Biomedical subjects

J M Mossard

Publications and source records attributed to J M Mossard.

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

[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

[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↗

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↗

PubMed1989

[Value of transesophageal auricular stimulation for evaluating the accessory pathway and effect of treatment in Wolf-Parkinson-White syndrome].

In order to assess the value of the various atrial pacing techniques employed to evaluate the anterograde conduction of the accessory pathway and the effect of antiarrhythmic agents in Wolff-Parkinson-White syndrome, transesophageal atrial pacing was performed in 12 patients before and during treatment with oral flecainide acetate in doses of 200 mg per day. Before treatment, the shortest interval conducted with a 1/1 atrioventricular conduction by the accessory pathway ranged from 225 to 600 ms (mean 311 +/- 98 ms), and the effective refractory period of the accessory pathway, measured by the extrastimulus method in 11 patients, varied from 240 to 320 ms (mean 273 +/- 22 ms). These two values were very close in each patient and correlated well with each other (r = 0.90; p less than 0.001). Atrial fibrillation could be induced in 3 patients. Three patients were considered "at risk" since their effective refractory period or minimal R-R interval in atrial fibrillation was 250 ms or less. Tachycardia was induced in 8 patients, and it was possible to induce arrhythmias in the 6 patients for whom we had recordings in spontaneous tachycardia. Under treatment with flecainide acetate, an anterograde conduction block appeared in 3 patients. In the remaining 9 patients the shortest interval conducted with a 1/1 atrioventricular conduction by the accessory pathway was longer in every case: it ranged from 270 to 540 ms (mean 407 +/- 84 ms; p less than 0.001), which corresponded to a 20 to 240 ms prolongation (mean 133 +/- 78 ms).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

[Value of cine magnetic resonance imaging in the diagnosis and quantification of valvular regurgitation. Comparison with angiography and Doppler echocardiography].

Thirty-three patients presenting with regurgitation of the mitral valve (19 cases), tricuspid valve (14 cases) or aortic valve (11 cases) documented by angiography (n = 20) and/or doppler-echocardiography (n = 28) were examined by cine-MRI in order to test this method in valvular regurgitation. Sixteen ECG-synchronized cine-MRI images were acquired by the GRASS technique every 40 ms on appropriate projections, with a resistive 0.28 Tesla Bruker magnet. The semiology of normal and pathological blood flow images at cine-MRI is described. Valvular regurgitations present as "signal void" jets the chronology and spatial extension of which depend on the severity of the lesion. The differential diagnosis with physiological flows is discussed. The diagnostic sensitivity of the method was 29/29 when compared with angiography and 29/33 when compared with doppler-echocardiography (2 cases of 1/4 mitral regurgitation and 2 cases 1/4 tricuspid regurgitation were not visible at cine-MRI). The specificity of this method, as can be judged from 104 patients explored, also seems to be satisfactory. The severity of regurgitation was graded from 1 to 4 with the three methods, on the basis of strict criteria. The differences in grade evaluation exceeded +/- 1 point in only one case of mitral regurgitation which was greatly underestimated by the doppler method as compared with angiography and cine-MRI. Thus, cine-MRI is a reliable method to evaluate valvular regurgitations and their severity. It solves the practical problem raised by non-echogenic patients when catheterization is to be postponed or avoided.

Adult↗

PubMed1989

[Relation of an increase of von Willebrand factor in the blood, acute myocardial infarction, unstable angina and coronary thrombosis].

Forty six patients admitted for precordial chest pain were included in this study. The clinical, electrocardiographic, enzymatic and angiographic features allowed retrospective identification of 6 subgroups (nos 1 to 6): all transmural myocardial infarction (Q-MI) (Group 1), Q-MI without intracoronary thrombus (Group 2), Q-MI with intracoronary thrombus (Group 3), acute non-Q wave infarction (non Q-MI) (Group 4), unstable angina (Group 5) and atypical chest pain (Group 6). Several blood clotting factors were studied; von Willebrand factor (VWF), fibrinogen, tissue plasminogen activator (t-PA) and its inhibitor (PAI-1) and factor VII. There was no significant difference in the fibrinogen, t-PA, PAI-1 or factor VII levels between the 6 groups. On the other hand, the VWF was increased in the all transmural myocardial infarction (Q-MI) groups (n. 1). In Group 3 with visible intracoronary thrombus the VWF was high or very high in all patients, attaining three times the normal values. The values were lower in Group 5 (unstable angina) patients in whom no thrombus was observed on coronary angiography. The differences between Group 1 and Groups 4, 5 and 6 were statistically significant (p less than 0.05). The VWF was higher in the Q-MI group with intracoronary thrombus than in the group without thrombus, but the difference was not statistically different. In conclusion, the VWF may be considered to be a marker for thrombus and/or endothelial activation but a larger study population would be required to identify more accurately the subgroups with thrombosis or risk of thrombosis.

Adult↗

PubMed1989

[Comparison of the left ventricular stroke volume and fraction measured with MRI and contrast ventriculography].

27 patients who underwent a contrast ventriculography in right anterior oblique at 30 degrees (for various cardiopathies) were studied by MRI with a mean delay of 5.7 +/- 6.2 days. After location of the medio-ventricular area, a diastolic horizontal section (apex of the R wave) and a systolic section (descending portion of the T wave) are carried out using the spin ultrasound technique. The same calculations are used for MRI au X-Ray contours (modified area-length method) by two strictly independent operators. With MRI, the LVSF is under estimated (40.4 +/- 19%) as compared angiography (46.1 +/- 18%). The linear correlation is 0.79 and in half of the patients (13 in 27) the deviation of the LVSF exceeds 10 p. cent. The volumes also tend to be underestimated with MRI (97 +/- 50 and 64 +/- 51 ml for the diastole and systole respectively) compared with angiography (123 +/- 66 and 73 +/- 62 ml), but the difference is only significant for the diastole and the linear correlation coefficients are improved at 0.82 and 0.90. Underestimation of the parameters measured with MRI is the consequence of multiple factors including the imprecise determination of the true telesystole, the marked effect of the partial volume related to the thickness of the section, and especially the obliquity of the plane studied on MRI, compared with the long axis of the heart. The error made by using a calculation algorithm, conceived for projective methods showing the long axis of the modeled ellipsoid, also explains the underestimation of volumes obtained with MRI, tomographic method. The simple technique used here seems especially interesting in the analysis of segmental contraction. Finally, the development of cine-MRI will undoubtedly be extremely beneficial in the study of ventricular contraction and relaxation.

Adult↗

PubMed1989

[Isolated ST-segment depression in precordial leads V2 to V4. An early electrocardiographic sign of posterolateral myocardial infarction].

The authors report the cases of two men, 62 and 66 years-old, who both presented a posterolateral myocardial infarction which, in the first two days, as only electrocardiographic sign, consisted in a baseline offset of the ST segment in precordial leads V2 to V4. Necrosis and its topography were confirmed in each case by elevated myocardial enzymes, the progression of the electrocardiogram and bidimensional ultrasound cardiography exploration. Coronary angiography performed in both cases, revealed, in the first case, an isolated narrow stenosis of a first marginal artery, and in the second case, significant stenoses of the circumflex and right coronary artery without lesion of the anterior interventricular artery. These cases, along with those recently published in the literature, suggest that such alterations of ventricular repolarization which represent the reciprocal projection of a high posterior sub-epicardiac lesion current, could complete the electrocardiographic criteria of really thrombolysis in a context of prolonged precordial pain.

Arrhythmias, Cardiac↗

PubMed1988

[Revascularization in the acute phase of myocardial infarction. Study of left ventricular function in the 3d week and 6th month].

27 patients with primary myocardial infarction are treated, in the first 6 hours, with intravenous thrombolysis with immediate coronary angiographic control showing a patent artery in 76 p. cent of the cases. The treatment is completed with intracoronary thrombolysis (5 times) and transluminal angioplasty (6 times), enabling to obtain a patency rate of 88 p. cent. The overall left ventricular function is evaluated at D21 and in the 6th month (M6). Among anterior infarctions, those treated during the first three hours have a better ejection fraction (EF) at D21 than those treated later (40.3 p. cent +/- 6 versus 33.2 p. cent +/- -NS); this functional benefit is confirmed at M6 (42.8 p. cent +/- 12 versus 30.6 p. cent +/- 8; p less than 0.06). On the contrary, among inferior infarctions, the EF is comparable at D21 and M6 regardless of the early nature of the treatment. One patient died prematurely from a cerebral vascular accident which occurred during the thrombolysis. These results are in favor of a significant myocardial salvation in anterior infarctions revascularised at an early stage and of an active approach in order to obtain the most complete possible revascularisation.

Angioplasty, Balloon↗

PubMed1988

[Modifications in the contraction and relaxation of the left ventricle in chronic ischemic cardiopathies. Study using equilibrium angio-scintigraphy].

Our purpose was to confirm that abnormalities of left ventricular filling, which are associated with abnormalities of contraction, play an important part in the genesis of cardiac failure in chronic ischaemic heart disease. We used equilibrium radionuclide angiography of the cardiac cavities to study the behaviour of the left ventricle during contraction and relaxation in three groups of patients: a control group of 15 patients without cardiac disease (G2), and a group of 28 patients with chronic ischaemic heart disease complicated by cardiac failure (G3). From the overall activity-time curves and their first derivatives were calculated the ejection fraction, the peak ejection rate and the peak filling rate, as well as the time in the cardiac cycle when these appeared, the reference point in time being the end-diastole. Separately, an analysis of spatial distribution, pixel by pixel, of the elementary values of these times was developed with the help of new functional images constructed, pixel by pixel, from the first derivatives of the activity-time curves. These functional images were exploited by calculating histograms of times, and the width of the bars at mid-height was taken as the dispersion parameter expressed as a percentage of the cardiac cycle. There was a significant reduction of ejection fraction in groups G2 (49.8 +/- 11.6 p. 100) and G3 (36.3 +/- 15.4 p. 100) as compared to control group G1 (60.3 +/- 8.4 p. 100) (G1-G2 p less than 0.05; G2-G3 p less than 0.001; G1-G3 p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

[Magnetic resonance imaging in the diagnosis of myxedematous pericardial effusions].

Two cases of myxedematous pericardial effusions studied by magnetic resonance imaging (MRI) are reported. After a reminder of the place of pericardial involvement in this disease, the advantage of MRI which provides original semiologic factors on the analysis of topographic extension and on the approach of the cellular characteristics of the effusion, is presented. Concerning the latter, difficulties of interpretation and current imprecisions are discussed but we will especially remember the advantage of this recent technique in the diagnosis of an effusion, even moderate, in hypothyroidism, mainly in patients with poor sonographic response.

Adult↗