Biomedical subjects

J Piessens

Publications and source records attributed to J Piessens.

At least 37 records · Page 2Linked to original sources

PubMed1993

Clinical applications of echocardiography in patients with acute myocardial infarction.

The ability of echocardiography to visualize ventricular wall motion abnormalities induced by ischaemia and infarction makes it an ideal tool in the assessment of patients with acute myocardial infarction. Echocardiographic derived measurements of infarction severity, such as the wall motion score index, correlate well with both early and late complications. Echocardiography is of considerable value in the detection of mechanical complications of myocardial infarction such as aneurysm and thrombus formation, infarction expansion, ventricular septal rupture and mitral regurgitation; Doppler echocardiography is of particular worth in the detection of the latter two complications. Serial echocardiographic imaging before and after various coronary reperfusion strategies allows useful assessment of the success of these strategies. Following a myocardial infarction, a predischarge resting or exercise 2-dimensional echocardiographic study provides valuable information regarding the likelihood of adverse cardiac events during long term follow-up.

Echocardiography↗

PubMed1993

The use of intracoronary ultrasound for quantitative assessment of coronary artery lumen diameter and for on-line evaluation of angioplasty results.

UNLABELLED: The value of intracoronary ultrasound for quantitative assessment of minimal coronary arterial diameter and for on-line evaluation of balloon angioplasty result was studied in 42 patients undergoing single vessel coronary angioplasty. Measurement of minimal luminal diameter of 75 matched coronary arterial segments showed a significant correlation between both the ultrasound and angiographic method (r: 0.759; p < 0.001). Furthermore using intravascular ultrasound it was possible to classify the obtained coronary balloon angioplasty results. A preliminary correlation between ultrasound classification and the in-hospital acute rethrombosis as well as late restenosis was attempted in individual patients. CONCLUSIONS: 1) Clinical use of coronary ultrasound is feasible and safe in selected cases. 2) A significant correlation between intracoronary ultrasound and quantitative coronary angiography is demonstrated. 3) Using intracoronary ultrasound seems promising for evaluation of the postangioplasty result, and may finally lead to improved selection of the interventional strategy.

Angioplasty, Balloon, Coronary↗

PubMed1992

Immediate and follow-up results of the conservative coronary angioplasty strategy for unstable angina pectoris.

To assess the results of a conservative coronary angioplasty strategy in unstable angina pectoris, the records of 1,421 consecutive patients without previous myocardial infarction undergoing a first percutaneous transluminal coronary angioplasty (PTCA) between 1986 and 1990 were reviewed. Of these patients, 631 had unstable and 790 had stable angina pectoris. Only after an intense effort to medically control symptoms, the unstable patients underwent PTCA at an average of 15.4 days (range 1 to 76) after hospital admission. Primary clinical success was achieved in 91.7% of patients with unstable and in 94.4% of those with stable angina pectoris (p = not significant). In-hospital mortality rates were 0.3 and 0.1%, respectively (p = not significant). Nonfatal in-hospital event rates for acute myocardial infarction, cerebrovascular accident and coronary bypass surgery were only slightly higher in patients with unstable angina pectoris; however, the difference from the stable group was significant when all events were combined (9 vs 5.9%; p less than 0.04). During 6-month follow-up, no significant difference in adverse events was found between the groups. The respective rates for the unstable and stable groups were 0.4 and 0.2% for death, 5.5 and 5.1% for major nonfatal events, and 17.7 and 20.1% for repeat PTCA. These results suggest that use of a conservative PTCA strategy in the treatment of patients with unstable angina pectoris results in favorable and similar immediate and 6-month outcomes compared with those in patients with stable angina pectoris.

Angina Pectoris↗

PubMed1992

Wiktor stent implantation in patients with restenosis following balloon angioplasty of a native coronary artery.

Intracoronary stenting has been introduced as an adjunct to balloon angioplasty aimed at overcoming its limitations, namely acute vessel closure and late restenosis. This study reports the first experience with the Wiktor stent implanted in the first 50 consecutive patients. All patients had restenosis of a native coronary artery lesion after prior balloon angioplasty. The target coronary artery was the left anterior descending artery in 26 patients, the circumflex artery in 7 patients and the right coronary artery in 17 patients. The implantation success rate was 98% (49 of 50 patients). There were no procedural deaths. Acute or subacute thrombotic stent occlusion occurred in 5 patients (10%). All 5 patients sustained a nonfatal acute myocardial infarction. Four of these patients underwent recanalization by means of balloon angioplasty; the remaining patient was referred for bypass surgery. A major bleeding complication occurred in 11 patients (22%): groin bleeding necessitating blood transfusion in 6, gastrointestinal bleeding in 3 and hematuria in 2. Repeat angiography was performed at a mean of 5.6 +/- 1.1 months in all but 1 patient undergoing implantation. Restenosis, defined by a reduction of greater than or equal to 0.72 mm in the minimal luminal diameter or a change in diameter stenosis from less than to greater than or equal to 50%, occurred in 20 (45%) and 13 (29%) patients, respectively. In this first experience, the easiness and high technical success rate of Wiktor stent implantation are overshadowed by a high incidence of subacute stent occlusion and bleeding complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

PubMed1992

The conservative coronary angioplasty strategy after thrombolysis for acute myocardial infarction: immediate and short-term results.

The in-hospital and short-term follow-up results of a conservative coronary angioplasty approach in 354 consecutive patients treated after thrombolysis for acute myocardial infarction were compared with results obtained in 408 control noninfarcted patients treated for the classical indication of myocardial ischemia. Only 20% of the study patients underwent angioplasty during the initial hospitalization period and the clinical success rate was 93% versus 95% in the control group (p = NS). No significant differences in the total number of in-hospital untoward events were observed (10.2% and 7.6%, respectively). During a 7.4 +/- 1.5 month follow-up period, the total number of adverse events was only 16.9% in the study patients but it was 27.8% in the control group (p < 0.001). There were no significant differences in death, myocardial infarction, or coronary surgery as individual events, but repeat angioplasty was less frequent in the study group (14.0% versus 21.5%, p < 0.01). Thus in-hospital results in patients undergoing angioplasty on a deferred basis after thrombolysis for myocardial infarction were largely comparable with those results obtained in noninfarcted patients. Moreover, short-term clinical follow-up events were reduced when compared with the control group, an observation apparently largely related to the subgroup without clinical evidence of residual ischemia.

Aged↗

PubMed1992

Transluminal coronary balloon angioplasty: a useful therapeutic modality in octogenarian patients with severe angina.

In this study, the immediate and short-term outcome of 9 consecutive patients aged 80 years or older undergoing percutaneous transluminal coronary angioplasty (PTCA) are reported. Of these 9 patients, 8, despite optimal medical therapy, had unstable Class IV anginal symptoms and 6 had multivessel coronary artery disease. Primary success at PTCA (successful dilation of all attempted lesions without any complications) was achieved in 8 of the 9 (89%) patients. The one patient with unsuccessful PTCA had subsequent successful elective coronary bypass graft surgery. The 8 patients with primary success at PTCA have been followed up for a mean of 27 +/- 15 (range: 6 to 45) months. During follow-up, no patient died, required a further revascularization procedure or had a myocardial infarction. Indeed, 7 of these 8 patients have, following PTCA, remained entirely asymptomatic with no decrease in their activity level. Angina has recurred in 1 patient but it is mild and does not restrict his activities. Based on our encouraging experience we suggest that PTCA should be considered favourably in the treatment of selected octogenarian patients with severe angina poorly controlled by medical therapy.

Aged↗

PubMed1992

Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies.

Single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. A database consisting of the angiographic reports of 50,000 consecutive coronary angiographies performed in adult patients in the University Hospital of Leuven between March 1973 and August 1991 was searched for the diagnosis of single coronary artery. All films concerned were reviewed and classified according to their anatomical type. Thirty-three cases of single coronary artery were retrieved, yielding an incidence of 0.066%. Patient characteristics and clinical data are described, with a discussion on the pathological importance of this finding.

Adult↗

PubMed1992

Specific coronary hemodynamic effects of nisoldipine and other vasoactive drugs.

The specific coronary hemodynamic effects of different vasoactive drugs were studied using a randomized, double-blind protocol in the "normal" contralateral artery after performing single-vessel coronary angioplasty. The intracoronary administration of 50 micrograms of nisoldipine resulted in an increase in epicardial diameter (+19%; p = 0.0001) and in coronary blood flow (+47%; p = 0.003), but the flow reserve decreased (-20%; p = 0.001). In placebo-treated patients, all parameters proved to be very stable and no significant changes were found. In a second study, 500 micrograms of diltiazem i.c. was administered to 20 patients, who were first randomized to pretreatment with either placebo (n = 10) or isosorbide dinitrate (0.5 micrograms/kg/min infusion; n = 10). There were increases in epicardial diameter (+10%; p = 0.0001) and coronary flow (+30%; p = 0.0001) in all patients. These changes were comparable in patients pretreated with placebo or nitrates but the reduction in coronary flow reserve was only significant in patients pretreated with placebo (+19%; p = 0.0008). In a third study, the hemodynamic effects of the intracoronary application of SIN-1 (500 micrograms), the active metabolite of molsidomine, were studied. There was a consistent increase in epicardial diameter (+26%; p < 0.0001) but the response at the microvascular level was heterogeneous and characterized by a trend to increased blood flow (+25%; p = 0.11) and decreased coronary vascular resistance (-18%; p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

PubMed1991

Ridogrel in the setting of percutaneous transluminal coronary angioplasty.

The safety of the combination of heparin and ridogrel therapy and its antiplatelet efficacy was examined in the setting of percutaneous transluminal coronary angioplasty (PTCA). In 32 patients without known aspirin intake for 10 days before PTCA, therapy with ridogrel (300-mg intravenous bolus) was begun just before PTCA and continued orally at a dose of 300 mg twice daily until discharge. Heparin was administered as a 10,000 IU bolus dose before PTCA and followed by an intravenous infusion at a rate of 1,000 IU/hour for 24 hours. Bleeding problems at the arterial entry site occurred in 13 patients, which required a blood transfusion in only 2 patients. One patient underwent emergency bypass surgery without specific problems of hemostasis. Ridogrel virtually eliminated thromboxane B2 from the serum (29,990 +/- 6,555 pg/0.1 ml before vs 63 +/- 7 pg/0.1 ml at 2 hours after ridogrel), with a concomitant increase in serum 6-keto-prostaglandin F1 alpha (511 +/- 34 pg/0.1 ml before vs 1,190 +/- 146 pg/0.1 ml at 24 hours after ridogrel). There were no acute reocclusions in the ridogrel-treated patients, whereas acute reocclusions occurred in 5.6% of the patients taking the standard aspirin + heparin regimen during the same period. Furthermore, at 6-month clinical follow-up patients treated with ridogrel compared favorably with those receiving standard treatment.

6-Ketoprostaglandin F1 alpha↗

PubMed1991

Immediate and short-term results of a 1988-1989 coronary angioplasty registry.

To determine the relevance of recent refinements in angioplasty technology to our particular practice, the records of 507 consecutive patients undergoing a first percutaneous transluminal coronary angioplasty (PTCA) at our center between October 1988 and May 1989 were reviewed. At the time of PTCA, 41% of these patients had class IV angina and 44% were identified as having multivessel disease. Dilatation was attempted in 734 lesions (mean 1.5 per patient), of which 95 (13%) were chronic total occlusions. Overall, 69% of the 734 lesions were judged anatomically complex, and, in dilating these lesions, a rail-type device was used almost exclusively. Successful dilatation was achieved in 659 of the 734 (90%) attempted lesions. There were low incidences of the major complications of death (0.4%), myocardial infarction (1.8%) and emergency bypass surgery (1.8%). Acute rethrombosis occurred in 54 patients (11%). In these patients, initial strategy of repeat dilatation was successful in 38 of 47 patients (81%). Overall, primary clinical success at PTCA was achieved in 480 patients (95%). At a mean follow-up of 7.5 +/- 1.5 months in 497 of the study patients, the event-free rate (freedom from cardiac death, myocardial infarction, repeat PTCA or coronary bypass surgery or recurrence of severe [class III to IV] angina) was 71%. In conclusion, despite the often complex coronary disease in patients currently presenting to our center, a high initial success rate and acceptable short-term outcome of PTCA was achieved.

Aged↗

PubMed1991

Lack of evidence for small vessel disease in a patient with "slow dye progression" in the coronary arteries.

A patient with chest pain of recent onset, suggestive for angina pectoris, was referred for diagnostic coronary angiography, which showed the typical phenomenon of "slow dye progression" in the absence of any significant coronary artery stenosis. While intracoronary Doppler measurements confirmed the extremely slow blood flow velocity, the coronary flow reserve and the calculated coronary blood flow proved to be within normal range. The present findings suggest that, in contrast with a previous hypothesis, the phenomenon of slow dye progression may not always be due to a microvascular cause. Epicardial artery disease, as suggested by the marked coronary artery ectasia, may be linked to the slow dye progression and predispose to coronary artery thrombosis.

Blood Flow Velocity↗

PubMed1991

Morphologic change in coronary artery stenosis with the Medtronic Wiktor stent: initial results from the core laboratory for quantitative angiography.

The purpose of this study was to assess the early changes in stenosis geometry after implantation of the Medtronic Wiktor stent in human coronary arteries. Morphologic changes were evaluated by quantitative coronary angiography using automated edge detection. The hemodynamic significance of the morphologic changes were assessed by the calculation of the theoretical pressure drop across the dilated and stented stenosis derived from the Poiseuile and turbulent resistances assuming a coronary blood flow of either 0.5, 1, or 3 ml/sec. Fifty patients were studied before and immediately after stent implantation. The stented coronary artery was the left anterior descending artery in 26 patients, the circumflex artery in eight patients, and the right coronary artery in 16 patients. Stent implantation resulted in an additional increase in the minimal luminal cross-sectional area and minimal luminal diameter of the dilated vessel without changing the curvature of the stenosis. Furthermore, there was a significant reduction of the "plaque area." This was associated with a normalization of the calculated resistances to flow and pressure drop across the stenosis. To a minimal extent, recoil (0.1 +/- 0.36 mm) was observed after stent implantation.

Adult↗

PubMed1991

Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia.

The prevalence of esophageal chest pain was studied prospectively in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. A group of 248 consecutive patients without previously documented heart disease was admitted for elective diagnostic coronary angiography. The clinical history classified 185 patients as having anginal pain and the coronary angiogram was normal in 48 of them. In 37 of these 48 patients full esophageal testing was performed including 24-hr intraesophageal pH and pressure recordings with indication of chest pain episodes as well as a number of esophageal provocation tests, ie, acid perfusion, edrophonium stimulation, balloon distension, and ergonovine stimulation, all performed under continuous esophageal manometric and electrocardiographic monitoring. In 19 of these 37 patients, the familiar chest pain could be reproduced by esophageal provocative testing without ischemic ST-T segment alterations; six of these 19 patients had also a positive 24-hr pH and pressure recording. These data strongly suggest an esophageal origin of chest pain in half the patients with typical angina and a normal coronary angiogram.

Angina Pectoris↗

PubMed1991

Long-term prognosis of male patients with an isolated chronic occlusion of the left anterior descending coronary artery.

The purpose of this study was to determine the long-term prognosis of patients with an isolated total occlusion of the left anterior descending artery (LAD). A total of 173 male patients with a chronic LAD occlusion and less than 50% narrowing of the other coronary arteries (group I) was compared with a group of 177 male patients with only insignificant coronary artery disease and a normal left ventricular function (group II). Baseline characteristics of both groups were comparable except for the inclusion of 54 patients (31.2%) with moderately or markedly reduced left ventricular systolic function in group I. During an 8-year follow-up period there was a greater number of patients with cardiac events in group I when compared with group II: cardiac death 11.2% versus 0.6% (p less than 0.0001), myocardial infarction 12.7% versus 3.4% (p = 0.001), myocardial revascularization procedures 11.6% versus 3.4% (p = 0.04). Stepwise discriminant analysis showed that a reduced ejection fraction and a family history of coronary artery disease were the best predictors for these adverse cardiac events.

Belgium↗

PubMed1991

Percutaneous transluminal laserangioplasty with balloon centered direct argon laser light. Experience with 12 patients and a minimal follow-up of 6 months.

Laser angioplasty with direct argon laser light, combined with a special centering balloon (Lastac system) was performed in 12 patients with a single superficial femoral artery occlusion. The mean length of the occlusion was 5.4 +/- 2.15 cm with a mean duration of occlusion of 7.8 +/- 5.9 months. Initial angiographic success was obtained in 9/12 procedures. Reason of failure was perforation in 1 patient and impossibility to pass the stenosis due to calcifications in 2 patients. Early rethrombosis in 1 patient reduced the primary success rate to 8/12 procedures. Peripheral emboli occurred in 2 patients, both successfully treated by thrombolysis or surgery. Of the 8 recanalized arteries, all remained patent with a mean follow-up of 7.1 +/- 0.68 months. It remains to be determined on larger series whether the Lastac system offers substantial advantages over other, less expensive systems of laser angioplasty.

Aged↗

PubMed1991

The value of the intracoronary electrogram for the early detection of myocardial ischaemia during coronary angioplasty.

The clinical value of intracoronary electrography for the detection of myocardia ischaemia was assessed during coronary angioplasty and compared to a standard technique of surface ECG monitoring. In 73 patients undergoing single lesion angioplasty, an intracoronary electrogram and four representative surface ECG leads were obtained. During angioplasty of the left anterior descending artery leads, I, V3, V5, V6 were recorded. For the circumflex artery leads I, aVL, aVF, V6, and for the right coronary artery leads II, III, aVF, V6 were monitored. Eight patients were excluded due to transient intraventricular conduction disturbances during balloon inflation; 65 patients remained for further analysis. Out of a total of 154 balloon inflations (35 in the circumflex, 71 in the left anterior descending and 48 in the right coronary artery), the percentage that produced a greater than or equal to 1 mm ST segment elevation, the time to the appearance of a greater than or equal to 1 mm ST segment elevation and the maximal ST segment elevation were recorded. During inflations in the circumflex artery, the respective values of these three parameters were 20%, 22.6 +/- 11.5 s and 0.37 +/- 0.80 mm in V6, the most sensitive surface lead, versus 70% (P less than 0.001), 14.4 +/- 9.6 s (P less than 0.01) and 5.82 +/- 6.35 mm (P less than 0.0001) on the intracoronary electrogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

PubMed1991

Torsades de pointes after intracoronary papaverine.

Coronary blood flow velocity and coronary flow reserve can be assessed in humans using a coronary Doppler catheter and the vasodilator papaverine. Although it is a safe, elegant and reproducible technique, serious complications can occur. Coronary flow reserve assessment in a 49-year-old man with a critical stenosis in the proximal part of the circumflex artery was complicated by a papaverine-induced ventricular arrhythmia. Several features of the present case report support papaverine-induced disturbances of the repolarization phase as the pathophysiological mechanism: a 'torsade de pointes' pattern of the tachycardia, the lengthening of the QT-interval, the appearance of a new U-wave and the presence of additional risk factors (hypokalaemia and alcalosis). Patients presenting additional risk factors for this complication should be excluded from coronary flow reserve assessment.

Angioplasty, Balloon, Coronary↗

PubMed1991

Hemodynamic changes after subselective intracoronary administration of nisoldipine in humans.

Hemodynamic changes after the subselective intracoronary administration of 50 micrograms of nisoldipine were analyzed in 24 nonstenotic coronary arteries using a randomized, placebo-controlled, double-blind protocol. The following hemodynamic parameters were studied: (a) epicardial coronary artery diameter, assessed by quantitative angiography; (b) coronary blood flow velocity, measured by an intracoronary Doppler probe; (c) coronary blood flow, calculated from the above parameters; (d) coronary flow velocity reserve, assessed after intracoronary administration of 10 mg of papaverine hydrochloride; and (e) heart rate and arterial blood pressure. Since 3 patients were excluded due to unreliable Doppler signals, a total of 21 patients was eligible for complete analysis (placebo: n = 9; nisoldipine: n = 12). In placebo-treated patients, all studied parameters proved to be very stable on repeat measurement and no significant changes were found. In nisoldipine-treated patients, a significant increase in epicardial diameter (+19%; p = 0.0001) and coronary blood flow (+47%; p = 0.003) was found. The coronary blood flow velocity transiently increased after nisoldipine, with a maximum (+80%) after 2 min and returning to baseline within 10 min. Finally, nisoldipine resulted in a significant decrease in the coronary flow velocity reserve by 20% (p = 0.001). All coronary hemodynamic effects were observed in the absence of changes in heart rate and arterial blood pressure. Therefore, the present data demonstrate that nisoldipine acts as a potent dilator of epicardial as well as resistance vessels in nonstenotic human coronary arteries.

Blood Pressure↗