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M Desnos

Publications and source records attributed to M Desnos.

At least 73 records · Page 4Linked to original sources

Organization and sequence of human cardiac myosin binding protein C gene (MYBPC3) and identification of mutations predicted to produce truncated proteins in familial hypertrophic cardiomyopathy.

Cardiac myosin binding protein C (MyBP-C) is a sarcomeric protein belonging to the intracellular immunoglobulin superfamily. Its function is uncertain, but for a decade evidence has existed for both structural and regulatory roles. The gene encoding cardiac MyBP-C (MYBPC3) in humans is located on chromosome 11p11.2, and mutations have been identified in this gene in unrelated families with familial hypertrophic cardiomyopathy (FHC). Detailed characterization of the MYBPC3 gene is essential for studies on gene regulation, analysis of the role of MyBP-C in cardiac contraction through the use of recombinant DNA technology, and mutational analyses of FHC. The organization of human MYBPC3 and screening for mutations in a panel of French families with FHC were established using polymerase chain reaction, single-strand conformation polymorphism, and sequencing. The MYBPC3 gene comprises > 21,000 base pairs and contains 35 exons. Two exons are unusually small in size, 3 bp each. We found six new mutations associated with FHC in seven unrelated French families. Four of these mutations are predicted to produce truncated cardiac MyBP-C polypeptides. The two others should each produce two aberrant proteins, one truncated and one mutated. The present study provides the first organization and sequence for an MyBP-C gene. The mutations reported here and previously in MYBPC3 result in aberrant transcripts that are predicted to encode significantly truncated cardiac MyBP-C polypeptides. This spectrum of mutations differs from the ones previously observed in other disease genes causing FHC. Our data strengthen the functional importance of MyBP-C in the regulation of cardiac work and provide the basis for further studies.

Base Sequence↗

Penetrance of familial hypertrophic cardiomyopathy.

Familial hypertrophic cardiomyopathy (FHC) is an autosomal dominant cardiac disease for which the penetrance remains a much-debated issue. Since the recent identification of the genes involved in the disease, the penetrance of FHC has not been reassessed in a large genotyped population. The aim of our study was therefore to evaluate it, according to age and sex, in ten families with previously identified mutations. Among 178 individuals we studied, 90 were genetically affected (9 different mutations in 3 genes). We found that penetrance, assessed by classical echocardiographic and electrocardiographic criteria, was (1) incomplete: 69%; (2) age-related: 55% between 10 and 29 years old, 75% between 30 and 49 y. and 95% over 50 y.; (3) greater in males than in females: 77% vs 58%, age-adjusted odds ratio: 3.98, CI 95%: 1.34 to 11,48; (4) similar for the genes analyzed. The consequences of these results for genetic counseling and linkage analyses are discussed.

Adolescent↗

[Compensatory enlargement versus chronic constriction. The two features of vascular remodelling after experimental angioplasty].

Considerable efforts have been made to prevent post-angioplasty restenosis targeted mainly against a pathogenesis suggesting a dominant role of hyperplasia. We and others have already shown that constrictive remodelling plays a major role in restenosis. This article evaluates not only the constrictive remodeling theory but also compensatory enlargement associated with prevention of restenosis. The present study on 33 rabbits used the following protocol. Four weeks after inducing an atherosclerotic lesion by air-dessication of a femoral artery segment and a high cholesterol diet, angioplasty was performed. The angiographic minimal luminal diameter significantly increased after angioplasty. Three to four weeks later, initial gain was significantly lost. Restenosis was quantified histologically as well as a remodelling index and a hyperplasia index. No correlations were observed between degree of stenosis and hyperplasia present at the same degree in animals with and without restenosis. On the other hand, there was a strong correlation between restenosis and constrictive remodelling, and with absence of restenosis and compensatory enlargement. Moreover, there was significant a correlation between the degree of hyperplasia and the compensatory remodelling. These data point to the double nature of remodelling: compensatory enlargement observed in animals without restenosis, and constrictive remodelling, the principal mechanism observed in animals with restenosis.

Angioplasty, Balloon↗

Remodelling: therapeutic opportunities.

Restenosis after angioplasty has been recently attributed to a lack of compensatory enlargement and/or chronic constrictive remodelling, rather than neointimal growth. Also, restenosis occurring after stent has been clearly related to neointimal growth. This clarification has dramatically helped in designing strategies targeted against the appropriate mechanisms. The mechanism of stent-related restenosis has been the most studied and several antiproliferative agents including gene therapy and radioactive stents have been successfully tested. Constrictive remodelling has been identified more recently and its pathophysiological mechanism remains poorly understood. Control of extracellular matrix metabolism might be an important pathway. Moreover, detection of the arteries that will 'enlarge' should avoid any preventive strategy including systematic stenting.

Adaptation, Physiological↗

Codon 102 of the cardiac troponin T gene is a putative hot spot for mutations in familial hypertrophic cardiomyopathy.

BACKGROUND: Familial hypertrophic cardiomyopathy is a phenotypically and genetically heterogeneous disease. In some families, the disease is linked to the CMH2 locus on chromosome 1q3, in which the cardiac troponin T gene (TNNT2) has been identified as the disease gene. The mutations found in this gene appear to be associated with incomplete penetrance and poor prognosis. Because mutational hot spots offer unique possibilities for analysis of genotype-phenotype correlations, new missense mutations that could define such hot spots in TNNT2 were looked for in unrelated French families with familial hypertrophic cardiomyopathy. METHODS AND RESULTS: Family members were genotyped with microsatellite markers to detect linkage to the four known disease loci. In family 715, analyses showed linkage to CMH2 only. To accurately position potential mutations on TNNT2, its partial genomic organization was established. Screening for mutations was performed by single-strand conformation polymorphism analysis and sequencing. A new missense mutation, Arg102Leu, was identified in affected members of family 715 because of a G-->T transversion located in the 10th exon of the gene. Penetrance of this new mutation is complete; echocardiographic data show a wide range of hypertrophy; and there was no sudden cardiac death in this family. CONCLUSIONS: The codon 102 of the TNNT2 gene is a putative mutational hot spot in familial hypertrophic cardiomyopathy and is associated with phenotypic variability. Analysis of more pedigrees carrying mutations in this codon is necessary to better characterize the clinical and prognostic implications of TNNT2 mutations.

Adult↗

"Crochetage" (notch) on R wave in inferior limb leads: a new independent electrocardiographic sign of atrial septal defect.

OBJECTIVES: This study sought to determine the clinical significance of a "crochetage" pattern--a notch near the apex of the R wave in electrocardiographic (ECG) inferior limb leads--in secundum atrial septal defect. BACKGROUND: Atrial septal defect is often overdiagnosed on the basis of classical clinical features. Thus, more specific signs on the ECG for screening are needed. Methods. We searched for a crochetage pattern in 1,560 older children and adults: 532 with secundum atrial septal defect, 266 with ventricular septal defect, 146 with pulmonary stenosis, 110 with mitral stenosis, 47 with cor pulmonale and 459 normal subjects. RESULTS: This pattern was observed respectively in 73.1%, 35.7%, 23.3%, 6.4%, 10.6% and 7.4% of these groups (p<0.001). In atrial septal defect, its incidence increased with larger anatomic defect (p<0.0001) or greater left-to-right shunt (p<0.0001), even in the presence of pulmonary hypertension. By multiple regression analysis, only shunt size (p<0.0006) and defect location (p<0.0001) were the determinants of its presence. In all groups, the specificity of this sign for the diagnosis was remarkably high when present in all three inferior limb leads (> or = to 92%), even when comparison was limited to patients with an incomplete right bundle branch block (> or = 95.2%). Early disappearance of this pattern was observed in 35.1% of the operated-on patients although the right bundle branch block pattern persisted. CONCLUSIONS: A crochetage pattern of the R wave in inferior limb leads is frequent in patients with atrial septal defect, correlates with shunt severity and is independent of the right bundle branch block pattern. Sensitivity and specificity of this sign are remarkably high when it is associated with an incomplete right bundle branch block or present in all inferior limb leads.

Adolescent↗

Rotational atherectomy with adjunctive balloon angioplasty versus conventional percutaneous transluminal coronary angioplasty in type B2 lesions: results of a randomized study.

A randomized pilot study was performed comparing conventional balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA] group) and rotational atherectomy (RA) with a medium size burr (50% to 70% burr/artery ratio) with systematic adjunctive balloon angioplasty (RA group) in type B2 stenosis. A total of 64 patients were included. Primary success was 93.7% in the RA group and 87.5% in the PTCA group (p = NS). Technical failure with no complication occurred once in each group. Acute complications occurred in three patients in the PTCA group and in one in the RA group. Angiographic restenosis rates were similar (RA group: 39%, PTCA group: 42%, p = NS) with a follow-up rate of 93%. In type B2 lesions, when compared with conventional angioplasty, RA with systematic balloon angioplasty does not seem to increase procedural success, and the restenosis rate remains comparable. However, these results must be confirmed in a larger series of patients.

Aged↗

Anticoagulant therapy in pregnancy. Report of 54 cases.

BACKGROUND: To investigate the adverse effects of anticoagulant therapy during pregnancy in a tertiary care center. MATERIAL AND METHODS: A prospective study was carried out between 1 January 1977 and 31 December 1994 and included 54 pregnancies in 50 women treated with anticoagulants. In Group I (n=43) oral anticoagulants were replaced for heparin from the sixth until the end of the twelfth week of gestation and acenocoumarol was not substituted. All patients received vitamin K antagonists during the second and third trimesters. Heparin was given after 36 weeks of pregnancy until the tenth day in the postpartum period. Statistical comparisons used Chi square test (with the Yates correction when appropriate) and Student t test. RESULTS: Mechanical heart valve prosthesis was the most frequent indication (68%). There was one artificial heart valve thrombosis during first trimester in Group I and none in Group II (p=0.45). One spontaneous abortion occurred in each group (p=0.86). Seven cardiac complications (13.7%) occurred during the second and third trimesters. We recorded no thrombotic episode of an artificial heart valve after the first trimester of pregnancy. Hemorrhagic complications occurred in mid-pregnancy (one case=2%) and during peripartum (eight cases=16%). Two maternal deaths occurred in the postpartum period, both were linked with the anticoagulant therapy. There was one coumarin embryopathy (Group II: 9%),but no neonatal mortality. CONCLUSIONS: (1) Hemorrhagic complications occur among 16% of patients receiving anticoagulant therapy during pregnancy. (2) Delivery and postpartum are the most critical periods.

Adult↗

[Three-dimensional echocardiography. Principles and applications].

Three-dimensional echocardiography is based on two methods of retrospective reconstruction from two-dimensional echocardiographic images. The acquisition of the two-dimensional images may be free or imposed, the transducer either carrying an emission-reception system or fixed to an articulated support providing data about its position. In the first system, manual tracing of the contours of the region of interest performed on each frame are superimposed after time sequencing (using the ECG) and spatial repositioning, so enabling three-dimensional visualisation of the contours of the cardiac structures: this approach provides reliable quantitative information (volumes, mass and ejection fractions) and has led to the redefinition of the echocardiographic criteria of mitral valve prolapse. The second system is based on equidistant sections obtained by progressive, controlled two-dimensional scanning (parallel, arc of a circle and rotational) of the structure of interest: a value of grey scale is assigned to the space between two adjacent pixels, enabling the formation of voxels which, when superimposed, give the required effects of volume and surface for three-dimensional imaging. It is then possible to obtain any section of the volume and simulate surgical views of the beating heart. This approach may significantly improve diagnostic accuracy compared with two-dimensional echocardiography and provides access to new quantitative and qualitative parameters.

Echocardiography, Doppler, Color↗

[Dynamic cardiomyoplasty: models of action and indications].

Cardiomyoplasty, proposed as an alternative to cardiac transplantation for the first time in 1985, has been carried out in over 500 patients over the world. The functional improvement after the procedure may be spectacular. The haemodynamic improvement at rest is generally small in terms of pre and postoperative ejection fractions. A dynamic effect of systolic assistance due to stimulation of the latissimus dorsi may be demonstrated in some cases by analysis of ventricular pressure-volume curves. However, it is probable that cardiomyoplasty prevents ventricular remodelling (girdling effect) and that chronic stimulation of latissimus dorsi, necessary to prevent atrophy and fibrosis, reduces wall stress. Therefore, many mechanisms, probably associated, may explain the clinical efficacy of cardiomyoplasty. Though the contraindications of this technique are now better known, its role with respect to cardiac transplantation in cases of severe congestive cardiac failure resistant to medical therapy still remain undefined.

Cardiomyoplasty↗

Clinical study of the effects of latissimus dorsi muscle flap stimulation after cardiomyoplasty.

BACKGROUND: Beneficial hemodynamic effects after dynamic cardiomyoplasty have been inconsistently demonstrated, and the effects seen may be due to the wrap itself, to flap stimulation, or both. The aim of this study was to determine whether flap stimulation per se acts as a systolic active process after cardiomyoplasty. METHODS AND RESULTS: Catheterizations were performed in 13 patients 14.4 +/- 7 months after cardiomyoplasty. New York Heart Association functional class decreased from 3.3 to 2.1 after the procedure (P = .0005). Hemodynamic evaluations were first performed with the stimulator on in the 2:1 mode and then after the stimulator had been off for at least 24 hours. Left ventricular (LV) ejection fraction increased from 25.1 +/- 6% before surgery to 28.2 +/- 6.7% with the stimulator on after cardiomyoplasty (P = .04). When stimulation was stopped, there was no change (P > .05) in indexes of systolic or diastolic LV function (peak systolic LV pressure, LV ejection fraction, peak positive dP/dt, peak negative dP/dt, or tau). Pulmonary capillary wedge pressure and cardiac index were unchanged when stimulated and nonstimulated settings were compared (P > .05). However, a remarkable heterogeneity of individual responses was observed. Ejection fraction and cardiac index decreased with the stimulator off in 3 patients, but peak positive dP/dt decreased in 6 patients; diastolic function deteriorated in 2 patients, but a slight improvement was noted in 3 patients. Cardiothoracic ratio, echocardiographic LV end-diastolic dimension, and fractional shortening remained unchanged between immediate (< 1 month) and long-term (36.7 +/- 25.9 months) postoperative evaluations. CONCLUSIONS: In the majority of our patients, there was no short-term hemodynamic benefit of flap stimulation; therefore, we conclude that the efficacy of cardiomyoplasty may be a consequence of a passive "girdling effect," which limits the progression of ventricular enlargement and further deterioration of ejection fraction.

Adult↗

[Use of anticoagulants during pregnancy].

Prolonged anticoagulant therapy may be indicated during pregnancy in patients with inborn diseases affecting haemostasis, mechanical heart valves, etc. A management scheme aimed at protecting both the mother and the foetus is presented on the basis of pharmacological data, the main series reported in the literature and the experience acquired at the Boucicaut hospital in Paris. Heparin should be used during the first trimester of pregnancy to avoid the teratogenic potential of antivitamin K drugs and to reduce the incidence of spontaneous abortions which increases in patients given oral anticoagulants. During the second and third trimester, antivitamin K drugs can be used more easily than heparin with no substantial increase in risk for the foetus. At delivery and during the immediate post partum period it is imperative to use a compound which does not cross the placental barrier (in order to avoid foetal hypocoagulation) and which has a short half-life. Heparin is therefore indicated again starting at eight months gestation. It is emphasized that despite careful management and follow-up by the co-ordinated efforts of cardiologists, obstetricians and the intensive care team haemorrhage occurs in 17% of the pregnant women given anticoagulants, particularly during the peri partum period.

4-Hydroxycoumarins↗

Doppler echocardiography in familial hypertrophic cardiomyopathy: the French Cooperative Study.

UNLABELLED: Familial hypertrophic cardiomyopathy (HCM) has been poorly studied, although it may represent 50% of all HCM. We studied 346 subjects belonging to 20 unrelated families. Patients were considered affected in view of left ventricular (LV) wall thickness. One hundred twenty-seven adults were considered affected, id est. had a left ventricular wall thickness (LVWT) > 13 mm, whereas 123 had a LVWT > 15 mm, suggesting that the cut-off value is usually not critical. Within affected patients, 95% had an asymmetrical HCM (interventricular septum/left posterior wall thickness > 1.3 mm), whereas 84% had a ratio > 1.5. Distribution of the affected patients according with Maron's classification are in keeping with published studies about sporadic forms. Doppler derived isovolumetric relaxation time was prolonged in HCM (105 +/- 23 vs 88 +/- 16 msec, P < 0.001), and the ratio peak velocity of A wave over peak velocity of E wave was significantly lower in affected individuals (0.99 +/- 0.56 vs 0.83 +/- 0.46, P < 0.05). None of the 24 children studied (10 +/- 3 years) were considered affected according to echocardiographic criteria. CONCLUSION: Echocardiography is the obligatory first step during genetic study for recognizing familial HCM. It allows classification in adults but not in children. Doppler estimate of diastolic function may be helpful in the future to recognize genetically affected subjects with normal or subnormal echocardiographic examination.

Adult↗

[Value and limitations of methods for measuring left ventricular mass].

M-mode echocardiographic measurement of the left ventricular mass is inaccurate when the hypertrophy is asymmetric and the ventricule very deformed. The routine calculation of the mass is based on several hypotheses, verified in normal and hypertensive subjects: the standard error (SEE) is 30-40 g, 10-15% (r > 0.9). The standard deviation of inter-examination differences (> 25 +/- 30 g with a variation coefficient c = 10-15%) makes it difficult to appreciate variations of mass in a given patient. Two-dimensional echocardiographic measurement of left ventricular mass requires the use of geometric formulae which have not been validated in the cardiomyopathies. The absence of a consensus on the models used has favorized the use of MRI and of ultrafast computed tomography. MRI measurement of mass has been validated in normal and ischaemic hearts (r > 0.97, SEE < 8 g, c = 15%) but the times of acquisition are long. Using ultrafast CT, not universally available, this measurement has been validated in vivo and in vitro, including in cardiomyopathy for which the SEE is low (6%) and reproducibility excellent (c = 4-8%), comparable with results in normal subjects.

Angiocardiography↗

[Clinico-pathological polymorphism of hypertrophic cardiomyopathy in echocardiography].

An echocardiographic Study of 322 adults (age: 40 +/- 16 years), belonging to 20 families with hypertrophic cardiomyopathy (HCM), was undertaken. Affected subjects had a LV diastolic wall thickness > 13 mm. The patients were classified according to the distribution of left ventricular hypertrophy (LVH) and by Maron's classification: 189 subjects were normal, 127 were affected and 6 could not been classified. By Maron's classification: 3% were type I, 33% were type II, 58% were type III and 6% were type IV. LVH was asymmetrical in 95% of cases (septum/posterior wall ratio > 1.3). The familial distribution of LVH of the 4 families in which HCM was genetically related to different loci (chromosome 11, 14 exon 13, 14 exon 8, fifth locus); the LVH was analysed from two short axis LV parasternal views and each plane was divided into 5 segments. The distribution of LVH was said to be identical between two first degree relations when all the same segments were affected, similar when they differed by only 1 or 2 segments and different when they differed by 3 or more segments. In the 26 pairs studied, LVH was identical in 2/26 (8%), similar in 11/26 (42%) and different in 13/26 (50%). Familial HCM usually gives rise to asymmetrical LVH affecting the septum and free wall. An identical distribution in 50% of affected first degree relatives.

Adolescent↗