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J P Roquebrune

Publications and source records attributed to J P Roquebrune.

12 recordsLinked to original sources
PubMed1992

[Hypolipidemic treatment after myocardial infarction].

Treatment of hyperlipidaemia is even more important after than before myocardial infarction. Currently available data should be confirmed by larger studies including women and lasting over 10 years. Analysis of the results would be facilitated by studying comparable groups with respect to left ventricular function and severity of the coronary disease. The total serum cholesterol should optimally be under 2 g/l and the LDL-cholesterol under 1.30 g/l. However, coronary artery disease is a multifactorial condition and the correction of only one predisposing factor, albeit a major one, is not sufficient for effective prevention.

Aged↗
PubMed1992

[How to evaluate the cost/effectiveness ratio of different therapies of coronary disease].

The results of epidemiologic studies on the efficacy of different strategies of prevention or improvement of the prognosis of coronary artery disease are generally expressed in terms of percentage reduction of risk; for example, the treatment of hypercholesterolaemia reduces the risk of coronary death by 21%. In order to improve the assessment of the efficacy of these approaches the authors propose to take into account the number of subjects which needs to be treated each year to prevent one cardiovascular event more than the control group (for example, in hypercholesterolaemia, 1,736 patients). This number depends on the reduction of risk and also on the incidence of complications in the control group. Using this method, the authors classified different therapeutic strategies in order of their efficacy: thrombolytic therapy in the acute phase of myocardial infarction, then aortocoronary bypass grafting of left main coronary or triple vessel disease, secondary prevention with stopping smoking, and betablocker therapy. Finally, primary prevention with anti-smoking campaigns, treatment of hypertension and hypercholesterolemia. Based on this figure and knowing the annual cost of patient treatment, it is possible to calculate a cost-effectiveness ratio for each of these therapeutic interventions.

Adrenergic beta-Antagonists↗
PubMed1986

[The diagnostic exercise test in coronary disease. Proposal for a more rigorous and efficacious interpretation].

Although exercise stress testing does not allow certain diagnosis of coronary artery disease, its interpretation should not necessarily be vague. By using the Bayes theorem and the many studies available we can now quantify the probability of a correct result for each individual case. Three parameters need to be known to undertake this calculation; the prevalence of the disease and the sensitivity and specificity of the investigation. The prevalence of the disease is beginning to be recognised taking into account the character of the pain. Four groups of increasing prevalence can thereby be defined: absence of chest pain, non-anginal pain, atypical pain and typical pain. Within each of these groups the prevalence of coronary disease is higher in men and increases with age. Information about the prevalence of multivessel disease after infarction is more limited. Only two groups can be distinguished which do not take symptoms, age or sex into consideration. The prevalence is 57% after anterior and 65% after inferior infarction. The sensitivity and specificity of stress testing can be determined by comparison with coronary angiography or, when this is available, by following up the patients. These parameters depend mainly on the methodology which should be strictly defined. When only significant ST depression is considered, the overall sensitivity and specificity of exercise stress testing is 70% and 80% respectively. These results vary according to the particular context; in women, the sensitivity and specificity are 72% and 75% respectively; in asymptomatic subjects the sensitivity and specificity are 50% and 85% respectively. With regards to the detection of multivessel disease after anterior infarction, the sensitivity and specificity are 58 and 85% respectively and after inferior infarction, 85 and 84% respectively. The use of diagnostic probability based on these parameters should lead to unambiguous practical management of patients related to the degrees of probability obtained. The underlying principles of this diagnostic approach cannot be questioned as they are based on a well established mathematical formula. However, much work remains to be done, on the one hand to determine the exact prevalence of coronary disease, and on the other hand to improve the sensitivity of exercise stress testing.

Adult↗
PubMed1986

[Monitoring and rehabilitation of heterotopic cardiac transplantation patients during the period of convalescence].

Heterotopic cardiac transplantation is a procedure performed in patients with severe pulmonary hypertension. Surgery is usually preceded by a long period of inactivity. This paper reports the results of a programme of cardiac readaptation, the complications observed, the improvement obtained and the problem replated to the absence of graft innervation. Eight patients who underwent heterotopic cardiac transplantation underwent the readaptation programme. This began with an exercise ECG on which the physical training programme was based. Sessions of respiratory and muscular physiotherapy were also arranged during the same period; a second exercise ECG was performed at the end of the programme to assess progress. Clinical, biological, electrocardiographic and echocardiographic parameters were carefully monitored. The results of the final exercise ECG showed the average maximal work capacity to be 90 watts for 3 minutes. The average increase in heart rate on effort was 25.92%. This was significantly higher than the resting heart rate (p less than 0.01). Two complications were observed during the programme: ventricular fibrillation of the cardiac graft and graft rejection on the 35th postoperative day, diagnosed by echocardiography. Progression of exercise capacity was observed in all patients. The two patients who made the least progress were those who underwent the fewest sessions of physical readaptation. This improvement was mainly related to peripheral muscular fitness. The training programme was well tolerated by all patients; the principal factor limiting an increase in cardiac output on effort was the absence of graft innervation. The heart rate can only be increased by two mechanisms: an increased venous return and raised concentrations of circulating catecholamines.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Should the new criteria of positivity in the exercise test be used?].

Until recent years the negative deflection of the ST-segment of an ECG was almost the only means of interpreting exercise tests in the diagnosis of heart disease. Recent publications have suggested new criteria of positivity. Most of these studies have focused on the absence of a decrease in the amplitude of the R wave in V5 or CM5 derivation, but the results tend to disagree and suffer from lack of reproducibility thus rendering interpretation of this criterion uncertain. Claims have also been made for other criteria with a predictive value at least equal to that of the ST-segment, but very few studies have been devoted to these criteria. The absence of the Q wave in V5 (three studies on a total of 278 patients) has a sensitivity of 82 per cent and a specificity of 76 per cent. Inversion of the U wave in CC5 (one study on a total of 248 patients) has a sensitivity of 21 per cent and a specificity of 99 per cent. Traces of the pressure in abnormally increased recovery (a study on a total of 87 patients) has a sensitivity of 95 per cent and a specificity of 90 per cent. These results cannot replace those obtained with the ST-segment which relate to hundreds of studies on tens of thousands of patients. For this reason it is important to specify better the value of these new criteria and to assess their contribution in association with changes in the ST-segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1985

[Epidemiology of arterial hypertension in students at the University of Nice].

These students, as representative of french population, were examined in 1983. Right humeral arterial blood pressure was measured three times on dorsal decubitus with a mercury manometer by a medical doctor. People with a systolic arterial pressure greater than or equal to 150 mmHg and/or diastolic arterial pressure greater than or equal to 90, were considered as hypertensive. These hypertensive people came then for a new complete examination, six months later. A witness group, drawn by lot, were examined in the same conditions. Systolic, diastolic and mild arterial blood pressures (in mmHg) were for: (table; see text) Prevalence of hypertension is 2.2 p. 100 (46) for girls and 11.9 p. 100 (184) for boys. The most important difference between high blood pressure people and normal blood pressure people lies in morphological characters. (Table: see text). Sport activities, coffee and diet concerning sodium are identical in the two groups. High blood pressure people smoke less than normal blood pressure people. Previous history of hypertension are more frequent in high blood pressure people than normal blood pressure people. Upright posture induce modification in pressure on high blood pressure people. Meanwhile, stress induced by mental arithmetic, does not bring more elevation pressure about high blood pressure people than normal blood pressure people. Six months later: 58 p. 100 of high blood pressure group have still a high blood pressure, 26 p. 100 have a borderline blood pressure (systolic greater than or equal to 140, diastolic greater than or equal to 85).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

[Preliminary study on the resumption of work after aorto-coronary bypass].

A questionnaire was sent 8 months to 3 years after aorto-coronary bypass to 98 patients who, before surgery, had had to abandon their professional activities because of ischaemic heart disease to assess the numbers who had returned to work: thirty six patients (37%) had not returned to work for medical or personal reasons; only one patient had been refused by his employee; sixty two patients (63%) had returned to work, 81% full-time and 19% with a different job. Only 19% had to stop working secondarily for medical reasons. The criteria thought initially to influence the chances of resumption of professional activity were analysed: factors not influencing the return to work were: type of work before operation (judged by the physical activity involved and the statute of salaried or independent worker), the severity of surgery (number of grafts and associated resection of aneurysm), a subjective assessment of physical condition after surgery (91% or patients not returning to work admitted to feeling well); uncontrollable factors influencing the return to work were: age of patient (average 51,7 years for those returning to work, compared to 55,1 years for the others), previous history of myocardial infarction (2,5 times more common in those not returning to work); finally, controllable factors influencing return to work were: the duration of unemployment before surgery (3,3 months for those returning full-time, compared to 16,4 months for those not returning to work); the period between surgery and resumption of activity which averaged 5 months and should not exceed 6 months. Three factors seemed to be particularly important: apart from the shortest possible period of unemployment before surgery, early physical reeducation after surgery based on chest physiotherapy and readaptation to physical activity and a psychological preparation for the return to work which should be started even before surgery.

Age Factors↗