-automatic blood pressure recording with the Dinamap system in the determination of dose-effect relationship, compared with the conventional sphygmomanometric method.

Administration, Oral↗
PubMed1989

Evaluation of the dose-effect relationship of perindopril in the treatment of hypertension.

The evaluation of the dose-antihypertensive effect relationship of a drug is essential for the rational determination of the effective dose. The efficacy and safety of the dose of 4 mg of perindopril in the treatment of mild-to-moderate hypertension were demonstrated by means of two double-blind studies conducted according to a rigorous methodology. This efficacy was still present 24 hours after the last dose of perindopril. The dose of 2 mg appeared to be insufficient to exert a significant antihypertensive effect. In the case of inadequate efficacy of the dose of 4 mg of perindopril, the dose of 8 mg is able to exert a greater antihypertensive effect without any major harmful effects. The antihypertensive efficacy is parallel to the percentage of converting enzyme inhibition induced by perindopril. The contribution of the automated method of blood pressure recording using the Dinamap method to establish a dose-effect relationship with reference to the classical sphygmomanometric method is clearly illustrated.

Adolescent↗
PubMed1989

[Value of digital subtraction of left ventriculographies by the venous route. Comparison with balanced scintigraphy of the heart cavities].

The development of numerisation material in radiology currently permits to perform usual cardiovascular tests. The authors report a series of 48 patients who benefited from the determination by numerised left ventriculography, of their stroke volume (SV). In 37 cases, the peripheral venous route is used while in 11 cases the central venous route is used, in the pulmonary artery trunk. The SV values obtained with both methods (one advocated by the manufacture and another one developed by the authors), are correlated with the SV values obtained with the isotopic method, used as reference. The correlations are satisfactory, approximately 0.79 for all patients of the study, and markedly improve when the injection of the contrast material is performed in the pulmonary artery (approximately 0.95). The authors conclude that determination of the left ventricle SV by numerisation is an interesting technique in centers where there is no department of nuclear medicine, and is absolutely necessary to complement right catheterisation.

Female↗
PubMed1988

Effect of diltiazem on myocardial infarct size estimated by enzyme release, serial thallium-201 single-photon emission computed tomography and radionuclide angiography.

Diltiazem is a calcium antagonist with demonstrated experimental cardioprotective effects. Its effects on myocardial infarct size were studied in 34 patients admitted within 6 hours after the first symptoms of acute myocardial infarction. These patients were randomized, double-blind to placebo or diltiazem (10-mg intravenous bolus followed by 15 mg/hr intravenous infusion during 72 hours, followed by 4 X 60 mg during 21 days). Myocardial infarct size was assessed by plasma creatine kinase and creatine kinase-MB indexes, perfusion defect scores using single-photon emission computed tomography with thallium-201 and left ventricular ejection fraction measured by radionuclide angiography. Tomographic and angiographic scanning was performed serially before randomization, after 48 hours and 21 days later. Groups were comparable in terms of age, sex, inclusion time and baseline infarct location and size. Results showed no difference in creatine kinase and creatine kinase-MB data between controls and treated patients, a significant decrease in the perfusion defect scores in the diltiazem group (+0.1 +/- 3.0 placebo vs -2.2 +/- 1.9 diltiazem, p less than 0.02) and a better ejection fraction recovery in the diltiazem group (-4.2 +/- 7.4 placebo vs +7.7 +/- 11.2 diltiazem, p less than 0.05). Myocardial infarct size estimates from perfusion defect scores and enzyme data were closely correlated. These preliminary results suggest that diltiazem may reduce ischemic injury in acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Enzyme Tests↗
PubMed1988

Hemodynamic and electrophysiologic effects of a new alpha 2-adrenoceptor agonist, rilmenidine, for systemic hypertension.

The hemodynamic and electrophysiologic effects of rilmenidine were examined after single oral administration to hypertensive patients. In 8 untreated hypertensive patients, cardiac output, pulmonary pressure and blood pressure were measured before and for 10 hours after the administration of 25 micrograms/kg of rilmenidine (1.3 to 2.4 mg, mean 1.88). In addition, electrophysiologic investigations were performed before and 2 hours after administration. Hemodynamics were repeated in 8 other hypertensive patients receiving 50 micrograms/kg rilmenidine (3.0 to 4.8 mg, mean 3.85 mg). The electrophysiologic study was repeated in 8 other hypertensive patients receiving 50 micrograms/kg of rilmenidine (3.2 to 4.4 mg, mean 3.90). In contrast to the results obtained at the dose of 50 micrograms/kg, there was no significant variation in pulmonary arterial pressure, cardiac index or stroke index after administration of 25 micrograms/kg. No significant variation was observed in heart rate, sinus function, conduction parameters or atrial, nodal and ventricular refractory periods after administration of 25 and 50 micrograms/kg. Rilmenidine, after single oral administration at the 25 micrograms/kg dose, led to a significant reduction in blood pressure and peripheral resistance without any significant change in cardiac output; the 25- and 50-micrograms/kg doses led to no alteration in heart rate and cardiac electrophysiology.

Adrenergic beta-Agonists↗
PubMed1988

Dilated cardiomyopathy: long-term follow-up and predictors of survival.

To determine long-term survival and the prognostic factors of dilated cardiomyopathy, we retrospectively studied a consecutive series of 111 patients (95 men, 16 women, mean age: 45.5 +/- 8.1 years) undergoing cardiac catheterization and diagnostic coronary angiography from January 1970 to December 1979. The inclusion criteria were: normal coronary angiography, diffuse hypokinesia of the left ventricle and left ventricular ejection fraction less than 50%. Base-line clinical data were collected from the hospital records and follow-up data were obtained from the general practitioners and cardiologists. A questionnaire was sent to all living patients. The length of follow-up ranged from 6 to 16 years. Six patients (5%) were lost to follow-up. At the time of catheterization, a majority of the patients had dyspnea and were in New York Heart Association (NYHA) classes II (41%) and III (31%). Clinical history revealed an excessive alcohol consumption in 56% of the patients. During follow-up, 66 patients (63%) died (heart failure: 37%; sudden death: 19%; non-cardiac death: 15%; unknown cause: 27%). Actuarial survival was 90, 50, and 33% at 1, 5, and 10 years, respectively. Univariate analysis revealed that 10-year mortality was related to: left ventricular ejection fraction less than 30%; left ventricular end-diastolic pressure greater than 10 mm Hg; cardiothoracic ratio greater than 54%; episodes of heart failure; left ventricular end-diastolic volume greater than 200 ml/m2, dyspnea of NYHA class III or IV; absence of smoking; absence of moderate systemic hypertension; electrocardiographic evidence of left ventricular hypertrophy and mean systemic arterial pressure greater than 95 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Sustained improvement in myocardial perfusion four to six years after PTCA in patients with a satisfactory angiographic result, six months after the procedure.

Of 46 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA) from April 1980 to August 1982 and who had a satisfactory angiographic result six months later, one died of cancer and 41 had a detailed evaluation with exercise single-photon emission computed tomography (SPECT, 40 patients) or repeat coronary angiography (one patient), 48-78 months after the procedure. During follow-up, two patients had recurrent angina due to progression of coronary artery disease requiring a second PTCA procedure of another coronary artery; one of them later had a limited myocardial infarction in an area supplied by the vessel initially dilated. At follow-up, only one patient had definite angina. All but one patient had a negative exercise test. Myocardial perfusion during exercise in the PTCA-related area, assessed by SPECT, was normal in 90% of the patients and showed a limited defect due to reversible ischaemia in the remaining four (10%). It is concluded that patients with a less than 50% stenosis six months after PTCA show sustained improvement in their functional status and myocardial perfusion, four to six years after the procedure suggesting continued patency of the coronary artery.

Adult↗
PubMed1988

Ten year follow up of patients with single vessel coronary artery disease that was suitable for percutaneous transluminal coronary angioplasty.

The 10 year outcome of patients with single vessel coronary artery disease who underwent coronary angiography more than 10 years before and who would have been potential candidates for percutaneous transluminal coronary angioplasty had it been available then is reported. Long term follow up data were obtained in 96 (91 men, five women; mean age 48 years) of 105 consecutive patients with single vessel coronary artery disease (greater than 70% stenosis), judged suitable for coronary angioplasty. Fifty patients had coronary bypass surgery within six months of catheterisation (surgical group) and 46 were treated medically (medical group). At entry to the study more patients in the surgical group had unstable angina, but fewer had a previous history of myocardial infarction. Ten year survival was 91% and remained excellent in all the subsets analysed. Moreover, the quality of life of these patients was good. Over the 10 year follow up, 16 (36%) of the patients treated medically and 13 (26%) in the surgical group were admitted to hospital because of cardiovascular events (including late coronary surgery in four of the patients treated medically). Lastly, 54/69 (78%) of the patients who were employed before catheterisation resumed work and 29 (42%) were still employed 10 years later. Although these data must be interpreted with care because of the limitations inherent in all retrospective studies, it appears that the long term results of conventional medical or surgical treatment are excellent in patients with single vessel coronary artery disease in whom percutaneous transluminal coronary angioplasty is now an option.

Adult↗
PubMed1988

Haemorheological abnormalities in arterial hypertension and their relation to cardiac hypertrophy.

Haemorheological characteristics were measured in a group of 52 patients with essential arterial hypertension (HT), and were compared with those of a group of normotensive subjects. The relationships between the arterial blood pressure (BP), the echocardiographic indices of left ventricular hypertrophy (LVH), and the haemorheological measurements, were studied. The group of hypertensive patients was found to have a hyperviscosity syndrome with significant elevations of blood viscosity at all shear rates (for gamma = 0.20/s, 29.6 +/- 0.6 versus 28.0 +/- 0.3 mPa.s, P less than 0.01: for gamma = 128/s, 4.2 +/- 0.05 versus 4.1 +/- 0.02 mPa.s, P less than 0.02, of plasma viscosity (1.29 +/- 0.01 versus 1.22 +/- 0.06 cSt, P less than 0.001); of erythrocyte aggregation index (17.8 +/- 0.06 versus 14.6 +/- 0.4, P less than 0.001); of erythrocyte filterability index (13.3 +/- 0.5 versus 8.8 +/- 0.2, P less than 0.001) and plasma fibrinogen level (3.4 +/- 0.9 versus 2.8 +/- 0.6 g/l, P less than 0.02). The haematocrit did not differ from that of normotensive subjects (43.3 +/- 0.6 versus 44.7 +/- 0.5%, NS). The left ventricular mass was increased and was positively correlated with the blood viscosity at a high shear rate (r = 0.38, P less than 0.01) and with the erythrocyte aggregation index (r = 0.47, P less than 0.01). Systolic, diastolic, and mean arterial blood pressures were positively correlated with the left ventricular mass (r = 0.34-0.47, P less than 0.05) and with the erythrocyte aggregation index (r = 0.42-0.46, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗